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Written by Mark Lazell | Editor of Signify Premium Insights – Digital Health.
This article provides several links to our Signify Premium Insights, evaluating recent industry-shaping events. To access these articles you will need a subscription or can simply request a 30-day free trial below.
Click the image above to read ‘SPI Digital Health: US EHR Vendors: Patchy Performances in Overseas Markets’
We kicked the month off with a delve into how the top four US EHR vendors are performing outside their home market. It was a reminder that for all of its domestic challenges, Oracle Health is actually doing pretty well overseas. Canada and the UK are happy hunting grounds for the company, although its nemesis Epic has also won some big contracts in Australia from under Oracle Health’s nose, notably what was reputed to be the southern hemisphere’s largest-ever EHR contract. Epic, rather more surprisingly, has a more muted presence internationally. It’s made gains in Canada, but has historically had software localisation challenges in some other markets.
Canada is also a good revenue source for MEDITECH, with more than half of all hospitals in the country using its IT. It is also developing one of three province-wide HIEs in Ontario. Sizeable hospital contracts for its Expanse EHR solution in Australia and the UK are also lending weight to its overseas ambitions. But it’s a less rosy picture for Altera, which has lost out to Oracle Health and Epic on hospital contracts in the UK and whose international footprint is limited to Italy, Israel, the Philippines and Ghana but there’s little growth.
The Insight begged the question: with US hospital IT procurement increasingly favouring larger vendors, will these companies continue to seek their fortunes overseas where their competitive edges are less sharp?
Click the image above to read ‘SPI Digital Health: Oracle Health’s Nashville Show Strikes Mixed Chords’
Oracle Health is rarely far away from the headlines (and not always for the best reasons) and so we reckoned that a summit in Nashville it convened recently would generate some interesting talking points.
It didn’t disappoint. Oracle founder and chairman Larry Ellison took centre stage in the Music City, laying out Oracle Health’s medium- to long-term priorities. He based his presentation around three main themes: data interoperability, cybersecurity and healthcare system automation.
While these are all important aspirational themes, and Oracle Health has a leadership role to play in them, there’s a sense this was an exercise in escapism for Ellison et al in Nashville from some of the more immediate issues facing the company.
It’s understandable why the company should wish to lay out its long-term vision for healthcare to stakeholders, but the burning question remains: when will Oracle’s acquisition of Cerner in 2022 really begin to translate into strong revenue growth?
Click the image above to read ‘SPI Digital Health: EHR Vendor Financials Q1 2024’
This leads us neatly onto our quarterly analysis of vendor financials, this time for Q1 2024. To be honest, the number of vendors that publish financials is dwindling…in the last few years Cerner, MEDITECH, Veradigm®, NextGen Healthcare, Altera Digital Health and athenahealth have all either delisted, been acquired or not reported data owing to financial irregularities, although some still publish quarterly results.
Our quarterly reviews always look at the inpatient and primary care EHR markets in the US and EMEA regions. While Epic continues to dominate the US inpatient market, and there’s little to get too excited with in EMEA primary care, the interesting stuff is happening in EMEA inpatient and US primary care markets.
It looks like the large hospital IT infrastructure projects in EMEA are really kicking in for vendors, whose revenues overall grew at a touch over 20% year-on-year. Nexus revenues grew 16% for the last 12 months while CGM Hospital Information Systems (HIS) business unit revenues were up 13% for the last full 12 months.
There were some interesting stories in US primary care too. Tier-2 vendor CareCloud®’s Q1 2024 revenues were down 13% on Q1 2023, while CGM’s primary care business was up 5% on the rolling 12-month average, thanks in part to some acquisitions it had made.
A key characteristic of this market is a relatively long tail of smaller, second-tier vendors. This has created a competitive environment but one in which there are significant opportunities for vendors to upsell into areas such as revenue cycle management, value-based care, virtual care and patient engagement. Will we see these areas having greater influence on vendor revenues in future?
Click the image above to read ‘SPI Digital Health: Is Peak Telehealth Behind Us?’
Another sector whose financials we regularly scrutinise is telehealth, and rumours that Optum was shutting down its virtual care business, and that Walmart had actually done so, got us thinking: are telehealth’s best days behind it?
The writing’s been on the wall in the high volume, low-acuity space for a while. Almost every quarter since we launched Signify Premium Insights (SPI) Digital Health in late 2022 we have analysed the financial results of the two leading US telehealth service providers Amwell and Teladoc and their revenue dials have moved little. They’re stuck in a saturated market with nowhere really to go other than trying to sell more to existing customers (something they are already doing). Could they take inspiration from, for example, Doctolib, which has pivoted from pure telehealth into other areas such as population health?
On the other hand high-acuity telehealth and remote patient monitoring (RPM) offer more hope, with tele-observation and tele-nursing seen as key to addressing severe staff shortages and squeezed healthcare resources.
Click the image above to read ‘SPI Digital Health: With Primefocus, LG Looks to Find its Home Beyond the Hospital’
RPM was also the theme of my Insight on LG Electronics’s launch of a new digital health start-up, Primefocus Health. The new company is a tech platform that supports providers’ RPM programmes, integrating with both the RPM hardware as well as EHR systems so that patient data can be collected and patient interventions made where necessary.
The launch comes as home care and hospital-at-home programmes begin to gain momentum and LG will have ambitions for Primefocus to play in this space. In terms of technical capabilities the Primefocus platform doesn’t appear to offer anything radically different from the competition. So to what extent can LG’s installed base of hardware in US hospitals give it the foundations for a serious hospital-at-home play?
Click the image above to read ‘SPI Digital Health: What Now for Lumeris and its $100M Value-Based Care Kitty?’
On to value-based care (VBC) now and news that enablement services and technology vendor Lumeris had secured another $100M of funding to expand its network of independent physician associations (IPAs), large health systems and Accountable Care Organisations (ACOs) across the whole US.
The move seems to be predicated on the fact that US reimbursement models will increasingly drive these organisations towards VBC. This is a ripe market and with a business model that straddles both VBC enablement and self-developed IT solutions, it has a more diverse customer base than some of its competitors. That should stand it in good stead for now, but how will the pure play IT vendors that sell off-the-shelf solutions (we’re thinking Commure, Innovaccer, Health Catalyst and Arcadia) respond to what is surely a competitive threat? And, as VBC becomes more mainstream, IDNs in particular will begin to allocate some resources to develop their own enablement services, so how will this affect Lumeris?
Click the image above to read ‘SPI Digital Health: With Consent Decree in Hand, What Now for Philips’ Ventilators?’
On a very different note, we looked at the implications from Philips’ reaching a final agreement with the US Department of Justice (DoJ) and FDA on a consent decree relating to subsidiary Philips Respironics.
The consent decree relates mainly to Philips Respironics’ US operations, which were curtailed in 2021 with the voluntarily recall of several sleep therapy and respiratory care devices. The company then prioritised remediation of the recalled devices.
While the consent decree is a big step in the right direction for a company whose products and R&D work have been closely scrutinised since 2021, how will it go about repairing its tarnished brand reputation?
It won’t be for the wont of trying. Philips has invested a lot of time and resources to remediate the recalled devices to satisfy the DoJ and FDA and claims to have made good progress.
There’s a sense that Philips Respironics is now at a turning point. Does the consent decree now give it a clear pathway back into the US market? And if so, how smooth would any pathway be?
Another household name to hit the headlines in May was Mayo Clinic and news that it had added health systems in Singapore, South Korea and the US to its distributed data network. There are now 11 health systems under Mayo Clinic Platform_Connect federated data platform.
These are big-hitting, tier one health systems with robust and sophisticated IT infrastructure in place that can offer clean, curated, de-identified data on complex and rare health conditions. The fact that two of them are non-US means this is the beginnings of a global data sharing alliance which is pretty unique.
There are some obvious questions around a global alliance. How would it be regulated? And with leading health systems and providers around the world increasingly building vendor-neutral data lakes that integrate with all existing healthcare provider IT systems, including EHRs, where does a global initiative fit in?
We round this month’s summary off with a look at General Catalyst and rumours that the venture capitalist has developed a $6B fund targeting tech start-ups. This is potentially significant for us in that GC has a particular taste for digital health firms. We can reasonably assume that a chunk of the $6B will be used in the same way. We also don’t expect it to veer from the tried and trusted strategy: investing in small, early-stage companies, even if it has struggled in the past to really scale these types of company.
But if that is to be the case, what does GC’s end game look like here? It’s a venture capitalist (and one that has demonstrated admirable patience over time) and so presumably wants a return on its investments in time. Also, it plans to buy a health system of its own, Summa Health, which is a significant departure from its usual type of investment. This will be another test of GC’s patient and skills where the results are by no means certain.
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About Mark Lazell | Editor of Signify Premium Insights – Digital Health.
Mark joined Signify Research in 2022 as Associate Editor to lead on the company’s Premium Insights – Digital Health service. Prior to Signify, Mark spent 25 years as an editor, publishing detailed analysis of healthcare and other high-tech sectors in the Middle East and Asia Pacific. He was the launch editor of Middle East Medical magazine, and produced detailed country reports and analyses, including interviews with regional policy makers and healthcare executives.
About the Signify Premium Insights Contributing Analysts
Signify Premium Insights rely heavily on the industry expertise from Signify Research’s expert medical imaging analyst team. This team brings with it many years of experience developing market reports, insights and providing consultancy services to the medical imaging industry.
Alex Green | Managing Director and Principal Analyst
Alex has 24 years’ experience in tech market intelligence. He leads on Signify Research’s Digital Health offerings focusing on integrated care IT, EHR/ EMR and telehealth. Prior to joining Signify he served as a Senior Research Director at IHS and as a Business Analyst/IT Project Manager in a joint NHS/ Government role.
Kelly Patrick | Research Director
Kelly joined Signify Research in 2020 as a Principal Analyst. She brings with her 12 years’ experience covering a range of healthcare technology research. Prior to joining Signify Research she was the manager of the Healthcare Technology team at Omdia (previously known as the Healthcare Technology team at IHS Markit/InMedica). Kelly is now a research Director leading the management of the research teams within the Clinical Care and Medical Imaging groups. Kelly’s core research focus has been on the clinical care space, including patient monitoring, anaesthesia, sleep & respiratory care, and infusion. Kelly has been the lead on several large custom and consulting projects, specialising on in-depth analysis across the clinical care and wider healthcare technology space.
Arun Gill | Senior Market Analyst
Arun joined Signify Research in 2019 as part of the Digital Health team focusing on EHR/EMR, integrated care technology and telehealth. He brings with him 10 years’ experience as a Senior Market Analyst covering the consumer tech and imaging industry with Futuresource Consulting and NetGrowth Consultants.
Vladimir Kozynchenko | Senior Market Analyst
Vlad joined Signify Research in 2023 as a Senior Market Analyst in the Digital Health team. He brings two years of experience in the consulting industry, having undertaken strategy, planning, and due diligence assignments for governments, operators, and service providers. Vlad holds an MSc degree with distinction in Business with Consulting from the University of Warwick.
Hamir Harbham | Market Analyst
Hamir joined Signify Research in 2022 as a Market Analyst within the Digital Health team. He holds a BSc in Economics having graduated from Loughborough University in 2022.
About Signify Research
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