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Epic Makes Progress 311356 NDX
Epic Makes Progress 311356 NDX
Customer Loyalty
Published 14 November 2017 - ID G00311356 - 24 min read
ARCHIVED This research is provided for historical perspective; portions may not reflect current
conditions.
Overview
Key Findings
■ Epic has a remarkably loyal customer base. Confidence in Epic's ability to execute on
the Healthy Planet vision and roadmap helps retain customers.
■ Healthy Planet's strengths are the care management and coordination functionality,
closed-looped analytics, and insights that are tightly integrated directly into the
clinician's workflow. The downside is that this appears to work best within an Epic
EHR environment.
■ Clients' chief complaint is the ease of integrating with non-Epic data — driving
several to seek interim solutions.
■ HDOs using Epic most successfully to advance population health programs are
those with more mature population health and analytic programs, mature resources
and strong leadership.
■ Customers desire greater vendor partnership from Epic. They are seeking industry
knowledge and experience to help them drive insights, deliver results and realize
value from the investment.
■ Conduct an open procurement and evaluate Healthy Planet along with other
population health management solutions. Develop an RFI that will tease out your
HDO's critical differentiators for a population health solution.
■ Perform thorough reference checks by focusing on both the results Healthy Planet
has helped to deliver (e.g., how well has it helped meet the HDO's value-based
contract risk measures) and the challenges that have been encountered. Ask how the
references mitigated the challenges.
Analysis
Population health management (PHM) is one of the top priorities of healthcare delivery
organizations (HDOs). It is a part of almost every senior leadership conversation,
particularly in the U.S., but also globally. PHM is viewed as a best practice for delivering
care, and it is synonymous in the U.S. with the adoption of value-based payment models.
It has become the de facto principle underlying healthcare transformation. Gartner has
been reporting for several years that this is the biggest shift in hospital operations in the
past 60 years. PHM is dependent upon information technology to enable a new set of
capabilities in analytics (e.g., real-time, situational and contextually aware), care
management and coordination, and patient engagement.
Gartner's "Population Health Management Maturity Model, Version 2.0, Lays Out a Future
Path for Healthcare Providers" presents a framework for understanding the role of
technology in supporting population health management. Gartner has found, through its
discussions with clients, that regardless of the vendor, implementing next-generation
analytics and population health management capabilities is tough and requires massive
organizational commitment. Organizational readiness, especially clinical alignment
around the goals, is equally important as the technology partner. Our framework suggests
not only the technology requirements, but the holistic framework customers should press
vendors to partner in.
One factor in this has been the power of the megasuite vendors (such as Allscripts,
athenahealth, Cerner and Epic) and the availability (or lack of) of a viable solution from
them. PHM solutions within the megasuite vendors have matured more slowly than some
of the early entrants into the market — such as Health Catalyst or Philips Wellcentive.
Time will tell whether their lagging pace was prudent in an evolving market or whether the
delay puts them at a strategic disadvantage as others capture market share. There is a
very broad array of stand-alone specialty solutions in the market, as shown in Gartner's
"Market Guide for Healthcare Provider Population Health Management Platforms." In total,
26 vendors are profiled in the Market Guide, and it represents only a fraction of the
saturated market. Buyers are looking for a population health management vendor that
has a solid foundation of data integration, analytics, functionality for care management
and coordination, performance management, and patient engagement (see "Gartner
Population Health Management Framework for Healthcare CIOs").
Capability Overview
For the purposes of this deep dive, we are focusing on the Epic Healthy Planet solution.
The product description provided to Gartner by Epic for this solution is as follows:
Healthy Planet is offered as a locally hosted solution (either as part of a customer's Epic
EHR deployment or as a stand-alone suite) or a vendor-hosted option known as Healthy
Planet Constellation. Regardless of the deployment model, Healthy Planet includes:
■ Caboodle data warehouse, a flexible and extensible warehouse for Epic, non-Epic
EHR and other data
In addition to loading data to the data warehouse (SQL Server; used most often for
analytics-focused projects), Healthy Planet is an open platform that helps organizations
incorporate data in the formats they need. Options include the following:
■ C-CDA loads via the Care Everywhere interoperability platform bring in patients' and
members' records and other clinical data.
■ HL7 interfaces are used for standards-based exchange with additional systems for
demographics, event notifications, lab data, results and more.
■ The Stargate flat file utility automates receiving, processing, and filing data from
other systems that might not support relevant HL7 or C-CDA exchange capabilities.
■ Care gaps
■ Reports/dashboards
■ Variation analytics
■ Variation and leakage analysis tools, which help identify opportunities for reducing
cost and keeping care in-network
■ Predictive analytics
Epic noted the following as part of its product direction and strategic roadmap:
■ A cognitive computing platform that runs machine learning and advanced analytics
on structured and unstructured data to deliver insights at the point of care
■ Expanded support for behavioral health and social and community care to unify care
professionals across the continuum and support holistic care management outside
the traditional healthcare walls
■ Machine learning to help guide care managers and clinicians through workflows
more efficiently and automatically suggest and queue up next steps
Capability Assessment
The capability assessment is a high-level analysis of strengths, weakness, opportunities
and threats of the Healthy Planet solution (see Figure 1). It is intended to help CIOs better
understand the viability of the solution and formulate the questions to ask Epic when
evaluating its product. The opinions below are based on formal customer interviews
conducted in mid-2017, a roundtable discussion conducted at Gartner's Data and
Analytics Summit in March 2017, various Epic vendor briefings, and Gartner interactions
with clients via inquiry calls.
Epic has a very loyal customer base. Epic customers are happy with Healthy Planet and
are committed to the ongoing development of the roadmap and vision. Customers are
seeing Epic rapidly catch up in areas that had been weaker, such as analytics and data
integration. There is also excitement around new features such as Healthy Planet Link,
which provides an organization the opportunity to share analytics with its partners. As
with any population health management platform, Gartner believes success is not entirely
dependent on the technology platform selected, but also on the organizational leadership
and cultural process changes that are needed to effectively use the capabilities the
product offers. Epic customers also echo this. Lessons learned from early adopters note
the need for strong leadership and governance, strategic direction and a clear roadmap.
Healthy Planet has demonstrated healthy year-over-year growth in customers live on the
platform. The biggest strength of the platform is the population healthcare management
and coordination capabilities being tightly integrated directly into the clinical workflows.
Epic is also providing customers with good technical support and guidance in the arduous
process of integrating claims data into the data warehouse.
The primary weaknesses we note are around non-Epic data integration and analytics.
Some customers are choosing to leverage other industry-leading analytic solutions as an
interim, but are very optimistic that Epic will catch up.
It's hard to completely isolate Healthy Planet from other Epic tools. Customers also
noted that, through additional capabilities offered by Epic (such as Epic Connect,
Care Everywhere and Happy Together), a solid network of interoperability is created
across providers and patients that creates better provider alignment, as well as
provider/patient alignment. Documentation and data capture standards are also
created across the entire platform, providing for easy clinical use and adoption. This
is, of course, if you stay within the Epic family of products. It was clear from all
customers that Gartner spoke with that the ability to transition the ambulatory
workflow into a population health paradigm works nicely. Care management
workflow is being adopted by all tiers of providers, and there is good relevant insight
provided from the registry reporting.
One customer noted that any challenges with the payer data is based entirely on the
data the payers provide — not because of any limitations with Healthy Planet. The
same customer also noted that new data competencies are needed. The
methodologies and concepts needed to develop the data — from loading the data to
transforming it into actionable information — require new skills and thinking, and
new education. Gartner has observed that those doing well don't expect perfection
and fully understand the significance of this task. Epic appears to be a solid partner
in this process.
It's also interesting to note that several customers specifically commented that they
are integrating IoT data and seeing value from it. This is especially important as
population health management strives toward solutions to allow for remote
monitoring of remote devices as care management solutions advance.
■ Customer Service Model: Healthy Planet implementation teams are said to be very
dedicated and committed to their customers, which translates into very high
customer loyalty and satisfaction. Customers find Epic to be a very good partner,
from implementation through support, evolution and upgrades. That the relationship
is routinely referred to as a "partnership" shows that the personalized support model
is not only valued, but relied on and depended on.
■ MyChart: Epic's MyChart was said to be a great asset for population health
management. This Epic tool has been around long before population health
management and Healthy Planet, but the tight integration now enhances the
customer experience and the provider/patient relationship, and facilitates many
population health management demands. Patient engagement has become an
integrated part of the equation of PHM.
■ Vision and Roadmap: Customers like the direction Epic is articulating with Healthy
Planet — which includes deeper and more advanced analytics, as well as additional
data integration points across the network and continuum of care. Customers have
full confidence in Epic's ability to execute on this vision. Even those customers who
were using third-party analytic solutions made it perfectly clear they expected it to be
only a two- to three-year interim solution. In some cases, there were plans in place —
as they were implementing the third-party solution — on how they planned to sunset
the solution once it was no longer needed.
Weaknesses
■ Analytics: Just like data integration, many customers are working outside
Healthy Planet. They are using their own enterprise data warehouses or third-
party solutions to integrate and process the data, perform analytic routines and
then bring the results back into Healthy Planet/the Caboodle data warehouse.
They are often using Tableau, which seems to work very nicely with Epic.
Similar to above, many of these clients are those working with fairly large and
sophisticated clinical integrated networks (CINs) with multiple spokes and
hubs. It's not necessarily uncommon or poor strategy to have the primary
analytics environment be a vendor different than the EHR. However, this is
noted as a weakness because customers are specifically using the interim
solution to compensate for what they would prefer to have Epic provide.
In these two areas, customers are expecting more, as they should, from Epic. Without
broader strength in data integration and analytics, Healthy Planet will be hard-
pressed to deliver actual results and ROI beyond Phase 1 deployment. Gartner
expects product maturing of Healthy Planet Link (a web-based portal distributing
analytic dashboards, risk scores and gaps-in-care reports across the CIN) and the
Happy Together framework (bringing together the longitudinal patient record) will
close these gaps.
■ Making sure users are using it in a way that translates into benefits
Opportunities
Weaknesses can translate into opportunities — opportunities for Epic to enhance its
product, and opportunities for the CIOs (buyers) to press Epic on how it is addressing the
concerns Gartner has noted. Epic can capitalize on its stellar customer relationship and
continue to actively listen and address the concerns. The product roadmap and vision
articulated for Healthy Planet is entirely consistent with feedback we received on gaps,
and the roadmap resonates very nicely with customers. Gartner sees the following as
significant opportunities for Epic to retain customer confidence in Healthy Planet as its
long-term and complete population health solution:
■ There are increasingly more stakes on the table and impact of success or
failure is more profound.
With Epic's massive customer base, it should have the industry lens to develop best
practices and critical success factors to guide and coach its clients.
■ Data Integration and Analytics: This has been noted repeatedly throughout this
research, and it is simple. Epic needs to continue focusing resources in this area and
catch up. There is a need for more standard content and reporting, as well as risk-
based analytics. One customer noted that this needs to happen quickly, before they
need to rely permanently on a third-party solution (a noted trend/concern among
Epic clients).
Epic customers want to see more integrated data across the continuum and better
usable integration of non-Epic EHR data. Epic's product roadmap and vision include
broader connections across evolving community care networks, using features like
Care Everywhere. Customers with clinically integrated networks, and even super CINs
expanding the network beyond their own immediate partnerships, are looking for
Epic to deliver augmented integration capabilities sooner rather than later.
Threats
Threats recognize factors that HDO CIOs need to consider about Epic's market position,
stability and ability to deliver.
Epic's biggest threat is itself. Failure to deliver on data integration and a viable stand-
alone solution will continue to perpetuate the isolated universe reputation. Gartner's
perception is that most clients have very homogeneous Epic environments, and that this is
what creates the tight integration and seamless workflows. Other solutions have proven
they can do the same, but with much better integration capabilities of data across all
leading industry EHRs, thus making the data more useful and the analytics more robust.
Competition still rules in the PHM market space, and there are many viable solutions
competing to get critical mass of customers and scale. It is a hotly competitive market
with some very credible population health management solutions that are in direct
competition with Healthy Planet and are growing market share. Although it seems
intuitive, there is actually limited evidence that buying a product native to the EHR is
necessarily less risky and easier to implement than a stand-alone solution.
The reality is that, whether it is Epic's Healthy Planet or another product, implementing a
population health platform and lifting it to productivity is tough work. And while Gartner
has not seen substantial evidence that there is marked benefit leveraging the PHM from
your EHR (after all, there are several leading PHM tools on the market that work well with
Epic), Healthy Planet is providing customers with an initial set of tools that are getting
good reviews. There is also ample confidence from a very satisfied customer base that
Epic will continue to enhance Healthy Planet features and close gaps.
Evidence
The document is our opinion on the product based on the following sources of
information:
■ Gartner focus groups at the 2017 Data and Analytics Summit, Grapevine, Texas
■ Data Integration: This is rapidly becoming the most important, and daunting,
element of the population health and overall information architecture. The HDO
needs to have a good handle on source and targets for data and analytics, an
integration mapping of sorts that navigates the path between the many sources of
data and the value creating analytics and applications uses. This is especially
needed across the care management and coordination workflow areas. Have this
data integration picture ready for vendor discussions.
■ Data Governance and Quality: Programs must be established to ensure the integrity
of the data. Data integration and quality issues will be one thing that is certain to
lead to cost overruns, disappointed stakeholders and a load of work that wasn't
expected. The most complex aspect of this is governance and standardization of
data sources across multiple, nonowned, affiliated providers.
■ Outcomes: Tightly tied to program design is having clear project goals and
outcomes. These are very often coupled with the very specific, discrete goals HDOs
have under value-based payment models.
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