Nearly 70 percent of CIS purchases in 2009 by hospitals over 200 beds were an Epic or Cerner integrated solution, according to a new KLAS report, "CIS Purchase Decisions: Riding the ARRA Wave."

Although they came from about five organizations, Cerner had a solid year with 31 hospital signings. "This is a pretty good stake in the ground for Cerner," said KLAS general manager of clinical research Jason Hess. "I think people recognize that ARRA and Meaningful Use is all about interoperability and integration, and you look at who the two truly notable integrated vendors are -- its Epic and Cerner. Certainly this is kind of a two-horse race as we watched it in 2009, and then the others are kind of at a distant third."

In 2009, Eclipsys, GE, McKesson Horizon and QuadraMed all lost more hospitals than they gained, according to the Orem, Utah-based company.

Hess said that though Eclipsys had a tough year, the company's acquisition by Allscripts may provide customers with a more compelling and complete offering. However, the devil of integration is in the details.

They are "now trying to mesh those two together and actually integrate them. I can't think of any vendor who has been able to do that very well on that scale, so certainly the cards are stacked against them, but it will be interesting to see how well they do over time. Overall, it's been viewed as a positive," said Hess.

Recent and pending changes in the market segment may shift the EMR purchase pendulum, according to the report. McKesson's Paragon product was originally developed for a community hospital environment, but sold to more large hospitals in 2009 than its Horizon solution did.

"Fundamentally what people like about Paragon is the track record of performance, and the fact that these guys have gone from being last by our watch several years ago to first, and that's just from some focus on the product, there are now lots of customers who are really happy with it," he added. Although they did not realize the same increases as Epic and Cerner, Meditech and Siemens both saw limited growth of their currently marketed solutions, KLAS found.

Meditech users share concerns that MAGIC and early C/S platforms do not provide the features and functionality needed to meet Meaningful Use requirements, and that there may not be enough time available for them to implement C/S v.6 and meet the coming deadlines, the report indicated.

But equal to Meditech's challenge in moving its large customer base onto versions with more sophisticated CPOE functionality is dealing with a lack of confidence in its overall ambulatory strategy. Many CIOs find its LSS offering less than robust. "It's kind of an Achilles Heel for Meditech because ambulatory integration is critical given the Meaningful Use measures that we know of today," Hess said.

Siemens Soarian growth continues slowly, but Siemens overall footprint is shrinking as providers replace the legacy solution Invision with another system, KLAS stated.

"(Siemens) does get a performance score that, by our watch, is continuing to go up on the Soarian Clinicals side, which is another positive," said Hess. "The John Glaser (the company's new CEO) story is very positive as well. A lot of people view him as a visionary, an icon, somebody who can walk into any hospital in the country and get an appointment with a peer CIO."

Some providers are looking forward with cautious optimism to GE's release of Quilibria, the result of collaboration with Intermountain Healthcare, even with GE's customer satisfaction rating decreasing by five points in 2009, KLAS found.

"Part of the challenge we hear is that there's a lot of misinformation about what Quilibria really is -- is that going to be content, like a Zynx kind of play where they can take Quilibria and dump it into any EMR, or is the go-forward strategy that GE's employing?" asks Hess. "That was supposed to have been live in 2010, and it's not yet."

Anthony Guerra is the founder and editor of healthsystemCIO.com, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at [email protected].