Will the Ubiquitous EMR Invade Cardiology Informatics?

September 29, 2014

EMR vendors threaten the cardiology imaging informatics field.

Ever since cardiology departments and practices have embarked on their digitization journey – about two decades ago – following, in some ways, in the footsteps of their radiology counterparts, the cardiology informatics market has continued to consolidate around a core set of industry vendors.

The set consists of vendors with roots in the imaging realm – equipment vendors, picture archiving and communication systems (PACS) vendors, and imaging IT vendors – most of which also acquired a specialty cardiology IT vendor between 2005 and 2007 and owe much of their market success to strong capabilities in cardiovascular image management (cardiology PACS).

The Threat for Imaging-Centric Vendors of Enterprise-Lead Decisions
The status quo in the cardiology informatics industry might be changing, however. With the PACS function of cardiology image and information systems (CIIMS) becoming increasingly commoditized, the stronghold of this core set of image-centric vendors is being questioned.

For the longest time, the electronic medical record (EMR) vendors did not make significant enough moves into department-centric IT solutions such as cardiology (or radiology) information systems. Until recently, they have acted as having bigger fish to fry, given the numerous functions their systems ought to provide to the broader healthcare enterprise and the blue ocean market they were addressing.

However, in what perhaps constitutes as the biggest threat to date for the core cardiology informatics vendors, major EMR vendors are starting to make forays into this highly guarded and coveted space. Taking advantage of the ongoing move of hospital IT decisions away from a strictly departmental level and towards the enterprise and CIO levels, EMR vendors, now more than ever, stand a better chance to break into this specialty market with their own cardiology IT solutions.

The United States Market Under Everyone’s Radar
This competitive threat is valid mainly in the U.S. market which, in the wake of the Affordable Care Act (ACA) and its meaningful use (MU) implications, has become a major EMR powerhouse. While the traditional imaging IT vendors have done little in trying to certify their CIIMS product for meaningful use, the EMR vendors have the major advantage of being able to pass on their Certification Commission for Healthcare Information Technology (CCHIT) marks onto their cardiology modules.

Although the EMR threat is imminent, to this day, the United States market remains largely imaging-centric in the purchasing decisions it makes for its radiology and cardiology information system – but for how long is the big question on every imaging vendor’s mind.

Widely Varying Perceptions by Region of the Role of EMRs
The image-enabled or multimedia EMR, which holds a record of a complete patient history including images, is increasingly being validated as a best practice in the clinical field. More so in cardiology than in radiology, it is critically important for information systems to paint the complete picture of a patient’s situation, especially for complex patient cases. This might be one of the reasons why EMR vendors seem to be targeting cardiology, more aggressively than radiology.[[{"type":"media","view_mode":"media_crop","fid":"28077","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_2059530804683","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2808","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 208px; width: 166px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Nadim Michel Daher, Principal Analyst, Medical Imaging, Frost & Sullivan","typeof":"foaf:Image"}}]]

From a global perspective, there are significant country disparities in the way EMRs are currently used in different countries and in the long-term strategy each health system appears to have regarding future EMR use. In Germany for example, EMRs are used mainly for billing and patient administration functions, whereas in the United Kingdom they are viewed as a platform for clinical enhancement, data analytics, and enterprise access to clinical information. Scandinavian countries have grown very EMR-centric, while southern European countries are still much more department-centric. In the global market, Asia appears to be the least EMR-centered of all.

Epic’s Solo Play and Cerner’s EMR-Led Consortium
As the EMR market leader in the United States, Epic is capturing much of the attention (and apprehension) of the current CIIMS vendor community. Epic’s initial cardiology product, the Cardiant cardiovascular information system (CVIS) launched in 2009, was not particularly well received in the marketplace. However Epic’s Cupid CVIS, the new-generation product, seems to have a greater market impact over the last two years, at least within the Epic customer base – the largest and most impenetrable EMR installed base in the United States.

As for Cerner, the second largest EMR vendor and Epic’s fiercest competitor, their approach of the CIIMS market opportunity seems to be at the antipodes of Epic’s. In what appears to be the first high-profile consortium forming around cardiology informatics, Cerner is marketing its PowerChart Cardiovascular solution alongside its CareAware vendor-neutral archive (VNA) and teaming up with a set of best-of-breed CIIMS vendors: Merge Healthcare, whose partnership with Cerner centers on Merge’s Hemodyamics offering; TomTec, for its set of advanced clinical applications; and Ascend HiT, for cardiovascular procedural reporting. Led largely by Cerner, who probably has more wherewithal than all of its partners combined, this multi-vendor effort has already laid the first stone of its United States adoption curve with the signing of the first few customers over the last few weeks.