Emergency Department Integration Trumps Functionality

KLAS report shows only 69% of best-of-breed clients indicated their current system is part of their long-term plans.
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Integration is a key focus for many hospitals considering emergency department (ED) strategies to help satisfy Meaningful Use objectives, and many are willing to sacrifice some functionality today for integration and anticipated functional improvements in the future, according to a new report by KLAS.

However, making the switch from best of breed to enterprise, and thus the sacrifice, can be painful.

"Enterprise ED offerings have traditionally not been as robust as the best-of-breed solutions in terms of functionality," according to report author and KLAS Research Director Steve VanWagenen. "But some providers have been willing to say, 'In terms of what's important to us, we're going to go with integration, or the enterprise solution, and hopefully our enterprise vendor will develop functionality over time and we'll be up to where we are today, if not better, in the long run.' Short term, however, it is painful for the clinicians to make that change."

Bucking the trend, some organizations are still putting departmental front-line clinicians first, with functionality trumping data liquidity. "You have other organizations saying, 'Our enterprise vendor is just not up to what we need to do. For the ED environment, we need tools to help us perform our roles better and faster, so we're not ready to make the change. We'll just stick with best of breed long term or we'll just keep it as a placeholder for the day (that will hopefully come) when our enterprise vendor will have an ED solution that is up to what we need."

The numbers definitely point to integration edging out functionality in the marketplace -- only 69 percent of best-of-breed clients indicated their current system is part of their long-term plans, compared with 93 percent of enterprise customers, KLAS found.

"The challenge for the industry is how do you grab the best-of-breed capabilities and find the integration? -- and that's the whole idea behind this report," VanWagenen said.

But grabbing that integration simply by selecting an enterprise vendor's offering may not be a foolproof plan, he said, noting that some vendors don't have the integration within their product suite one would imagine. "The ED systems still, in some cases, aren't developed in tandem with a lot of the other products that some of the enterprise vendors offer, so they run into the same challenges a best-of-breed vendor would face in terms of having to interface with the core in-patient EMR and other ancillary systems," he said.

Tying with scores of 88.2 out of 100, enterprise vendor Epic and best-of-breed vendor Wellsoft took the top spots. They were followed by MEDHOST (83.8) and Allscripts (83.2). The report also highlights Cerner, CMR, Eclipsys, Emergisoft, EmpowER, McKesson, MEDITECH, Picis, and T-System and includes brief updates on a dozen additional EDIS vendors. The study compiled feedback from more than 700 providers.

With more than a handful of best-of-breed providers, and an industry trend toward enterprise offerings, the market may be ripe for some M&A. "There's a lot of folks out there doing ED systems," added VanWagenen. "So there's definitely going to be some consolidation over time as providers look for that mix of integration and functionality."

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