The Impact Advisor: July 2020

The Impact Advisor: July 2020

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July 2020



Only Epic and Meditech gained hospital market share in 2019, per a recent KLAS report. According to KLAS (via FierceHealthcare): “Epic’s market share continued to grow across organizations of all sizes in 2019 – it now accounts for just under 40% of the acute care beds in the United States … Just over half of Epic’s wins were competitive decisions; the remainder were the result of standardization and acquisition.” The only other vendor with a net gain in hospital market share in 2019 was Meditech. Notably, according to this blog from KLAS about the report, “Meditech’s Expanse is emerging as a possible player in the larger space, with one larger organization choosing to standardize on the solution.” Meanwhile, KLAS stated (per HealthLeaders) that “Cerner saw a net decrease in market share for the first time since KLAS began tracking losses in 2010 … The decrease is especially notable in terms of number of beds.”

(Note: click here for the high-res version of the chart above)
Source: KLAS, 6/15/20

Why It Matters:

Epic’s strong performance once again in this year’s report is obviously a key takeaway (though certainly not a surprising one), with KLAS noting “to date, Epic is the only vendor to have not lost a big organization to a competitor.” With more consolidation among health delivery organizations almost certain to result in the aftermath of the COVID-19 pandemic – and with standardizing on a single EHR across the enterprise increasingly being a priority – we wouldn’t be surprised to see Epic’s market share increase even further in the coming years. We also think the continued momentum from Meditech that KLAS observed is worth noting. The KLAS report confirms that Meditech Expanse is definitely gaining real traction, particularly in the “highly competitive midsize market” (200–500 beds). Whether Meditech Expanse will eventually be able to emerge as a true competitor in the large hospital space still remains to be seen – but it will certainly be something to watch closely over the coming year.

*Impact Advisors is a vendor-agnostic consulting firm.


Per a recent analysis by Harvard researchers, “while [ambulatory] visit numbers have rebounded” after declining “by nearly 60%” in late March, “they are still substantially lower than before the U.S. pandemic began.” The report, which is based on data from clients of patient intake software vendor Phreesia, also states: “initially, as in-person visits dropped, telemedicine visits increased rapidly. Since that peak in mid-April, telemedicine use has begun to decline, though it remains substantially higher than prior to the pandemic.” The authors acknowledge that “the fraction of all visits identified as telemedicine [in the study] may be underestimated” though, given that “early in the pandemic, providers were still creating processes to designate telemedicine visit types in their scheduling software.”

Percent change in visits from baseline1

1 Per the authors, “data are presented as a percentage change in the number of visits in a given week from the baseline week (March 1–7)”

Source: “The Impact of the COVID-19 Pandemic on Outpatient Visits,” Commonwealth Fund, 6/25/20

Number of telehealth visits in a given week as a percent of baseline total visits2

2 Per the authors, “data are presented as a percentage, with the numerator being the number of telemedicine visits in a given week and the denominator being the number of visits in the baseline week (March 1–7).  Telemedicine includes both telephone and video visits.”

Source: Adapted from “The Impact of the COVID-19 Pandemic on Outpatient Visits,” Commonwealth Fund, 6/25/20

Why It Matters:

With so much variance from state to state (and even from provider to provider) right now, we would definitely take the numbers themselves with a grain of salt. That being said, we think the second chart above is certainly a good visual reminder of the steep jump in virtual care provided by physician groups in an extremely short period of time. This is important because the rapid onset of the pandemic did not afford the luxury of planning, so even as outpatient visits are starting to rebound in some regions, there is still a considerable amount that many physician practices need to sort out from a telehealth perspective (workflow changes, technology/platform standardization, reimbursement issues, etc.). Complicating matters even further is the rapid evolution in patient demand. Prior to the pandemic, many patients had never even participated in a virtual visit with their physician. Now, almost overnight, patients don’t just have experience with virtual visits – they have expectations. Understanding and adapting to those expectations needs to be a foundational component of every physician practice’s telehealth strategy moving forward.


A recent article in the Wall Street Journal looks at “how a patient’s journey through the hospital is starting to change as pandemics become a looming threat” – with many specific examples from leading hospitals and health systems. Per the story, in an effort not to be “caught flat-footed again,” more hospitals are “turning to new protocols and new technology to overhaul standard operating procedure, from the time patients show up at an emergency room through admission, treatment and discharge.” The WSJ adds: “These changes promise to markedly reduce risk and disease spread – and change the way people experience care even in times when there is no crisis.”

Why It Matters:

Importantly, the story includes some excellent examples from leading health systems of solutions that are mobile, journey-based, and technology enabled. Perhaps most telling, though, is that many of the changes and initiatives described in the article are not intended to be temporary. In fact, a number of the hospitals and health systems that were interviewed are clearly taking action right now with the near future in mind – where the ability to provide virtual, streamlined, and personalized care will be a basic requirement for staying competitive.


An article published in Applied Clinical Informatics by UW Medicine Information Technology Services (ITS) looks at the experience of one of the first health systems in the U.S. to treat COVID-19 patients – and the “the rapid rollout of capabilities” that was required “to support [the health system’s] clinical response to the COVID-19 pandemic.” According to UW Medicine, “the unfolding pandemic of COVID-19 necessitated a previously uncharted reorganization of health care system infrastructure, processes, and priorities … Through a shared sense of purpose and nimble response to clinical and operational requests, the [UW Medicine] ITS team played an integral role in responding to this public health emergency.”

UW Medicine’s COVID-19 order set (Epic ambulatory EHR)

Source: Appl Clin Inform 2020;11:265–275

UW Medicine’s COVID-19 Incident Command Dashboard

Source: Appl Clin Inform 2020;11:265–275

Why It Matters:

The article is a fascinating look at how the IT department at one of the first health systems in the country to treat COVID-19 patients handled the crisis. We think it also serves as an important reminder that just as interesting as what leading hospitals and health systems have done (and are doing) in response to this pandemic is how they are doing it: the rapid pace, the decisive actions, and the flexibility to quickly adapt when needed. The reality is that the pandemic has forced the IT function at health delivery organizations to be nimble and agile in ways that they have never had to before. Coming out of this crisis, we think leading hospitals and health systems will be the ones that are able to build on these tenets as they prepare for a rapidly approaching “New Normal” in health delivery.


Q: How can we reorganize or make our labor costs more efficient as we recover from the COVID-19 pandemic and in planning for the future?

A: We know the coronavirus pandemic hit healthcare systems and hospitals hard, and recovery is slow-going as areas of the country continue to see spikes in new cases. The pandemic is also shining a spotlight on system inefficiencies and teaching us lessons that can help improve daily operations moving forward.

The key here is proactively managing labor expenses to meet current needs (understanding that they may still be constantly changing) and with eyes toward unforeseen future challenges. This still means balancing and meeting the needs of staff and patients while prioritizing safety, quality, and compassionate care. Here are a few tips to keep in mind in your efforts to make labor costs more flexible to meet changing needs.

1. Use data and analytics for the best estimate on future patient volumes. Review productivity standards across the organization and take time to consider groups and functions that are “fixed” expenses and decide whether they are essential or nonessential. Dig into expenses from the past few months to plan for a potential surge in the coming months and year.

2. Generate more flexibility by maintaining or expanding a virtual workforce and researching more outsourcing opportunities and touchless systems to reduce disease spread. Many organizations had to improve staffing and scheduling systems to support the shift to a virtual workforce, so applying real-time data and analytics to support managers can yield further potential labor expense reductions. So, too, can outsourcing and integrating automation for needs such as pre-registration and in-office portable devices.

3. Perform a comprehensive assessment of talent and align them with updated strategic goals. In addition, updated strategic goals will be crucial as this unforeseen pandemic necessitates updates to your short-term and long-term strategic goals, including staffing. Rely on a team that can use the data and learn from pandemic experiences to identify new skill sets that will be needed for the future.

(Response provided by John Klare, Managing Director, Performance Excellence Service Line Leader at Impact Advisors)