Enterprise Resource Planning

Remaining first-time buyers: 65 percent
"There are tons of hospitals that aren't using it," says Schuchardt. "It's the logistics part of every business: Looking for inefficiencies and duplicative efforts. If you don't know that's going on, it makes it very hard to cut costs – which is the first step in reducing expense. So I think that's an area the market could definitely use. As these health systems get larger and larger, knowing where your spend, knowing where you're inefficient is really the first step in any sort of merger. It's important to have that understanding. Clinical efficiencies are where the lion's share of the savings are going to come from, but you can't get there without getting efficient from a business perspective."

Executive Information Systems

Remaining first-time buyers: 30.7 percent
Executive information systems may be a bit of an outmoded term at this point – "cost/utilization analytics is how vendors are positioning that, as opposed to EIS, which is an older HIMSS Analytics name," says Schuchardt – but both names boil down to the same concept: dashboards, primarily aimed at C-suite decision-makers. "It's a dashboard, to say, 'Where's our spend, how many beds are full right now, what's patient throughput, what's days in receivable?'" he says. "It puts all of that into an easily consumable format for high-level consumption." He adds: "All of these things are becoming software-as-a-service, just like everything else."

Financial Modeling


Remaining first-time buyers: 51.6 percent
"This connects really nicely with executive information systems," says Schuchardt. In this new value-based world, this world of ACOs and risk stratification, you have to be able to model. "When you're making an agreement with Anthem or Blue Cross about risk, you have to be able to see what the risks actually are, and you need to start thinking about them across a variety of possible outcomes. You could call that cost/utilization analytics. Would be a more buzzy term for it. As these systems get larger and larger you're going to want to see that. Being able to model possible outcomes is critically important to entering into risk sharing agreements with insurance companies and not ending up totally owned by them."

Infection Surveillance System

Remaining first-time buyers: 49.3 percent
Most hospitals at this point have a "core," EMR-centric IT system, says Schuchardt. "But it's the surrounding applications, that allow you to gain efficiencies around all that electronic data that are very very lightly adopted." Technology that can help keep tabs on healthcare-associated infections can lead to big gains -- or at least prevent unnecessary losses. He points to a recent article showing that "more than 50 percent of hospitals in Florida are simply taking the readmissions hit" -- acceding to CMS payment reductions rather than staving them off. "That's a massive hit. If you're trying to make gains and you're not committed to a penalty of negative third-of-a-percent, how do you increase your revenue if your incoming stream has a break on it because you can't keep patients from coming back?"

Laboratory (Molecular Diagnostics) and Laboratory (Outreach Services)

Remaining first-time buyers: 48.2 percent and 41.8 percent, respectively
"These are interesting too," he says. "If you look at the number (of hospitals) that has acquired them, it's really high. The bigger hospitals have acquired a lot of this. But it's not universal by any means." Molecular diagnostics is clearly on the rise. And lab outreach – ensuring diabetics take their insulin, for instance – is critically important. "You could say it's lab technology, it's boring," says Schuchardt. "But it's about patient compliance, really."

Medical Necessity Checking

Remaining first-time buyers: 32 percent
"Should that test be ordered? Have you already had one?" Think of this one as "next-level clinical decision support," he says. "Not only just that the doctor orders a medicine for you but someone else says, 'Hey, that person shouldn't take that because they're on this,' or 'Hey, there's a cheaper one.' The medical necessity checking is diving deeper into the data repository to say, 'This person has had an MRI in the last six months. Do not do another one.' Or, 'The X-rays on this patient can show you an additional look from what you're requesting in this test.'"

Nurse Communication System

Remaining first-time buyers: 30.3 percent
This one represents a big change in workflow for some hospitals – but could lead to big gains. "A nurse call system, everybody used to have to have them," says Schuchardt. "But it was a wire in the wall that called down to an intercom in the nurse station. We have the technology now for that not to be a wire: for the nurse to wear that around her neck. For it to go to the next available person if someone doesn't answer. And then to log all of those calls. It gives you much more data to use, and helps create efficiencies in staffing as well as in quality of care. It's really taking it to the next level. A nurse can click on her pager and send the same call directly to an orderly, as opposed to walking down there to find out what you want and then going to find an orderly."

Nurse Staffing/Scheduling

Remaining first-time buyers: 30.7 percent
"Down here in Florida there's an interesting anecdote," says Schuchardt, who lives in the Miami area. "There are places here where, in the winter, the population doubles. But the number of nurses doesn't. And keeping them scheduled and rested is important. As nurses play a much larger role in care now, keeping them where they're supposed to be is important."

Patient Portal
 and Physician Portal

Remaining first-time buyers: 30.9 percent and 38 percent, respectively
Despite the technology challenges for meeting Stage 2 meaningful use patient engagement requirements, "most people have a smartphone now," says Schuchardt. "I think the interesting challenge for the patient portal now is the rural communities that don't have Internet." From a physician portal perspective, right now the use is around retrieving diagnostic results, entering orders and electronic signatures. In both instances, "even in places where they're installed, the usage is much lighter than what people who understand the technology capabilities would imagine," he says. "There are a lot of people who aren't using this, and even the people who are using it aren't doing much with it, other than the ability to see a lab result if you're a doc or pay a bill if you're a patient."

Single Sign-on

Remaining first-time buyers: 43.2 percent
"Single sign-on is a big deal," says Schuchardt. "For people who have the same EHR system across the continuity of care, it's not that big of a deal. But that's not a lot of places. And I think that as we think about accountable care and population health, and the network leakage that people talk about from the hospital side, and about keeping people in your ACO, having the ability to access that stuff very quickly is important for provider engagement. The flip side of that: Is there a more secure way of doing that, or do people have concerns about similar passwords across similar environments. I think single sign on keeps you from having the same password everywhere, by managing that from a technology perspective."

Staff Scheduling

Remaining first-time buyers: 42.2 percent
To some degree, this one speaks to the size of the U.S. hospital market, says Schuchardt: "There are a lot of hospitals and the majority of them have fewer than 100 beds. That is something that you may not need until you're a larger organization or you're scheduling people at multiple places – a campus with multiple buildings."  If you're a large organization, "it's more important," he says. "If you have three people in your billing office, you really don't care as much."

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