The global market for electronic health records is as diverse and far-flung as the countries and cultures served by the technology. Different regions are at different levels in their IT maturity, have different historical preferences for certain vendors, and have different healthcare imperatives they're trying to solve.

The new Global EMR Performance 2018 report from KLAS arrives just as the EMR market is burgeoning in a big way around the world, and aims to address vendor performance by specific regions to offer accurate picture of how regional and multiregional companies are delivering for their provider customers in each area.

WHY IT MATTERS
KLAS notes that the size and scale of IT deployments have generally grown significantly worldwide in recent years, "rapidly changing the global EMR landscape."

The new report, drawing on provider feedback from 365 inpatient providers worldwide over 18 months, aims to offer an "accurate picture of how vendors respond to regional needs," gauging "how confident customers are in their vendor’s overall R&D efforts, in their dedication to healthcare in various regions, and in their ability to strategically partner with organizations to help drive deeper EMR adoption."

The report examines the performance of smaller, more localized players such as Agfa HealthCare, Cambio, ChipSoft, Dedalus (Medasys), DXC Technology's Lorenzo, everis, MV SOUL, Philips Tasy Java and Tieto.

But the largest, multiregional vendors, many of them gaining traction in competitive markets abroad based in part on their reputations here in the States, are American names we all recognize.

Epic is still new to many regions, for instance, but 75 percent of responding organizations worldwide reported high overall satisfaction. Cerner, as the only company on the list with installs in all corners of the world, also has above-average satisfaction. Some vendors look to be focusing on honing their perform in certain international regions, such as Meditech in Canada and the UK & Ireland.

THE LARGER TREND
The global EMR market varies "significantly by region in terms of both market share and performance," according to the KLAS report. "Multiregional vendors may have large customer bases in certain regions and none in others, and they may perform much better in some regions than they do elsewhere."

While there is currently no vendor broadly deployed in all regions with high customer satisfaction across all of them, researchers said, some regions have different preferences than others.

Canada. Meditech has been a longtime player north of the border and has generally earned high marks for meeting "Canada-specific needs," said KLAS. Its recently launched Expanse platform "will be critical for long-term customers on legacy platforms, who need updated technology to meet market demands." Cerner does OK in Canada, according to the report, but customers in Canada often report feeling that they get "US-focused rather than Canada-specific functionality." Allscripts has recently reaffirmed its commitment to our neighbor to the north, and researchers say it's working to develop more localized functionality as customers, broadly speaking, see better strategic engagement.

Europe. Generally, speaking, European customers had positive reviews of Epic's "commitment to the region and strong executive relationships," said KLAS researchers, who nonetheless noted that the company "can miss market nuances, potentially slowing their regional growth." Cerner has boosted its relationship with Millennium customers and, likewise, their confidence in its R&D efforts, even if it wasn't always quick to respond to region-specific change requests. InterSystems has made quick inroads across Europe, but is having "development and implementation issues," according to the report. Meanwhile, despite specific challenges for each, Agfa HealthCare, Cambio, ChipSoft, and Dedalus (Medasys) get high marks based on their customers' confidence in their R&D and regional dedication.

Middle East. InterSystems has been a leader in the Middle East for years, but researchers find that "multiple concurrent implementations in the UAE have suffered from stretched resources, as have established customers to a lesser extent."  Cerner, on the other hand, the vendor with the most sizable market share in the region, "has demonstrated stable performance thanks to robust functionality and strong integration." Epic has three live customers in the region, who say they're very satisfied, but "also want to see a greater regional presence and improved regional expertise," according to KLAS.

AsiacPac. "Cerner has steadily improved across the region in past years due to deepening adoption and the cloud functionality they recently made available in the region," according to the KLAS report. Meanwhile, InterSystems' performance has declined "substantially" researchers said, thanks to delivery challenges in Oceania that seem to stem from resource diversion challenges with a big Australian implementation. Still, its customers in Asia – China, Thailand –are "generally pleased."

Latin America. MV and Philips are the biggest vendors in the region, but opinions on them have diverged over the past year, KLAS said. "MV’s ratings have improved slightly thanks to their easy-to-use product and ongoing investment in R&D," researchers said, pointing to strong executive relationships and guidance, but weak lower-level support. "Conversely, Philips’ scores have decreased. While the product itself has improved, specifically in stability, Philips’ efforts to grow outside of Brazil – where their Latin American customer base has historically been centered – have left Brazilian customers feeling forgotten."

ON THE RECORD
"Epic is a relative newcomer in many regions yet performs best in providing a consistently positive experience across regions thanks to strong partnerships and strategic guidance throughout the implementation process," KLAS researchers wrote.

"Cerner is the only vendor with customers in every region and comes next in global performance and consistency," the researchers added. "While overall satisfaction is above average, customers say they have largely driven their own success. Cerner is willing to engage strategically, though generally not proactively and often at an extra cost."

Meditech, meanwhile, "performs above average in Canada and the UK & Ireland thanks to more strategic engagements in recent years," according to the report, which raised concerns about the company's slow growth and development in those market. It also noted that Allscripts customers "have achieved deep adoption" but "often feel they drove their implementation themselves."

And InterSystems has seen some market decline in recent years thanks to challenges related to its "inability to provide adequate staff to meet increasing regional demands," the report shows. "European customers report delayed implementations and stretched vendor resources, and customers in the Middle East and Australia experience similar challenges with new implementations and transitions to new country-specific EMR editions."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com