HIStalk Advisory Panel: Allscripts 5/21/12

The 79-member HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news development and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a provider organization (hospital, practice, etc.), you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

For this report, I asked panel members what advice they would provide to Allscripts after the company’s recent earnings disappointment and board shakeup. Their responses have been edited for brevity and to ensure their anonymity. Your comments are welcome.

Vision and Strategy

• The anti-takeover defense made them look weak in my eyes. They need to communicate their go-forward strategy with large clients as soon as possible. People here are worried that our vendor is going out of business.
• Phil Pead was all about the stock price and less about the product, integration, and ease of use. Allscripts tried to tell the integrated story with several different legacy flavors of PM/EMR – too many products, too many moving parts. The Eclipsys purchase was 2-3 years too late since Epic and Cerner have already beaten them and Epic is the only one with a real story of true integration. On the low end, they are most likely getting hurt bad by eClinicalWorks, athenahealth, Greenway, and similar companies. My advice: sell Eclipsys and use the money to pick a lane with one or two flavors of product and just kill it in that space. They cannot be all things to all people.
• They need to re-examine their market and whether this Eclipsys thing is really going to work. Seems like Glen did not learn anything from McKesson and GE.
• Post-acquisition is difficult and companies sometimes make all the parties feel good by including all the legacy resources – people and products – in the path forward. That leads to lack of vision, resource mismanagement, and excessive costs. I think Allscripts got caught in that vortex. They need to clarify what they want to be, then clean up the operation despite painful changes and bruised egos. A change at the top may be necessary to keep the institutional shareholders and analysts at bay while they right the ship.
• Put a plan in front of your most important customers and enlist them to create a public statement of support. Customers trump boards of directors every day.
• Come clean to everyone with what the problem is. Replace the corporate audit firm. Either replace the management team or give them a 12-month notice to clean up their own mess and then get out, assuming there is a belief they can clean it up. Appoint an external firm to work with the board to identify the issues and to decide which board members should stay. Make sure key intellectual capital employees are willing to stay and reinforce your need for their services.
• Allscripts is a finalist in our inpatient EHR selection. The recent news has raised concerns about the company’s viability. Show the market you can recover and succeed since partnering with Allscripts at this point represents significant risk. The failure to integrate Eclipsys products is a key issue since companies like GE and McKesson promised it after an acquisition and failed miserably, leaving customers in a lurch.
• A trick of publicly traded companies is to reveal all your bad news at once, let the market kill you, then build back up. I assume this is the case and future revenues will come with a clean slate. I think they will have some good upcoming quarters.
• They have had a pretty successful ambulatory product offering. They need to leverage that business model to tackle new accounts. With the internal politics hopefully behind them, they can concentrate on integration. They have a good product – I hope they understand that. It’s their execution that’s hurting them.
• Senior management, led by the CEO, need to be transparent if they’re going to put this turmoil behind them. They need to communicate clearly, thoughtfully, and comprehensively what the plan is, with no BS and PR. Humbly admit past mistakes, acknowledge vulnerabilities, reiterate its strengths and lay out the plan to recover. Spend 30-60 days to do a thorough, honest self-assessment – including consideration of the complaints of its critics – and play out best- and worst-case scenarios. If past decisions (i.e. integration) are criticized, those can’t be changed, but they should be acknowledged and addressed. The market is still large and I don’t believe it’s too late for Allscripts to get its share. It may not achieve a #1 or #2 market position, but it can still emerge as one of the winners. It has good products, a sizable customer base, and many talented employees. The message should be positive and encouraging, but above all, credible. In the absence of an ability or willingness to do this, Allscripts should fire Glen Tullman and hire a CEO with the determination and commitment to turn the company around, like fresh leadership did at IBM with Lou Gerstner.

Sales

• The sales team needs better access to technical resources. When they do a dog and pony show for our executives, our technical team is always invited and the sales team can’t answer their questions. I want to be sold, but they can’t bring it.
• Closing deals is the way to show viability. We’ve evaluated their products for our clinics and they didn’t stack up well. One group we’re associated with uses Allscripts and they have not been happy with the product for some time, but I don’t see them moving away from it.

Products

• They need to focus on clean integration of products they are selling as integrated. The last few times we purchased ‘integrated’ solutions from Allscripts, we had to take over the integration because we were getting nowhere with the company.
• Articulate the vision of the combine Allscripts-Eclipsys platform and provide a well thought out plan on how they will get there.
• They may want to take the approach McKesson used for Horizon Clinicals – sunset Eclipsys and focus on ambulatory. They carved out a nice space in the ambulatory area and the R&D dollars going into Eclipsys integration could have been used to further the ambulatory product line. Ambulatory clients are confused. This plays right into the hands of Epic.
• Allscripts needs to stop talking about an integrated record as though they can compete with Epic. They need to find a way to leapfrog Epic. Take what Sunrise customers are developing using Objects Plus/Helios (some of which knocks the socks off Epic) and incorporate it into the product.
• We were a long-time Misys client who left after Allscripts dropped the ball. They couldn’t deliver on support. They decimated their personal relationships by replacing dedicated professionals by a different nameless person every time we made a support call. Their salespeople couldn’t even present a proposal for community integration without innumerable failures in the demo. The ‘free upgrade’ from Misys EMR to Allscripts Professional turned into a morass of fees for training that would have cost more than  buying a competitor’s product. Not surprisingly, small practices in our area have turned to eClinicalWorks and Greenway and never looked back. Simply merging individual products repeatedly without true integration and delivering on promises is not sufficient for success.

Services

• The India-based support we were getting from Eclipsys and then Allscripts was horrible, but they have really taken the bull by the horns and cleaned it up. Recent responses to our problems were clean and focused and I have been pleasantly surprised.
• Outsourcing support to India was a bad idea. Docs like me call and we get people who don’t know the product. The same is true of their patient portal – it is a Babel Tower.
• We have seen deteriorating support and turnover amongst the sales/support team that crosses product lines. Physicians are losing confidence in the product.
• We’re a large Allscripts Professional client and it’s been frustrating to watch them struggle to grow and try to compete with Cerner and Epic. Their overall support and quality has suffered, especially with new releases.
• Please care about me and provide support. I know life isn’t the best for you right now, but I still have to work and I need you to fix the support structure. Keep current customers from being so put out with you and fewer of use will become someone else’s customer.
• Hire more qualified staff. They are hiring high school graduates for implementation consultant positions and giving them only basic training before sending them out to clients at $205 per hour.