An Inside Look At The Integration Engine Landscape For Application .

AN INSIDE LOOK AT THEINTEGRATION ENGINELANDSCAPE FORAPPLICATION PROVIDERS2018 Findings Report

CONTENTS1METHODOLOGY & MAKEUP4AIDED & UNAIDED AWARENESS8PERCEPTIONS12THIRD-PARTY INTEGRATION ENGINES22CONCLUSIONS

BRAND AWARENESS:METHODOLOGY & MAKEUPwho responded andwhat we learned

BRAND AWARENESS: METHODOLOGY & MAKEUPwho responded and what we learnedMETHODOLOGYrespondent detailsThis survey consisted of nearly 300 onlineresponses from the application provider industry.In addition, several live phone interviews wereconducted to add “color” to the overall findingsTime on Job80%The vast majority ofrespondents had beenwith their companies forless than five years.and validate interpretations.Time in BusinessThe survey took place over the courseof three weeks and represents a snapshot intime. The following results are what we believe52%to be the prevailing attitude and understandingAbout half of companieshave been in the healthcaresoftware business for fiveyears or less.of the integration engine market byapplication developers.The application vendor market is interesting inthat it reflects its youth. Seen in the “Time inBusiness” graphic to the right, more than half ofthe respondent’s companies have been aroundJob Function52%TechnologyOthers: Product Client Service Innovation Quality & Regulatoryless than five years.1

BRAND AWARENESS: METHODOLOGY & MAKEUPwho responded and what we learned25%25%81-10020%301 CustomersNumberof Customerswith EHRIntegration1-5 Customers10%61-8010%42%0-2013%41-6021-4010%101-300 CustomersEHR integration appears to be an all-or-nothing propositionNumberofCustomers21%with smaller companies (0-20) serving a large portionof EHR customers (42%).6-20 Customers15%Other8%Payers10%51-100 Customers13%21-50 hysiciansProviders are, by far, the most common target. But newerapplication vendors are diversifying their markets awayCustomer count by respondent’s company sizefrom physicians and providers.2

BRAND AWARENESS:AIDED & UNAIDEDleaders and followersin the space

BRAND AWARENESS: AIDED & UNAIDEDleaders and followers in the spaceMeditechHealth CatalystELLKAYJitterbit InforEpicGE Healthcare DaticaMicrosofteSolutionsOrion Health Mirth CloudMineIatrics MISAP nsAthenaInteroptex ValidicMuleSoftIBMMcKessonAllscriptsCorePointRedox had nearly threetimes the awareness ofthe nearest soro InterSystemsNoteworthPilotfish44%We measure unaided awareness because it’s a good indicator of which brands are invited to RFPopportunities most often each year. Typically, the top-three known brands (with some variation) areasked to participate.5%Redox awareness indicates a significant leadership position among the application providers and an evenMirth Cernergreater opportunity to unify the space under a common technology platform.15%9%5%RedoxEpicDatica4

BRAND AWARENESS: AIDED & UNAIDEDleaders and followers in the spaceWhich Brand is Most FamiliarRedoxMuleSoftFamiliarity with Redox results inApigeeeven greater mind share.PokitDokDaticaiNTERFACEWARE (Iguana)SansoroELLKAYNot FamiliarSomewhat FamiliarVery FamiliarI Work with this BrandWe offered a vendor list to respondents and asked about familiarity with each. As you can see, Redoxbrand awareness grows substantially with aided recall. And, while Datika nearly doubled its awarenessas well, everyone else is significantly lower.5

BRAND AWARENESS: AIDED & UNAIDEDleaders and followers in the spaceWho’s Most Familiar with RedoxThose who have been inthe software space for a longerperiod have LESSfamiliarity with Redox. 5 yearsNot Familiar6-10 yearsSomewhat Familiar10 yearsVery FamiliarTotalI Work with this BrandWhen we looked further into the popularity of the Redox brand, we found that all awareness isn’tcreated equal. The older, more established application providers—while strong—had less awareness ofthe Redox brand than their younger counterparts.6

BRAND AWARENESS:PERCEPTIONScompetitive differentiatorsbetween brands

BRAND AWARENESS: PERCEPTIONScompetitive differentiators between brandsHow integration engines are perceivedAPIsData ed API integration”“Healthcare data exchange platform”“ EHR-specific, cloud-based interface engine”“API platform and vendor”“Data extraction and interoperability”“ EHR integration and third-party“Data API integration”“Data integration for healthcare”“ Create APIs for other vendors to hook into”developer marketplace”“ EMR integration to software products”“ Specific EHR integration for HL7interfaces only”“ Facilitate data transfer and softwareintegration with EMRs”8

BRAND AWARENESS: PERCEPTIONScompetitive differentiators between brandsCompetitive Differentiation in the ultantQuick Timeto ValueBest inTheir IndustryRedox and Datica areperceived to be the leadersin most key areas.ResponsiveWhile most vendors seem to be crowded into similar areas of strength, Datica and Redox share asignificant lead in the areas of Trust, Experience and Consulting expertise. However, the speed Redoxdelivers in the areas of Time to Value (ROI) and Responsiveness are driving factors in their success. Theyalso lead Ease of Implementation, as well as a clear edge as Best in Their Industry.9

BRAND AWARENESS: PERCEPTIONScompetitive differentiators between brandsWhat Does Experience Mean?RelationshipsCase StudiesIntegrators that already have relationships with health systemsThey want to see that they’ve done a project with a similar EMRlower barriers for their app partners“ Well, the EMR is sacred space and obviously letting an outsider come“ If we have a large hospital system that is already using one of thesetinker in your EMR, that’s high risk.”integration partners, I’m going to go with that to adjust that speed and– Chris, CEO of start-up applower that barrier of entry.”– Ryan, small app start-upReputationReferencesStart-ups leverage their integration partner’s reputation to gainCustomers want to know the detailsaccess to bigger players“ The biggest difference, it seemed like Datica had a lot more“ A lot of hospitals are really comfortable that we’re working with Redoxindustry experience from their team integrating and actually doingjust because of their industry knowledge.”work with EHRs.”– Billy, app start-up, Redox customer– Ryan, small app start-up10

THIRD-PARTYINTEGRATION ENGINESthere are three key must haves:experience, security and scalability

THIRD-PARTY INTEGRATION ENGINESexperience, security and scalability19%Yes, Frequently47%Over half of respondentNo, Not at Allapplication providers partnerDo YouPartner withan IntegrationVendor?with an integration vendor atleast some of the time.35%Yes, Sometimes“ Unfortunately, every implementation of an Epic or Cerner is its own special little snowflake. So, they’re alldifferent. And, manual implementation with every single one is not particularly scalable, at least without amassive investment of resources. So, if we can find ways to streamline those implementations, that’s a good thing.”– Chris, CEO of start-up app12

THIRD-PARTY INTEGRATION ENGINESexperience, security and scalabilityWhen an Application Provider Chooses to Go it AloneCostConsiderationsNotNeededCreate OwnSolution“ Because we have that expertise in-house“ EMR integration is not essential at this“Easier to build in-house”and we would like to reduce costs.”point in time”“Costs are high”“Lack of customer demand up to now”“Due to cost”“ Not needed – using other means tosync data”“We attempt to develop them in-house”“We do a lot of one-off work ourselves”“ We have built proprietaryintegration solutions”“ Happy to integrate ourselves givenmodern APIs”“ Integration is too custom by client. in-houseexpertise is a mandate for HIT companiesbeyond the “startup” phase”13

THIRD-PARTY INTEGRATION ENGINESexperience, security and scalabilityApp vendors are looking for partners thatcan reduce the lag time to integration and cutsome of the workload burden on their staff.“ Scalability is when we create one connection to them and that can serve multiple customers, thatcan serve multiple needs, and then that third party will handle all of the individual connections. So,it’s a little bit of a cost savings, but it’s a complexity savings more than anything for us. We’re goingto maintain one type of relationship, one type of API connection. If we want to bring on anothercustomer, it’s a lot more of a controlled cost and a controlled scope for us.”– Ryan, CEO of start-up appScalability is becomingsynonymous with reducedtime to implementation.“ There’s always going to be those base projects, like getting the connection established, doing themapping, doing the transformation, working with integration people, managing some of the projects.It’s not ever going to be plug and play the way it is now. Maybe in five, ten years once FHIR gets moremature, and we get more standards, and people start figuring out what they want to do in the commonworkload. Right now, there’s that chunk of work for each organization, and we want that to be reallyeasy to manage, and easy to complete, and I think that’s what scalability means to us.”– Billy, healthcare start-up, Redox customer14

THIRD-PARTY INTEGRATION ENGINESexperience, security and scalabilityApp companies rely on quickimplementation to keep their customershappy and their invoices rolling out.“ The wondrous magic of Apple’s products doesn’t start with the product, it starts with the box. Youtake it home, it’s in a premier bag, and it’s this perfect box with just the right finish, and it feels nice,and you pull the cellophane off and you open it, it’s not hard to pull off by the way, so you’re notfrustrated. And you open the box and it’s got the Apple sticker and you pull it up and you’ve gotyour phone and you’ve got cool packaging, and it all feels premium. Before you ever turn on yourphone, you are already excited to be involved with Apple. They nailed it. It is exactly the same thing inHow often do you have a perfectimplementation? What does itcost you when it’s not?our industry. Get it done right at the beginning and that sets the pace for the rest of your relationship.And if not, you’ve got an overhang that you’ve got to crawl out of.– Chris, CEO of start-up app15

THIRD-PARTY INTEGRATION ENGINESexperience, security and scalabilityMost Important FeaturesThere are three key must-havesthat should be highlighted inmessaging when it comes toselecting a third-party solution.Experiencein HealthcareVery y AcrossFacilitiesNeutral/Not ImportantWhen asked about the most important features when selecting a vendor, we weren’t surprised to findExperience and Scalability topped the list. In today’s healthcare environment, the volume of growthand acquisitions means scalability has risen to the top in decision-making. It also stands to reason thatExperience (a proven track record) means less risk in selecting a vendor.16

THIRD-PARTY INTEGRATION ENGINESexperience, security and scalabilityNice-to-Have FeaturesOther features are alsoimportant, but much less so thanthe top three, and should be usedmore strategically in ardsVery ImportantConnectivityActive DeveloperManagement (VPNs)CommunityImportantManagedServiceNeutral/Not ImportantMany of the features that rank lower on the importance scale include things that aren’t always dealbreakers, but we caution you not to undervalue them, either. Easy to Use Dashboards, for instance, canstill be a deal breaker based on who has to use them and their influence within the purchasing process.17