The Promise of What Was: Allscripts and Its Quest to Become Too Big to Fail

Too big to fail comes to mind when I think of Allscripts. That’s the way the company was painted when it made news on June 9, 2010, after announcing it had bought Eclipsys.

Needless to say, the last two years have not produced the expected milk and honey for the vendor, which currently occupies the largest footprint in the ambulatory EHR market. Poor quarterly reports, board member infighting and firings and a pile of implementation troubles stemming from far too many systems currently running have made for a mess of a time.

What’s ironic about everything that’s going on with the company now is that at the time it was announced, the Allscripts deal with Eclipsys was game changing for those of us in the vendor space. No one will admit it publicly (other than me, here), but when this merger was announced in 2010, there were many executives at competitive companies wondering just how long their respective business ventures would still be around because of the move.

At the time, I worked for what was then considered the third or fourth largest EHR/PM in the space and the Allscripts news sent wave of shock and perhaps a bit of panic through my office. We braced for the worst and hoped for the best, and started to develop strategies akin to what might have been implemented at the Alamo.

It was hard not to feel the pressure. A great EHR army was coming and we stood in its path to greatness.

After all, with language like this (from the press release about the merger), it was hard not to be a little worried:

“The combination of Allscripts and Eclipsys will create a clear leader in healthcare information technology, with the most comprehensive solution offering for healthcare organizations of every size and setting.

“By combining the leading physician-office and post-acute care solutions from Allscripts with Eclipsys’s leading enterprise solutions for hospitals and health systems, the combined company will offer a single platform of clinical, financial, connectivity and information solutions. The combined company’s client base will include over 180,000 U.S. physicians, 1,500 hospitals, and nearly 10,000 nursing homes, hospices, home care and other post-acute organizations. The combined company will be positioned to connect physicians, other care providers and patients wherever care is provided-in the hospital, in small or large physician practices, in extended care facilities, or in a patient’s home – resulting in the unique ability to deliver a single patient record and a seamless patient experience.”

Even at our best, this new entity was a behemoth far larger than even our marketing folks and their clever wit could help us position our way out of. So we held our breath, and, I bet like a lot of vendors, we waited …

It’s easy to cast stones when you know where they should be thrown based on the luxury of hindsight, but I said from the beginning of all this – to the president of our company and to her executive support team including the then SVP of marketing – that the one weakness of Allscripts was that it was being positioned as too big to fail.

But before long, the fear started to subside and we slowly began to realize we were receiving more than our fair share of scraps; in fact, we were actually at the banquet table along with the likes of others who, like us, previously must have wondered how much of a future we’d actually have left. In the end, we were still closing deals. All vendors kept signing deals. Finally, the fear abated and the “promise” of what was to come never came.

Certainly, Allscripts hasn’t failed in wanting to go private, it just needs to find a private place to go for awhile where it can sort out its problems, do away with some of its product overabundance and cut the proverbial fat without having to continually find ways to report positive balance sheets.

Even if it proves too big to fail, there’s nothing stopping it from stumbling backward from time to time.