Community (1–200 Beds) HIS 2018
Innovation Wanted

KLAS Definition of Community HIS

To examine how HIS vendors perform against the unique needs of smaller acute care hospitals, KLAS combines the performance data for acute care EMRs with the performance data for revenue cycle management systems to create the Community HIS market segment. Feedback in this market segment is collected solely from hospitals with 1–200 beds.

Products Included in This Report

Standalone hospitals in this market segment (i.e., those not part of a multihospital organization) have accounted for a growing portion of the EMR purchasing decisions made in the United States over the last couple of years. As a result, this report focuses specifically on the acute care HIS products most commonly considered and deployed by these standalone hospitals. This means that some vendor platforms that can be found in 1–200 bed hospitals are excluded from the scope of this research; for example, if they are not the vendor’s primary solution for smaller hospitals or if the smaller hospitals that use the solution are part of larger health systems.

The charts below give a snapshot of each vendor’s overall EMR market share among 1–200 bed hospitals, including the number of standalone versus multihospital customers, a breakout of customer size within the 1–200 bed size range, and which vendor platform is rated in this report.

EMR purchasing decisions by standalone community hospitals have steadily increased over the last three years, with 2017 marking the first time such decisions accounted for the majority of acute care EMR decisions in the US. With these decisions, community hospitals are giving their HIS vendors notice—innovation wanted. Specifically, innovation to help community hospitals address today’s healthcare challenges and improve their financial viability. With new solutions and new deployment models shaking up some long-held customer perceptions, this report seeks to help community hospitals understand which vendors are innovating to meet their unique needs.

Cloud Solution Expectations Boost Perceptions of MEDITECH’s Innovation; athenahealth Disrupting Critical Access Market

Historically a mediocre developer, MEDITECH currently ranks alongside longtime innovators Cerner and Epic and new acute care entrant athenahealth in customer perceptions of innovation. MEDITECH customers attribute this to the vendor’s new cloud solution (recently christened Expanse, but formerly known as 6.16, Web, or MaaS). Though few are currently live on Expanse, many community hospitals have contracted for it in the last two years, and customers are vocal about its potential to improve physician usability and decrease the IT footprint. athenahealth has the highest percentage of customers who describe them as innovative, thanks to a cloud-based solution that aligns vendor and customer incentives and minimizes the high costs typically associated with HIS contracts—benefits particularly attractive to critical access hospitals, athenahealth’s predominant customer base. Acute care market share leaders Cerner and Epic are seen as having the ability and resources to make headway with pressing issues such as interoperability, value-based care, and usability.

Seeking Innovation, CPSI Evident & MEDHOST Customers Considering Other Options; Paragon Customers Holding Out Hope

In terms of customers’ innovation perceptions, Allscripts Paragon, MEDHOST, and CPSI Evident trail the leaders by a wide margin. CPSI Evident and MEDHOST customers report that development is focused more on keeping up with regulations and addressing functionality gaps than on forward-looking improvements to interoperability or to usability for clinicians other than physicians. Customers of both vendors acknowledge efforts to improve the physician experience—CPSI customers mention a new physician GUI; MEDHOST customers report positive feedback around the Physician Experience platform. Prior to the acquisition by Allscripts, Paragon customers were frustrated with McKesson’s failure to deliver an integrated outpatient solution or upgrades that adequately addressed workflow and functionality challenges. Since the acquisition, customers report that Allscripts has created a development road map and steering committee. These efforts came too late for some customers who were already in the process of leaving, but others are reconsidering, hopeful that Allscripts can deliver the long-awaited integrated outpatient solution (Avenel, currently in beta).

Epic and Cerner Lead in Considerations Thanks to Combo of Innovation and Delivery Track Record

Innovation alone is not enough to entice community hospitals. While perceptions of innovation have increased consideration of athenahealth and MEDITECH, Epic and Cerner still see the most new deals outside of critical access hospitals, combining innovation with a track record of delivery. Epic Community Connect customers report the highest overall satisfaction, thanks to integration with critical exchange partners and Epic’s track record of keeping development promises. For community hospitals, Epic’s provider-hosted model inhibits strong vendor relationships. Cerner demonstrates consistent development year over year. Some technology doesn’t meet customer expectations, specifically Cerner’s revenue cycle software, which has been a longstanding challenge. For years, MEDITECH has catered to community hospitals and provided them with functionality-rich software. Ineffective support and a prohibitive cost structure have historically led many legacy MEDITECH customers to choose other vendors rather than upgrade. athenahealth’s reputation for innovation in the ambulatory environment is stimulating interest among community hospitals outside the vendor’s current acute care base of predominantly critical access hospitals. Perceived gaps in ancillary functionality have led several contracted but not yet live organizations to cancel contracts with athenahealth and revert back to a previous vendor, primarily CPSI and MEDHOST.