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Community (1–200 Beds) HIS 2018

Community (1–200 Beds) HIS 2018
Innovation Wanted

Authored by: Gregory Fenton & Paul Warburton April 19, 2018 | Read Time: 6  minutes

With market energy extremely high in the community space, KLAS is planning to do study around the unique needs of the providers whose organizations are on the smaller end of the inpatient hospital market (<200 beds). Providers in this space need the focus and attention from their vendor partners to be successful and to provide the needed functionality for their service lines to take care of their patient populations. Financial viability is top of mind for provider leadership teams in the community space and providers need a more dynamic and forward thinking approach to help them become more financially secure as they begin to take on new risk based agreements and stay viable in the coming years.


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 customer landscape 1 to 200 beds

The following platforms are excluded from the performance data in this report:

Allscripts Sunrise Clinical Manager

After acquiring McKesson’s Enterprise Information Solutions portfolio, Allscripts announced intentions for the Paragon platform to become their primary solution for smaller hospitals. Sunrise Clinical Manager is intended primarily for larger institutions outside this report’s scope.

Cerner Millennium Traditional Deployment

Though smaller hospitals may choose a traditional Millennium deployment, the majority of smaller standalone hospitals that consider Cerner look at the less resource-intensive CommunityWorks deployment.

CPSI legacy systems

CPSI has multiple legacy HIS platforms available to smaller hospitals, but the Evident platform is their go-forward solution and is the product most frequently considered by smaller hospitals.


EpicCare Inpatient EMR

While some standalone hospitals with 100–200 beds contract directly with Epic for the full inpatient EMR, the system is more frequently deployed by larger hospitals and health systems. Smaller standalone hospitals primarily consider contracting through a host organization for Community Connect.

MEDITECH Expanse & legacy systems

Most smaller standalone hospitals considering MEDITECH look at MEDITECH’s 6.x platform. Interest is also growing in the new cloud-based Expanse, which is a separate product from the C/S-based 6.x and currently has too few live customers for performance to be measured.



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.

confidence in vendors ability to improve customers financial viability

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).


athenahealth and Cerner Partner Most Closely with Customers on Financial Viability


confidence in vendors ability to improve customers financial viability

All vendors can do better at providing community customers with flexible contracting and payment models and at helping them identify cost-saving opportunities and improve workflow efficiencies. athenahealth and Cerner customers feel their vendors are the most attentive to customers’ financial health and are strongest in responding to customer feedback, being flexible with contracts, and offering revenue cycle services. athenahealth customers highlight the aligned incentives created by the vendor’s percent-of-collections model. Epic and MEDITECH customers’ confidence stems from the robustness of their vendors’ functionality, which they feel gives them the tools they need to drive revenue on their own. For Epic customers, improved integration with referral organizations improves the bottom line. MEDITECH customers appreciate the new reporting module, which provides community hospitals with reporting that impacts reimbursement. They report hope that Expanse will improve efficiency; it is too early for this to be validated. Allscripts Paragon, CPSI Evident, and MEDHOST customers report that their vendors don’t take a particularly innovative approach to helping reduce costs or providing new revenue or deployment models. Customers report potential for MEDHOST’s hosted solution to reduce costs, but feedback is still early.


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.

emr purchasing decision insights 1 to 200 beds

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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.

Key Topics

  1. KLAS Definition of Community HIS & Products Included in This Report
  2. Cloud Solution Expectations Boost Perceptions of MEDITECH's Innovation; athenahealth Disrupting Critical Access Market
  3. Seeking Innovation, CPSI Evident & MEDHOST Customers Considering Other Options; Paragon Customers Holding Out Hope
  4. athenahealth and Cerner Partner Most Closely with Customers on Financial Viability
  5. Epic and Cerner Lead in Considerations Thanks to Combo of Innovation and Delivery Track Record


how innovative are his vendors for their community hospital customers

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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2020 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.