Small-Hospital EHR (1–200 Beds) 2024
Buyer’s Remorse among Recent Decision-Makers

Future Buying Energy Coalescing around Epic Community Connect, MEDITECH Expanse & Oracle Health

While small standalone hospitals have historically considered a wide array of competitive options for EHR vendors, more recently, these hospitals have increasingly focused their considerations on just three vendors: Epic, MEDITECH, and Oracle Health. In decisions made so far in 2024, most organizations who selected a vendor have gone with Epic or MEDITECH. Organizations consider Epic Community Connect (hosted by larger Epic customers) for the potential to enhance internal integration and clinician satisfaction. Cost and the lack of direct support from Epic can be limiting factors up front. No current customers in this sample plan to replace Epic Community Connect. MEDITECH Expanse is primarily considered as an option to improve usability; most considerations and selections come from organizations on a legacy MEDITECH product (i.e., C/S v.5 and 6.x, MAGIC). Still, provider organizations not already on MEDITECH’s solution often consider the Expanse platform as well. Organizations who selected Expanse did so due to past vendor experiences and high physician usability.

Oracle Health is the most considered solution among interviewed small standalone hospitals in the last two years. Potential customers say they see value in the broad platform and appreciate its low up-front cost. They also consider Oracle Health for the promised strong support. Further, market share data shows that Oracle Health had the most net-new small-hospital wins in between 2021 and 2023 (see next section). Interviewed organizations who selected Oracle Health primarily cite promised improved integration and expanded functionality. In validated 2024 purchase decisions, the frequency of provider organizations saying Oracle Health is their likely choice has declined, with only one respondent saying Oracle Health is the likely choice so far. Some respondents mention not considering or going with Oracle Health because of prior experiences with the vendor—concerns include ad hoc costs and lack of flexibility in the shared model, as any change requires approval from other customers on the same instance of Millennium.

Majority of Oracle Health & TruBridge* Respondents Would Not Buy Solution Again

As mentioned above, KLAS’ market share data shows that interviewed small hospitals most often chose Oracle Health in net-new decisions between 2021 and 2023. Though many interviewed new customers hoped for improved integration and functionality, overall, they feel their expectations have not been met. Low satisfaction is driven by inefficient vendor processes around implementation, training, and support, which leave respondents feeling overwhelmed and left to work through challenges (e.g., integration) on their own. No interviewed customers plan to leave Oracle Health, though more than half would not purchase the solution again. Respondents often feel stuck because of the expense and feel obligated to make the solution work. TruBridge* was selected by a smaller number of organizations primarily for the solution’s cost. These customers are the most dissatisfied in this report sample—they report an old, difficult-to-use user interface, issues integrating with other technologies, and a lack of vendor guidance on solution optimization. Despite having recently purchased the system, a few respondents are so dissatisfied that they plan to move away from TruBridge and are considering Epic Community Connect, MEDITECH, and Oracle Health.

Newer customers of Epic Community Connect and MEDITECH Expanse are more satisfied with their solutions’ current performance and are optimistic their experience will continue to improve. Respondents of both vendors feel they have received the modern tools they were hoping for and that there have been few misalignments between sales promises and deliverables.

*Limited data

MEDITECH Highlighted for Few Unanticipated Costs; Epic Customers Find Value in Broad Functionality

Because small standalone hospitals’ finances are often limited, the value and ROI that they realize from their technology investments are critical to their satisfaction. Although interviewed MEDITECH customers note the expense of moving to Expanse, they feel the vendor has done their best to reduce additional costs. Some respondents opt for MEDITECH as a Service (MaaS) because of the standardized experience and lower up-front costs. Interviewed customers would like to see greater analytics functionality and more guidance on how to optimize their tools and further drive value. Epic Community Connect respondents feel that the cost is high but is also somewhat balanced by the breadth of the offering. Additionally, they say recruiting Epic-certified staff is made easier given Epic’s prevalence in the market. Being hosted by another organization has downsides that affect value—for example, cost of interfaces, irregular price increases determined by the host organization, and unanticipated additional charges for on-site training. Oracle Health respondents report the lowest value score among measured vendors, as many feel a lack of clear up-front pricing has led to missed expectations around the system’s value. Respondents report unexpected costs for new modules and workflow customizations they feel should be included in the initial scope of the project; these ad hoc costs have prevented some from achieving the integration they hoped for across the vendor’s broad functionality set. TruBridge*, often purchased specifically for the perceived lower cost, falls short in delivering strong value because of the need for additional third-party tools for functions outside clinical documentation and billing, such as analytics and a portal. Respondents’ sense of value is also dragged down by support that doesn’t sufficiently respond to and solve problems.

*Limited data

Though Critical to Reducing Clinician Burnout, Initial & Ongoing Training Not Prioritized by Vendors or Provider Organizations

Research from the KLAS Arch Collaborative (a provider-led effort to unlock the potential of EHRs by improving the end-user experience) shows that EHR education is one of the biggest factors in clinicians’ EHR satisfaction. While EHR education, specifically preimplementation and ongoing training, is something vendors can directly support, investment in and dedicated resources for training and implementation are often among the first things to be reduced or eliminated by smaller hospitals due to cost. Both vendors and provider organizations need to work together to increase investment and improve processes—vendors by being more prescriptive and provider organizations by avoiding understaffing and training cuts. Across vendors, interviewed customers are disappointed with their implementation and training.

Training and implementation guidance for Epic Community Connect reflects the efforts of and support from the host provider organizations rather than Epic directly. While some hosts have standardized and created robust implementation and training programs, the quality of training and implementation varies vastly by host site. And respondents often recommend getting very specific details on what will and will not be covered as part of the implementation—e.g., on-site training, interfaces that will and won’t be built, and documentation about the go-live process. Organizations using MEDITECH appreciate the vendor’s knowledgeable resources. Still, customer satisfaction on the quality of implementation and training is relatively lower than other MEDITECH metrics—respondents want more guidance and structure around the actual build and go-live processes to ensure all data flows well between the respective tools. Interviewed Oracle Health customers specifically note that expectations set in the sales process were ultimately not met due to insufficient resources and turnover during implementation, ultimately leading to unoptimized workflows. Respondents also feel the training materials are insufficient; many have had to resort to third-party implementation resources and thus rate value lower. TruBridge* respondents report inconsistent quality of personnel, noting that success often depends on knowing the right experts and going to them directly to get additional guidance and help. While most respondents feel dissatisfied with the vendor’s training and implementation, two report high satisfaction, as they feel they were able to get in touch with the right experts.

*Limited data