This document summarizes four electronic health record (EHR) vendors that target small hospitals: CPSI, Medhost, Healthland, and NextGen. It provides an overview of each vendor's origins, acquisitions, client base, product lines, and recent revenue trends. While small in size, the market for small hospitals under 100 beds represents over 2,300 facilities in the United States. The document analyzes how each vendor has positioned themselves to serve this sizable small hospital market.

1. 2014 HIS Vendor Review
Part 4: Small Hospital Vendors
© 2015 by H.I.S. Professionals, LLC, all rights reserved.
By Vince Ciotti, Principal
HIS Professionals, LLC
CPSI Medhost Healthland NextGen

2. Small Hospital Vendors
• Our revenue review ends with vendors targeting:
– Small hospitals of under 100 beds, including
Critical Access Hospitals (CAH) of <25 beds
– Before you dismiss this “tiny” market, realize
there are over 1,300 CAH hospitals in the US,
– Plus another ≈1,000 from 25 to 100 beds, so
this “small” market has a large footprint!
• This episode covers the 4 big small vendors:
- In the bottom of the pack in revenue
- But with huge client bases
- Origins, acquisitions, & mergers
- Recent revenue growth/decline
- Candid assessment of future prospects
© 2015 by H.I.S. Professionals, LLC, all rights reserved.

3. • Computer Programming & Systems, Inc. – was founded in 1979
and has been on our HIS vendor revenue charts for decades:
• A rather
impressive
revenue
HIS-tory
considering
their target
market is
hospitals
with under
100 beds
who have
small IT
budgets…
© 2015 by H.I.S. Professionals, LLC, all rights reserved.

4. • They have a total of about 650 clients, most of which are CAH or
under 100 beds, with only a few larger community hospitals:
CPSI Client Base
© 2015 by H.I.S. Professionals, LLC, all rights reserved.

5. (this page left blank intentionally)
CPSI’s Many Product Lines

6. • Compared to the bewildering array of products from giants like
McKesson, Siemens, Allscripts, GE, Meditech, etc., CPSI is easy:
CPSI Products & Prospects
- It’s the “CPSI System,” period.
- Saving them a ton of money on
marketing staff, brochures, ppt
slides, proposals, contracts, etc.
• Other “quirks” include having never bought anything, ever!
– They self-developed every single application & module
inhouse, and their product breadth is amazingly wide & deep:
• Not only every clinical & financial app, but all ancillaries,
and even their own Time & Attendance system and PACS!
• So we’re pretty bullish on them remaining on top of the small
vendor market for quite some time, especially if small hospitals
are getting over their post-MU blues and going to market again.
© 2015 by H.I.S. Professionals, LLC, all rights reserved.

7. • At HIMSS in April, 2015, CPSI
shocked the small hospital
crowd when they renamed
themselves as Evident, LLC.
• Evident-ly they feared their
old moniker of “Computer
Programming & Systems, Inc.”
sounded a little archaic…
2015 Flash!
• They also re-named their HIS from “CPSI System” to “Thrive,”
which is what they hope to do in the mid-size hospital market of
100 to 300 beds. Easier to announce that goal than to attain it…
– They kept the name “TruBridge” for their RCM outsourcing
business, so now we’ll see if the marketing mavens on Wall
Street who sell such “branding” techniques pay off…
© 2015 by H.I.S. Professionals, LLC, all rights reserved.

8. • Founded as Health Management Systems in 1984, HMS was
acquired by VC firm Primus in 2007, who formed HealthTech
Holdings as their parent company, then merged them with EDIS
leader MedHost in 2010. Confused? So am I, but at least now no
one mixes them up with the other “HMS” vendor in NYC…
- HMS grew rapidly by selling to the many hospital
chains also based near Nashville, like Community
Health Systems, with 200 hospitals in 29 states.
• Their forte for these chains is an ERP designed to pool cash
payments from many hospitals into one central bank, while
centralizing AP, purchasing & materials as well - tricky stuff!
- MedHost was a long-term leader in EDIS
systems, and with a slick interface to
HMS, they pose a nice solution to how
EDs are the source of most admissions.
© 2015 by H.I.S. Professionals, LLC, all rights reserved.

9. • Being privately held, we’ve had to estimate their revenue for the
years between these acquisitions and mergers, the only time $
figures are made public, but the strong growth of hospital chains
like CHS has given them a solid base for revenue growth:
• Adding
Medhost’s
EDIS
revenue in
2012 gave
them a huge
revenue
spurt, and
they’re
probably
down a bit…
HMS/Medhost Revenue HIStory
HMS
Medhost
© 2015 by H.I.S. Professionals, LLC, all rights reserved.

10. • Their HIS client base is skewed toward the smaller & mid-sized
hospitals that proprietary chains like CHS tend to acquire; in
addition, they have ≈370 EDIS hospital clients of all bed sizes.
Medhost HIS Client Base
© 2015 by H.I.S. Professionals, LLC, all rights reserved.

11. • Founded as Dairyland in 1981 in Minn, Healthland grew rapidly
in their specialty market among small hospitals in the Midwest.
Re-named Dairyland Health Systems (DHS), they were acquired
in 2007 by Francisco Partners (who also bought QuadraMed).
- Healthland’s original HIS was such a “classic” they
named it that, to distinguish it from several other HIS
vendors & systems they’ve acquired over the years:
• “Centriq” – Healthland’s latest “go forward” system they are
trying to convert their large client base of ≈500 small hospitals
(most under 50 beds) over to; so far, about half have moved…
- Advanced Professional Software (APS) out of Waco, TX, in
2008, a financial vendor acquired mainly for its 140 clients.
- American Health Network (AHN), whose modern “Claris”
system helped lead Healthland into developing its modern HIS:
© 2015 by H.I.S. Professionals, LLC, all rights reserved.

12. • Being privately held like HMS, we’ve had to estimate
Healthland’s revenue for the years between these acquisitions,
the only time $ figures are made public, but the addition of APS
and AHN’s systems and clients should have given them growth:
• Their
revenue
suffered
post-Y2K like
almost every
other HIS
vendors did,
and they
probably
slowed post
MU…
Healthland Revenue HIStory
Y2K
MU
© 2015 by H.I.S. Professionals, LLC, all rights reserved.

13. • NextGen is the smallest player in the small-sized hospital market
in number of hospitals, but they have the largest revenue ($445M)
due to the huge physician practice revenue from ≈40K MD clients.
- NextGen’s parent firm QSI (Quality Systems Inc)
was formed many decades ago, and they are a
giant in the physician practice market, commonly
known as “ambulatory” (as if hospitals didn’t have
a lot of outpatients who walk in for tests…)
• QSI recently acquired the “free” interface engine formerly
known as Mirth, so you may see their name pop up in IE bids...
• NextGen got into the hospital field by acquiring two HIS vendors:
- Opus– a solid EHR piloted by hospital
chain Universal Health Systems (UHS).
- Sphere – Florian Weiland’s rock-solid
financial systems, both RCM & ERP.

14. • At HIMSS in April, 2015, a
NextGen rep surprised us by
stating they would no longer
be selling the Opus/Sphere
“solution” to community
hospitals, but just CAH sites.
• They’ll keep supporting it for
the ≈80 current clients on
Opus & Sphere, but new
prospects will be CAH only…
2nd 2015 HIMSS Shocker…
• Sad news for the 25-100 bed hospitals who hoped that a giant
firm like NextGen would pour the financial investment needed to
build a truly integrated hospital & physician practice system.
© 2015 by H.I.S. Professionals, LLC, all rights reserved.

15. • Interesting trend how many leading physician practice vendors
are buying their way into the hospital HIS market like NextGen:
– Allscripts – this MD giant with ≈50K physician practices on its
PM and EHR systems acquired Eclipsys in 2010 to enter the
large hospital market through its strong RCM & EHR systems.
– Athenahealth just acquired RazorInsights, a very small HIS
vendor (≈$2M in annual revenue) with only ≈30 clients,
mostly CAH, based in GA. Athenahealth is a major player in
the physician practice market with about 60K providers.
• I guess these moves make them feel they can compete with Epic
by playing in both markets, but what a difference to have a fully
integrated system for hospitals & physician practices like Epic
pioneered (and Meditech & Paragon are now starting to build),
versus buying an HIS and building an interface to its foreign DB
and OS, like these 3 physician practice vendors have done…
Latest Big Entrant into Small Market

16. Recap
• So there it is, the 2014 revenue figures for the 12 leading HIS
vendors, separated into their three target market niches:
– Large hospitals >300 beds, AMCs & IDNs, who buy:
• Cerner, Epic, Allscripts and GE
– Mid-sized community hospitals from 1-300 beds, who buy:
• Meditech, McKesson’s Paragon, NTT Data & QuadraMed
– Small hospitals under 100 beds, who generally buy from:
• CPSI (“Evident”), Medhost, Healthland and Next(“Last?”)Gen
• The only question I couldn’t answer is why so many have blue as
the color of their logo – is it a sign of recent market activity?
• I’m sure I missed a few things more, so if you have any questions
(like how much I got for my 1969 Honda CB750 on eBay), contact:
- vciotti@hispros.com
- 505.466.4958