2017 HIS Vendor Review Part 4: "Small" HIS Vendors By Vince Ciotti & Elise Ames HIS Professionals, LLC

1. 2017 HIS Vendor Review
Part 4: “Small” HIS Vendors
© 2017 by H.I.S. Professionals, LLC, all rights reserved.
By Vince Ciotti & Elise Ames
HIS Professionals, LLC
CPSI NTT Data Harris
Medhost

2. “Small” HIS Vendors
• Our HIS vendor review ends with four whose
2016 annual revenue is “only” $250M or less.
– Three of these are privately held or small
HIT divisions of much larger parent
companies, so we had to estimate their
revenue past on past years’ experience.
– Most are a “family” of discrete sub-
systems as illustrated on the right:
• This episode covers their:
- Revenue HIStory over the years
- Products & client base by bed size
- Recent mergers & acquisitions
- A surprise announcement from NTT!
- Candid assessment of future prospects

3. • Computer Programs & Systems, Inc (CPSI) – re-branded as
Evident last year, is back as CPSI, evidently proving something…
• Their revenue had dropped 11% in 2015 as part of the post-MU
droop, but their acquisition of Healthland proved to be a boon:
• CPSI’s 2016
revenue
increased by
47%,
reflecting
strong sales
among ≈350
Healthland
clients,
earning them
the #8 spot.
#8:

4. The CPSI “Family”
• Like most other HIS vendors, CPSI has branched out into many
specialty markets to increase their annual revenue far beyond
the core HIS comprised of an EMR, Ancillaries, RCM, & ERP
(only Epic and Meditech stick close to their HIS knitting).
• CPSI’s family of products/divisions/brands now includes:
• First acquired by Healthland in 2013, this major LTC player
has brought CPSI into over 2,000 facilities in 47 states.
• Known simply as the “CPSI System” for decades, this new
brand name is CPSI’s core HIS, running on over 600 clients.
• Leading HIS vendor in the CAH market, acquired for its 400+
client hospitals running on Classic, Centriq, APS and AHN.
• Acquired by Healthland in 2015, this Revenue Cycle
Management specialist runs BOs for hospitals & SNFs.
• CPSI’s consulting division, TruBridge also offer RCM
management services as well as complete IT outsourcing.
CPSI Rural
ACO Program
• CPSI’s partnership with Caravan Health that claim to be
running 23 ACOs in 32 states with over 17K physicians.

5. Below is the rough # of clients on Evident’s “Thrive” (formerly “The
CPSI System”) and Healthland’s Classic, Centriq, APS & AHN systems:
Evident Client Base
We’re
sure
the
number
of
clients
will
shift
from
red to
blue
rapidly!

6. • Rather than a complex array of products targeted for various
sizes of hospitals, CPSI market strategy is relatively simple:
CPSI’s Products & Prospects
- They sell “Thrive,” period.
- And primarily to small hospitals
(although they will rarely turn
down a large hospital’s RFP…)
• According to CPSI’s press release in November of 2015, support
the older Healthland “Classic” system runs out this year, whereas
the newer “Centriq” system will be supported for ≈5 more years.
• So we’re pretty bullish on CPSI remaining on top of the small
hospital market for some time, as their sharp sales team has
direct access to the C-suite of hundreds of Healthland clients.
• By contrast, Cerner offers Millennium to larger hospitals &
Community Works to smaller ones, Epic now has All Terrain,
Utility & Sonnet for the 3 market sizes of hospitals, etc.

7. • Known as Keane for many decades, it’s hard to remember this
relatively new name in HIS is selling the tried & tested HIS known
as “Optimum,” with a full array of proven components:
- Suite of clinicals: EHR, CPOE, LIS, RIS, RX, etc.
- Robust revenue cycle (formerly PatCom), with a
long track record going back to PHS in the 80s.
- Solid ERP suite from ORMED, who sold them rights
to their system despite being sold to Harris…
• Like Siemens & GE, their parent firm is an international giant
with billions (of Yen) in annual revenue, and their healthcare IT
division includes many pieces beyond a pure HIS, including:
- Long Term Care – in which they are an
industry leader over a thousand clients.
- ≈200 clients on their Optimum HIS: mostly
financials, only ≈10 hospital EMR attests.
#9:

8. • Bit of a roller coaster ride since Keane sold to Caritor in 2007,
who then sold to NTT Data in 2010. All 3 parents had billions in
IT revenue in many other industries besides healthcare, so we’ve
been estimating what slice their HIS $s comprised below:
NTT Data Revenue HIS-tory
(Y2K)
Caritor NTT
Data
Keane

9. • In March of 2016, NTT Data shocked the industry by buying
Dell’s IT consulting division for $3B. Dell was spending $60B for
EMC, and needs these funds to help trim its $43B of debt…
– Dell acquired Perot systems back in 2009 for $3.9B, so they’re
losing a bundle, but EMC is quite an enticing target.
• The odd thing is what this does to NTT Data which will now be
both a “consulting” firm and an HIS vendor. Imagine a scenario
where Dell/Perot consultants issue an RFP for a hospital looking
to acquire a new HIS – would they send it to themselves? To
other vendors?? Evaluate other vendor proposals???
• Many HIS vendors have “consulting” divisions that offer
assistance during implementations, interim staffing, technical
assistance, etc., but strategic planning, IT assessments, system
selections and contract negotiations usually require objectivity…
2016 Game Changer?

10. • After reading our previous slide, just this month NTT Data,
announced they were spinning off their HIS division into:
2017 Flash!
Funded by private investor GPB
Capital Holdings, Cantata Health
is now free from the giant Dell
division that dominated their
HIMSS booth in Orlando...
(Maybe the name counters the rumors of a “con-Tata”!?)
• With Mike Jones as CEO leading about 250 FTEs, Cantata will
now sell and support NTT Data’s two core HIS systems:
- Optimum – proven HIS system about 200 hospital clients,
mostly RCM, with less then 10 ONC EMR attestations...
- NetSolutions – a leading LTC/SNF player with 1,700 clients
- Our prognosis is mixed: they’ll do well in LTC, but it will be tough
competing with HIS vendors having a strong EMR and RCM.

11. • If you’re getting confused with the re-branding of vendor and
product names, and the rash of M & As in the HIS market, we’re
sorry but this one will give you an even worse headache!
• Our # 10 vendor in terms of annual revenue is Harris Healthcare,
the new name that the N. Harris division of Constellation
Software (not to be confused with several other “Harris” firms out
there), has given their HIT division according to a VP at HIMSS.
2017... - Starting as Compucare in the 70s, they self-
developed the “Affinity” HIS in the 90s.
- Bought by QuadraMed, who failed building
an EMR in the early 2000s, and sold to:
- VC firm Francisco Partners who acquired CPR
from Misys/Per Se (née UltiCare from HDS)...
- Still with us? Ah, the heck with it, lets just
look at what they acquired last year alone:
#10a: Harris Healthcare

12. - A leading ERP player, Ormed tried to crossover into
the HIS field by acquiring CSS HealthTech in 2014.
- Picis is a major player in the Perioperative
market (OR, Anesthesia, Recovery Room, etc.).
- Their PulseCheck is a leading EDIS product, and they also market a
strong ICU/CCU system, as well as medical device dashboards.
- An OB/GYN physician practice EMR specialist.
Harris Healthcare 2016 Acquisitions
- CSS’ EMR failed to achieve MU2, so Ormed sold to Harris in 2016.
- Their full suite of robust & affordable ERP apps (GL, AP, PR, HR,
Mat. Man., Cost Acc., EIS, DSS, etc.) runs in over 350 hospitals.
- “MetaVision” EMR for hospital ICU & anesthesia.

13. • QuadraMed’s revenue figures were public for about 25 years, so
here’s a chart of how they grew handsomely during the 90s
when hospitals were buying like crazy for Y2K, then dipped when
they sold their huge Quantim HIM coding to Nuance in 2012.
• Parent Constellation has revenues in the billions, but we have to
estimate Harris’s HIT revenue, which probably doubled in 2016
with the acquisition of Ormed, Picis, digiChart, and iMDsoft.
• Their 2015
acquisition of
of NextGen’s
Opus &
Sphere gives
them targets
to sell Affinity
& QCPR to…
Harris/QM Revenue HIS-tory
Y2K Quantim
Sale 2016
M&As

14. Harris Healthcare Prognosis
• The addition of so many specialty products to their core HIS of
Affinity and QCPR will enable Harris Health to score high on
feature checklists of RFPs (Request For Prevarication).
• However, the need for numerous interfaces among these
many products, each written in different programming
language, data base and operating system, will make
integration even harder than synchronizing the many slide
shows, brochures, web sites, proposals, contracts, etc.
• Short term, they should do well
selling to the NextGen HIS clients
and specialty niches like Picis’ OR
and EDIS. In the long term, it will
be challenging for them to
compete with more integrated
vendors like Meditech & CPSI…

15. • Tied for #10 is MedHost, originally founded way back in 1984 as
Health Management Systems. HMS was later acquired by VC
firm Primus in 2007, who formed HealthTech Holdings as their
parent company, and then merged them with MedHost in 2010.
- HMS grew rapidly by selling to small and mid-sized
hospitals, and specialized in serving hospital chains
also based near Nashville, like Community Health
Systems, with about 200 hospitals in 29 states.
• Their forte for these chains was an ERP designed to pool cash
payments from many hospitals into one central account, while
centralizing AP, purchasing & materials as well – slick stuff!
- MedHost was a long-term leader in the
EDIS field, and with a slick interface to
HMS, they can now handle the many IP
admissions from the ER very well.
#10b:

16. • Being privately held, we’ve had to estimate their revenue during
these many years of acquisitions and mergers; the shrinking size
of hospital chains like CHS (selling 25 sites) has probably reduced
their revenue a bit, so we estimate them at ≈$160M in 2016:
• Adding
Medhost
EDIS in 2012
gave them a
big revenue
jump, but
there have
been few
HIS sales
outside of
the chains…
Medhost/HMS Revenue HIS-tory
HMS
Medhost

17. • Their HIS client base is mostly smaller & mid-sized hospitals that
hospital chains like CHS tend to acquire; included in the hospital
figures below are ≈370 EDIS clients of mostly larger bed sizes.
Medhost Client Base
Acute Care Hospitals Non-acute Care Facilities

18. Recap
• This episode ends our review of the leading HIS vendors for 2017,
based on their FY2016 annual revenue. Biggest news:
– Re-packaging:
• Epic now has 3 products: All Terrain, Utility and Sonata for
large, mid-size and small hospitals, and can run remotely.
– Re-Branding:
• Evident = CPSI again; QuadraMed = Harris Healthcare
– New entrants:
• athena & eCW are now in HIS; NTT Data spun off Cantata
• Thanks to HIStalk for taking so much of their valuable blog space
with our annual ramblings. In case you have any questions,
comments, or you’re as confused as we are about any of this:
- vciotti@hispros.com eames@hispros.com
505.466.4958 413.329.6925