4. 2018 low end vendors 4-6

1. 2018 HIS Vendor Review
Part 4: “Small” HIS Vendors
© 2018 by H.I.S. Professionals, LLC, all rights reserved.
By Vince Ciotti & Elise Ames
HIS Professionals, LLC
CPSI HarrisHealth Medhost Cantata

2. “Small” HIS Vendors
• Our HIS vendor review ends with four whose
2017 annual revenue is “only” $300M or less.
– The last 3 are privately held or small
divisions of much larger parent
companies, so we had to estimate their
revenue based on past years’ figures.
– Most are a “family” of discrete sub-
systems as illustrated on the right:
• This episode covers their:
- Revenue HI$tory over the years
- Products & client base by bed size
- Recent mergers & acquisitions
- A new spin-off from NTT Data (Dell)
- Candid assessment of future prospects

3. Top 10 Compara-chart
• To put these last four vendors in perspective, note the huge
disparity in $ size (& market share) from HIS market leaders:

4. • Computer Programs & Systems, Inc (CPSI) – re-branded as
Evident in 2016, now 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 revenue
increased by
40% in 2016
and 4% last
year, reflecting
continued
strong sales
among ≈300
remaining
Healthland
clients.
#7:

5. The CPSI “Family”
• Like most HIS vendors, CPSI branched out into many specialty
markets to increase their annual revenue far beyond the core
HIS comprised of an EHR, Ancillaries, RCM, & an integrated
ERP (only Meditech & HMS also wrote their own ERP!).
• 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 as the “CPSI System” for decades, the new name for
their HIS is now “Thrive,” running in 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 offers 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.

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

7. • Rather than a complex array of products targeted for various
sizes of hospitals, CPSI’s HIS sales strategy is relatively simple:
CPSI’s HIS Products & Prospects
- 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 after the acquisition, support
the older Healthland “Classic” system has ended, whereas the
newer “Centriq” system will be supported for ≈4 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 targets Millennium to large & Community
Works to small, Epic has All Terrain, Utility & Sonnet for the 3
market sizes, Allscripts’ Sunrise = large & Paragon = small, etc.

8. • #8 this year is Harris Healthcare, the new name that the N. Harris
division of Canadian giant Constellation Software has given their
HIT division comprised of many acquired vendors/products.
• Constellation/Harris follows an interesting business model of
leaving the companies that they acquire as separate financial
entities, rather than burying them in the parent firms’ dollars…
• Their core HIS product has long roots going back 50 years:
- Started as Compucare in 1969 by Sheldon
Dorenfest, building an HIS through FM…
- Bought by Baxter then sold back, Compucare
self-developed the “Affinity” HIS in the 90s.
- Then bought by QuadraMed, a major HIM
coding firm (Quantim), who later added:
- The “CPR” EHR from Misys/Per Se, originally
named “UltiCare” by Health Data Sciences.
#8: Harris Healthcare

9. - 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.
Other Harris Healthcare 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.

10. • QuadraMed’s revenue figures were public for over 20 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 increased in 2017
due to the acquisitions of Ormed, Picis, digiChart, iMDsoft, etc.
• Plus acquiring
NextGen’s
Opus/Sphere
gave them
prospects for
Affinity RCM,
QCPR EHR,
etc.
Harris/QuadraMed HI$-tory
Y2K Quantim
Sale
Recent
M&As

11. Harris Healthcare Prognosis
• Their business model of having each acquired firm run as an
independent company is wise for short-term success: execs
will manage each business to hit good numbers every year.
• However, the acquisitions of so many products all written in
different programming languages, data bases & OS, will be a
tougher sale to CIOs who generally prefer integrated solutions
with a minimum of time & money-consuming interfaces. Sort
of like one-stop shopping but multiple check-out carts…
• 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…

12. • #9 this year 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 the
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
hospital admissions from ERs very well.
#9:

13. • Being privately held, we’ve had to estimate their revenue during
these many years of acquisitions and mergers; the shrinking size
of some chains like CHS reduced past years revenue, but strong
HIS & EDIS sales last year brought them back up to ≈$175M:
• Medhost
now offers a
hosting, and
claim 13
2017 sales:
Allegiance,
Curae
Health,
Everest
Rehab,
Springhill…
Medhost/HMS HI$-tory
HMS
Medhost

14. • Medhost has a client base of over a thousand US clients as well as
≈20 international (Caribbean), among four main product lines:
– HIS = the HMS full suite of apps: EHR, RCM, Access, HIM, ERP
and ancillaries that used to be known as Monitor in ≈600 sites
– EDIS = Medhost’s very functional ER system in ≈400 sites
– Long Term Care & Behavioral Health = ≈500 non-acute sites
Medhost Client Base

15. • Starting as Keane decades ago, bought by Caritor, then NTT
Data, who spun off the HIS division as Cantata with the proven
HIS known as “Optimum,” with the full array of systems:
- Full clinical suite: 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 which is now owned by Harris…
• NTT Data acquired consulting giant Dell for $3B last year, so had
to spin off this HIS division to keep their consulting objective.
Cantata is a lot smaller but now focused primarily on HIS with:
- ≈245 FTEs, including many veterans…
- ≈200 clients on the Optimum HIS...
- ≈1,700 non-acute clients on NetSolutions
#10:

16. • Bit of a revenue roller coaster ride since Keane sold to Caritor in
2007, who then sold to NTT Data in 2010. Like so many vendors,
NTT offered many services beyond pure IT, so Cantata’s 2017 HIS
revenue is starting out much lower than last year’s estimate:
Cantata Revenue HIS-tory
(Y2K)
Caritor
NTT
Data
Keane
C
a
n
t
a
t
a

17. • Here’s the final table of HIS vendors product by hospital bed size:
Products by Bed Size

18. Recap
• This episode ends our review of the Top 10 HIS vendors for 2018,
based on their FY2017 annual revenue. Biggest news this year:
– MIA:
• McKesson joins Siemens as former #1 vendors with
decades of HIStory and billions in revenue, now gone.
– Re-packaging:
• Epic now has 3 varieties: All Terrain, Utility and Sonata.
– New Names:
• NTT Data bought Dell and 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