Ask the Pros: Best Critical Access Hospital Vendor?

QUESTION: “What vendors would you recommend for a Critical Access Hospital (CAH) of 25 beds?”

ANSWER: That’s easy: just look at vendors whose client base consists mainly of 25 bed CAHs:

1. The “Big 3” are CPSI, Healthland and HMS, who each have hundreds of CAH facilities each; indeed, these three small-hospital leaders have few clients over 100 beds in size! They feature strong integration, offering almost every financial and clinical application, obviating costly interfaces. CPSI even has a self-developed PACS and T & A system. HMS just bought superb ED vendor “MedHost,” while Healthland just rolled out their own self-developed ED. Their prices are highly affordable (between $1M to $1,5M in capital), and can be easily operated by the 1-2 FTEs common in CAH IT departments.

2. Close behind them are two mid-range vendors with a fair number of CAH clients, but somewhat pricier ($2M to $3M in capital):

a. Meditech, acquired by many CAHs back in the 90s when its Magic prices were more affordable than today’s C/S or Release 6.

b. McKesson’s Paragon, a true Client/Server system based on small-hospital pioneer SAI, running pure MS SQL and Windows.

3. Farther back in the pack are some old stalwarts and a few newcomers worth a look-see:

a. Keane, whose First Coast runs in a number of CAH sites, being migrated to “Optimum.”

b. IntraNexus, with a number of CAHs running their hot, new “Sapphire” system.

c. QuadraMed, whose Affinity system ran in many CAHs, now being migrated to QCPR.

d. Sphere’s financials, recently acquired by NextGen, who just picked up Opus cinicals, a potent new combination.

4. I’ll end with what vendors we would NOT recommend for a CAH: “high-end” systems like Epic, Cerner, Eclipsys, GE, Siemen’s Soarian and McKesson’s Horizon. These vendors have so saturated the large AMC and multi-hospital IDN market that they are now trying to penetrate the community hospital market, even down to CAHs. They accomplish this by allowing their large clients to run CAHs remotely. Although their systems are indeed far more robust than their small and mid-size competitors, several aspects of their systems make them problematic for CAHs:

a. Long, costly implementations that require scarce FTEs in nursing and ancillary departments

b. Complicated “building” of screens & reports, to adopt “factory” templates to individual needs

c.  Lack of proven Revenue Cycle and/or “ERP” modules (AP, GL, PR, HR and Materials)

d. Heavy demands on IT staffs for data base administrators and report writers, scarce in the CAH hinterlands.

These “high-end” systems run remotely might be very attractive to community hospitals in the 100 to 300 bed range, but could cause long-term agida in the cash-strapped world of a CAH.