Small hospitals changing EHRs faster than large hospitals, says KLAS report

To help small healthcare organizations make more informed decisions about their electronic health records and patient accounting systems, KLAS researchers interviewed small hospitals (250 beds or fewer) about their experiences, finding significant differences from similar reports in recent years.


Small hospitals are changing their EHRs and patient accounting systems at a greater rate than that of their large-hospital counterparts, according to the new Small-Hospital Patient Accounting report from the KLAS Arch Collaborative. 

KLAS researchers examined customer satisfaction across the firm’s customer experience pillars, including relationship, product, culture, operations and value.

Researchers asked about relationships, product functionality, culture and value. The vendors –Epic, Meditech, CPSI and Oracle Health – varied across these categories. 

The report also contains score data for Medhost and athenahealth, but KLAS researchers say the data was too limited and separated out their scores for each metric.

The operations metric, however, proved to be the sorest point across all vendors, according to the report summary.

From limited information in training materials and understaffed resources to accessible training tools that offer limited guidance, the KLAS researchers found small hospital respondents struggling with EHR implementation and needing more support.

Meditech had the highest score (81.7%) in the operations metric, a composite of customer ratings on the quality of training, quality of implementation and ease of use, and Oracle Health the lowest score (58%).

Meditech had the highest score for relationships, value and culture while Epic had the highest score for product functionality. 

While all vendor scores across all metrics never fell below 49%, Oracle Health consistently received the lowest score of the four primary vendors whose customers were considered in the study, and that was reflected in the overall performance scores.

Though the data was limited, Medhost saw improvement – its operations score increased by 10 points over the previous year.

“The vendor has improved the product’s ease of use and integration, though initial and ongoing training is still a pain point,” the researchers said.

Meanwhile, athenahealth showed an overall performance reduction from 2020 to 2022, according to the handful of clients who responded to KLAS.

“Small hospitals using athenahealth (limited data) report training is severely lacking and want the vendor to provide training tailored to the inpatient market,” said researchers.


Small hospitals began turning to larger tech companies more than 10 years ago with an appetite for healthcare information technology that exceeded most vendors’ abilities to deliver for the market. 

Just five years ago, rural hospitals needed simplified EHRs just to stay afloat, but the instability and pressures of COVID-19 forced many to close. They rely on federal funding to continue operations.

Companies like Cerner, now Oracle Health, have been innovating with the cloud and other technologies to deliver on small hospital EHR demands and budgets.

But even with a lot of attention paid to mid- and large-size healthcare systems, practice management platforms do not always meet customer needs, according to previous KLAS research released in December.


“Small hospitals are changing their [electronic medical records] and patient accounting systems at a greater rate than that of their large-hospital counterparts,” the KLAS researchers said in the report summary. 

“While many vendors offer viable clinical systems, there are significant differences across the customer experience with patient accounting that should not be overlooked by small hospitals.”

Andrea Fox is senior editor of Healthcare IT News.
Email: [email protected]

Healthcare IT News is a HIMSS Media publication.

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