What EHR Systems Are Critical Access Hospitals Actually Using? A Data-Driven Look at the CAH EHR Landscape

If you work in health care IT - especially at or supporting a Critical Access Hospital - you have probably wondered at some point what EHR systems your peers across the country are actually running. Not what vendors say their market share is. Not what analyst firms think is happening. What is actually installed, reported to the federal government, and powering the clinical workflows at the 1,300+ CAHs across the United States right now.

We wanted to know the same thing. So we went and found out.

About This Analysis

Health Tech Authority conducted an independent analysis of EHR adoption across U.S. Critical Access Hospitals by combining two publicly available federal datasets: the CMS Provider of Services (POS) file (Q4 2025 extract) and the ONC Certified Health Information Technology Reported by Hospitals for Promoting Interoperability Performance dataset (2024 reporting year, updated January 2026).

CAH facilities were identified using CMS Certification Numbers (CCNs) in the 1300-1399 range per state, which is the standard CMS numbering convention for Critical Access Hospital designations. The ONC dataset was filtered to core EHR products only, excluding ancillary certified health IT products such as quality reporting tools, health information exchange platforms, and standalone lab systems that also appear in the Promoting Interoperability data. The goal was to identify the primary clinical EHR system each CAH reported using for the 2024 performance year.

The full dataset, including every CAH with its identified EHR vendor, state-level breakdowns, and MEDITECH platform generation detail, is available for download: CAH EHR Vendor Report 2024 (Excel).

The Numbers

Out of 1,381 CAHs identified in the POS file, 1,058 had a core EHR system identifiable in the Promoting Interoperability data. The remaining 323 either did not have vendor data populated in their PI attestation, received a hardship exemption from the program, or may be in the process of closure or status conversion.

Here is what the 1,058 reporting CAHs are running:

A handful of facilities reported products from multiple EHR vendors, likely reflecting transitional states or environments where different systems serve inpatient and ambulatory functions.

If you have followed the broader hospital EHR market, Epic's position at the top probably does not surprise you. KLAS Research reported that Epic held 42.3% of hospitals and 54.9% of beds in the overall acute care EHR market in 2024. But the CAH picture has some important distinctions worth unpacking.

Epic's CAH Story Is Really a Community Connect Story

Epic's 36.9% share among CAHs is notable, but it does not mean 390 Critical Access Hospitals went out and bought Epic on their own. The vast majority of Epic-running CAHs are accessing the platform through Epic's Community Connect program, a hosted model where a larger health system extends its Epic environment to smaller, independent organizations.

This matters for a few reasons that go well beyond the technology itself.

In a Community Connect arrangement, the smaller hospital becomes a tenant on the host system's Epic instance. The host manages the infrastructure, handles upgrades, provides support, and controls governance decisions. For a 20-bed CAH with two IT staff, not having to stand up and maintain a full Epic environment is genuinely appealing. The cost is lower, the implementation is faster, and you get access to the same clinical tools that large academic medical centers use.

But there is a trade-off that does not always get discussed openly: the smaller organization does not own the license. Customization is constrained by the host's configuration. Upgrades happen on the host's timeline. And perhaps most significantly, the relationship itself can create strategic dependencies that extend well beyond IT.

An August 2025 analysis published by HIT Consultant, referencing research from the Coker Group, documented how Community Connect agreements can restrict license ownership, complicate data portability, limit third-party integrations, and subordinate governance to the host health system. Federal Stark Law exemptions allow the host to subsidize up to 85% of the implementation cost, which makes the financial case compelling - but it also means the smaller hospital's technology strategy becomes deeply intertwined with the host's business strategy.

For the CAH administrator or board member reading this, the question is worth asking directly: is the host system extending Epic to your facility because they want to improve regional care coordination, or because they are building a referral pipeline and positioning for eventual acquisition? In many cases, the honest answer is probably both. That is not inherently wrong, but it should be understood and negotiated with clear eyes.

There is an interesting counter-example developing in Colorado. Aspen Valley Health, a Critical Access Hospital, is currently the only CAH in the country operating its own Epic instance. They are now using the Community Connect model in reverse - serving as the host for other rural hospitals. Their framing of "independence through interdependence" is a compelling alternative to the standard hub-and-spoke model where the hub is always a large urban system. Whether this model scales remains to be seen, but it is worth watching.

Oracle Health: The Incumbent Under Pressure

Oracle Health (formerly Cerner) holds 24.9% of the CAH market, which is consistent with their overall acute care position. For many CAHs, the Oracle relationship predates the 2022 acquisition by Oracle Corporation. These are often long-standing Cerner CommunityWorks customers - the Cerner equivalent of Epic's Community Connect model - where the platform is delivered as a cloud-based, multi-tenant deployment of Cerner Millennium tailored for smaller facilities.

The CommunityWorks model has some structural differences from Epic Community Connect that matter to CAHs. Oracle Health contracts directly with the smaller hospital rather than routing through a host system, which means the CAH maintains a more direct vendor relationship and does not take on the same governance dependencies inherent in the Community Connect model. Oracle reports more than 300 CommunityWorks customers across 45+ states.

That said, Oracle Health is at a complicated juncture. KLAS Research reported that Oracle lost a net 74 hospitals in 2024, and customer satisfaction metrics have been volatile since the Oracle acquisition. Oracle is actively migrating the Cerner platform to Oracle Cloud Infrastructure (OCI) and launched a new AI-native EHR in August 2025 for ambulatory settings, with acute care functionality planned for 2026. For the CAH running CommunityWorks today, the transition to OCI is being positioned as a requirement for accessing new capabilities.

What this means practically for a 25-bed CAH in rural Kansas or Nebraska - two states where Oracle Health has significant CAH market share in our data (34 and 24 CAHs respectively) - is an open question. The platform migration introduces uncertainty, and CAHs typically have the least capacity to absorb disruption during a major system transition.

MEDITECH: The Quiet Workhorse

MEDITECH holds 15.7% of the CAH market in our data, and the platform generation breakdown tells an encouraging story for their customer base. Of the 166 CAHs running MEDITECH, roughly 119 (about 72%) are on current-generation Expanse builds (2.1 or 2.2 versions), reflecting strong migration progress within the installed base. Another 29 are on MEDITECH 6.x, with only a handful remaining on older Client/Server or MAGIC platforms. 

MEDITECH has been recognized as Best in KLAS for Community Hospitals with 1-150 beds, and their positioning in the CAH space is differentiated in a meaningful way: MEDITECH contracts directly with the hospital, the hospital owns its instance, and the platform is available as a cloud-hosted offering (MEDITECH as a Service) without requiring affiliation with a larger health system.

For CAHs that prioritize independence and direct control over their EHR environment, MEDITECH Expanse is arguably the strongest option in the market. The trade-off is that MEDITECH's interoperability ecosystem is smaller than Epic's Care Everywhere network, which connects roughly 2,000 hospitals and 45,000 clinics. For a CAH that refers heavily to an Epic-based health system, that interoperability gap can create friction that a Community Connect arrangement would eliminate.

The geographic concentration in our data is striking. South Dakota shows 18 MEDITECH CAHs out of 37 total - nearly half the state's Critical Access Hospitals. MEDITECH also has notable concentrations in Montana, Nebraska, and Missouri.

TruBridge: Still a Major Player Where It Counts

TruBridge (formerly CPSI/Evident) holds 15.5% of the CAH market at 164 facilities, making it effectively tied with MEDITECH for the third-largest share. TruBridge's presence is heaviest in the South and parts of the Midwest - Texas alone accounts for 26 TruBridge CAHs, more than half of that state's total.

TruBridge has historically positioned itself as the affordable option for small hospitals, and their integrated EHR and revenue cycle management offering is designed specifically for the resource-constrained environment that most CAHs operate in. The 2025 Black Book Research survey of rural hospitals identified TruBridge as the leading vendor for comprehensive RCM capabilities in the small hospital space.

However, TruBridge is navigating its own challenges. KLAS reported that TruBridge had negative net hospital market share in 2024, with several hospitals migrating to MEDITECH Expanse or Epic. The vendor has been investing in product improvements and customer satisfaction, and overall satisfaction scores improved slightly in 2024, but the trend line bears watching for any CAH evaluating their long-term platform strategy.

The Smaller Players

athenahealth (36 CAHs, 3.4%), Altera Digital Health (17 CAHs, 1.6%), and MEDHOST (17 CAHs, 1.6%) round out the identifiable vendor landscape. athenahealth's presence among CAHs is concentrated in Kansas, where 10 of their 36 CAH installations reside. Altera Digital Health (formerly the Allscripts hospital division, now owned by Harris Computer under Constellation Software) offers the Paragon platform, which has historically served smaller acute care facilities. MEDHOST, which is also now part of the Harris Computer portfolio, maintains a modest but persistent presence in the CAH market.

The consolidation of Altera and MEDHOST under the same private equity umbrella is a trend worth tracking for CAHs currently running either platform. Consolidation does not always mean discontinuation, but it does introduce questions about long-term product roadmaps and investment.

Regional Patterns Tell a Story

The state-level data reveals that EHR decisions in CAHs are not random. Regional patterns are strong, and they often reflect the influence of dominant health systems, state-level purchasing cooperatives, and historical vendor relationships.

Wisconsin is essentially an Epic state for CAHs: 46 of 52 CAHs with reported EHR data are running Epic. Given that large Wisconsin health systems like Aspirus, Marshfield Clinic Health System, and Advocate Health (formerly Advocate Aurora) are Epic shops, this likely reflects widespread Community Connect adoption.

Minnesota follows a similar pattern with 56 of 69 CAHs on Epic. Kansas, by contrast, is Oracle Health and TruBridge territory with 34 and 16 CAHs respectively, and only 5 on Epic. Texas leans heavily TruBridge at 26 of 49 CAHs. South Dakota is MEDITECH country at 18 of 37.

These patterns are not just trivia. If you are a CAH evaluating an EHR transition and the dominant health system in your region runs Epic, the Community Connect path will likely be the path of least resistance for interoperability and referral coordination. Whether "path of least resistance" is the same as "best strategic decision" depends on your organization's priorities around independence, governance, and long-term positioning.

What About the 323 CAHs Without EHR Data?

Roughly 23% of CAHs in our analysis did not have a core EHR product identifiable in the 2024 Promoting Interoperability data. This does not mean they do not have an EHR. The ONC dataset noted that by 2021, 96% of hospitals had adopted certified EHRs, and CAH adoption of at least basic EHR systems is high.

The gap likely reflects a combination of factors: hospitals that received a hardship exemption from the Promoting Interoperability program, facilities that attested but did not have vendor data populated in the dataset, hospitals in the process of closing or converting to Rural Emergency Hospital (REH) status, and a small number that may genuinely be operating on uncertified or legacy systems that do not qualify for PI reporting.

What This Means for Your Organization

If you are at a CAH evaluating your EHR options, or if you are an IT leader supporting CAHs, here are the practical takeaways from this data.

The market is consolidating. Epic is growing its CAH footprint primarily through Community Connect, and that growth is accelerating. If the regional health system you refer to is on Epic, you will almost certainly be approached about Community Connect if you have not been already. Understand the full scope of what you are agreeing to before you sign.

Independence has a cost. MEDITECH Expanse and Oracle Health CommunityWorks both offer models where the CAH contracts directly with the vendor and maintains more control. TruBridge does the same. These options typically require more internal IT capacity or a strong MSP relationship, but they preserve your organization's ability to make its own technology decisions.

Legacy platforms are a ticking clock. If your CAH is running MEDITECH Client/Server, MEDITECH MAGIC, an older TruBridge build, or a MEDHOST system, you are likely already feeling the pressure of a platform that is no longer receiving significant development investment. The question is not whether you will need to move, but when and to what.

The data is public and free. If you want to see what specific hospitals in your state or region are running, download the ONC Promoting Interoperability Hospital dataset and cross-reference it against the CMS Provider of Services file. Or save yourself the trouble and download our compiled report, which has already done the join for all 1,381 CAHs.

Methodology Notes

This analysis was conducted in March 2026 using the most current publicly available federal datasets at the time of writing. CAH identification was performed using CMS Certification Number (CCN) conventions from the Provider of Services file. EHR vendor identification was based on certified health IT products reported by hospitals through the Medicare Promoting Interoperability Program for the 2024 performance year.

Core EHR products were distinguished from ancillary certified health IT (quality reporting tools, health information exchange services, lab systems, etc.) through product name analysis. Products identified as core EHR systems included inpatient and ambulatory clinical platforms from Epic, Oracle Health, MEDITECH, TruBridge, athenahealth, Altera Digital Health, and MEDHOST.

The 323 CAHs without identifiable EHR vendor data may include active hospitals with functioning EHR systems that simply did not appear in the PI dataset for the reasons discussed above. This analysis should be understood as a snapshot of reported data, not a guarantee of completeness.

Sources

• CMS Provider of Services File, Q4 2025. data.cms.gov
• ONC Certified Health Information Technology Reported by Hospitals for Promoting Interoperability Performance, 2024. healthit.gov
• KLAS Research, U.S. Hospital EMR Market Share 2025. beckershospitalreview.com
• Black Book Research, Future-Ready EHR Vendor Rankings for Small and Critical Access Hospitals, 2025/2026. newswire.com
• Coker Group / HIT Consultant, "The Hidden Risks of Community Connect EHR Models for Local Hospitals," August 2025. hitconsultant.net
• Oracle Health CommunityWorks. oracle.com
• Aspen Valley Health / Heart of the Rockies Regional Medical Center, Epic Connect Partnership Announcement, March 2026. hrrmc.com
• Definitive Healthcare, Most Common Hospital EHR Systems by Market Share, May 2025. definitivehc.com
• EHR Source, "The 10 Largest EHR Vendors in 2026," February 2026. ehrsource.com