Moving to a new electronic health record (EHR) is one of the most complex and high-stakes decisions a healthcare organization can make. From early planning through implementation and long-term optimization, each choice shapes not only IT operations but also clinical workflows, financial performance, and future scalability. 

For organizations considering MEDITECH Expanse, one of the first and most important decisions is whether to pursue a traditional licensed implementation or MEDITECH’s cloud-based subscription model, MEDITECH as a Service (MaaS). 

Both approaches offer distinct advantages. The right path depends on your organization’s financial strategy, internal IT capabilities, implementation timeline, and long-term vision for innovation, growth, and system management. 

Understanding the Difference: MEDITECH Licensed vs. MaaS 

MEDITECH’s Licensed model represents a traditional EHR deployment approach, where the organization owns and manages its environment. This model provides flexibility in hosting, allowing systems to deploy MEDITECH Expanse on-premises, in a private or public cloud, or through a hybrid approach. It also allows for more control over how and when functionality is implemented. 

MEDITECH as a Service (MaaS), by contrast, is a fully managed, cloud-hosted model delivered through Google Cloud Platform (GCP). In this model, MEDITECH manages infrastructure, updates, and core system components. Organizations typically go live with a standardized version of Expanse with less responsibility for ongoing system maintenance. 

As healthcare organizations accelerate cloud adoption, selecting the right model is increasingly important. While both deployment models offer the opportunity to free up internal resources for more strategic initiatives, they differ in flexibility, customization, support considerations, and long-term value realization.

Licensed vs. MaaS: Planning Considerations

Cost and Financial Strategy

What to consider: Are lower upfront costs a priority, or does long-term cost control better align with your financial and capital planning strategy?

Licensed	MaaS
Upfront investment includes licensing fees. Total cost of ownership can be optimized through managed hosting and cloud strategies, offering both cost control and predictability.	With a subscription-based pricing model, recurring fees can aid in planning, though long-term costs depend on usage, storage, and additional services.

Customization and Flexibility 

What to consider: Will your organization require tailored workflows, phased implementation, or integration with third-party applications?

Licensed	MaaS
Offers flexibility to customize workflows, deploy modules incrementally, and integrate third-party applications to support complex operational needs or unique clinical workflows.	Provides a standardized deployment model with limited customization. MEDITECH manages core applications and dictionaries.

Hosting and Infrastructure Strategy 

What to consider: Does your organization's IT strategy lean toward customization and control?

Licensed	MaaS
Supports on-premises, public cloud (such as AWS or Azure), private cloud, or hybrid hosting models. This flexibility allows organizations to align infrastructure decisions with broader IT strategy.	Fully managed hosting within MEDITECH’s cloud environment. Infrastructure, performance, and availability are managed by MEDITECH.

Licensed vs. MaaS: Implementation Considerations

Implementation Timeline and Speed to Value 

What to consider: Is speed to deployment a primary driver, or is a phased and highly customized implementation more important? 

Licensed	MaaS
Implementation timing offers flexibility in planning, build, testing, and go-live sequencing for more tailored system configuration.	Offers a standardized deployment timeline that can simplify planning. Speed to value depends on governance, readiness, and resources.

Training, Adoption, and Change Management 

What to consider: How will you design, deliver, and sustain end-user training? 

Licensed	MaaS
Organizations using licensed models can deploy internal training or choose a partner with platform-specific experience for customized end-user education.	MEDITECH provides structured training support based on applications and user volumes, helping reduce the burden on internal teams.

Innovation and Scalability

What to consider: How will your organization support growth, evolving care models, and new technologies such as analytics and AI?

Licensed	MaaS
Licensed environments enable custom innovation and support best-of-breed integrations with greater control and customization.	Designed to accommodate increasing patient volumes and data with a standardized environment and a routine schedule for updates.

Licensed vs. MaaS: Support Considerations

System Performance, Updates, and Control 

What to consider: How important is control over system updates and upgrade timing?

Licensed	MaaS
Provides full control over update timing and configuration. This is particularly valuable for organizations with highly customized workflows that require testing before changes are introduced.	Updates are managed and deployed by MEDITECH across MaaS environments. This ensures consistency, but requires alignment with MEDITECH’s update schedule.

IT Resourcing and Operational Support 

What to consider: Does your organization have the staffing and expertise required to support and maintain the system over time?

Licensed	MaaS
Firms using licensed models often partner with experienced firms to extend IT capabilities, optimize performance, and reduce internal burden without sacrificing control.	Transfers much of the operational burden to MEDITECH, potentially reducing internal IT demands but offering less flexibility than partner-supported models.

Post-Go-Live Support 

What to consider: How do you plan to address managed services, application support, and coding support?

Licensed	MaaS
MEDITECH provides software support, while organizations can rely on experienced partners for Tier 1-3 support and operational processes.	MEDITECH provides infrastructure and system support, while organizations retain responsibility for certain application-level and operational functions.

Security and Compliance 

What to consider: How will you manage security, compliance, and risk mitigation?

Licensed	MaaS
Organizations can partner with experienced firms to develop a flexible approach to security, monitoring, and compliance.	Relies on MEDITECH for compliance with built-in disaster recovery and vendor-managed security practices.