Building in-house healthcare technology is a daunting task, especially in a market dominated by off-the-shelf options like Epic and Cerner. But those options can be expensive and disruptive to existing physician workflow, leading a number of health organizations to start from scratch. "We found the IT solutions in the open market were not going to meet our needs," said Landmark Hospitals CEO William Kapp. Landmark needed an electronic health record (EHR) that would function not only as a medical record, but also as a health information exchange (HIE) between its five long-term acute care hospitals. "We couldn't find a solution that made any sense for us and the existing options were prohibitively expensive."