EHR Product Market Shares Rankings: The Envelope Please!

Posted on May 27, 2014 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

In politics, it’s the horse race, that is, who’s in front and where’s the rest of the pack. We have our own EHR version, who’s got the biggest market share and where’s everyone else.

In politics, there’s no end of polling by candidates, parties, media and all stops in between. We aren’t so lucky. You can count the reliable EHR market share estimates on one hand and not need your thumb. Of those available, I’ve found SK&A’s to be the most comprehensive and reliable free option, though they do require a registration.

Leaders of the Pack

Table I shows the top 20 EHR vendors’ installed base for all US practitioners. Not surprisingly, Epic leads with about 11 percent. Table II shows the market’s concentration: the top seven have almost half the market.

Table I All practioners

The remaining 13 vendors have about a 20 percent market share. The remaining vendors, about 470 companies, have the remaining 30 percent. But don’t go away just yet. There’s more to the story.

Table II All Shares

Market Share by Practice Size

Market share by practice size refines the picture a bit more. For their analysis, SK&A divided practices into five classes shown in Table III. Each of these is examined in turn.

Table III Group Size

As you’ll see, the larger the number of practitioners in a class, the more concentrated the market becomes. However, the greatest number of practices is in the smaller classes. For example, SK&A reports that 80 percent of practices have 10 or less practitioners.

For example, both EPIC and eClinicalWorks have a ten percent market share. EPIC does this by having a large percent of practices with the highest number of practitioners.

 eClinicalWorks, on the other hand, achieves its share by selling to a many, smaller practices. As a result, you’ll see ECW’s market share drop as the numbers in a class increases, while EPIC’s share will go up.

Class 1 – 1 to 3 Practitioners

Table IV shows the top twenty vendors and again shows a heavy concentration in a few vendors. eClinicalWorks is the leading small practice EHR vendor with a 10 market share. The eight top vendors have half the market in this class.

Table IV 1 to 3 Practitioners

The other 12 top vendors have a 20 percent market share. The remaining 470 vendors split the remaining 30 percent.

Two EHR cloud vendors, Practice Fusion and athenahealth, have an 11 percent market share. While others offer hosted or private cloud products, these two are the sole cloud only solutions in the top 20.

This market segment shows less diversity than those before it. In this case, four vendors have almost half the market, Epic, Allscripts, eClinicalWorks and NextGen.

Class 2 – 4 to 10 Practitioners

The remaining 52 percent, Table V,  is spread among 16 vendors. Notably, athenahealth and Practice Fusion drop in this class to about 3 percent.

Table V 4 to 10 Practitioners

As the next classes show, the market tightens up considerably with a few vendors having greater and greater shares.After NextGen, the other 16 vendors have 30 percent of the market. This leaves all the remaining vendors with 23 percent of the market.

Class 3 – 11 to 25 Practitioners

In this class, Tables VI and VII, three vendors have a market majority: Epic, Allscripts and NextGen. The top seven vendors have over three-quarters of it. The concentration among is so great that three top 20 vendors, AdvancedMD, AmazingCharts and Office Ally are no shows.

Table VI 11 to 25 Practioners

Table VII 26 to 40 Practioner

Class 4 – 26 – 40 Practitioners

Table VIII shows the bunching of vendors in this practitioner class. Only about half of the major vendors had any significant share. All the remaining top 20 vendors lack any significant shares.

Table VIII 26 to 40 Practitioners

Epic’s dominance is even more pronounced in this final class as shown in Table IX. EPIC’s share 47.7 percent and GE has 11.9. Together, they have market share of about 70 percent.

Class 5 – 41 Practitioners and More

Epic’s dominance is even more pronounced in this final class as shown in Table IX. EPIC’s share 47.7 percent and GE has 11.9. Together, they have market share of about 70 percent.

Table IX 40 Plus Practioners

The remaining five vendors have a 20 percent market share: Allscripts, Cerner, NextGen, McKesson. The other 400 plus vendors divide the remaining 10 percent.

There are some interesting changes in this class’ shares, Table X, compared to the previous classes. Cerner drops from second place with 12.5 percent to fourth place with 9.2 percent.

Table X 40+ Practitioners

MEDICTECH all but disappears dropping from 4.7 percent to 0.9. On the other hand, EPIC, GE, Allscripts, NextGen and Greenway increased their shares.

Source and Other Boring Details

The net has many EHR market share analyses, however SK&A’s stands out for several reasons. Most importantly is the active way they gather their statistics. They call every medical practice in the US every six months. This includes all hospitals, private or affiliated practices and urgent care clinics, etc. This approach means that few practices are left out and the answers gathered are on the same basis.

This differs substantially from studies that hang a question out and scoop in whatever they get. They don’t give all practices an equal chance to answer. They are flawed compared to those that actively contact practices or based on statistical samples.

Many other studies base their estimates on ONC’s MU attestations. In fact, most market studies I’ve seen cite ONC. The problem with ONC’s count is that it only includes those in the MU program. Those who don’t, perhaps 40 percent, are left out.

SK&A is not the only company that uses an active approach to determining market share. However, it is the only one I know of that actively surveys the market using that approach and publishes the results free. This is unusual.

I also want thank them for briefing me on their methodology. They did this with only the barest of descriptions of what I was up to.

Future Posts – Hospital and MU v Market Share

There are two other, related topics I’ll cover in future posts.

Hospital Practices

The first is a look at hospital based EHRs. Definitive Healthcare, similar to SK&A, actively surveys the in-patient market by calling practices. They have generously furnished their analysis to Where SK&A breaks down its findings by class size, Dimension looks at hospitals by factors such as:

  • Bed size
  • Independent v affiliated hospitals, and
  • In-patient v ambulatory systems used in hospitals.

MU EHRs v Market Share

The last issue I want to look at is how the vendor rankings in MU’s attestations actually compare to those in this analysis. A preliminary look shows many differences.