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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 EHRSelector.com, 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 healthcarescene.com. 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.

NFL EMR and Patient Generated Data

Posted on February 2, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


We wrote previously about the NFL using eCW, but this tweet seemed appropriate on the day of the super bowl. It was interesting to think that they have multiple video angles available of the injury. I wonder how/if that changes the assessment of the injury by the doctor.


This is a great image and does show the partial disconnect between those using smart devices to track themselves and the sick patients who could really benefit from them. Word on the street is that the latest iOS8 from Apple will have a bunch of health and fitness tracking built in along with a new app called Healthbook. I’ve been waiting for the smartphone to basically do what all these other external tracking devices are doing. If Apple hops in, then we’ll see that happen.

NFL Uses eCW To Do Concussion Assessment

Posted on July 29, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Late last year, the NFL announced that it was using eClinicalWorks’ EMR to standardize their healthcare documentation for players. (Around the same time, the NBA announced that it was implementing Cerner’s EMR.)

Now, we learn that the NFL is gearing up to launch eCW as part of a pilot study of data sharing. It’s also rolling out a program bringing concussion assessment to the field-side.

According to USA Today, the league is distributing iPads to every medical staff member — equipped with X-rays, imaging studies, notes and more — to boost its ongoing efforts to improve assessment of concussions.

All of the iPads rolled out to NFL clinicians will be loaded with X2 software which includes a standard concussion assessment instrument, the Sideline Concussion Assessment Tool (SCAT-3). SCAT-3 is the most advanced version available of neurocognitive test used to determine whether a player has a concussion, USA Today reports.

For most teams, the data collected on the deployed iPads will end up being printed and placed in a paper chart.

However, eight teams — the Steelers, Baltimore Ravens, Denver Broncos, Houston Texans, New England Patriots, New York Giants, New York Jets and San Francisco 49ers — are part of a pilot program in which the results collected on the iPad will be sent via Internet into the patient’s EMR.  Eventually, if the pilot works as expected, the EMR data will be shifted as needed between all 32 NFL teams.

What makes the new pilot a bit unusual is that there’s apparently some politics involved in sharing medical data across the league.

The players, agents and the NFL Players Association are apparently concerned that when team members are being scouted by other teams in the league,  the medical data could potentially be used against them. They’re also concerned as to whether certain health information could work against players in free agency or grievance hearings.

The NFL told USA Today that it’s still working out how it will handle free agent medical records, calling the pilot program a “work in progress.”  The league does not intend to use the EMR to share records between teams until the pilot is over.

Farzhad Uses Twitter to Call Out EHR Vendors

Posted on September 12, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

When it comes to ONC, I think a few things have always been clear:
1. ONC has its heart in the right place.
2. ONC hates the government restrictions that have to work within as much as the rest of us.

If you’ve ever had a chance to meet with someone from ONC in person, then you know the first item to be true. They really do have a sincere desire to improve healthcare in America through the implementation of IT. Not only do you see that in person, but their actions compliment this as well. In fact, I’d say that they’re some of the most sincere parts of Washington DC that I’ve ever met.

The challenge comes with the second point. ONC has to work within the legislation and government regulations that they’re given. I once posted about Blumenthal’s HIMSS adress as being meaningless. Someone at ONC found it and asked what they could do to make his address more meaningful. I told them nothing, because he was subject to the government muzzle. I think they’re reply was something like, “Many of us here don’t like the government muzzle either.” Another simple example of how they are very sincere people at ONC. I wonder if Blumenthal could offer a non-muzzled speech now.

I say all of this as background for a tweet that Farzad Mostashari sent out to EHR vendors. The thing I love most about this tweet is that Farzad is using the farthest extent of his power possible to push forward health IT within the government framework. This is no easy task, but I think Farzad’s tweet is brilliant:

I think the ONC pledge is still being considered by many EHR vendors. I know how EHR companies make decisions and so this won’t be any different. However, Farzad already posted this tweet with EHR companies that have made the pledge:

I’ve also seen tweets from NextGen and Azzly. We’ll see if others pop up on the #ONCPledge hashtag.

Oh the power of a tweet! Can you imagine how simple, but powerful Farzad’s request could be? No complicated legislation. No expensive stimulus. No mind numbing regulation. Just good old fashioned public pledge to do what’s right. I wonder how else this could be used.