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I Want to Thank the Academy, Err, the Hospital CIO: EHR Hospital Market Share

Posted on July 7, 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.

We’re always interested in who’s up and who’s down. Whether it’s TV shows, Senate races, book sales or baseball stats, we want to know who’s up, who’s down and who’s going nowhere.

We’re big on trends, shares and who’s going where. The closer the race, the more avid the interest – My Nats would be sitting pretty if only the Braves weren’t so pesky. The EHR market place is no exception for interest, even if the numbers are a lot harder to follow than the National League East.

In my last foray into EMR market share, I looked at SK&A’s stats from their rolling survey of US medical practices.

Another company, Definitive Healthcare similarly tracks the hospital EHR marketplace. They’ve generously shared their findings with Healthcare Scene and I’ve used them here. Please note: Any errors, mistakes or other screw-ups with their numbers are mine alone. With that said, here’s what I’ve found.

How Many Divisions Does the Hospital Market Have?

Definitive divides the hospital market into several categories that can be daunting to follow. That’s not their making. It’s the nature of the market.

The major division that Definitive reports on is inpatient versus ambulatory systems. You might think that ambulatory systems are only for non hospital setting, but hospitals, of course, have many outpatients and use ambulatory EHR systems to serve them.

The Inpatient Marketplace

Among inpatient systems, EPIC leads with a 20 percent share shown in Tables I and II. The market is highly concentrated with EPIC, Cerner and Meditech commanding 54 percent. The remaining 46 percent scatters with no one breaking double digits.

Table I All Inpatient Hospitals EHR Vendor Market Shares

Table II All Inpatient EHR Shares

 The Ambulatory Hospital Marketplace

The picture for hospital ambulatory systems used is notably different. See Tables III and IV. While EPIC and Cerner vary slightly from their inpatient share, the other vendors shift all over the place. Allscripts barely registers 4 percent in inpatient, jumps to third place with 14 percent.

Siemens and HMS drop off the top ten being replaced by eClinicalWorks and NextGen. At 22 percent is the catchall, Other EHRs. This is up 8 percent from its inpatient 14 percent.

Table III All Ambulatory Hospitals

Table IV All Amb Hospitals

Inpatient EHRs: Health Systems and Independent Hospitals

Definitive also breaks down inpatient hospitals by health system hospitals v independents. Almost a majority of health systems, 47 percent, choose EPIC and Cerner. See Tables V and VI. Indeed, the top four vendors, EPIC, Cerner, Meditech and McKesson astoundingly have a 74 percent share. The other vendors are at 7 percent or less.

Table V Inpatient Healthcare Systems Hospitals

Independent hospitals differ a bit from this pattern. Non major vendors have 12 percent and open source Vista has 5 percent, but otherwise the pattern is similar.

Table VI Inpatient Independent Hospitals

Inpatient Hospitals by Size: Under and Over 100 Beds

Hospitals with 100 plus beds, no surprise, favor EPIC, Cerner and Meditech. These three have a monopolistic 64 percent. See Table VII.

Table VII Inpatient Hospitals with =>100 Beds

Small, Inpatient Hospital Systems: A More Competitive Market

Small hospitals are a different story. The top five vendors are bunched around 14 percent each. See Table VIII. The mix of vendors is starkly different. Meditech and Cerner lead with EPIC third. However, Epic drops nine percent from the prior group to 14 percent in this.

In the prior tables, the top three vendors have a market majority. In this group, 65 percent of the market belongs to the third through tenth vendors. You can see the difference in competition in Tables VIII and IX.

Table VIII Inpatient Hospitals =>100 Beds

Table IX Inpatient Hospitals <100 Beds

Hospital Ambulatory EHR Systems by Bed Size

The ambulatory market for hospitals with 100 plus beds is similar to the inpatient market. EPIC, Cerner and Allscripts have a 53 percent share.

The remaining share is split among several vendors, with eClinicalWorks, and athenahealth making an appearance. Significantly, Other EHRs ranked second.

Smaller hospitals’ ambulatory systems, as with smaller inpatient hospitals, show a competitive market. The category Other EHRs actually leads with a 21 percent share. Tables X and XI show the difference between these two markets.

Table X Ambulatory Systems =>100 Beds Table XI Ambulatory Systems <100 Beds

Market Shares: What’s the Conclusion?

In this and previous posts, I’ve looked at EHR vendor market shares sliced up in several ways. I’ve used what I consider reliable, independent data sources from SK&A and Definitive Healthcare. I used their information because they are careful to include all practices in their surveys not just those that bother to reply.

I also used them for the simple reason that they were freely available to us. There are other sources, such as KLAS, that produce market surveys, but they charge about $2,500 for their analysis. Moreover, they keep all but the most general findings behind their paywall.

What then is the message from all these numbers? It’s this: there is a competitive market, but it’s only robust among small practices. Those with three or less practioners have the most competitive market with eClinicalWorks in the lead. Within major segments, EPIC, Cerner and Meditech dominate. The non hospital market is more mixed, but EPIC, Cerner, etc., share increases as practice size grows.

For these larger practices, it’s monopolistic competition. If you’re looking for an EHR and you have ten or more docs, you can find any number of vendors. It’s most likely you’ll end up choosing among just a few big guys.

This reminds me of when we shopped for kitchen cabinets and counter tops. We were impressed with some dramatic possibilities. The sales rep, who we got to know well, laughed:

“When folks start out they focus on the avant garde. Then they realize they’re choosing for several years. Suddenly they get more conventional.”

If you come by our place, you’ll see our oak cabinets and white tile counter top. I think it goes that way with hospital execs choosing EHRs. They may toy with something different, but in the end, they’ll go with what they know. After all, no one every got fired for buying EPIC. Well, almost no one.

Next: Attribution and Market Share

If you still haven’t got your fill of market numbers, I have one more topic to explore. I’m interested in knowing how market share relates to MU attestations. That is, does a high market share guarantee a high attestation rate? The next post in this series will look at that.

If you have questions on market share, please post a comment or write me at:

EMR Market Share

Posted on October 6, 2010 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the most popular questions I get asked (although far behind the Which EMR is Best? question) is what’s the EMR market share look like. The problem is that there really isn’t any great data out there for EMR market share. Plus, the numbers that EMR vendors give out just clouds up the conversation completely.

Here’s an example from an article about Allscripts completed merger with Eclipsys:

“What this merger heralds is the coming together of the health care system,” says Tullman. In other words, Allscripts now provides service to about 180,000 physicians (roughly 30% of all U.S. physicians), more than 1500 American hospitals (about 50% of U.S. hospitals with 200 beds or more) and over 10,000 post acute care facilities (more than 75% of U.S. facilities).

These numbers just make me laugh. The wrong assumption that people make is that when they say they provide services to 180,000 physicians that they mean their providing EMR services. After all, Allscripts has something like 7 different EMR software products, right? Too bad that assumption would be way off base.

I think it’s pretty clear that the Allscripts product that’s most widely used is SureScripts (ePrescribing). Take out the SureScripts users and I wonder how many physicians really use Allscripts products. The number would be DRAMATICALLY lower.

Of course, we could have easily known this if we just looked at the “30% of all U.S. physicians” quote. There aren’t even that many physicians using an EMR (let alone an Allscripts EMR). I’m sure similar things could be said about the hospital numbers listed above.

Yes, these numbers are just the “spin” that is so prevalent in marketing and PR. That is their job after all. Hard to complain too much about them doing their job.

One thing is certain. Trying to figure out EMR market share is pretty much impossible. Plus, the ones that are the loudest aren’t always the ones with the most market share. Remember that.

New CEO of Medical Informatics Engineering (MIE) and EMR Vendor Market Share

Posted on August 10, 2010 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Many people that read this blog have never heard of Medical Informatics Engineering (MIE) until they saw this blog post. Honestly, before HIMSS this year I hadn’t really ever heard of them either. However, at HIMSS I was introduced to their story and was really intrigued. Yesterday they announced a new CEO, Bruce Lisanti to lead the company. Here’s a section of the press release:

“With the pending changes in the US healthcare system and with meaningful use criteria now finalized under the HITECH Act’s electronic health records (EHR) incentive program, there is an unprecedented opportunity for growth and expansion in the healthcare IT industry,” said Mr. Lisanti. “Electronic health records can enable physicians, hospitals, labs and patients to work together more easily. When combined with fully functional personal health records (PHR), electronic communication and access to information can substantially reduce the overall costs of the healthcare system. As one of the only fully integrated, web-based EHR systems available today, MIE has an enormous opportunity to become a leader in this space.”

“MIE has already demonstrated an impressive ability to promote the broad adoption of this technology on a regional scale,” Lisanti continued. “The MIE Health Information Exchange is currently utilized by over 90 percent of the physicians in Northeast Indiana with 55 percent of these doctors using the WebChart EHR system from MIE. Our goal is to take this model nationally, positioning MIE as a leader in healthcare IT.”

What I find most interesting about stories like this is that they’re happening every single day. With over 300 EMR vendors out there, there are hundreds of MIE like EMR vendors that don’t see all the headlines, they don’t have big fancy conferences, but they’re just grabbing their portion of the EMR market.

I guess that’s why I mostly just laugh when I see someone try to calculate the EMR vendor market share. The company with the largest EMR market share is called “Other” and includes the 100’s of EMR vendors that most people don’t know about.