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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, 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.

Physician Designed EHR, EHR MU Documentation, and Top EHR Ratings Lists

Posted on March 16, 2014 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.

I really hate this discussion. It reminds me of the republican-democrat debates. They always go too far and both sides (in this case Physicians and EHR vendors) often only see their side and miss the opposite viewpoint. It’s very polarizing. The best situation is the mix of both sides of the equation. Plus, you usually need someone who can help translate and moderate between the two viewpoints. That’s much easier said than done. You can definitely learn a lot about an EHR vendor when you learn if they’re more physician designed or tech designed.

Many people unfamiliar with these standards probably don’t undstand this tweet from Mandi since they assume it’s a standard and so the ONC documentation should be good enough, no? The reality is that every implementation of the ONC standard is different and you have to have documentation of how that EHR vendor implemented the standard.

I appreciate Chandresh’s tweet more than most. I’ve often considered the idea of starting an EHR rating site. They are a dime a dozen and I don’t think any of them are very good. The best ones use some high level filters to help you narrow the search. This has some value, but isn’t really an EHR rating site. The problem with an EHR rating is the sheer scale of responses that you need to collect for it to be valuable. There are 300+ EHR vendors. There are 40+ specialties. There are practices from solo doctor up to hundreds in a multi specialty clinic. There are 50 states. There are hundreds of insurance plans. You get the picture. The number of randomly collected quality ratings you would need is impossible. I enjoy a good list as much as the next person, but just remember what I mention above when you see the next list of Top EHR vendors.

Then again. Maybe Chandresh and I should get together and do an EHR rating service based on if the EHR was a physician designed or tech designed EHR.

KLAS Names Top EMR Vendors For Mid-Sized Practices

Posted on January 27, 2014 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 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.

A new report by KLAS has designated Epic, athenahealth and Greenway as the top three EMR vendors among mid-sized healthcare practices.  The report, which also identified unpopular EMRs in the space, drew its conclusions based on analysis of ability, workflow and integration capabilities, according to iHealthBeat.

To do the study, KLAS interviewed clinicians and IT personnel at practices with 11 to 75 doctors.

Researchers named the top three mid-sized EMR vendors as Epic Systems, which scored a 85.3 points out of 100; athenahealth, which scored 83.5 points; and Greenway, which scored 81.3 points.

Each of the top three vendors distinguished themselves in unique ways.  For example, researchers found that practices liked Epic’s consistent delivery in large hospital-based practices, athenahealth’s “nimble deployment” and system updates, and Greenway’s exceptional service to smaller, independent practices.

Meanwhile, KLAS noted that Allscripts, McKesson and Vitera had the highest percentage of dissatisfied customers, practices which felt stuck with their current EMR system but would not purchase it again.  Reasons for their dissatisfaction included upgrade issues, lack of support, and a perceived lack of vendor partnership, iHealthBeat said.

When it comes down to it, it’s pretty clear when these practices need from their vendors, and a feeling of partnership and mutual support seems to top the list of matter which researchers is doing the study.  But it’s clear that these characteristics can be pretty hard to come by, even from companies you’d think had plenty of resources to deliver a sense of support and availability to their customers.  Allscripts, McKesson and Vitera (although it is Greenway now) had better get their act together quickly, as mid-sized medical practices are a major market, even if they don’t spend quite as much as hospitals.

Top EMR Vendors – Solo Physician Practice – Black Book Rankings

Posted on August 19, 2011 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.

I’m always interested in ways to try and differentiate the various EMR and EHR vendors. I’m completely sympathetic with doctors who are sorting through the 300+ EMR Companies in the marketplace. Most doctors I know, don’t want to become software selection experts or at least don’t want to spend their free time doing it.

However, it’s amazing the various services out there that try and capitalize on this need that doctors have to narrow down the field of EHR vendors. I think that’s basically what the Black Book EMR Rankings (listed on Amazon even) are basically doing with their EHR rankings. Yes, I know Black Book’s been around for a while, but I just saw it again and had to post.

They try and say that they sent the survey out to 70,000 “physician leaders and non-clinical administrators of publicly traded hospital corporations, private hospitals, academic medical institutions, multispecialty medical group practices, small and multiple physician practices, hospitalist groups, emergency departments, institutional members and officers of various healthcare/medical and IT professional organizations, subscribers of our media partners and previously validated survey participants.”

The problem is that they only received “4502 validated respondents ranked 174 EMR suppliers.”[emphasis mine] I’m not a statistics guru, but I wouldn’t be putting my EMR selection on an average of 25 responses per EMR. Plus, for many EMR it was likely much lower than 25. Not to mention, they only had responses from 174 companies. What about the other 126+ EHR vendors that had 0 responses?

Plus, the Black Book breaks it down even further by size of practice. They have 6 categories in just the ambulatory side. That’s an average of just over 4 responses per EHR vendor per category size. Although, it’s less since they have a bunch of acute care categories as well.

When you look at the list, I see a lot of the major EHR companies and a bunch of companies I’ve never heard of before. Not to mention there are a lot of big time EHR players from companies that Black Book probably has never heard about that aren’t on the list.

Unfortunately, there’s no real quality source to differentiate the various EHR companies. If there was I’d shout it from the rooftops (or at least my blog). Until then, the only solution is the work of reviewing your needs and evaluating the various EHR software yourself.

Since I’m sure many will wonder what EHR vendors made the Black Book list, here’s the list of Top Ambulatory EHR companies by practice size after the break: Read more..