US Hospital EMR Market Share 2018
Small Hospitals Hungry for New Technology

athenahealth’s inpatient solution continued to gain traction, garnering more contract wins among small hospitals than any other solution. The cloud-based platform is particularly attractive to the smallest hospitals, who require minimal IT footprints and up-front costs. Indeed, athenahealth’s 2017 wins occurred solely among hospitals with under 50 beds. Questions regarding the solution’s maturity are a concern for some—in 2017, 13 contracted customers backed out before going live, returning to previous vendors, primarily CPSI. MEDITECH’s new cloud-based technology (Expanse) also generated buying energy among smaller hospitals (details below). Smaller hospitals have expressed initial interest in eClinicalWorks’ cloud-based inpatient solution (10i); to date, very few contracts have been signed.

2017 marked the first time in three years that MEDITECH saw a net increase in US hospital EMR market share. These early signs of renewed energy are driven primarily by Expanse, MEDITECH’s newly christened web-based platform. Expanse has been in development for many years, with ambulatory integration and enhanced usability as key goals, and it has created increased migration activity among MEDITECH’s legacy customers—58% of those who made a go-forward decision in 2017 chose Expanse, while 42% went with other vendors. In some recent years, MEDITECH’s systems have not generated significant consideration outside of the existing MEDITECH base, but Expanse is changing that. Some community hospitals (1–200 beds) using other vendors’ legacy solutions chose in 2017 to switch to Expanse.

In 2017, Allscripts nearly doubled their acute care EMR customer base with the acquisition of McKesson’s Paragon and Horizon EMRs. Both solutions have been losing customers for years, and 2017 was no different. It should be noted that many Horizon and Paragon customers who left in 2017 had already made decisions to switch to other vendors prior to being acquired by Allscripts. These losses are no surprise given Horizon’s sunset status and McKesson’s consistent underdevelopment of Paragon, most significantly their inability to deliver an integrated ambulatory solution. More notable are the losses sustained by Sunrise Clinical Manager (SCM), Allscripts’ go-forward solution for larger organizations. SCM’s market share had been relatively stable for a number of years, but in 2017, two large multihospital organizations switched their SCM hospitals to Epic, looking to simplify their IT infrastructure and consolidate to an integrated solution.

For years, Cerner and Epic have been the most considered EMR vendors across all hospital sizes. In competitive decisions by large organizations, they are almost the only vendors considered. In 2017, Cerner saw the most acute care hospitals wins out of all vendors. Epic had fewer wins but sustained no losses, giving Epic the highest net market share growth. Cerner lost 25 hospitals, 15 due to customer standardization. Epic’s strong integration and consistent development are major reasons that their market share remains more stable and that they are chosen by larger health systems and hospitals; Cerner’s long-time patient accounting challenges continue to be a primary factor when large organizations choose not to go with Cerner. Cerner’s and Epic’s alternative deployment models for smaller hospitals both saw significant wins. In this space, Cerner outpaced Epic—for these hospitals, the initial cost and lack of direct contracting in Epic’s community model can be a concern; Cerner offers more flexible pricing models and direct contracting.