Top Trends in EMR Market Share

Despite COVID-19, we saw decisions in all levels of the market, from small hospitals to big IDNs. In fact, the number of decisions that happened in 2020 caught us by surprise. Although we did see a dip in decisions made during the second quarter, we still saw a jump at the end of the year as smaller organizations decided not to postpone any longer.

For large organizations, choosing a new EMR vendor is usually a three-to-five-year decision process, and it’s closer to three years when organizations are seriously looking. For this reason, COVID-19 couldn’t derail some of these big decisions.

In the US, almost everybody has an EHR at this point, but we’re still always a little amazed at how many decisions there are and how much churn there is in the market. We always think we’re going to eventually run out of new decisions to review and that health systems will settle in and start doing other things, but then the market still keeps going. We saw interesting changes as we collected and analyzed the data for this year’s 2021 US Hospital Market Share report.

A Significant Gap

Looking at the wins and losses by vendor, Epic has the biggest lead in net growth compared to other vendors. Though this is not a record for the most hospital contracts ever won in a year, it’s the most significant gap we’ve seen at KLAS in all the years we’ve been doing this. This speaks to the consistency Epic has built out across their tool set for the large organizations that continue to choose them.

 At the 50,000-foot view, Epic’s accomplishment in such an unprecedented year stands out. It will be interesting to see whether the organizations going with Epic were somehow able to handle COVID-19 pressures better, but we have no idea whether that was a factor at this point. It will take time to understand whether the gap between Epic and the others was impacted by the pandemic or something else.

Large Versus Small Decision Drivers

When you think about large versus small hospitals, there are some big shifts in motivation as far as large hospitals go. These drivers remained the same during the pandemic.

Large Hospital and IDN Drivers

For enterprise decisions, it often comes down to getting a solution that helps organizations bring most of their data in one place for better transparency. Second only to clinical capability, data aggregation can trump almost any other consideration. Epic has driven the highest integration satisfaction for several years, and that bleeds over into interoperability.

Midsize and Small Drivers

In smaller settings, there are fewer interfaces to work with. For example, smaller clinics could set up an interface with their pharmacy and maybe set up a working relationship with the hospital they refer patients to. Managing those interfaces is far less complex than the many interfaces larger hospitals manage. Integration is still important in the small space, but it is not as big of a pain point as it is for large organizations.

These markets instead focus on the right budgetary option, and rightfully so; cost is a much bigger deal on the smaller, community side. Rural hospitals close their doors every year because they can't justify the dollars and cents any longer. If they can decrease costs by lumping together other enterprise pieces, that's a win.

The other big consideration on the small side of the space is physician retention. It can be a challenge to get talent and then retain that talent. Having good technology that physicians like to use plays an important role.

Cerner’s Reach

Cerner has had the upper hand in the small community market for the past several years. When you look at the solution, several factors stand out. One, it’s a proven clinical system with a broad reach. Two, it’s presented in a format that helps control the costs. They simply have managed to tailor their solutions to the drivers that matter in the small space. No one else has been able to reach the market in the same way thus far.

However, it’s worth mentioning that the community market is also more competitive than any other market. Historically, it has been an afterthought for most bigger vendors. So, smaller hospitals have many more options to consider, depending on their priorities. MEDITECH is also a solid competitor there.

US Hospital Market Predictions

The potential for disruption in the US EMR market is there—some of these bigger vendors have questions swirling around them that could change the outlook. These include the following:

• What impact will Allscripts have on the smaller market as they start to shift their focus there?
• MEDITECH is doing well in the midsize and small space, but can they win the confidence of some bigger organizations to become more competitive in that setting?
• Can Cerner figure out their revenue cycle piece?

As those questions are answered, it’s going to throw big rocks in the pond and cause all kinds of waves that we just can’t see right now.

The other possibility is something that’s constantly on the rumor mill. Some of the larger healthcare IT vendors have tried getting into the EMR space for years, and these vendors have ultimately struggled. But there could be one that might work. Will someone like a patient engagement vendor get involved and shake up the market? Or will they just stay on the outside?

We encourage you to read the report to get a more complete overview of the vendors and the updates in the EMR market.

Photo credit: Costello77, Adobe Stock