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Canada EMR 2020
Comprehensive Vendor Performance and Market Share Overview
Author
Everton Santos
Author
Jonathan Christensen
From 2015–2019, 22 EMR purchase decisions were finalized in Canada, representing 50+ organizations. Many of these decisions—which impacted 175+ inpatient facilities—were group or even provincial decisions made by organizations looking to achieve economies of scale and lower costs by pooling their collective resources. This report—focused mainly on English-speaking regions—is KLAS’ first report solely on Canada’s EMR market. It highlights which vendors are gaining market share and which are best meeting customer needs. Market share data includes contracts signed through December 31, 2019; decisions made in 2020 are excluded. Customer satisfaction insights come from interviews with 37 individuals using go-forward platforms at 28 healthcare organizations.
Epic and MEDITECH Selected Most Frequently in Recent Decisions; Allscripts Considerations Dwindling
Epic has grown significantly in Canada since 2015, becoming the preferred option in large, multihospital decisions. From 2015–2019, seven decisions finalized in favor of Epic, increasing their market share in the country from a single hospital to over 130 and making Epic the second largest EMR vendor in Canada in terms of hospitals contracted. MEDITECH has a long history in Canada and is the largest EMR vendor in terms of hospitals contracted. 31 of the 35 hospitals (19 organizations) that chose MEDITECH’s Expanse platform from 2015–2019 were migrations from legacy MEDITECH systems, some as part of group decisions. These customers chose to gain the updated physician interface of MEDITECH’s latest platform while retaining the familiarity of working with MEDITECH. However, MEDITECH’s overall market share in the country has dropped—8 other organizations (including 4 larger multihospital organizations and accounting for 88 hospitals) chose to leave (most moved to Epic). Cerner is the only other vendor with a significant footprint in Canada. From 2015–2019, they were selected in 2 decisions (accounting for 9 hospitals). Allscripts’ Sunrise platform has been used in Canada for over a decade. However, no hospitals have selected it in the last 10 years, and 3 customers have replaced it in that time period.
Epic Excels in Implementations and Partnerships
Seven of Epic’s Canadian customers are live (three more signed in 2020 and are now implementing; these wins fall outside this report’s 2015–2019 time frame). Live clients report strong partnerships that start at implementation. While Epic’s big-bang methodology is seen by some as inflexible, it comes with strong guidance, collaboration, and best practices that customers say enable deep clinical adoption from go-live. Epic’s earliest Canadian customers initially reported having to educate Epic on the Canadian market, but customers no longer voice this concern, saying Epic has made a concerted effort to better understand customers in Canada and be more responsive to country-specific needs.
MEDITECH’s Revamped Expanse Interface a Win; Delivery Inconsistent
MEDITECH’s latest platform—Expanse—offers a new tablet-based physician interface for their web-based acute care, ambulatory care, and ED modules. Customers eagerly anticipate the release of the nursing module, Expanse Patient Care (it is currently in beta and is expected to be generally released in mid-2021), and a future revamp of the administrative modules. Though customers are pleased with the technology itself, MEDITECH’s execution of the Expanse rollout has been inconsistent.
Customers who report more successful implementations say their organizations took more personal ownership for driving their project forward and making sure requests didn’t fall through the cracks. Less satisfied customers say MEDITECH was not proactive in providing guidance and best practices during the implementation or preparing customers for the system’s post-go-live maintenance requirements. Success has been hampered in a few cases by stability challenges and a buggy release. While MEDITECH requires customers to work with a READY-certified consultant—either Navin, Haffty & Associates (who recently joined forces with Engage) or Healthtech Consultants (acquired by Nordic in 2019)—these consultants have not fully filled the strategic gap that customers expect MEDITECH to fill, and while helpful, these firms’ involvement has not guaranteed customer success.
Cerner’s Overall Performance Stable; Perceptions of the Product Declining amid Limited Access to Updates
Overall satisfaction among Cerner’s Canadian customers has changed little over the past three years. Customers describe the solution as robust and comprehensive and feel they have a good relationship with Cerner. The support meets most of their needs and has been helpful during the COVID-19 pandemic. However, customers are less enthusiastic as they consider the future—the Citrix-heavy, client/server footprint is resource intensive to maintain, and organizations would like a lighter, less resource-intensive option. Customers acknowledge recent development to the cloud-based HealtheIntent platform, though this platform has had limited uptake in Canada to date. Slow customer uptake of recent developments and the fact that some organizations are still rolling out functionality years after initially going live has left some customers feeling they do not get full value from the solution. Cerner now offers a remote hosted option in Canada—a unique offering in the country; it requires fewer customer resources, and users report a good experience.
About This Report
Data for this report comes from two sources: (1) KLAS performance data and (2) KLAS market share data.
KLAS Performance Data
Each year, KLAS interviews thousands of healthcare professionals about the IT products and services their organizations use. These interviews are conducted using a standard quantitative evaluation, and the scores and commentary collected are shared in reports like this one and online in real time so that other providers and IT professionals can benefit from their peers’ experiences.
The performance data in this report was collected over the last 18 months. The number of unique responding organizations for each vendor is given in the chart below.
What Does “Limited Data” Mean?
When measuring customer satisfaction, KLAS requires that the sample size for any given product reach certain thresholds before data can be reported on. In research dedicated to a specific region, such as Latin America, sample sizes of 6 or higher are considered fully rated, and sample sizes of 3–5 are marked as limited data, via an asterisk (*) or other indicator. If the sample size is less than 3, no score is shown. There are a variety of reasons that sample sizes may be small—e.g., some products are used in only a small number of facilities, and some vendors are resistant to providing client lists. Additionally, it should be noted that a vendor’s sample size may vary from chart to chart as some respondents choose not to answer particular questions. Note that when a vendor has a low number of reporting sites, the possibility exists for KLAS scores to change significantly as new surveys are collected.
Overall scores are measured on a 100-point scale and represent the weighted average of several yes/no questions as well as other questions scored on a 9-point scale.
KLAS Market Share Data
In addition to the customer satisfaction data described above, KLAS also tracks market share and buying trends for the global EMR market.
How Is EMR Market Share Measured?
The market share data reported in this study is based on hospital EMR purchasing trends published in KLAS’ global market share reports. It indicates market share status as of December 31, 2019, and does not include details on contracts signed in 2020 (though some historical market share data was adjusted as new information came to light during KLAS’ research for this current report). A simplified version of KLAS’ market share methodology is outlined below. For the full methodology, please see “Global (Non-US) EMR Market Share 2020.”
In this report, any given vendor’s EMR market share is defined as the total number of inpatient hospital facilities—as opposed to organizations, which may be comprised of multiple hospitals—whose most recent contract is with that vendor. For example, if a vendor signs a contract with a four-hospital organization, that vendor’s market share would increase by four. KLAS acknowledges that in some countries, the term “hospital” may be used to refer to an organization with multiple inpatient facilities. However, in this report, “hospital” is used to refer to a single inpatient facility.
At any point in time, only one EMR company can be recognized as a hospital’s most recently contracted vendor. When a hospital contracts with a new EMR vendor, the change is considered a “win” for the new vendor and a “loss” for the incumbent vendor (if one existed). In this report, a win does not depend on the legal status of a contract or on whether a provider organization is a paying customer. Additionally, while KLAS tracks vendor losses, these losses are not shown in charts in this research since many hospitals outside the United States are moving from paper or from a conglomeration of best-of-breed departmental systems to an enterprise platform. Where relevant, losses will be commented on in the text.
What Counts as an EMR?
The EMR is the core record used by hospitals for day-to-day clinical tasks, such as clinical noting and documentation, ordering, results reporting, and ePrescribing. Some systems in this research may not include all of these clinical functions, but they are all viewed by their users as their core patient record. Solutions used solely for document management or scanning are excluded from this research, even though they are the primary clinical system in use at some hospitals.
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.