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European EMR 2018

European EMR 2018

Authored by: Everton Santos and Jon Christensen August 22, 2018 | Read Time: 5  minutes

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Europe has one of the most dynamic and competitive EMR markets in the world, with active tenders in nearly every region. Amidst this activity, multiregional vendors are becoming more prevalent, forcing regional solutions to redefine themselves in order to stay relevant. To determine which vendors are best meeting current customers’ expectations and needs, this report examines KLAS market share data as well as performance feedback gathered in 100+ interviews with decision-makers at customer organizations in 12 European countries.

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Multiregional Vendors Perform Stronger: Epic Leads, Followed by Cerner and Allscripts


Multiregional vendors are more consistent in offering a positive overall experience than the regional vendors in this report. Epic has grown rapidly in market share (especially among larger academic and regional organizations in the Netherlands and Scandinavia), while hitting timelines and maintaining strong customer relationships. While generally pleased, customer leadership admits that Epic’s approach can feel somewhat US-centric, and one recent implementation has struggled to get end-user buy-in. As Cerner has grown (primarily in the UK), they have strengthened relationships while delivering new functionality; however, the experience is not consistent across all customers. Allscripts’ recent implementations have progressed quickly and successfully; overall development and localization have been slow.


overall performance vs recent hospital wins

estimated european market share

InterSystems’ Rapid Growth Creating Serious Delivery Challenges


From 2012–2017, more European hospitals (including both public and private hospitals) came under contract with InterSystems than with any other vendor. This growth expanded the already-large InterSystems customer base, which is anchored by InterSystems’ framework contract in Scotland. Growing pains stemming from this rapid growth have resulted in missed implementation timelines, slow delivery of promised functionality, and a lack of localized functionality for country-specific editions of TrakCare, making Europe InterSystems’ lowest performing region globally. In 2017, InterSystems slowed sales efforts in Europe in an effort to address these challenges; UK and French customers have yet to report improvements. Italian customers do not report the same challenges.


ChipSoft Strongest Regional Vendor; DXC Technology and Medasys Falling Behind

Better than any other regional solution measured, ChipSoft has kept pace with the multiregional vendors in development, technology, and customer satisfaction. However, unlike other EMR leaders in Europe, ChipSoft does not foster strong customer relationships. DXC Technology and Medasys are falling behind in support and development. DXC Technology’s UK-specific Lorenzo platform has performance and usability challenges, and delivery of promised functionality has lagged.


support and service vs quality and development

Medasys expanded their portfolio, but as resources have shifted, support has declined, leading to a large backlog of tickets, some of which go unresolved for months or even years. Agfa HealthCare and Cambio are also slower in development, though customers are more positive about their overall experience.


european regions

European EMR Decisions Hotly Contested—Epic, InterSystems, and Agfa HealthCare Have Seen Most Growth

When it comes to EMR decisions and market share, healthcare provider organizations are looking more and more to multiregional vendor platforms. Available in a wide number of languages, Epic and InterSystems have grown the most thanks to their broad functionality. Cerner Millennium’s flexibility and broad language support have resulted in slower, albeit steady, growth. Agfa HealthCare ORBIS is somewhat unique among the regional EMRs in that the solution continues to transcend borders and languages. New customers have selected it in multiple countries in Central Europe and in France.

top six selected vendors

Most regional solutions, except DXC Technology’s xHIS and HCIS, have not been as successful in branching out. ChipSoft grew rapidly in the Netherlands, but decisions there have dried up, and ChipSoft has struggled to expand to Belgium, let alone outside the Benelux Union. DXC Technology’s Lorenzo has not been selected by any new customers in the UK since 2016. Scandinavian suppliers Cambio and Tieto have been slow to develop and have not signed any new EMR customers for several years.


UK and Ireland

Cerner Most Consistent; MEDITECH, Allscripts Excel with Their Small Bases

Performance among Cerner, DXC Technology, and InterSystems—the three largest EMR suppliers in the UK and Ireland—is diverging. Cerner has handled their growth best, improving the customer experience through hosting and stronger relationships post-NPfIT. DXC Technology and InterSystems have struggled. DXC Technology has missed development timelines and releases for Lorenzo, which has performance and usability challenges. InterSystems has also missed timelines, and recent implementations have had major challenges—some feel TrakCare’s UK edition is not yet fully baked. MEDITECH and Allscripts perform highly for their limited customer bases. Recent Allscripts SCM go-lives have gone relatively smoothly, and Allscripts has strengthened their regional resources. MEDITECH has helped customers drive deeper adoption by helping them personalize workflows.


regional performance ratings united kingdom

Central/Western Europe

Central/Western Europe Seeking Strong Performers—Cerner Stepping Up

Most provider organizations in Central/Western Europe use regional EMRs, though multiregional vendors are present and their influence is felt. For example, Medasys is expanding their portfolio to compete with multiregional vendors, though this has led to unfinished modules and delayed responses to support requests. Agfa HealthCare’s ORBIS is flexible and is being evolved to meet the specific needs of various countries. Ongoing development is slower than desired, and support can be hit or miss. Cerner has strong relationships with their limited number of Millennium customers, who feel the system is powerful and robust. However, Cerner is slow responding to regional requests. French InterSystems customers also report issues with slow responses to requests and say that their TrakCare edition doesn’t meet all local needs. Epic signed their first contracts in Belgium (French) and Switzerland (German) in 2017.


regional performance ratings central western europe

Benelux/Scandinavia

Epic on the Rise; ChipSoft Developing; Cambio Falling Behind

Provider organizations in Scandinavia are selecting Epic for the clinical functionality and portfolio breadth, which exceeds that offered by fading regional solutions such as DIPS (Norway) and CGI (Finland). Other regional vendors ChipSoft (Netherlands), Cambio (Scandinavia), and Tieto (Finland) are redefining themselves to try to keep pace. With their highly fit-for-purpose Dutch EMR, ChipSoft has best matched Epic’s development. However, weak customer relationships and perceived executive-level arrogance are challenges, and ChipSoft has struggled to expand beyond the Netherlands. Cambio is broadly used in various care settings, including inpatient, outpatient, and community settings; development has been slower than customers would like. Tieto (not rated) is working on a platform migration that is behind schedule and struggling. Cerner recently signed their first Millennium customers in Belgium (2017) and Sweden (2018). DXC Technology has signed two customers on Care Solutions since 2016.


regional performance ratings benelux scandinavia

Southern Europe

KLAS only has performance data on InterSystems in Italy. Strong relationships and highly customized TrakCare environments make this InterSystems’ strongest performing region in Europe.

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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. © 2020 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.