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European EMR 2022 European EMR 2022
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European EMR 2022
Which Vendors Meet Customer Needs in a Rapidly Shifting Landscape?

author - Eder Lagemann
Eder Lagemann
author - Jonathan Christensen
Jonathan Christensen
author - Sidney Tate
Sidney Tate
April 5, 2022 | Read Time: 11  minutes

In the past few years, there has been significant merger and acquisition (M&A) activity among EMR vendors who market in Europe as well as significant purchasing activity by healthcare organizations, creating one of the world’s most dynamic EMR markets. From 2016–2020, KLAS validated over 300 EMR decisions impacting over 1,200 inpatient facilities (comprehensive data for 2021 purchases not yet available). Using this data and customer feedback from 100 organizations, this report examines the customer satisfaction, market share, and recent market energy of European EMR vendors and evaluates which are best meeting customer needs in this competitive market.

european subregions

Dedalus & CompuGroup Medical Increase Market Presence via Acquisitions; Cerner Shifts Strategies

With nearly twice as many inpatient facilities as any other vendor, Dedalus has emerged as the market share leader in Europe, thanks in large part to multiple recent acquisitions—Medasys in 2018, Web100T in 2019, some of Agfa HealthCare’s solutions across various markets in 2020 (including the ORBIS EMR), and DXC Technology in 2021. From 2016–2020, Dedalus’ portfolio of acquired and self-developed platforms saw more growth than any other vendor’s, winning a total of 240 hospitals, primarily within France, Italy, and the DACHL region. CompuGroup Medical acquired two platforms from Cerner in 2020—the Selene platform (Spain) and the medico platform (DACHL). These acquisitions put CompuGroup Medical in second for number of contracted hospitals as of December 2020, greatly strengthening their position in the DACHL region and marking their entrance into Western Europe. Cerner divested the two aforementioned platforms as they shifted their focus in Europe to the Millennium PowerChart and platforms. They likewise narrowed which countries they market the Millennium platform to; it remains to be seen how Oracle’s acquisition of Cerner will impact their European EMR strategy. Throughout these changes, the Millennium and customer bases have continued to grow, and at the end of 2020, Cerner was third in Europe for number of contracted hospitals.

european hospital wins and migrations 2016 through 2020

Softway Medical & Epic See Most Organic Growth in Europe

Vendors with significant M&A activity aren’t the only ones who have seen growth. French vendor Softway Medical had the second most hospital wins from 2016-2020, all within France. They have grown their customer base consistently, gaining an average of 39 hospitals per year. They are used by both private and public organizations and have seen recent growth due to being selected by multiple regional hospital groups—groupements hospitaliers de territoire (GHTs). Epic has more than doubled their European customer base in the last three years, thanks to finalizing several large contracts in the UK in 2020. Other deals have expanded Epic’s presence into Northern Europe and the DACHL region.

Multiregional Vendors Epic & Cerner Deliver Strong, Consistent Experience; Telekom Leads among Regional Vendors 

In Europe, multiregional vendors see the highest customer satisfaction. Epic’s robust solution and close partnerships, particularly during the pandemic, have fostered satisfaction and loyalty among customers, giving Epic the highest overall score in Europe. Most respondents appreciate Epic’s commitment to developing and improving their EMR, though some customers in Northern Europe would like Epic to improve the ongoing training. Both of Cerner’s platforms— in the DACHL region and Millennium PowerChart in the UK—are rated above average for European EMRs. Respondents in multiple subregions appreciate the platforms’ quality and ability to drive outcomes, and UK respondents report stronger partnerships from Cerner in recent years. All customers would like Cerner to more quickly develop functionality specific to their respective subregion.

Germany-based Telekom Healthcare Solutions is the only regional vendor to compete closely with the multiregional vendors in terms of customer satisfaction, thanks to their strong support and system flexibility. Dedalus’ acquired platforms perform below average. Because many of these were recent acquisitions, it remains to be seen whether Dedalus will improve the customer experience; for now, customers still encounter difficulties.

overall performance score

UK, Ireland, and Channel Islands

Cerner Drives Outcomes amid Growth; Epic Rapidly Expands Regional Presence; InterSystems Improving after Growing Pains

regional performance energy and presence uk ireland and channel islandsSince 2016, Cerner and Epic have had the most new wins in the UK. According to early market share data, 2021 was Cerner’s strongest year for new wins (not charted), and in 2020, Epic quintupled their hospital base. Allscripts and System C saw small but consistent growth from 2016–2020 (each winning one or two deals annually), while InterSystems and Dedalus (DXC Technology) Lorenzo have seen little to no growth since 2016.

Cerner is the highest performing of the fully rated vendors in the subregion, and respondents note improvements to the user experience as well as Cerner’s partnership and focus on the UK market. Millennium PowerChart drives positive outcomes, though customers continue to want faster development of the user interface and advanced technologies. While Allscripts customers report their platform provides core functionalities, some say Allscripts focuses on sales more than customer outcomes. InterSystems customers—particularly in Scotland—mention the vendor has hired a deeper bench of knowledgeable staff to address issues with resource bandwidth and expertise. This has resulted in improved responsiveness and upgrades. Though improving, InterSystems sometimes fails to hit timelines, and several English organizations have terminated their implementations due to unmet workflow and functionality expectations. Epic, MEDITECH, and Dedalus Lorenzo all have limited data in this subregion. All Epic respondents are highly satisfied with their experience and Epic’s tight partnerships. MEDITECH’s platforms are seen as providing high value for the price, and Expanse customers are satisfied with the web-based solution’s interface. Dedalus Lorenzo clients report significant frustrations, and most are looking for other options.


Dedalus Leads in Market Share; Telekom & Cerner Drive Quality Customer Experience 

regional performance energy and presence dachlIn 2020, Dedalus entered the DACHL market through their acquisition of ORBIS, and CompuGroup Medical strengthened their position in the subregion by purchasing medico from Cerner. CompuGroup Medical has also seen organic growth via their CLINICAL platform, thanks to a large 2019 deal in Austria. Meierhofer and CISTEC likewise have grown organically—Meierhofer with moderate, consistent growth in Germany, and CISTEC with smaller, consistent growth in Switzerland.

Germany-based Telekom Healthcare Solutions leads in performance among fully rated vendors. Customers say the vendor facilitates a supportive relationship and plans enhancements to meet their needs. The enhancements sometimes take longer than preferred and are delivered as new products that require a costly implementation. Dedalus ORBIS customers enjoy working with account representatives with strong expertise. They are disappointed with the solution’s low performance, citing integration, pricing, and mobile app development as areas where they most want to see improvement. Customer satisfaction has been consistent since the Dedalus acquisition of ORBIS in 2020. The limited number of Cerner respondents appreciate the solution’s quality, integration, and functionality. They would like Cerner to adhere to a development schedule for the platform and enhance features like the user interface. CompuGroup Medical medico has a long history in the area. The limited number of respondents want to see faster enhancements and fewer unexpected costs.

Benelux/Northern Europe

Epic’s Strong Partnerships Positively Impact Customer Satisfaction; Many ChipSoft Customers Feel Stuck

regional performance energy and presence benelux northern europeChipSoft and Epic hold the majority of the market in the Netherlands, and recent deals have allowed ChipSoft to move into Dutch-speaking Belgium. In Northern Europe, few outstanding tenders remain after large decisions were finalized between 2016 and 2020, through which Epic and Cerner made inroads against local suppliers. Of the local suppliers, Swedish vendor Cambio and Danish vendor Systematic have maintained their ground.

Epic leads in performance thanks to strong partnerships and collaboration around future developments. Customers want better training so they can leverage the product’s features. Customers of Netherlands-based ChipSoft are frustrated with the vendor’s lack of responsiveness. Many feel stuck and believe ChipSoft is not motivated to address customer concerns. Additionally, respondents feel the vendor doesn’t partner with them or accept input on future enhancements. Customers of Cambio say upgrades take longer than preferred, and because they sometimes have bugs, respondents want Cambio to check data quality before rolling out upgrades. The vendor recently announced they will be moving away from their COSMIC platform and developing a new platform.

Western Europe

Softway Medical Leads French Market in Recent Wins; Various Challenges Drive Low Satisfaction among InterSystems & Dedalus Customers

regional performance energy and presence western europeFrench vendor Softway Medical saw the most purchasing energy in France from 2016–2020, thanks to their web-based and cost-effective EMR. They won more than twice as many hospitals as any other vendor in the subregion, and much of this is due to being chosen in several new GHT decisions. Other vendors have benefitted from GHT consolidation decisions, particularly Dedalus (DxCare and ORBIS platforms), Maincare Solutions, SIB, and Hopsis, all of whom have maintained steady growth in Western Europe. Cerner continues to support Millennium customers in the subregion, though they no longer actively market any products in France and market only in Spain.

A variety of difficulties contribute to low customer satisfaction with Dedalus DxCare, InterSystems, and Dedalus (DXC Technology) xHIS. Dedalus DxCare customers appreciate the system’s configurability but report challenges with basic functionalities and slow development. InterSystems customers in France report frustration with the vendor’s unkept promises regarding up-to-date functionality, along with their lack of responsiveness. These perpetual issues have driven multiple organizations to consider options for a new EMR. Before being acquired in 2021, customers of Dedalus xHIS in Spain reported poor relationships with DXC Technology. The support structure was lacking, and it was difficult to get problems resolved. It remains to be seen whether Dedalus will improve the customer experience.

Southern Europe

InterSystems Delivers Strong Product & Relationship; Dedalus Expands Large Customer Base 

regional performance energy and presence southern europeKLAS has limited visibility into EMR decisions in Southern Europe, aside from the Italian market, which is largely dominated by Dedalus and InterSystems. Across various platforms, Dedalus has the larger customer base of the two in Italy. Their presence has grown consistently year over year as they have added net-new clients and migrated others to their newer platforms (e.g., C4C, Tabula Web App). InterSystems saw a significant uptick in the country in 2020—the Veneto health region selected TrakCare EPR, more than doubling InterSystems’ number of contracted hospitals.

Italy is InterSystems’ highest-performing subregion in Europe, with customers reporting strong relationships and proactive service. Additionally, respondents say the customizable TrakCare EPR meets most of their needs.

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 solutions and services their organizations use. For this report, interviews were conducted over the last 18 months using KLAS’ standard quantitative evaluation for healthcare software, which is composed of 16 numeric ratings questions and 4 yes/no questions, all weighted equally. Combined, the ratings for these questions make up the overall performance score, which is measured on a 100-point scale. The questions are organized into six customer experience pillars—culture, loyalty, operations, product, relationship, and value.

customer experience pillars

Sample Sizes

Sample sizes displayed throughout this report (e.g., n=16) represent the total number of unique customer organizations interviewed for a given vendor or solution. However, it should be noted that to allow for the representation of differing perspectives within any one customer organization, samples may include surveys from different individuals at the same organization. The table below shows the total number of unique organizations interviewed for each vendor or solution as well as the total number of individual respondents.

Some respondents choose not to answer particular questions, meaning the sample size for any given vendor or solution can change from question to question. When the number of unique organization responses for a particular question is less than 6, the score for that question is marked with an asterisk (*) or otherwise designated as “limited data.” If the sample size is less than 3, no score is shown. 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.

KLAS Market Share Data

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.

about this report

Hospitals that have contracted for a new EMR normally continue to use their previous system for one or more years before/after going live with a new one. During this time, the hospital might be considered a customer of both vendors, but only the most recently contracted vendor receives market share credit in this report. Likewise, there may be a space of time between when a previous vendor’s contract ends and a new contract is formalized. In these cases, the previously contracted vendor is recognized as the current vendor until the new agreement is formalized. However, healthcare organizations have the final say on their own status, so in rare cases when an organization has directly informed KLAS of a decision, a win might be counted before a contract is legally signed.

In cases where two or more healthcare organizations join together to make an EMR purchase decision, KLAS regards the decision as a single contract even if multiple contracts are signed with each participating entity because there was a single, collective decision-making and selection process.

Where Does Market Share Data Come From?

The market share data reported in this study is based on hospital EMR contracts that were in place in European countries as of 31 December 2020. In some cases, the text in this report refers to Cerner’s 2021 hospital wins in the UK to provide necessary context; however, these counts are not included on any charts. Additionally, the market share counts for DXC Technology as of 31 December 2020 are included in the counts for Dedalus even though Dedalus’ acquisition of DXC Technology was finalized in 2021.

The data comes from multiple sources, including publicly available information and the numerous conversations KLAS has each year with healthcare organizations around the globe. KLAS also provides vendors with the opportunity to report their annual hospital EMR wins. In all cases, KLAS makes a best-effort attempt to use third-party sources and our vast network of healthcare organization connections to independently validate all recently signed EMR contracts. While KLAS believes the data in this report is directionally correct, we acknowledge that some variation may result from lack of vendor transparency/participation.

A Note about Terminology and What Counts as an EMR

Though the nomenclature used to describe the core patient record used throughout a hospital varies from region to region or language to language (e.g., EHR, EPR, EMR, EPD, EPJ, DPI, KIS, HCE, PEP, etc.), the term that will be used in this research is EMR (electronic medical record).

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.

Additionally, the term “vendor” is used throughout this report to refer to the company supplying the EMR technology. KLAS recognizes that different countries may have different terminology, including “supplier.”

author - Sarah Hanson
Sarah Hanson
author - Madison Moniz
Madison Moniz
author - Jill Wilcock
Project Manager
Jill Wilcock
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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. © 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.

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