Global (Non-US) EHR Market Share 2024
Large Regional Decisions Impacted a Broad Number of Hospitals

Dedalus Adds the Most Beds; Epic Has Most Hospital Wins & Largest Global EHR Market Share among Measured Vendors

Dedalus had a strong year and was selected in the largest number of contracts thanks to high energy and increased investment in the Italian market, where numerous health systems (including three large regional groups) moved to the modular C4C platform. In Latin America, the go-forward Dedalus Care platform received its first clients, including a public ministry in Panama. Across all regions, over 30,000 beds were impacted by EHR decisions in Dedalus’ favor. Epic had the most new hospital wins in 2023, thanks primarily to two contracts finalized in Canada and Australia. The state of New South Wales (NSW) contracted to implement Epic in 191 hospitals (most are replacing Oracle Health). Including their US market share, Epic now has the largest total EHR market share (by number of hospitals) of any vendor in this research. Oracle Health—who gained the third-highest number of hospitals—was selected in a relatively high number of new decisions. They continue to have a strong presence in Canada, where the province of Nova Scotia selected them, and in the UK, where several large trusts contracted with them. A large private group in the Middle East also selected Oracle Health. In Ontario, an existing MEDITECH client migrated to Expanse, and the vendor also had wins in the private sector among multihospital groups in Australia, Ireland, Kenya, and Tanzania.

Europe

Large Decisions Finalized for Dedalus, CompuGroup Medical, Hopsis & Softway Medical

France

GHTs continue to significantly drive EHR activity, as over half of the hospitals impacted by purchase decisions in France are tied to a GHT. The three major GHT decisions finalized in 2023 went in favor of Hopsis. Softway Medical and Dedalus were also selected for expansions within a GHT; outside of this, most of these vendors’ purchase energy was in the private sector—a departure from previous years. Additionally, Nexus AG was selected by a small private group, and an ESPIC (établissement de santé privé d’intérêt collectif) migrated to InterSystems.

UK & Ireland

EHR investment in the UK ramped up in the past year. Although EHR consolidation across integrated care systems (ICSs) is frequently discussed, most finalized decisions were made by trusts that had no enterprise EHR in place. Of the five public trusts that made decisions, four selected Oracle Health (two will connect to instances from neighboring trusts). In Ireland, two maternity hospitals joined the Oracle Health maternity record program. MEDITECH had an active year in the private sector—two groups in Ireland and one in England selected the vendor. The other public trust in England that made a decision selected System C. A private group in England chose to extend IMS MAXIMS to three small hospitals.

Northern Europe & Benelux

The Netherlands was the most active country across Northern Europe and Benelux thanks to purchase energy from rehab groups. ChipSoft was selected by two such groups for their inpatient environment. Another two rehab groups migrated to the go-forward platform from local vendor SDB Groep (who acquired Avinty). Two acute care hospital groups also made decisions—a three-hospital group selected ChipSoft and a large university hospital selected Epic (both replacing Oracle Health i.s.h.med). In Luxembourg, due to canceled contracts with French vendor Maincare, two groups opted to revert to their existing solutions from Dedalus and Oracle Health. Additionally, a wellbeing services group in Finland chose Tietoevry.

Asia/Oceania

Epic Most Widely Contracted Vendor in Oceania after NSW Selection; Kranium & IQVIA Selected by Private/Nonprofit Groups in Asia

Latin America

MV & Philips Led in Brazil; Dedalus Selected in Panama & Peru

Canada

Middle East/Africa

Oracle Health & Health Insights Selected in Middle East; MEDITECH, SIB & Dedalus Chosen in Multihospital Decisions in Africa

About This Report

A Note about Terminology and What Counts as an EHR

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 EHR (electronic health record).

The EHR 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 EHR technology. KLAS recognizes that different countries may have different terminology, including “supplier.”

How Does KLAS Measure EHR Market Share?

In this report, any given vendor’s EHR 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, such as Spain and the Netherlands, 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 company is recognized as the most recently contracted vendor for a hospital. KLAS considers a change in a hospital’s most recently contracted EHR vendor 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 charted 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. KLAS will comment on losses in geographies where relevant.

Hospitals that have contracted for a new EHR 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, provider 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.

When measuring market share, KLAS counts any facility that offers inpatient services. Most of the contracts discussed in this report were made by general acute care hospitals, including community hospitals and facilities offering sub–acute or step-down care services (as long as those facilities have overnight inpatient beds). However, this research also includes some EHR decisions made by inpatient rehabilitation facilities, specialty acute care facilities (e.g., for oncology, pediatrics, or ophthalmology), and inpatient psychiatric hospitals. Outpatient facilities, urgent care centers, day hospitals, and residential treatment facilities are excluded. Below is a breakdown of 2023 EHR purchasing by hospital type.

In cases where two or more healthcare organizations join together to make an EHR 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. In 2023, decisions of this nature occurred in Australia, Canada, France, Germany, and Italy.

Types of Wins

KLAS places newly contracted hospitals into various categories. Multihospital organizations and standalone hospital organizations that switch to a vendor not previously in use at the organization are counted as “net new” wins. “Add-on” wins occur when an existing customer extends their EHR contract to an additional hospital within the organization. Often, these add-on wins come about as the result of acquisitions/mergers, newly constructed hospitals, or organizations consolidating from two or more EHRs to a single solution.

Contract changes in which an organization stays with their current EHR vendor but moves to another platform from that vendor as their go-forward solution (usually requiring sizable build/implementation effort) are noted where applicable but are not included in a vendor’s overall wins. Often, these decisions are complete platform migrations, though in some cases the organization may move forward with functionality from both platforms. For simplicity’s sake, KLAS refers to all such decisions as “migrations,” regardless of whether other vendors were also considered or how competitive that decision may have been. In this report, the following vendors all had at least one customer migration: CompuGroup Medical (CGM KIMSYSTEM to CGM REHA), Dedalus (DOPASYS to Care4U; Galileo or Tabula Clinica to C4C; xHIS or MedView to Dedalus Care/MedView Evo; Argos to wHospital), ezCaretech (BESTCare 1.0 to BESTCare 2.0), InterSystems (Clinicom Médical to TrakCare), MEDITECH (C/S or MAGIC to Expanse), MV (Hospidata to SOUL MV), and Philips Tasy (Delphi-based solution to Java/HTML5 code base). Customers who upgrade their current system or re-sign with their current vendor to extend the length of their existing contract are also excluded from a vendor’s overall wins, though they are presented in the vendor’s market share counts in applicable markets.

Geographic Regions 

The overarching geographic regions used in this report are based—with some variation—on the United Nations’ geographic regions. Since all EHR purchases in Northern America in the past nine years have occurred in either Canada or the United States and since this report excludes US market share data, the UN’s designation of Northern America has been replaced with the KLAS region of Canada. EHR purchases for overseas territories are discussed in the sections for their respective geographic regions (as defined by the UN) and are not grouped into counts for the overarching country (e.g., American Samoa, Puerto Rico, Guam, and the Virgin Islands for the US; British Virgin Islands, Falkland Islands [Isla Malvinas], and other British Overseas Territories for the UK; French Guiana, Guadeloupe, Martinique, Mayotte, Réunion, and Saint Pierre and Miquelon for France; Curaçao for the Netherlands; etc.). For more details on the US EHR market, please refer to KLAS’ annual US hospital EHR market share report.

Vendors that are widely considered by provider organizations in multiple regions and have a significant number of validated customers in at least two regions are labeled as “multiregional.” Vendors whose customer base is heavily skewed toward a single region are designated as “regional” and grouped by region. These designations are re-evaluated annually. In this year’s report, KLAS shifted ezCaretech to be a regional vendor (Asia), removing the vendor’s multiregional designation as they have not had significant growth outside of Asia in the past five years.