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Global (Non-US) EMR Market Share 2019 Global (Non-US) EMR Market Share 2019
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Global (Non-US) EMR Market Share 2019
Large Public Tenders Shape 2018 EMR Landscape

author - Everton Santos
Everton Santos
author - Jonathan Christensen
Jonathan Christensen
May 2, 2019 | Read Time: 7  minutes

In 2018, over 180 healthcare organizations outside the United States made EMR purchase decisions—impacting 377 hospitals (303 new wins, 74 migrations). Though public tenders represent just 5% of the contracts signed, they account for over a quarter of the hospitals impacted. Examining these and other EMR decisions, this report aims to determine how EMR vendors fared in 2018 so that organizations looking to buy know what their peers are selecting.

Epic and Cerner Contracts Account for the Most New Beds among Multiregional Vendors

Epic’s 2018 contracts were some of the largest in scope, accounting for more new beds than any other vendor. The majority of these beds came from a regional decision in Singapore in which Epic was chosen as the go-forward vendor in two of the country’s three integrated healthcare clusters. In total, Epic signed four new contracts (across three regions), one of their lowest totals in recent years. Cerner was selected as the go-forward platform by two counties in Sweden who will be migrating to Millennium from a legacy Siemens solution. These decisions represent two of the largest contracts signed in 2018, both in size and technology scope (they include population health management) and are Cerner’s first Millennium deployments in the Nordics. The Millennium platform was not purchased outside of Europe in 2018.

2018 new hospital wins by contract type and number of beds3

Agfa HealthCare, Dedalus, and InterSystems Also Broadly Selected

total number of hospital migrations in 2018Agfa HealthCare, Dedalus, and InterSystems were each selected in eight or more decisions. Agfa HealthCare was selected in 10 separate decisions (more than any other multiregional vendor). The wins occurred in two regions and include a number of net new large multihospital decisions. Dedalus had the most hospital wins of any multiregional vendor; these wins came mostly through GHTs in France; additional wins came from other decisions in France, Italy, and Kuwait. InterSystems was third in terms of new contracts (8) and saw the most geographic diversity, signing contracts in Asia, Europe, the Middle East, and Oceania. Relative to previous years, InterSystems saw a dip in new wins (16 hospitals in 2018 vs. 30+ per year since 2014). Some prospective clients report that InterSystems has not responded to tenders due to constrained resources.

EUROPE: EMR Purchasing Picks Up in 2018; Agfa HealthCare (DACH), Cerner (Scandinavia & UK), and Dedalus (Mostly France) Benefit Most


2018 regional breakdown europeAgfa HealthCare—the region’s market share leader—has seen the most growth over the last few years. In 2018, Agfa’s biggest gains came in Germany, where the vendor expanded their presence through several net new large multihospital contracts. Meierhofer (who has the second highest energy) added six hospitals; five came through a net new multihospital healthcare group. A Cerner customer chose to add on to an existing contract. Due to initial confusion regarding Cerner’s go-forward plans in the region, Cerner’s growth has not matched what Siemens’ was prior to the acquisition.

The Nordics

Two of the largest decisions globally were signed in Sweden. Both were previous Siemens customers who migrated to Cerner Millennium, the platform’s first customers in the Nordics. Systematic was selected in two healthcare regions in Denmark, replacing Cambio and DXC Technology. Denmark’s five regions are now locked in with Systematic (3) and Epic (2).

Western Europe

Dedalus signed the most new hospitals of any vendor in Western Europe. These wins were focused mostly in France, where Dedalus leveraged their existing presence to deploy DxCare across four GHTs. The majority of Agfa HealthCare’s new hospitals in France came via a contract with a large university hospital. InterSystems (two standalone hospitals) and Cerner (one add-on hospital) also had new wins in the region. In Luxembourg, Maincare Solutions was selected in a decision impacting half the hospitals in the country. This is Maincare’s first contract outside of France.


2018 saw an uptick in EMR purchasing in the UK. Epic and Cerner both signed two contracts for three hospitals. Epic has signed four contracts in England over the last two years following a four-year dry spell. Cerner capitalized on their strong market presence among GDE facilities, being selected by a “fast follower” trust. They also had an add-on. In Scotland, where nearly 90% of the hospitals are either implementing or live with InterSystems, an additional Health Board chose the vendor’s TrakCare platform. Allscripts signed another trust in the South of England, their only SCM win outside the US. MEDITECH gained one contract and lost another due to the NHS’ GDE program. DXC Technology Lorenzo has not been selected in the UK since 2016, and one Lorenzo customer publicly announced plans to move to System C in 2018.

LATIN AMERICA: MV Surging Ahead in Brazil; everis Growing in Other Countries 

2018 regional breakdown latin americaEMR purchasing in Latin America continues to be high, particularly in Brazil. MV led all vendors in contracts signed in 2018. Most of the growth came in Brazil, where MV signed almost 40% more hospitals than in 2017. They continue to be selected by some of the largest hospitals in Brazil. Philips did not see a similar uptick. Customers report Philips has shifted focus away from Latin America (e.g., key executives have been relocated) as the vendor has begun marketing in other regions. SPDATA and Pixeon continue to grow in Brazil, though generally in much smaller, specialty facilities (less than 60 beds). Outside of Brazil, everis had the most growth. They were selected in a province-wide decision in Argentina covering 47 inpatient facilities, the second largest contract signed in any region. everis is the only vendor who has been selected in provincial or statewide decisions in Latin America since 2013. MV also saw growth outside of Brazil, signing their first customers in Ecuador and two customers in Panama. MEDITECH expanded their presence in Puerto Rico.

MIDDLE EAST & AFRICA: 2018 Purchasing Slow; Health Insights and InterSystems Selected in Largest Decisions

Health Insights’ new cloud platform has garnered interest from existing customers and from other organizations, positioning Health Insights as one of the stronger of the Middle East’s regional vendors. In 2018, Health Insights added two new contracts (four hospitals) and more beds than any other vendor (the number gained in 2018 equals the number Health Insights gained in the previous six years combined). InterSystems, who has had the most wins in the region since 2012, signed one new contract, with a large university hospital in Saudi Arabia. ezCaretech, who is relatively new to the region, was selected by a private healthcare group. Provider interest in the vendor’s BestCare solution continues to grow and is high relative to their small market share. Dedalus was selected by a small private hospital (less than 100 beds) in Kuwait, their first customer in the country. Purchases of Cerner, the overall market share leader in the region, have waned with no new Millennium purchases since 2016.

ASIA & OCEANIA: Epic and InterSystems Continue to Grow; ezCaretech expands in South Korea

In Asia, Epic was selected as the go-forward vendor for two of Singapore’s three integrated healthcare clusters (12 hospitals), one of the biggest decisions in terms of beds to finalize in 2018. Epic was also selected in the largest decision in Oceania, where they will be rolled out across three organizations in Australia as part of a collaborative partnership. InterSystems, the only multiregional vendor with significant contracts in China, added 2 organizations (3 hospitals) in that country. InterSystems was selected by an organization in New Zealand (2 hospitals), expanding their presence among New Zealand’s private healthcare groups. ezCaretech was chosen by a university hospital in South Korea, extending the vendor’s strong presence among South Korean academic institutions. Philips continues to leverage their extensive imaging network to market their EMR outside of Brazil; in 2018, a hospital in Australia—Philips’ first English-language EMR deployment—chose the Philips Tasy solution.

2018 regional breakdown middle east africa
2018 regional breakdown asia oceania

CANADA: No New Contracts Signed

2018 regional breakdown canadaNo net new contracts were signed in Canada in 2018 (compared to six in 2017). Two existing MEDITECH customers (comprising four hospitals) chose to migrate to Expanse. Over the last five years, 19 organizations in Canada using legacy MEDITECH platforms have made a go-forward decision: 16 chose to migrate to Expanse; 3 moved to other vendors. 2019 may prove to be a busier year in Canada as several larger provincial decisions are currently underway.

author - Elizabeth Pew
Elizabeth Pew
author - Jess Wallace-Simpson
Jess Wallace-Simpson
author - Robert Ellis
Project Manager
Robert Ellis
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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.