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Global (Non-US) EMR Market Share 2023
Global (Non-US) EMR Market Share 2022
Global (non-US) EMR Market Share 2020
Global (Non-US) EMR Market Share 2019
Global (Non-US) EMR Market Share 2018
Global EMR Market Share 2017
Global Market Share 2016
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Global (Non-US) EMR Market Share 2021 Global (Non-US) EMR Market Share 2021
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Global (Non-US) EMR Market Share 2021
Strong Activity Despite the Pandemic

author - Everton Santos
Everton Santos
author - Jonathan Christensen
Jonathan Christensen
May 4, 2021 | Read Time: 14  minutes

Despite the COVID-19 pandemic, 2020 was a strong year for EMR purchasing. KLAS validated 158 contracts (135 net new and 23 migrations) impacting 426 hospitals and over 86,000 beds. EMR purchasing in Asia and Latin America was most impacted by the pandemic, while Europe saw the smallest decrease in activity. Overall, purchasing dropped about 30% from the record levels seen in 2019.

Multiregional Vendors Bounce Back in 2020—Epic, Dedalus, InterSystems & Cerner Lead

2020 wins & migrations by contract type and number of beds

COVID-19 most impacted purchasing in Asia and Latin America; multiregional vendors with a presence in other regions were less deeply affected and saw an upswing in purchase activity in 2020. This stands in contrast to 2019, a banner year for regional solutions. The largest 2020 wins (by number of beds) went to Epic, who gained large public contracts in Australia, Canada, and the UK. Dedalus acquired Agfa HealthCare’s EMR business, adding to past acquisitions that have aided their growth since 2016 and making them the most prominently used EMR supplier outside the US. In 2020, 20 organizations chose one of Dedalus’ solutions. 2020 was InterSystems’ most successful year since 2016. Their biggest win was a regional decision in Italy covering about 30 hospitals; 3 groups also selected them in the Middle East. Cerner also saw growth in 2020, with 11 organizations choosing either Millennium or Cerner’s contracts were the most geographically diverse of any vendor, spanning 10 countries and 5 regions. Most of ezCaretech’s energy was in South Korea, where it is the preferred solution among large organizations.

Regional Softway Medical, MV, Maincare Solutions, Philips & Cambio See Strong Year

The second tier of EMR purchasing activity was primarily among regional vendors. Softway Medical followed up a strong 2019 with another successful year: 4 GHTs (3 in France, 1 in French Guiana) chose their platform. Despite the significant slowdown in purchasing across Brazil, 33 organizations selected MV. Maincare Solutions was chosen by one GHT for their 9 hospitals. Philips’ purchase activity was down overall, though still good: 10 organizations purchased Tasy for the first time, including Philips’ first contracts in Argentina and Colombia. Cambio (with wins in Sweden) and CISTEC (with wins in Switzerland) round out the vendors who contracted over 2,500 beds.

iconKLAS would like to recognize vendors who helped combat the COVID-19 crisis by making technology available to field hospitals across the globe—including but not limited to Advanced Technology Company (ATC), Allscripts, Cerner, DXC Technology, Epic, InterSystems, MV, NTT DATA (everis), and Philips.



Epic & Dedalus Headline Strong Year

Western Europe
Groupements hospitaliers de territoire (GHTs) continue to drive EMR consolidation and decisions in France. Softway Medical benefited most for the second year running, with 3 GHTs selecting them. GHTs also finalized decisions in favor of Dedalus and Maincare Solutions. Large private groups finalized decisions in Spain (Cerner for 18 hospitals) and Portugal (NTT DATA [everis] ehCOS for 9 hospitals, the first ehCOS customer in Europe).

2020 was the UK’s most active year since 2016 (in number of hospitals and beds). The largest decision was from Northern Ireland, who chose Epic (covering over 5,500 beds); 3 other decisions in England (spanning 4 trusts) also favored Epic. Cerner was chosen in 2 decisions in England (11 hospitals), further increasing their leading market share in the country. System C (4 hospitals), Allscripts (1 hospital), and MEDITECH (1 hospital) were selected by one public hospital trust each. DXC Technology Lorenzo and IMS MAXIMS have not been selected in this area since 2016; 4 trusts recently terminated InterSystems contracts.

2020 regional breakdown: europe

Germany was the DACH region’s most active market in 2020. Dedalus’ acquired ORBIS platform was chosen by 8 organizations (mostly net new, in contrast with previous years that mostly saw existing customers extend Dedalus to recently acquired or constructed facilities). 2020 was CISTEC’s most successful year to date; they were chosen by 6 organizations (10 hospitals) in Switzerland. Meierhofer (3 decisions covering 6 hospitals) and CompuGroup Medical (2 hospitals, 1 migration) were also chosen in DACH countries.

Purchase activity grew in Italy in 2020. One region selected InterSystems to be deployed at 6 of its 9 organizations (29 hospitals). Dedalus strengthened their position in the market, with 2 provincial health agencies (12 hospitals) choosing C4C and Tabula Web App. Two existing customers chose to migrate to C4C.

In Sweden, 4 regions (17 hospitals) exercised the option to join the SUSSA group and move forward with Cambio. ChipSoft was selected by one hospital in Dutch-speaking Belgium (EMR extension) and one in the Netherlands (net new). CompuGroup Medical was the only vendor in this research to win contracts in Eastern Europe (2 new hospitals in Poland and 1 in Russia). Epic’s first Community Connect contract in Europe came in the Netherlands.

Latin America

In Brazil, Purchasing Down 50%; MV Tops Market for 5th Year Running; Philips Expands into Argentina and Colombia

Though COVID-19 dramatically slowed Brazil purchases, MV continued to be selected most, with nearly double the new beds of any other vendor. Philips maintained the position of second-most chosen, though their lead over other solutions has narrowed. Consideration of SPDATA has grown among larger and more geographically diverse organizations. The average size of new customers was larger in 2020 than any other year, with wins spread across seven states. MedView, recently acquired by Dedalus, had its strongest year in Brazil in the last five years, with 1 large private organization extending the platform to 9 facilities. Pixeon was chosen by 1 hospital.

Other Latin American Countries
EMR purchases in Spanish-speaking Latin America and the Caribbean continue to be sporadic. Philips was selected in Argentina and Colombia for the first time, by private groups. Cerner was selected by 2 organizations in the region (in Chile and the Caribbean). Two hospitals in Puerto Rico chose MEDITECH, expanding the vendor’s market lead in the country. Softway Medical was selected for the GHT covering French Guiana. For the second year in a row, CPSI was selected by a public health provider in the Caribbean. No contracts finalized for DXC Technology, InterSystems, MV, or NTT DATA (everis).

2020 regional breakdown: latin america

Middle East & Africa

Cloud Solutions Expands in KSA Public Sector; InterSystems, Cerner Most Active in Other Countries

Middle East
Saudi Arabia was the most active market in 2020, with Cloud Solutions benefiting most. After a successful pilot with the Ministry of Health, Cloud Solutions was selected for 25 greenfield hospitals in the southern provinces Jazan and Najran. DXC Technology, ezCaretech, Harris Healthcare, and IQVIA (first win in the region) were selected for a single Saudi hospital each. InterSystems was also chosen by 1 Saudi hospital as well as 2 organizations in the UAE. A private hospital in the UAE selected Cerner Millennium (its first win in the region since 2016). A 3-hospital group in Egypt and a standalone hospital in Oman selected (the latter Cerner’s first in the country). YASASII also was selected in the UAE. Advanced Technology Company (ATC), Adaptive TechSoft, Epic, Health Insights, and MIMSYS gained no new contracts in the region in 2020.

KLAS validated one contract in Africa: a private group in French-speaking Réunion extended their existing Dedalus EMR environment to another hospital.

2020 regional breakdown: middle east/africa

Asia & Oceania

Wins for ezCaretech in Asia, Epic & Cerner in Australia

Validated contracts in Asia were about half the number KLAS typically sees in the region. South Korea–based ezCaretech had the best year, headlined by 2 organizations in their home country selecting them for 5 hospitals (over 2,300 beds). A large, standalone private hospital in Malaysia selected Cerner (the first client in the country). Two private hospitals in India selected Napier Healthcare, expanding the vendor’s footprint among small, private hospitals in the country. InterSystems gained 1 add-on hospital. Allscripts, Epic, MEDITECH, and Health Insights were not selected in 2020 in Asia.

After a slow 2019, EMR activity in Oceania picked up in 2020 (all in Australia), marking the region’s second-highest activity level in the last five years. The largest contract was the Australian Capital Territory’s public tender (4 hospitals), which went to Epic, nearly doubling the vendor’s footprint in the country. One large public hospital group in Victoria (3 hospitals) selected Cerner Millennium, expanding Cerner’s market-leading presence in the country. One rural health alliance in Victoria decided to extend Allscripts Sunrise to 6 more hospitals following the pilot hospital’s go-live.

2020 regional breakdown: asia/oceania


Two Large Groups Select Epic; Migration to MEDITECH Expanse Continues to Be a Common Choice

The only net new Canadian contracts in 2020 went to Epic (2 organizations, 12 hospitals). Since 2016, Epic’s market share in the country has grown from 3 hospitals to 146; in that same time span, 51 hospitals (net new and migrations) have gone to other vendors. In 2020, 2 organizations (3 hospitals) opted to extend MEDITECH Expanse to more facilities. Cerner was not selected in 2020.

2020 regional breakdown: canada

About This Report

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.”

How Does KLAS Measure EMR Market Share?

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, 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 EMR 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 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, 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.

In a small number of cases, delays occur between when a new contract is signed and when it comes to KLAS’ attention or when KLAS can validate it. If that delay is of one year or less, KLAS will recognize the win/loss in the following year. Thus, a very minimal number of the new contracts counted in this year’s report may have actually been signed in 2019.

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 EMR decisions made by inpatient rehabilitation facilities, inpatient psychiatric hospitals, and specialty acute care facilities (e.g., for oncology, pediatrics, or ophthalmology). Outpatient facilities, urgent care centers, day hospitals, and residential treatment facilities are excluded. Below is a breakdown of 2020 EMR purchasing by hospital type.

2020 hospital wins & migrations by hospital type

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 organization extends their existing EMR contract to a new hospital. Often, these add-on wins come about as the result of acquisitions/mergers, newly constructed hospitals, or organizations consolidating from two or more EMRs to a single solution.

Contract changes in which an organization stays with their current EMR 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 a decision may have been. In this report, the following vendors all had at least one customer migration: Allscripts (BOSSnet to Sunrise), Cerner (MedSeries4 to Millennium), CompuGroup Medical (Phoenix to CLINICAL), Dedalus (Tabula Clinica to C4C [Collaboration 4 Care], DxCare to ORBIS), ezCaretech (BESTCare 1.0 to BESTCare 2.0), Maincare Solutions (M-CrossWay to Maincare-IC), MEDITECH (C/S to Expanse), MV (MV2000 to SOUL MV), and Philips (Tasy Delphi to Tasy Java). 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.

Where Does Market Share Data Come From?

The market share data reported in this study is based on hospital EMR purchasing activity (i.e., executed contracts) that occurred 1 January–31 December 2020. The data comes from multiple sources, including publicly available information and the numerous conversations KLAS has each year with provider organizations around the globe.

KLAS also provides vendors with the opportunity to report their annual hospital EMR wins. KLAS then validates this information with provider organizations through in-depth interviews, publicly available information, and other means. Advanced Technology Company (ATC), Allscripts, Cambio, Cerner, ChipSoft, CPSI, Dedalus, DXC Technology, Epic, ezCaretech, Health Insights, IMS MAXIMS, InterSystems, MEDITECH, Meierhofer, MV, Napier Healthcare, NTT DATA (everis), Philips, Pixeon, SPDATA, and Tieto had high levels of disclosure and transparency throughout this process. CompuGroup Medical and YASASII provided a medium level of transparency. Other vendors that are included in some market share numbers—such as ALERT, CISTEC, Cristal-Net, Harris Healthcare, Hopsis, i-SOLUTIONS Health, IQVIA, Maincare Solutions, MIMSYS, Nexus AG, SIB (Syndicat Interhospitalier de Bretagne), Softway Medical, and TOTVS—did not provide KLAS with client lists, though KLAS did validate a number of wins for CISTEC, Harris Healthcare, Maincare Solutions, SIB, and Softway Medical in 2020.

In all cases, KLAS makes a best-effort attempt to use third-party sources and our vast provider network 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.

KLAS is confident that the decisions tracked in this report account for most EMR purchasing that occurred in 2020 in Canada, Europe (excluding Eastern Europe), Latin America, the Middle East, and Oceania. However, EMR purchasing in Asia involves a wide variety of vendors, many of which KLAS does not currently track, so KLAS acknowledges that the picture given for EMR purchasing in Asia is less complete. KLAS also has less transparency into EMR purchasing happening in Africa.

KLAS’ historical global market share information is continually being updated as new information comes to light. In some cases, contracts are canceled, new vendors are chosen, hospitals close, or KLAS discovers that a contract previously recorded did not include EMR functionality. This review of the historical data necessarily results in some shifts in vendors’ overall market share numbers.

In 2020, KLAS made significant efforts to update vendor market share counts in Asia, Canada, Europe, and Latin America. This ongoing data review resulted in notable market share shifts for the following vendors:

  • ALERT—Moderate decrease in Europe
  • Cerner—Moderate increase for in Latin America; significant decrease for non-Millennium platforms in Africa and Asia
  • Dedalus—Moderate increase for MedView in Latin America; minimal increases in Europe to various platforms
  • DXC Technology—Moderate decrease for xHIS in Latin America
  • Hopsis—Moderate increase in Europe
  • InterSystems—Minimal decrease for TrakCare across multiple regions
  • MV—Moderate decrease in Latin America
  • NTT DATA (everis)—Moderate increase in Europe; moderate decrease in Latin America
  • Philips—Minimal increase in Latin America

Additionally, significant adjustments were made to global market share counts for CompuGroup Medical and Dedalus as both acquired additional EMR solutions from Cerner and Agfa HealthCare, respectively. Agfa HealthCare’s market share is now wholly rolled into the market share counts for Dedalus. Cerner’s market share was adjusted in Europe to account for the divestitures of Selene (in Spain) and medico (in Germany).

Geographic Regions

The geographic regions used in this report are based—with some variation—on the United Nations’ geographic regions. Since all EMR purchases in Northern America in the past eight 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. EMR 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, 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, and Réunion for France; Curaçao for the Netherlands; etc.). For more details on the US EMR market, please refer to KLAS’ annual US hospital EMR 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.

author - Amanda Wind Smith
Amanda Wind Smith
author - Natalie Jamison
Project Manager
Natalie Jamison
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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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