Global (Non-US) EMR Market Share 2021
Strong Activity Despite the Pandemic

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

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.

KLAS 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.

REGIONAL INSIGHTS

Europe

Epic & Dedalus Headline Strong Year

DACH
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.

Italy
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.

Other
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

Middle East & Africa

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

Asia & Oceania

Wins for ezCaretech in Asia, Epic & Cerner in Australia

Canada

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

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.

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:

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.