Global (Non-US) EMR Market Share 2022
The Impact of the Pandemic’s Second Year

Health Insights, Dedalus, and Cerner Lead Multiregional Vendors in 2021

After a quiet 2020, Health Insights saw a strong uptick in 2021. The year’s largest EMR contract went to Health Insights: via a partnership with Vodafone Egypt, MEDiCACLOUDCARE (Health Insights’ core EMR) will be deployed in a private cloud environment, covering nearly 80 university hospitals. The vendor also signed their first client in Qatar and their second and third clients in Malaysia. Dedalus had another strong year, bolstered by purchasing in Europe. Their market-share-leading ORBIS platform continues to grow through new wins and M&A activity in the DACHL and France. Additionally, Dedalus acquired DXC Technology in 2021, gaining almost 400 hospitals on multiple EMR platforms. Cerner rounds out the top three multiregional vendors (by contracted beds) thanks to significant activity in the UK and Canada. They were selected by 5 trusts in England, building on their market-leading presence there. Also, a conglomerate of 7 organizations in Ontario, Canada, chose Millennium for their 11 hospitals. MEDITECH had a successful year, supported by 2 large group decisions in Canada from legacy C/S clients moving their 35 hospitals to Expanse.

Europe: Softway Medical and SIB Bolstered by GHT Decisions; Dedalus Active in DACHL, Cerner in the UK

UK, Ireland, and Channel Islands
2021 was England’s most active year in the last five years. This is likely to continue, driven by the push toward integrated care systems (ICSs). In 2021, 10 acute care or specialty trusts selected a new EMR. Cerner extended their market share lead among public trusts with 5 acute care trust selections. The other trust decisions in 2021 were split between Allscripts, Epic, MEDITECH (a migration to Expanse), Nervecentre Software, and System C. Additionally, 1 mental health trust selected Civica, and the Channel Islands of Jersey and Guernsey both selected IMS MAXIMS (replacing InterSystems).

Other Areas
Other parts of Europe were relatively quiet in 2021. ChipSoft was selected by 3 organizations in the Netherlands, increasing their market share lead in the country. Of tracked vendors, only Dedalus had contracts in Italy; 2 organizations chose C4C, and 1 chose Galileo. KLAS validated a contract for Nexus AG in Eastern Europe but was unable to learn the number of facilities impacted, so it isn’t included in this report. No new contracts were validated in the Nordics, where most large regional initiatives have already been finalized over the last five years.

Middle East/Africa: Health Insights Selected in Large Egypt Decision; InterSystems and IQVIA Lead Out in the Middle East

Latin America: In Slowing Brazil Market, MV and Philips Lead; MEDITECH Makes Gains in the Caribbean

Asia/Oceania: ezCaretech Branches Out as Asia Rebounds; Oceania Quiet

Canada: Two Large MEDITECH Migrations to Expanse; One Conglomerate Chooses Cerner

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.

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 2021 EMR purchasing 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 that decision may have been. In this report, the following vendors all had at least one customer migration: CompuGroup Medical (KIMSYSTEM to CGM REHA), Dedalus (Galileo to C4C), IQVIA (Arcus to Arcus Air), MEDITECH (C/S or 6.x to Expanse), MV (MV2000 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.

Where Does Market Share Data Come From? 

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 that were missed in previous years’ reports, 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 2021, this ongoing data review resulted in notable shifts (+/- 10 or more hospitals) for ALERT, Maincare Solutions, and Cerner (all adjusted down in Europe); and for Softway Medical and Hopsis Easily (both adjusted up in Europe). In 2021, Dedalus acquired DXC Technology’s software portfolio, resulting in a significant increase in Dedalus’ overall market share. In addition to the changes noted above, KLAS has included in relevant market share counts Cerner’s 15 contracted US overseas military hospitals (previously counted under KLAS’ US hospital market share research). Additionally, this year is the first that KLAS has included market share and recent wins for Adaptive TechSoft (Middle East), CertaCure (Middle East), IQVIA (Asia and Middle East), OASIS (Middle East), Orion Health (Asia and Oceania), and Telstra Health (Australia). As KLAS makes adjustments in market share, combines vendors’ market share based on M&A activity, or adds new vendors to the research, historical trending charts are updated accordingly. The trending charts in this report supersede trending data given in previous iterations of this report.

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, Réunion, and Saint Pierre and Miquelon for France; Curaçao for the Netherlands). 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.