Global (Non-US) EMR Market Share 2023
Europe Continues to Lead, Energy Picking Up in Other Regions

Dedalus, Oracle Health (Cerner), IQVIA Lead Multiregional Vendors in 2022 Wins

Dedalus has grown significantly through acquisitions in the last five years, and their platforms continue to be widely considered and selected (chosen across nine countries in 2022). Their 2022 acquisition of Lutech’s wHospital platform in Italy (34 hospitals) accompanied strong growth in DACHL and France. They were also selected for a health region in Morocco. Oracle Health (who acquired Cerner) had a strong year of EMR wins. They were contracted for the third-highest number of beds thanks to large multihospital decisions in their favor—for Millennium in Canada, the UK, and the UAE; for i.s.h.med in Germany. IQVIA had a strong year in Asia thanks to two large contracts in India, including a state health department deploying Arcus Air in the cloud to 16 hospitals. Another notable regional contract is NTT DATA’s selection by an Argentinian province, which chose to expand their existing ehCOS contract to an additional 75 hospitals and 550+ health centers.

Europe

Regional Decisions Bolster Softway Medical, Dedalus & CGM

DACHL
KLAS validated 21 decisions in DACHL countries. Oracle Health (Cerner) was selected in two, which account for the most beds impacted, including a large private group extending i.s.h.med to 10 more hospitals. Dedalus and CGM were selected in seven decisions each. Dedalus was chosen by a multihospital rehab group in Switzerland, a standalone hospital in Austria, and five organizations (two new contracts, three extensions) in Germany. CGM was selected by seven organizations across the medico and CGM REHA platforms in Germany. CISTEC was chosen by a consortium of five organizations in Switzerland.

Other Areas
In Poland, CGM was selected by two large groups, adding to CLININET’s strong market presence in the country. EMR activity has slowed down in the Netherlands but ramped up in Belgium, where Softway Medical was selected by a health network in French-speaking Wallonia; this is the vendor’s first Belgian client. ChipSoft added a new client in Dutch-speaking Flanders. Dedalus, the market share leader in Italy, was selected there by a regional health provider, and they also finalized the acquisition of wHospital from Lutech Group.

Latin America

MV Leads in Brazil Decisions, Followed by Philips; NTT DATA Selected in Argentina

Middle East/Africa

Oracle Health (Cerner) Selections Boost Already Strong Presence, Dedalus Selected in Morocco

Asia/Oceania

IQVIA, InterSystems, ezCaretech Most Widely Selected as EMR Activity Rebounds

Canada

Oracle Health (Cerner) Selected in the Only 2022 Hospital EMR Decision

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 2022 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), InterSystems (Clinicom to TrakCare), Maincare (M-CrossWay to Maincare-IC), MEDITECH (MAGIC or 6.x to Expanse), Meierhofer (M-KIS Akut to M-KIS Next), MV (MV2000 or Hospidata to SOUL MV), Nexus AG (from xmCare to Nexus EPD), and Philips Tasy (Delphi-based solution to 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 2022, this ongoing data review resulted in notable shifts (+/- 10 or more hospitals) for Nexus and InterSystems (both adjusted down in Europe), Softway Medical (adjusted up in Europe), and Dedalus (adjusted up, mostly in Europe). In 2022, Oracle Health acquired Cerner’s software portfolio, resulting in the transfer of Cerner’s existing market share to Oracle Health. Similarly, Allscripts’ market share was transferred to Altera Digital Health after Harris Computer Corporation acquired Allscripts’ hospital and large physician practice business and rebranded it as Altera Digital Health. Dedalus also acquired the wHospital solution as part of their acquisition of Lutech Group’s healthcare portfolio, resulting in a 34-hospital increase in Dedalus’ overall market share. Additionally, this year is the first that KLAS has included market share and recent wins for Origin Integration Studios (Asia) and Ciberbit (Europe and Asia). Historical trending charts are updated accordingly as KLAS adjusts market share numbers, combines vendors’ market share based on M&A activity, or adds new vendors to the research. The trending charts in this year’s report supersede trending data given in previous iterations.

Geographic Regions

The geographic regions used in this report are based—with some variation—on the United Nations’ geographic regions. Since nearly all EMR purchases in Northern America in the past nine years have occurred in either Canada or the United States (the one exception being in Saint Pierre and Miquelon, a French overseas territory) 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 (with Saint Pierre and Miquelon being grouped in). Similarly, EMR purchases that occur in a country’s 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; 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.