US Acute Care EHR Market Share 2024
Large Organizations Drive Market Energy

Epic Is Only Vendor to See Net Increase in Market Share

Epic was the only vendor to achieve a net increase in market share in 2023—both in number of hospitals and number of beds—and they now cover over half of all acute care multispecialty beds in the US. They continued to outpace competitors, winning the highest number of health-system hospitals, standalone hospitals, and customer add-ons. 77 hospital wins were the result of 3 large health systems choosing Epic. Both current and prospective large-organization customers are drawn to Epic because they see the vendor as a consistently high performer that provides strong healthcare IT, quality relationships, and the opportunity to streamline workflows and improve clinician satisfaction. Large specialty organizations have also turned to Epic to consolidate IT systems. Among small standalone hospitals, Community Connect (sold and supported by larger hub organizations using Epic rather than by the vendor) was the top choice because of the need to more easily exchange data with other Epic facilities. Some large multispecialty organizations also chose to roll out Epic to their specialty hospitals, and a few standalone specialty hospitals contracted for Community Connect.

Oracle Health CommunityWorks Loses Edge among Standalone Hospitals with ≤200 Beds

In 2023, Oracle Health saw their largest net hospital loss on record, the result of multiple large multispecialty organizations choosing to leave. Additionally, growth among small standalone hospitals (≤200 beds)—who have been the primary source of Oracle Health’s market share wins since 2016—stalled across all vendors. Due to economic pressures, these hospitals are primarily focused on optimizing existing technology, resulting in 41 decisions in 2023 compared to 73 in 2022. Further, Oracle Health’s decline in performance and persistent revenue cycle challenges have resulted in some customers leaving Millennium and prospective small standalone hospitals being deterred from choosing Oracle Health. Net-new standalone customers that contracted with Oracle Health in 2023 cited a desire to improve integration, enhance relationships with exchange partners, and leverage the vendor’s broad technology platform. Meanwhile, purchase energy among specialty hospitals has been on the rise since 2019, especially for Oracle Health (see Trend in Inpatient Specialty Hospital Wins, 2017–2023 chart below). The vendor has accumulated the most specialty hospital wins from 2017–2023; in 2023, 2 large organizations consolidated to Millennium, with 1 contracting 47 of their specialty hospitals and the other contracting 7. The organizations report that the broad technology and integrated clinical suite will set them up for success.

MEDITECH’s Retention Rate Significantly Declines after All-Time High in 2022

MEDITECH’s legacy customer retention rate—which has historically been 40%–50%—jumped to 84% in 2022 due to a large health system’s decision to migrate from MAGIC to Expanse. In 2023, however, the retention rate dipped to the lowest on record; about one-quarter of their legacy losses were due to merger and acquisition activity, while the remaining losses were more competitive. Several MEDITECH customers (primarily those on legacy systems but including some Expanse customers) moved to Epic to consolidate systems and improve data exchange with other Epic organizations. Current customers want MEDITECH to provide more guidance and focus more on developing additional or enhanced functionality (e.g., interoperability, patient engagement, analytics). Adoption of MEDITECH’s interoperability and patient engagement functionalities is low, contributing to customer belief that the vendor lacks these functionalities. Still, MEDITECH saw several new sales, which were split between health systems and standalone hospitals—about half of these wins were former TruBridge (CPSI) customers. The majority of hospitals that contracted for Expanse wanted to improve usability and integrate their acute and ambulatory care systems. A few specialty hospitals also contracted with MEDITECH—since 2019, MEDITECH’s specialty hospital wins have typically been surgery or rehab hospitals connected to smaller community hospitals.

Bottom Line on Other EHR Vendors

Altera Digital Health: Following the acquisition by Harris, Altera Digital Health refocused on Paragon as their primary platform for smaller hospitals, with Sunrise being primarily for midsize hospitals. In 2023, 3 small health systems (comprising 7 hospitals) contracted for Paragon; additionally, 1 Sunrise customer migrated to Paragon. There were no new contracts for Sunrise. 15 of Altera’s 23 hospital losses were due to 1 large organization moving to Epic.

Azalea Health: No new contracts in 2023, as purchase energy among small standalone hospitals decreased overall. Their 3 losses went to MEDITECH, Oracle Health, and TruBridge (CPSI).

MEDHOST: Small customer base; no net-new contracts in 2023. MEDHOST was acquired by Harris in early 2024, and it is unclear what changes customers should expect. 3 losses went to Oracle Health, 1 went to MEDITECH, and 1 went to TruBridge (CPSI).

TruBridge (CPSI): Recently rebranded from CPSI. 2 wins were customer add-ons, and 3 were new standalone multispecialty hospitals; additionally, 5 legacy customers migrated to TruBridge EHR (formerly Evident Thrive). Small standalone hospitals have moved away from TruBridge; they feel a lack of partnership and development has eroded value. Of the 41 small standalone hospitals that made a go-forward decision in 2023, 14 were moving away from TruBridge.

Additional Insights

About This Report

Where Does KLAS’ Market Share Data Come From?

The market share data reported in this study is based on acute care EHR purchasing activity (i.e., executed contracts) that occurred in the United States from January 1–December 31, 2023. It includes EHR market share data for acute care hospitals and for non–acute care specialty hospitals—meaning psychiatric, long-term acute care, rehabilitation, surgical, orthopedic, and other specialty hospitals. The data comes from multiple sources, including publicly available information and the thousands of conversations KLAS has with provider organizations each year. KLAS also gives vendors the opportunity to report their annual acute care hospital EHR wins, which KLAS then validates with provider organizations. While KLAS believes the data in this report is directionally correct, we acknowledge that some variation may result from lack of vendor participation.

Additionally, KLAS’ historical market share information is updated as circumstances change. These changes are driven by things such as hospital closures, contracts being canceled before a solution is implemented, the removal of international hospitals included in US contracts, and KLAS becoming aware of duplicates in our data set. This review of the historical data necessarily results in some shifts in vendors’ overall market share numbers.

How Does KLAS Measure EHR Market Share?

At any point in time, only one company is recognized as the contracted vendor for a hospital. KLAS considers a change in a hospital’s most recently contracted EHR as a “win” for the new vendor and a “loss” for the vendor being replaced. A win does not depend on the legal status of a contract or on whether a provider organization is a paying customer yet. Hospitals that have contracted for a new EHR normally continue to use their previous system for one or more years before or after going live with the new one. During this time, the hospital could 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 signed. In these cases, the previously contracted vendor is recognized as the current vendor until a 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.

After market share numbers for any given year are published, it may be necessary for KLAS to make a small number of adjustments due to hospital closures or new information coming to light. For this reason, the market share numbers shown in this report for previous years may not align exactly with the numbers published in those years’ market share reports.

Contract changes that don’t involve a change in the core EHR product do not qualify as wins. For example, contract renewals, the addition of modules, shifts in deployment models (e.g., moving to hosting), and other changes are treated as extensions of the original hospital win. Further explanations of KLAS’ market share terminology are given below.

Wins

New standalone hospitals: A single standalone hospital that chooses a new EHR system, or a single hospital within a larger organization that makes an EHR purchase separate from the rest of the organization.

New health system hospital: A hospital that is part of a larger health system that makes an enterprise decision to replace the core EHR used in a majority of their hospitals.

Customer add-on: An organization using a go-forward EHR that implements that product in newly acquired hospitals or decides to roll out the EHR to additional hospitals within their organization who were not yet contracted for the EHR.

Losses

M&A/standardization: A health system with multiple EHRs that decides to consolidate to a single EHR. Also, a hospital that is acquired and put onto the acquiring organization’s EHR. Generally, these are also counted as add-on wins for the new EHR vendor.

Competitive loss: When an organization replaces an existing EHR with an EHR from a different vendor as the result of a new standalone or health system contract. These decisions may or may not involve a full RFP.

Migrations

Hospitals that choose to transition from a legacy product to a go-forward EHR from the same vendor are classified as a migration. Since these customers are already included in the vendor’s total market share count, the migration does not generate a net change to that count. Therefore, with the exception of specialty hospitals (see below), these legacy migrations are not classified as a win or a loss, regardless of how competitive a decision may have been.

Specialty Hospitals

KLAS does not track specialty hospital losses, but specialty hospital wins are tallied and shown separately from each vendor’s acute care hospital wins and overall market share counts. This includes specialty hospitals that choose to migrate from a legacy solution to a go-forward platform from their current vendor.

Product Designations Used in This Report

• Component [C]: Community Connect is marked as a component product in KLAS research since organizations purchase it through a larger hub organization rather than directly from Epic.