US Hospital EMR Market Share 2023
Market Energy Driven Mostly by Small Organizations

Oracle Health (Cerner) Achieves Double-Digit Hospital Growth with Small Hospital Wins; Large Hospital Losses Leads to Decline in Beds

In 2022, Oracle Health (Cerner) saw their first double-digit net gain in hospitals since 2018. Unlike in previous years, in which growth was fueled by expansion from large customers, Oracle Health’s hospital gains in 2022 were driven primarily by small standalone hospitals opting for the CommunityWorks platform—49 of their 50 acute care wins were for hospitals under 200 beds (this is the fifth consecutive year Oracle Health signed the most hospitals of this size), and almost three-fourths were for CommunityWorks. However, due to the disparity in size between the small hospitals they gained and the larger hospitals they lost, Oracle Health still saw a significant overall decline in beds, the most of any vendor in this report. Due to ongoing revenue cycle challenges, larger Oracle Health customers are leaving; smaller hospitals continue to use the platform, though some share concerns about their experience with Cerner Patient Accounting/CommunityWorks Financials.

Note: Scores come from KLAS’ standard performance research and are not tied specifically to the recently contracted organizations charted elsewhere in this report. Score not shown for Altera Digital Health Sunrise due to insufficient data from organizations with ≤200 beds. EpicCare Inpatient EMR is not sold to organizations of this size.

MEDITECH Sees Record-High Legacy Migrations but Loses Market Share

Continuing to Outpace the Market, Epic Is the Only Vendor with Positive Net Change in Hospital Market Share and Number of Beds

Bottom Line on Other EMR Vendors

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 EMR purchasing activity (i.e., executed contracts) that occurred in the United States January 1–December 31, 2022. It includes EMR market share data for acute care hospitals and for non–acute care specialty hospitals—meaning psychiatric, long-term acute care, rehabilitation, and other specialty hospitals, such as surgical and orthopedic 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 EMR 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. (For example, this report accounts for six large IDNs that moved several of their hospitals to Epic before 2022.)

How Does KLAS Measure EMR 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 EMR 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 EMR 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 EMR 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 the terms win, loss, migration, and specialty hospital are given below.

Wins

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

New IDN hospital: An entire IDN or health system that replaces the core EMR used in the majority of their hospitals.

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

Losses

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

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

Migrations

Hospitals that choose to transition from a vendor’s legacy product to the same vendor’s go-forward EMR are classified as a migration. Since these customers are already included in a 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.