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US Hospital Market Share 2021 US Hospital Market Share 2021
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US Hospital Market Share 2021
EMR Purchasing Continued Despite COVID-19

author - Coray Tate
Coray Tate
author - Paul Warburton
Paul Warburton
May 19, 2021 | Read Time: 8  minutes

Despite the COVID-19 pandemic, EMR purchasing was up in 2020, fueled in large part by decisions among large organizations as well as standalone community hospitals. This report investigates the EMR buying trends that prevailed in a year unlike any other.

2020 Sees Epic with Largest Gain over Competitors in Terms of Market Share Growth

2020 was not Epic's biggest year for market share growth—that was 2015, when 144 hospitals went to Epic—but their growth has never so decisively outpaced the competition’s. A significant number of Epic’s 2020 wins (46 hospitals and over 15,000 beds) came from large organizations (>10 hospitals), most of whom switched from Cerner, MEDITECH, or Allscripts. A single large win in Q1 included 37 hospitals and just under 7,000 beds. Over the last five years, Epic has gained an average of 90 hospitals a year—the solution’s stability and deep integration have made it the preferred choice among large organizations, whose smaller regional partners often follow suit in order to gain improved collaboration. 3 hospitals left Epic in 2020, all due to M&A activity.

Impact of COVID-19 on EMR Contracting

Contracting naturally took a back seat as COVID-19 cases ramped up and the country went into lockdown. It rebounded some in Q3 and then spiked in Q4 as organizations reinstated budgets and revived tabled HIT initiatives. Decisions by large organizations (>10 hospitals) often take several years, and most of those that were paused in 2020 are back in full swing, with Epic, Cerner, and MEDITECH leading in consideration.

number of hospitals impacted by emr contract by quarter
2020 us acute care hospital wins and losses by vendor

Cerner Sees Second Consecutive Year of Net Market Share Decrease

In 2020, a 37-hospital organization chose to move to Epic; 31 of the hospitals were using Cerner, accounting for over half of Cerner’s 2020 hospital losses. Over the last six years, Cerner has lost a total of seven large customers (representing over 28,000 beds), due mainly to significant, ongoing concerns with Cerner’s revenue cycle functionality. Despite their tug-of-war with Epic to retain large customers, Cerner has seen strong success competing for community hospitals. Cerner’s 2020 wins came largely from smaller organizations and hospitals who were drawn to the pricing and competitive functionality.

2020 multispecialty acute care market share

MEDITECH Expanse Viewed as Path Forward; Proof Points Limited for Non-Core Functionality

Purchases of MEDITECH Expanse—which is chosen by both legacy MEDITECH customers and net new customer organizations—are driven by the platform’s acute care, ambulatory, and revenue cycle integration as well as improved clinician workflows. The net new hospitals that signed with MEDITECH in 2020 are all under 100 beds, and most (~75%) have around 25 beds. Despite high interest, MEDITECH lost 62% of the legacy customers that made a decision in 2020. A quarter of the legacy customers that moved to another vendor in 2020 did so as the result of M&A activity. The remainder were competitive decisions that opted not to migrate to Expanse (almost all went to Epic); not all of these decisions involved a full RFP. About half of all customers that left MEDITECH (from any platform) were hospitals with 100–200 beds. Some cite price as a barrier; more frequently, organizations pass on Expanse due to limited adoption of non-core modules (e.g., population health management).

2020 acute care hospital losses by type of loss
2020 acute care hospital wins by type of win

Cerner’s Broad Functionality Drives Highest Energy among Small Standalone Hospitals; Azalea Health Working to Revitalize Acquired Prognosis Solution

2020 saw an uptick in EMR decisions among small standalone hospitals. Cerner was chosen twice as often as the next closest competitor—smaller hospitals looking for broad functionality and continued development often select the Millennium platform, most frequently through Cerner’s CommunityWorks model. A majority of MEDITECH’s wins in this space were competitive, showing that Expanse is resonating with smaller hospitals. The majority of CPSI’s new 2020 contracts came from small standalone hospitals. Epic is typically cost prohibitive for this group, but some standalone hospitals looking to improve collaboration with referral partners chose Epic’s Community Connect model. Azalea Health, who is working to modernize the former Prognosis solution, was chosen by a couple of small standalone hospitals in 2020. Though Allscripts had no wins among small standalone organizations in 2020, they have announced a streamlined version of the Sunrise platform intended for community hospitals. Across all hospital sizes, 2020 was stable for Allscripts compared to previous years.

2020 wins among small standalone loosely affiliated hospitals

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 from January 1–December 31, 2020. 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. MEDHOST is the only vendor that did not share a list of 2020 wins and losses with KLAS.

Additionally, KLAS’ historical market share information is updated as circumstances change (for example, a contract is cancelled or a product is sunsetted). This review of the historical data necessarily results in some shifts in vendors’ overall market share numbers. While not reflected in the 2020 win/loss numbers, the following changes have been accounted for in the vendors’ individual market share totals:

  • Allscripts—The Horizon platform was officially sunset in 2018. The 34 hospitals still on the platform are no longer counted in Allscripts’ market share and are independent of any EMR vendor.
  • Azalea Health—KLAS validated 8 hospitals whose contracts with the vendor had gone unreported in previous years.
  • Epic—Epic does not require current customers to sign new contracts for hospitals added through M&A. Epic is therefore sometimes not aware that additional hospitals have been added until the hospitals go live. KLAS was made aware of 39 such hospitals in 2020.

How Does KLAS Measure 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/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.

In a small number of cases, delays occur between when a new contract is signed and when it comes to KLAS’ attention. Thus, a very minimal number of the new contracts counted in this year’s report may have actually been signed in 2019. Additionally, 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.


New standalone hospital: 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.


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.


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. Specialty hospitals that choose to migrate from a legacy solution to a go-forward platform from their current vendor are counted as wins.

legacy vs go forward solutions

author - Madison Moniz
Madison Moniz
author - Natalie Jamison
Project Manager
Natalie Jamison
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.