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US Acute Care EHR Market Share 2024
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US Hospital Market Share 2021
US Hospital EMR Market Share 2020
US Hospital EMR Market Share 2019
US Hospital EMR Market Share 2018
US Hospital EMR Market Share 2017
2016 Hospital EMR Market Share
Acute EMR Market Share
Clinical Market Share 2014
Clinical Market Share 2013
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CIS Purchase Decisions
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US Hospital Market Share 2022 US Hospital Market Share 2022
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US Hospital Market Share 2022
Strong Purchasing Energy across Large, Small, and Standalone Hospitals

author - Tyson Blauer
Tyson Blauer
author - Paul Warburton
Paul Warburton
April 26, 2022 | Read Time: 7  minutes

EMR purchasing continued to be high in 2021, despite hospitals and health systems grappling with inflation, lingering complications from COVID-19, overburdened clinicians, and a historic nurse shortage. This report examines trends in EMR purchases that occurred in the US from January–December 2021.

A Note about Acquisitions
In 2021, Oracle entered the acute care EMR space through their acquisition of Cerner, becoming the second biggest EMR provider in the US. Additionally, at the beginning of 2022, Harris acquired Allscripts’ EMR technology, effectively increasing their number of inpatient beds by a factor of 17.

Epic Still Top Choice among Large Organizations; MEDITECH Increases Net New Wins and Legacy Retention

Epic’s 2021 net growth in EMR market share exceeded all other vendors’, with a large portion of this growth coming from 4 net-new customer organizations (comprising a total of 28 hospitals). Epic continues to be the top choice for large organizations, and with nearly half of all acute care beds in the US, Epic is also chosen by many smaller hospitals looking to streamline data sharing via Community Connect. Epic’s 4 hospital losses were due to M&A activity. MEDITECH saw their second highest net growth in acute care hospital market share, which came primarily from standalone hospitals and customer add-ons. 2021 was also a successful year for MEDITECH in terms of retention among legacy customers; rather than move to another vendor’s EMR, 75% of legacy customers who made a go-forward decision in 2021 chose to move to Expanse. This is a marked increase from 38% retention in 2020.

2021 us acute care hospital wins and losses by vendor 2021 us acute care market share percent of hospitals percent of beds

Market Share Continues to Decline for Allscripts & CPSI

Allscripts has seen a decline in hospital market share over the last several years with both Paragon and Sunrise. Efforts to move Paragon customers to a version of the Sunrise platform streamlined for community hospitals have not generated many migrations (3 in 2021). Some larger specialty hospitals signed with Allscripts in 2021, and a few existing customers brought on additional facilities that were newly built or acquired. Of the customers who left Allscripts in 2021, 75% went to Epic, and the remaining 25% went to Cerner, MEDITECH, or CPSI. In 2021, 31 of CPSI’s legacy customers contracted to move to the vendor’s go-forward platform. 29 other legacy customers as well as 14 customers on the go-forward platform left, with most going to Cerner or MEDITECH for more comprehensive, innovative technology. This resulted in CPSI having the largest net decrease in hospitals.

legacy retention rates

Cerner Wins Significant Number of Small Customers while Losing Large Acute Care Hospitals

Cerner’s net-new customers continue to be mostly small standalone hospitals. In 2021, Cerner led the market in wins among small standalone hospitals (≤200 beds), with most selecting Cerner’s CommunityWorks model. 63% of Cerner’s acute care hospital wins were for CommunityWorks; the model saw only one loss. Cerner also saw the most 2021 specialty hospital contracts, including one large Millennium customer organization expanding throughout the US, accounting for 65% of Cerner’s specialty contracts. Despite these wins, Cerner lost a substantial number of Millennium PowerChart customers and had the most losses on a go-forward platform. The vast majority of leaving customers moved to Epic. About half of Cerner’s hospital losses were competitive, while the remaining were customers who switched to Epic after being acquired by larger organizations. These large-hospital losses resulted in Cerner seeing the largest net decrease in number of beds. Outside of Cerner’s government contracts, no net-new large health systems have selected Cerner since 2013.

2021 wins among small standalone hospitals
net change in acute care market share 2017 to 2021 number of hospitals number of beds

Bottom Line on Other EMR Vendors

Azalea Health: Small customer base remained stable in 2021. One loss due to a Cerner organization standardizing its smaller hospitals. Vendor primarily focuses on ambulatory EMR market.

MEDHOST: Small customer base remained stable in 2021. Three of their losses went to MEDITECH. Saw fewer losses in 2021 than in previous years. Vendor did not share list of new wins with KLAS, and KLAS validations also did not reveal any 2021 wins. 

Additional Insights

looking ahead acute care emr considerations selections for 2022 and beyond
acute care hospital market share 2016 to 2021
emr market share by region

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, 2021. 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. While not reflected in the 2020 win/loss numbers, the following changes have been accounted for in the vendors’ individual market share totals:

  • Allscripts—7 hospitals removed
  • Cerner—21 hospitals removed
  • CPSI—4 hospitals added
  • Epic—14 hospitals added (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 14 such hospitals in 2021.)
  • MEDHOST—1 hospital removed
  • MEDITECH—2 hospitals removed

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.

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 2020. 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 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.


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. This includes specialty hospitals that choose to migrate from a legacy solution to a go-forward platform from their current vendor.

author - Sarah Hanson
Sarah Hanson
author - Jess Wallace-Simpson
Jess Wallace-Simpson
author - Andrew Wright
Project Manager
Andrew Wright
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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.

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