Unpacking the dynamics of the hospital EMR market

A deep dive into the key players and emerging trends in the acute market shows a few surprises in market movement.



The year 2022 saw a robust pace of acute EMR purchasing in the United States, mostly thanks to a notable increase in migrations and decisions made by small organizations. The driving factors behind these purchases were enhancements to clinician satisfaction, improvements around interoperability and revenue cycle stability.

The US Hospital EMR Market Share 2023 report delves into these factors and more trends surrounding EMR purchases that took place in the US from January to December 2022.

Epic’s success

Epic remains the undisputed leader in market share, consistently outperforming competitors both in terms of customer satisfaction and overall market growth. The company's upward trajectory has been long and steady without regressions, unlike their competitors.

Epic has a long history of delivering a consistently exceptional customer experience and has built an extremely loyal base that evangelizes to their peers. The vendor leads the industry in having a fully integrated system, promoting data sharing between hospitals and leveraging best practices to ensure customer success.

Additionally, the vendor's emphasis on consolidation and success in onboarding more hospitals onto their solution have further strengthened its position. The combination of these factors has solidified this company as a formidable and reliable vendor in the industry.

MEDITECH’s position

MEDITECH has delivered a consistent customer experience with their Expanse platform, which is stable and meets their customers’ needs. Their satisfaction scores are only slightly behind Epic’s, but that hasn’t fully insulated them from losses, and MEDITECH experienced a net loss this year instead of a net gain.

Interestingly, MEDITECH has had great success with migrating customers from their older platforms like the MAGIC solution or client/server, and 2022 was a banner year for migrations. This data suggests that perceptions about the Expanse product may differ between current and prospective MEDITECH customers.

Current customer satisfaction doesn’t seem to correlate with sales and retention in quite the way that KLAS normally sees. But, based on historic trends, the current trend is likely to shift if MEDITECH can continue delivering well for their customers.

Good and bad news for Oracle Health

Oracle Health’s recent performance is the inverse of MEDITECH’s, with double-digit growth in the total number of hospitals and customer satisfaction with their EMR and revenue cycle at or near all-time lows.

Oracle Health is continuing a pattern of winning more contracts with small hospitals than any other vendor while losing larger customers. The result is a sizeable increase in their total number of hospitals — their numbers increased by double digits in 2022. However, despite that growth in sites, Oracle Health still lost approximately 5,000 beds in the past year.

Larger organizations have typically felt the most pain with the vendor’s persistent revenue cycle issues. While that continues to be a major driver for large customers to leave, scores from smaller hospitals are now even lower. Despite offering a potential fix in RevElate, its new revenue cycle solution, few sites have adopted it, and customers of all sizes don’t feel the vendor is providing adequate resources to help them be successful with the products they have.

Appetite for change

The future of the EMR market seems to point to continued consolidation, both of vendors and of hospitals. Large IDNs continue to grow and take on more standalone hospitals, and Epic is the vendor of choice for larger groups.

The real competition is downstream for the remaining standalone hospitals, with each vendor trying to balance delivering modern technology and exceptional service at an affordable price point.

The acute EMR market, as a whole, needs more competition. Competition is healthy for innovation and pushes existing players to improve, but right now, the field continues to narrow with less prominent vendors slowly petering out. It is fair to say that, especially in this economy, health organizations would like to have more options in general.

The EMR space needs something new to spark change in the current trajectory. That may come in the form of a new type of vendor, a revitalized platform, a change in a current vendor’s company culture, or a leap in supporting technology.

Paul Warburton is an Insights Director and Tyson Blauer is a Research Director with KLAS Research.

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