Epic Gains More EMR Market Share; Cerner Loses Ground for Second Year in a Row

EMR acquisition spiked in the fourth quarter, after being put on hold during the COVID-19 lockdown in the first half of 2020.

The COVID-19 pandemic allowed electronic medical record (EMR) company Epic to continue to gain a greater share of the U.S. acute care market last year, according to the 2021 U.S. Hospital Market Share report from KLAS.

Cerner, on the other hand, saw a second consecutive year of net market share decreases. A 37-hospital organization chose to move to Epic; 31 of the hospitals were using Cerner, accounting for more than half of Cerner's 2020 hospital losses.

During the past six years, Cerner has lost a total of seven large customers, representing more than 28,000 beds, KLAS reported.

That single, large win in Q1 2020 for Epic included almost 7,000 beds. Epic's 2020 wins involved 46 hospitals and more than 15,000 beds. A sizable number of those wins came from large organizations of 10 hospitals or more, most of whom switched from Cerner, MEDITECH, or Allscripts.

Over the past five years, Epic 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," according to the report.

KLAS, a Salt Lake City–based research and insights firm, reports market share among the top EMR companies serving 5,495 acute care hospitals as follows:

• Epic 31%
• Cerner 25%
• MEDITECH 16%
• CPSI 9%
• Allscripts 5%
• MEDHOST 3%
• Azalea Health 0.5%
• None/Other 10.5%

The report also captured each EMR company's account gains and losses during 2020:

• Epic gained 101 facilities
• Azalea Health gained 4 facilities
• Cerner lost 19 facilities
• MEDHOST lost 12 facilities
• CPSI lost 12 facilities
• Allscripts lost 1 facility
• MEDITECH last 9 facilities

"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," the report stated.

Three hospitals left Epic in 2020, but all were due to merger and acquisition activity, the KLAS report stated.

EMR purchasing was up in 2020, despite the COVID-19 pandemic, fueled mostly by decisions among large organizations as well as standalone community hospitals, KLAS reported. EMR purchasing took a back seat as cases ramped up and the U.S. went into lockdown but rebounded some in Q3 and then spiked in Q4 as organizations reinstated budgets and revived tabled HIT initiatives.

Despite its tug-of-war with Epic to retain large customers, Cerner has seen strong success competing for community hospitals, and its 2020 wins came primarily from smaller organizations and hospitals drawn to Cerner's pricing and competitive functions, KLAS reported.

The net new hospitals that signed with MEDITECH in 2020 were all under 100 beds each, and about 75% of them have around 25 beds. MEDITECH lost 62% of the legacy customers that made a decision in 2020. A quarter of those legacy customers that moved to a different vendor in 2020 did so because of M&A activity. Some who left MEDITECH cited price as a barrier, but more frequently, healthcare organizations passed on MEDITECH's Expanse platform due to limited adoption of non-core modules, such as population health management.

EMR decisions among small standalone hospitals saw an uptick in 2020, according to KLAS. Cerner was chosen twice as often as the next closest competitor. These hospitals often select the Cerner Millennium platform, most often through Cerner's CommunityWorks model. A majority of MEDITECH's wins in this market were competitive, showing that Expanse is resonating with smaller hospitals.

Although Allscripts had no wins among small standalone organizations in 2020, the company has announced a streamlined version of the Sunrise platform intended for community hospitals. Across all sizes of hospital, 2020 was stable for Allscripts compared to previous years.

The KLAS report is based on acute care EMR purchasing activity, such as 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, rehabilitation, and other specialty hospitals, such as surgical and orthopedic facilities. The data comes from multiple sources, including publicly available information, thousands of conversations KLAS has with provider organizations, and vendors. The full report is available for download on the KLAS website.