Starting in 2015, penalties begin to kick in for healthcare providers who fail to make “meaningful use” of their electronic health record (EHR) systems. Healthcare professionals have taken note. At the end of 2012, just over 107,000 eligible providers had attested to meaningful use of a complete EHR in an ambulatory setting. A year later, that figure had almost doubled, jumping to just over 209,000 by the end of 2013. During this time, hundreds of vendors have cropped up to seize a share of the demand for EHR products.
Software Advice has tracked the proliferation of EHR vendors over the last two years based on the Centers for Medicare & Medicaid Services (CMS) data from meaningful use (MU) attestations. In March 2013, Software Advice analyzed tens of thousands of 2012 MU attestations to determine EHR vendor MU market share. CMS recently published their 2013 data, so Software Advice released an updated report on EHR market share. They analyzed EHR use separately in the ambulatory and inpatient hospital setting.
Ambulatory Setting
For the ambulatory EHR market share, Software Advice notes that the vendors dominating the market haven’t changed much from 2012 to 2013. “In fact, the same vendors comprise the top 10 market share spots in 2013 as in 2012,” the report states. Like the 2013 report, Epic Systems Corporation still controls around 20 percent of the market. Allscripts and eClinicalWorks remain in second and third place with 10.7 percent and 8.2 percent respectively—showing that Allscripts has lost some ground and eClinicalWorks has increased its share during the last year.
Ambulatory Meaningful Use Market Share, March 2014
Ambulatory Meaningful Use Market Share, March 2013
A quick look at the chart shows how fragmented the market remains for EHR vendors. Five of the top 10 vendors have a market share of less than 3 percent each, and nearly 40 percent of the market uses an EHR from a vendor that falls outside of the top 10. Software Advice stated that the “market fragmentation continues in the face of much speculation about the inevitability of consolidation, and despite the recent merger of two of the biggest players: Greenway and Vitera.” They note that since “this merger happened at the end of 2013 and the companies continue to sell their products under separate labels, [they] considered them separately in this report.”
Amazingly, despite the large number of vendors, the market isn’t completely saturated. In 2012, there were 437 unique vendors with MU attestations (including those in the inpatient or hospital settings). By 2013, that figure jumped to 556—an increase of over 25 percent.
Based on information collected from Software Advice’s healthcare contacts, the number of EHR buyers replacing existing software has nearly doubled since 2010. However, the percentage purchasing software for the first time has declined. “In other words, EHR replacements are on the rise, indicating a fair amount of dissatisfaction among consumers. This has doubtlessly contributed to the ever-growing number of vendors entering the market,” the report notes.
Inpatient Hospital Setting
The top ten vendors account for 90 percent of the market when looking at inpatient hospital attestations. Epic Systems Corporations holds a similar market share in this category as well—19.1 percent. However, their market share in hospitals dropped more than 5 percent in the last year, from 24.9 percent. MEDITECH and CPSI, numbers two and three on the list, hold more of a share than the competition in the ambulatory setting. Here, the top three boast 50.5 percent of the entire market.
Hospital Meaningful Use Market Share, March 2014
Hospital Meaningful Use Market Share, March 2013
Software Advice notes some potential reasons for the less diversified market in hospitals. “There are far fewer inpatient hospitals in the U.S. than there are ambulatory care practices. That means each hospital attestation carries more weight in terms of determining market share in this analysis—so it’s not entirely surprising that we see less fragmentation. Similarly, there are also fewer vendors who make products for the inpatient hospital setting, which contributes to a more consolidated market.”
Software Advice Methodology
“Using MU attestations as a proxy for market share has its limitations,” Software Advice stated, “but it may still be the best representation of market share available.” First, sales data is not publicly available for most EHR vendors, and when it is, vendors use a variety of methods for calculating their customers—some count users, others medical providers, and still others count the number of practices. CMS data provides a level playing field.
Second, MU attestation data is kept up to date, for “an almost real-time assessment of the market. However, a “challenge of analyzing the MU dataset arises from the fact that many providers have now attested to MU multiple times—e.g. once for Stage 1 and once for Stage 2. These providers have multiple entries in the MU dataset, so these duplicates were identified and removed from the data for this report, such that each unique provider was counted only once.”
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Software Advice’s report provides useful information about the biggest players in the EHR systems market. It will be interesting to see whether 2013’s total of over 500 vendors will finally be the saturation point. As more healthcare providers make the required switch to electronic, vendors will be hard pressed to locate new business. However, as the report indicates, many buyers have been unhappy with their current system and made a switch in vendors. Next year will show whether providers move towards vendors at the top of the market—Epic, Allscripts, eClinicalWorks, etc.—or contribute to the fragmentation. View the full 2014 report here.
