The sale of hospital EHR systems nearly doubled in 2009 over 2008, driven by the American Recovery and Reinvestment Act (ARRA), according to a new report by research firm KLAS. Epic and Cerner captured nearly 70 percent of the new large hospital sales.

KLAS' eighth annual clinical market share report details the wins and losses of acute care electronic medical record (EMR) vendors at large hospitals with more than 200 beds.

CIS Purchase Decisions: Riding the ARRA Wave, reflects data collected from more than 1,600 hospitals with more than 200 beds in the United States and Canada. During the economic downturn in 2008 EMR sales reached a seven-year low.

"Changes in the CIS (clinical information systems) marketplace as a result of ARRA seem to have blindsided some vendors and left them struggling to stay afloat in the large hospital market," said report author Jason Hess. "In 2009 Eclipsys, GE, McKesson Horizon and QuadraMed all lost more hospitals than they gained; they are struggling to regain lost ground."

 Three prominent provider concerns emerged in the research regarding CIS decisions: integration, clinical adoption and reliability. Organizations not only want a truly integrated system that clinicians will actually use; they want a vendor that can be a consistent and reliable partner in their efforts to reach meaningful use, Hess said. "Nearly 70 percent of the new 2009 hospital purchases in the report are an Epic or a Cerner integrated solution."

Although they did not realize the same increases as Epic and Cerner, MEDITECH and Siemens both saw limited growth of their currently marketed solutions. MEDITECH users share concerns that MAGIC and early C/S platforms do not provide the features and functionality needed to meet meaningful use requirements and that there may not be enough time available for MEDITECH clients to implement C/S v.6 and meet the coming deadlines. Siemens Soarian growth continues slowly, but Siemens' overall footprint in the market is shrinking as providers replace the legacy solution Invision with another system.

Recent and pending changes in the market may shift the purchase pendulum. McKesson's Paragon product was originally developed for a community hospital environment, but sold to more large hospitals in 2009 than its Horizon solution did. The recent Allscripts-Eclipsys merger may be a catalyst that will affect the product offering and its success. Some providers are looking forward with cautious optimism to GE's release of Quilibria, the result of collaboration with Intermountain Healthcare, even with GE's customer satisfaction rating decreasing by five points in 2009.