Cerner leads the worldwide EHR market with Epic taking the second spot, Allscripts in third and GE Healthcare at fourth. 

“In the competition for large healthcare systems, it's the top four EHR companies mainly participating with some exceptions,” Mary Anne Crandall, a senior analyst at Kalorama Information, wrote in the firm’s annual report on the state of EHRs.

For 2017, Cerner earned 17.3 percent market share, while Epic has 8.8 percent. 

Allscripts, thanks to mergers and acquisitions of Misys and Eclipsys, rose to 6.1 percent. 

That’s when looking at the overall global market. When homing in on the physician office space, however, Crandall said Epic is in the lead and Meditech is also in play. 

"In the physician office arena, competition is fierce,” said Crandall. It’s not just the big four like it is among larger customers. Instead, athenahealth, eClinicalWorks, NextGen and NueMD are all vying for clients. “There are a lot of competitors.” 

As it did last year, Kalorama pointed out that no one company has a majority share of the market as of 2017. One notable change from Kalorama’s report about 2016 is that McKesson was then in the second spot behind Cerner and ahead of Epic and Allscripts. 

There are other ways to slice and dice the EHR market. Just last month, KLAS researchers found that both Cerner and Epic showed what KLAS called “market energy,” based on how many deals a vendor is likely to land in the immediate future. 

KLAS found Epic in the lead with 393 potential customer wins, while Cerner has 304. Athenahealth is at 129, with Meditech close behind with at 125. Allscripts, meanwhile, could score as many as 72, GE Healthcare has 61 potential customers, while eClinicalWorks is looking at 45, Merge/IBM at 39; and Philips has 33 prospects. 

Looking ahead to 2018, Kalorama’s Crandall said the firm expects Epic to continue gathering market share and adding to its ambulatory customer base.

Allscripts, meanwhile, bought McKesson's EHR technology in 2017, part of the Enterprise Information Solutions business unit that includes the Paragon EHR system. Kalorama said that will enable Allscripts to offer a stronger hospital offering, especially among smaller providers and health systems.

What’s in store for athenahealth is unclear. Activist investor Elliott Management, which owns 9 percent of athenahealth’s stock, sent a $6.5 billion takeover bid last week, which athenahealth’s board is currently reviewing. 

Cerner, for its part, has gotten a revenue boost from its modernization contract with the U.S. Department of Defense and is awaiting a final decision about whether Veterans Affairs will sign a contract to modernize its EHR with Cerner as well. VA CFO Jon Rychalski told the Senate Committee on Appropriations that the VA will make that decision by May 28. 

Kalorama explained that it determines market share by looking at revenue for EHR and EMR platforms, Computerized Physician Order Entry systems as well as consulting, installation, training and servicing. 

Twitter: @Bernie_HITN
Email the writer: bernie.monegain@himssmedia.com