Most health systems that signed on for a new electronic health record install in 2018 – be they large or small, government-run or private-sector – opted for Cerner or Epic, according to the new market share report from KLAS.

That may be unsurprising at this point. But it "does not tell the whole story," said researchers, who charted what they said the "busiest" buying period of the past three years, with gains and losses from blue chip vendors making for a EHR landscape that looks very different from earlier this decade.

Here's what the KLAS report had to say about the major players:

Allscripts

Fourteen hospitals opted to trade Allscripts' Sunrise Clinical Manager platform in favor of Epic in 2018, the report shows, while 16 providers traded the Paragon system (acquired from McKesson in 2017) for other vendors. The company has phased out McKesson's Horizon technology, meanwhile, and the three hospitals who opted to replace that system this past year didn't stick with Allscripts.

"In terms of new sales, one small IDN and one standalone hospital chose SCM in 2018, and one athenahealth customer moved back to Paragon," KLAS notes. "Over the last few years, several specialty hospitals have chosen SCM; many choose the solution for the amount of customization it offers."

athenahealth  

The recent round of layoffs at athenahealth hopefully mark the tail end of two years of activist investor tumult. As it looks toward the future, the now-private company has some ground to make up.

"Critical access hospitals have chosen athenahealth in recent years, though energy tapered off significantly in the latter half of 2018, with organizations reporting that athenahealth has paused sales and stopped responding to RFPs," said KLAS researchers, who note that some customers have been gratified by recent version updates and future development of the inpatient product, but others a challenged by certain functionality gaps and remain uncertain about the company's future plans.

Cerner

Cerner again gained the most new hospital clients in 2018, but customer attrition tamped down its net gains in market share, according to the report. Much of its growth this past year came thanks to the finalization of its deal with the U.S. Department of Veterans Affairs – giving Cerner 147 new acute care and 20 specialty hospitals to outfit with new technology.

Indeed, "government contracts have made up 39 percent of Cerner’s hospital wins over the past five years," according to KLAS. The flip side, however, is that it was "chosen by fewer organizations in the private sector, the majority being smaller hospitals. Sixty-five hospitals left Millennium in 2018 (52 of which came from two health systems); the vast majority moved to Epic."

Epic

Yes, Epic continues to dominate the private-sector market, especially with large hospitals and health systems. That market (inpatient facilities with 500 beds or more) is not quite as active with new installs, but those organizations that do opt for a replacement system "almost exclusively choose Epic."

The fact that these large organizations across the U.S. have by now spend billions for a integrated enterprise-wide platform means that any future changes of direction would require "significant rip and replace," according to KLAS – and that, practically speaking, narrows the choices to Epic and its competitors. "Four key vendors remain in the large space – Epic (with 163 hospitals), Cerner (77 hospitals), Allscripts (16 hospitals), and MEDITECH (12 hospitals)."

MEDITECH

MEDITECH, the longest-standing EHR vendor (founded in 1969, it celebrates its 50th anniversary this year), is holding it own in the market thanks in large part to its recent web-based Expanse technology, which has "proven compelling to both legacy MEDITECH customers and those outside the MEDITECH base," according to KLAS researchers.

"For the second year in a row, a number of organizations outside of MEDITECH’s base – mostly small to midsize hospitals – chose Expanse. In addition, 19 legacy hospitals migrated to Expanse (out of the 53 MEDITECH hospitals that were part of a go-forward decision in 2018)."

Regional fiefdoms emerging

Generally speaking, the report makes the case that market imperatives around mergers and acquisitions have "resulted in regional standardization in some areas of the US, with certain regions being heavily influenced by specific vendors."

KLAS researchers note that, "as large health systems have expanded their reach into new geographic areas, Epic has been the primary beneficiary of this standardization. Cerner has also benefited, while legacy products from MEDITECH and Allscripts have been the most often replaced."