In March 2013, Software Advice published an EHR market share report based on the Centers for Medicare & Medicaid Services (CMS) data from meaningful use (MU) attestations through the end of 2012.
Since then, despite some well-publicized MU program dropouts, medical providers by and large have continued to adopt EHR software, and MU attestations have grown.
CMS data is now up to date through the end of 2013, so we’ve decided it’s time for a market share update. This report covers EHR meaningful use market share data from 2013 compared to 2014.
However, it’s important to note that MU is being replaced by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) health care legislation, which will completely transform the old federal EHR incentive program. MACRA is intended to protect physicians from automatic annual Medicare rate cuts and provide a legal framework for value-based Medicare reimbursement.
It’s also important to note that MACRA applies only to individual physicians, whether practicing alone or in groups. It doesn’t apply to hospitals or large-sized hospital-based practices.
In addition, you can view the top EMR vendors covered in our latest edition of FrontRunners for Electronic Medical Records. This can serve as a better tool for you to evaluate medical software vendors.
Ambulatory EHR Market Share
By the end of 2012, just over 107,000 unique eligible professionals had attested to meaningful use of a complete EHR in an ambulatory setting. By 2013, that figure had almost doubled, jumping to just over 209,000—a 95 percent increase.
The vendors dominating the market haven’t changed much over the last year. In fact, the same vendors comprise the top 10 market share spots in 2013 as in 2012. The only notable movement comes from athenahealth and McKesson, which have switched places in the rankings. At the end of 2012, McKesson ranked eighth and athenahealth ninth, while 2013 saw those rankings reversed—but their respective shares differ by just a fraction of a percent.
Overall, we saw very little movement in market share among the leading vendors. Although the number of new providers attesting to MU nearly doubled, the most popular EHR products used for attestation didn’t change by much. The charts below illustrate meaningful use market share today versus one year ago.
What’s surprising is how fragmented the market continues to be: five of the market’s top 10 vendors boast 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. Just as the market leaders are holding steady, smaller vendors are clearly maintaining their footholds and didn’t concede any ground in 2013 (compared with 2012, when “other” vendors claimed a 35.3 percent share of the market).
This 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. (Because this merger happened at the end of 2013 and the companies continue to sell their products under separate labels, we’ve considered them separately in this report.)
Even in the face of such mergers, the number of EHR products on the market continues to proliferate. 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.
In 2013 we reported that, among the EHR buyers Software Advice talks to on a daily basis, the percentage replacing existing software has nearly doubled since 2010, while 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.
Hospital EHR Market Share
When it comes to inpatient hospital attestations, the biggest vendors show greater market dominance: the top 10 account for over 90 percent of the market, while the top three alone account for over half of it.
Of course, 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.
That being said, Epic notably continues to hold the top spot in both ambulatory and inpatient settings, solidifying the company’s position as the overall market leader. The charts below illustrate meaningful use market share in the hospital setting today versus one year ago.
EHR vendor market share is notoriously difficult to pin down. Using MU attestations as a proxy for market share has its limitations, but it may still be the best representation of market share available, for several reasons.
First, sales data is not publicly available for most EHR software vendors. Additionally, different EHR vendors use different methods for calculating their customer bases. Some count the number of users (which could include everyone from physicians to administrative staff); others count the number of medical providers; still others count the number of practices—and so on.
This makes an apples-to-apples comparison difficult. The EHR Incentives Programs, on the other hand, provide a level playing field by clearly defining “eligible professionals” as those with one or more of a specific list of degrees or certifications.
Furthermore, MU attestation data is kept active and up to date. The CMS regularly publishes the latest figures, allowing for an almost real-time assessment of the market.
One 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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