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*Updated May 2019
Ten years ago, overall EHR adoption was hovering at about 73 percent of U.S. hospitals. Today that number has risen to a 98 percent implementation rate, which may be attributed, in part, to the Centers for Medicare and Medicaid Services' (CMS) Meaningful Use incentive payments initiative, called the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2011. The intent of HITECH was to encourage healthcare providers to utilize electronic data recording and sharing technology, such as EHR systems, to improve clinical quality and care transparency among patients. And most providers did just that -- with the majority of all installations occurring back in 2014. But what about the remaining two percent of hospitals that have not yet installed EHR systems? The holdouts tend to be on the smaller end of the spectrum in terms of both revenue and bed size. Specifically, psychiatric hospitals are the most likely to not have adopted an EHR yet.
Ambulatory or outpatient systems are designed for use in small physician practices and other outpatient facilities, often with only a single department and little need for in-house interoperability. Inpatient systems, however, are designed for hospital settings. This requires a system to function for multiple departments, and interoperability is emphasized more than in an outpatient setting. Though choosing the right inpatient EHR application can be challenging, it is advantageous compared to the traditional manual method of printing and note-taking, which leads to missing or duplicate data if not tracked properly.
Large vendors Epic and Cerner collectively hold over 50 percent of the market share. While the inpatient EHR market is dominated by large nationwide vendors, smaller vendors and proprietary systems are still holding their own -- even in rural and critical access hospitals. It is true that larger hospitals are more likely to implement advanced EHR systems like those offered by Epic and Cerner, but more than 80 percent of critical access and rural hospitals reported using at least a basic EHR system.
|4.||Evident, a CPSI Company||8.1%|
|10.||Indian Health Service||0.5%|
Fig 1 Inpatient EHR vendor market share, Definitive Healthcare's Hospitals & IDN platform, spanning 6,401 hospitals
Currently, large vendors Epic and Cerner collectively dominate both the inpatient and ambulatory EHR market share, splitting over 50 percent. We've seen Epic as the biggest mover of EHR market share, rising from around 5 percent to 30 and 33 percent of inpatient and ambulatory implementations, respectively, over the past 10 years. On the flip side, a few bigger vendors have seen their market share decrease significantly; MEDITECH dropped about 11 percentage points since 2009, although they still hold the third largest spot in terms of the overall market.
So far, EHR systems do a great job of managing the patient record, but they are a bit narrowly designed. Over the last five years we have seen a massive acceleration (~300 percent increase) in complementary systems being installed in order to bridge the gaps in what EHR systems can do. Modules such as clinical decision support systems, patient portals, and computerized physician order entries have been at the forefront of this next wave. We will also start to see ancillary systems such as laboratory information systems, oncology management tools, operating room software, and other deeper-level integration programs start to tie together not only hospitals, but also associated sites of care like physician groups and surgery centers.
Want to learn more about EHR market share, and which EHR vendors and systems a particular hospital uses? Interested in learning about other technologies that hospitals are implementing, like telehealth systems, HIS, patient portals, etc.? Definitive Healthcare's platform can help you: