According to the research firm KLAS, 2018 was the busiest in recent years for Electronic Medical Records (EMR) software market, and recent purchasing trends show a progression in the Electronic Health Records (EHR) and Practice Management (PM) software landscape.

The market share report also stated that most of the healthcare practice, hospitals and organizations that signed on for a new EHR Software implementation in 2018, whether they were large or small, government-run or private-sector, chose for Cerner or Epic EHR software systems.

Here’s what the KLAS report had to say about the major EMR systems’ players:

Epic EHR software 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.”

Large organizations across the U.S. have by now spend billions for an integrated enterprise-wide platform. This 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. The market share of the top 4 EMR software vendors is as follows:

Epic (163 hospitals)

Cerner (77 hospitals)

Allscripts (16 hospitals)

MEDITECH (12 hospitals)

14 hospitals chose to trade Allscripts’ Sunrise Clinical Manager platform in favor of Epic in 2018, according to the report, while 16 providers traded the Paragon system which was accquired by 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. Over the last few years, several specialty hospitals have chosen SCM; many choose the solution for the amount of customization it offers.”

athenahealth hopefully marks the tail end of two years of activist investor tumult. As it looks toward the future, the top EMR vendor needs to fill various loopholes.

“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,” stated the KLAS research team. The future of the company remains indecisive due to different shifts in the market trends.

The top EHR software Cerner got 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.

39% of the Cerner market is because of government contracts and affiliations. The flip side, however, is that it was “chosen by fewer organizations in the private sector, the majority being smaller hospitals. 65 hospitals left Millennium in 2018 (52 of which came from two health systems); the vast majority moved to Epic.”

One of the oldest EHR software MEDITECH celebrates its 50th anniversary this year and is holding up 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).”