Small hospitals drove EHR market demin 2022, says KLAS

New research from the KLAS Arch Collaborative shows clinician satisfaction, interoperability revenue cycle stability were among the big drivers for decisions to replace electronic health record systems in U.S. hospitals this past year.


KLAS’ annual U.S. Hospital EMR Market Share 2023 report looked at small large organizations with multiple hospitals, stand-alone hospitals of all sizes, academic medical centers, children’s hospitals specialty hospitals. 

Researchers looked at market trends for the overall hospital industry based on EHR vendors’ wins losses from January to December 2022, including Epic, Meditech, CPSI, Oracle Health, Azalea Health, Medhost Altera Digital Health (formerly Allscripts). 

They asked hospital customers about their overall experiences with these vendors their EHR platforms, gauging hospital loyalty to a platform. They gained insights into how these customers judge their vendors’ operations, about the value of the EHRs to their organizations.

Of note, Oracle Health, which was created by Oracle’s $28 billion acquisition of Cerner last year, saw its first double-digit net gain in hospitals since 2018. 

KLAS researchers said that large hospitals fueled previous growth, but small hospitals integrated delivery networks in 2022 opted for the company’s CommunityWorks platform. 

Nearly all of Oracle’s wins in the acute care space last year were hospitals with fewer than 200 beds, according to the report. However, the loss of large hospitals frustrated by revenue cycle challenges resulted in Oracle Health seeing “a significant overall decline in beds,” they added, “the most of any vendor in this report.”

CPSI Altera also had a large share of losses in EHR contracts last year.

Among small standalone hospitals, Epic Meditech saw market gains earned small hospitals’ highest overall performance scores at 86% 83% respectively. Meditech saw the most wins in legacy migrations in 2022.

The performance also resulted in Meditech seeing its highest retention rate over the study’s six-year period, “highlighting the strong confidence legacy customers have in Expanse,” researchers said. 

But KLAS noted that one contract resulted in a significant contribution to the company’s success in this category.

“Approximately one-quarter of all hospitals in the U.S. are currently using legacy [EHR] solutions, the majority of which are still being supported,” the researchers said. 

“The large number of hospitals still using a legacy solution speaks to the financial challenges these hospitals face as well as the significant burden of migrating to a different [EHR],” they added. 

Like Oracle, Meditech also experienced a loss in total beds total hospitals, in large part due to hospital mergers acquisitions the resulting standardization of medical records. 

Eleven of the company’s losses saw legacy customers move to Epic’s Community Connect model, according to KLAS.

Epic was the clear market leader, since it is the only vendor the researchers found to have a positive net change in both hospital market share number of beds. The Wisconsin-based company had the most wins in all but two categories.

“They continue to win customers from all [EHR] vendors, including vendors not highlighted in this report,” the researchers said. 

“Epic’s footprint is the largest in the country – they cover nearly half of all acute care beds in the U.S., their customers include most of the largest, well-resourced academic medical centers in the U.S.”

The researchers said KLAS considers a change in a hospital’s most recently contracted EHR as a “win” for the new vendor a “loss” for the vendor being replaced. They said they source data from multiple sources, including vendors that annually self-report their acute care hospital EHR wins.

The 29-page report also looks at regionality in hospital EHR market share includes an expanded vendor insights section.


KLAS researchers finding that the overall EHR market had been driven by the energy of small hospitals changing their EHRs is consistent with its Small Hospital Patient Accounting Report released in March.

According to the earlier report, which focused chiefly on Epic, Meditech, CPSI Oracle Health, all vendors have struggled to provide training that meets the needs of small hospitals.

“While many vendors offer viable clinical systems, there are significant differences across the customer experience with patient accounting that should not be overlooked by small hospitals,” the researchers said.

Prior to its 2022 purchase by Oracle Health, Cerner had focused on signing community hospitals of varying sizes to its CommunityWorks platform. 


“Epic maintained their position as the top choice for large organizations continued to increase the distance between themselves the rest of the market,” said KLAS researchers in the 2023 report. 

Andrea Fox is senior editor of Healthcare IT News.
Email: [email protected]

Healthcare IT News is a HIMSS Media publication.

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