KLAS Research characterized partnership and responsiveness as key drivers of customer satisfaction
Epic Systems has bolstered its status as the dominant player among vendors of electronic health records (EHR) software, winning nearly 70% of new hospital contracts in 2024. Most, if not all, of these rollouts will include clinical laboratory data imported into the EHR system.
According to a recent market share report from KLAS Research, Epic added a net 176 acute care multispecialty hospitals in 2024, marking its largest-ever annual net gain, KLAS reported. Meanwhile, Epic’s largest rival, Oracle Health, saw a net loss of 74 hospitals during the year. Meditech, the No. 3 EHR vendor, saw a net decline of 57 hospitals.
The report, titled, “US Acute Care EHR Market Share 2025,” was based on interviews with healthcare organizations as well as data from vendors and other sources, KLAS said.
“Across all vendors, the level of partnership has emerged as a key differentiator,” KLAS stated in its report. “A vendor’s reputation for listening to customers, taking feedback, and implementing requested changes greatly impacts customer satisfaction—often translating to gains in overall market share.”
In their KLAS report, authors Bradley Hunter (left) and Paul Warburton (right) wrote, “Though still high overall, acute care EHR purchase energy slightly cooled in 2024. Health systems continued to drive most of the decisions.” Photo copyrights: KLAS Research.)
Drivers of Epic’s Success
Among large health systems—defined as those with more than 10 hospitals—KLAS noted the following market share for EHR vendors:
Epic—48%.
Oracle—27%.
Meditech—15%.
All other EHR vendors—10%.
Among all acute care hospitals, Epic’s market share is 42.3% compared with 22.9% for Oracle and 14.8% for Meditech.
Epic also dominates in terms of percentage of hospital beds, with a 54.9% market share compared with 22.1% for Oracle and 12.7% for Meditech.
Overall, acute care EHR purchases declined in 2024, as 272 hospitals bought an EHR system, compared with 319 in 2023, KLAS reported.
The report attributed Epic’s success to “the stability and interoperability capabilities of the product as well as generally high satisfaction among current customers. Beyond strictly technological considerations, Epic’s reputation for customer partnership has brought them to the forefront of most EHR considerations.”
Oracle’s Market Decline
For the first time, Oracle declined to offer a list of new contracts, KLAS reported. To arrive at its estimates for the company, KLAS said it used “publicly available resources and our standard internal research methods.”
What accounts for Oracle’s market decline? “As has been the case historically, healthcare organizations continue to cite poor partnership and a lack of follow-through on promises as some of their biggest concerns,” KLAS reported, adding, “While many Cerner customers hoped the 2022 acquisition by Oracle Health would lead to relationship improvements, the vendor’s loyalty and relationship ratings have dropped over 10 points since November 2021 (just before the announced acquisition).”
On the other hand, current and potential Oracle customers have expressed “cautious optimism” due to recent technology developments, KLAS reported, including rollouts of Clinical AI Agent, Seamless Exchange, and Oracle Cloud Infrastructure, plus announcements of a new EHR system and patient portal.
“More than one-third of customers report that over the last six months, there has been a positive change in the vendor’s execution/delivery,” KLAS reported. “This represents a notable change from the overall sentiment during the last couple of years.”
Compilation shows US Veterans Administration spent the most at $16B
Clinical laboratory leaders and pathologists will be interested in which hospital systems are making the largest investments in electronic health record (EHR) technologies. Especially considering laboratory information systems (LIS) must interface with these platforms and require extensive reworking when hospitals change their EHRs. For example, hospitals moving to the Epic Systems EHR often require their laboratories to implement the Epic Beaker LIS as well.
According to information sourced by Becker’s Hospital Review, the top 16 hospital systems each spent $500 million or more on EHRs, adding, however, that the information is “not an exhaustive list.”
Number three on the list is Kaiser Permanente which operates multiple hospitals within its nine healthcare networks across the United States serving 12.5 million members. For that reason, its total investment in EHR technology represents a much larger number of hospitals than the other health systems on the list.
Of the 16 providers on the list, 12 installed EHRs provided by Epic Systems of Verona, Wis. Four of the providers implemented EHRs from Oracle Health (formerly Cerner), North Kansas City, Mo., and Meditech of Westwood, Mass.
“Looking forward, there are many advantages in terms of investing in the future and how we will be aligned with technologies including digital and AI applications,” said pathologist Angelique W. Levi, MD (above), vice chair and director of pathology reference services at Yale School of Medicine, in a news release following a site visit to Geisinger Diagnostic Medicine Institute in Danville, Pa., to see Epic Beaker in operation at Geisinger’s clinical laboratory. “But what we gain immediately—having all the patient information accessible in one place in a linked and integrated fashion—is very important.” (Photo copyright: Yale School of Medicine.)
Provider, EHR, Investment
Becker’s list below shows the total amount invested by the 16 healthcare systems was approximately $38.32 billion. The average EHR implementation cost is $2.39 billion for a large healthcare provider.
Becker’s stated they assembled this list from public sources and that there may be other EHR/hospital contracts with a total cost that also would make the list. It is not common to see a list of what hospitals actually spend to acquire and deploy a new EHR.
Epic added 153 hospitals to its client base in 2023. Epic’s EHR competitors—Oracle and Meditech—both experienced declines in client retention rate, Healthcare IT News reported based on the KLAS data.
“Both current and prospective large organization customers are drawn to Epic because they see the vendor as a consistently high performer that provides strong healthcare IT [information technology], quality relationships, and the opportunity to streamline workflows and improve clinicians’ satisfaction,” Healthcare IT News said of the KLAS report’s findings.
In a blog post, authors of the KLAS report explained that in 2023 Oracle added specialty hospital clients and Meditech “saw several new sales” which included healthcare systems and independent providers.
In the next few years, the industry is “ripe for disruption. Another vendor could come in and turn everything on its head,” the KLAS blog article concluded. “Even those who choose Epic want to have more competitive options to choose from.”
Preparing for an LIS Change
Clinical laboratory leaders who may be transitioning their LIS during a new EHR installation may learn from colleagues who completed such an implementation.
Angelique Levi, MD, vice chair and director of pathology reference services at Yale School of Medicine, who was part of the pathology team, noted that one challenge for labs is addressing “information that’s from many different places when we’re talking about cancer care, prognostic testing, and diagnostics.
“It’s become much more complicated to manage all those data points,” she continued. “Without being on an integrated and aligned system, you’re getting pieces of information from different places, but not the ability to have linked and integrated reports in one spot.”
EHR implementations are among the most labor-intensive, expensive projects undertaken by hospitals. Therefore, it is crucial that clinical laboratory and pathology leaders research and learn why an EHR (and possibly LIS) change is needed, what is expected, and when results will be received.
Technology like Apple’s VR/AR headsets may prove useful to clinical laboratories in accessioning and in pathology labs during biopsy grossing
In what has been billed as a first, medical teams in the US and UK used Apple’s Extended Reality (XR) Vision Pro headset system to assist in surgical procedures. The surgeons themselves did not wear the $3,500 headset. Instead, surgical nurses used the device for touch-free access to a software application that assisted them in setting up, organizing, and performing the operations. For pathologists and clinical laboratories, in the histology laboratory, such an arrangement involving XR headsets could be used when a biopsy is at the grossing station as well.
The headset software the team used during surgery was developed by eXpanded eXistence, Inc. (eXeX), a Florida-based company whose primary product is an iOS (Apple mobile operating system) application that provides similar functions for mobile devices. eXeX adapted the iOS app to work on Apple’s Extended Reality headset.
Extended Reality is an umbrella term for augmented reality (AR) and virtual reality (VR). Apple refers to the technology as “spatial” computing.
Within the clinical laboratory, XR headsets could be used in the accessioning process as the accessioner works through the steps to confirm all required information accompanies the test requisition and that the patient’s specimen is processed/aliquoted appropriately.
“The eXeX platform, enhanced by artificial intelligence, is designed not as a medical device but as an organizational and logistics tool. It aims to streamline the management of tens of thousands of items, including equipment, tools, technologies, consumables, implants, and surgical products,” said neurosurgeon Robert Masson, MD, eXeX’s founder and CEO, in a February news release.
Masson first deployed the software in his own surgical practice. Then in March, eXeX announced that a surgical team at Cromwell Hospital in London used the system in two microsurgical spine procedures, according to a March new release.
That news garnered media coverage in the UK as well as in US-based publications that follow Apple.
“We are in a new era of surgery, and for the first time, our surgical teams have the brilliance of visual holographic guidance and maps, improving visuospatial and temporal orientation for each surgical team and for each surgery in all specialties,” said neurosurgeon Robert Masson, MD (above), eXeX’s founder and CEO, in a press release. Clinical laboratories may one day use XR headsets in the histology lab at the grossing station. (Photo copyright: Masson Spine Institute.)
Surgical Process Not Glamorous, But Important
Despite being on a cutting-edge XR platform, the eXeX software addresses “the least glamorous part” of the surgical process, Masson told Gizmodo.
“People assume that surgical healthcare has got to be sophisticated and modern,” he said. “The reality is the way we organize it is probably the most archaic of all the major industries on the planet. It’s all memorization and guesswork with scribbles on pieces of paper.”
The advantage of an XR headset is that it allows use of the eXeX software in a sterile environment, he added. “The ability to interact with digital screens and holograms and lists and maps and products unlocks all kinds of possibilities. Suddenly, you’ve got an interactive digital tool that you can use without violating the sanctity of sterility.”
Does he foresee a future when the surgeons themselves use XR headsets in the operating room? Not necessarily, Masson told Gizmodo.
“There’s always a tendency to say, ‘look at this amazing tech, let’s put a screw in with it,’” he said. “Well, we’re already putting screws in without the headset, so it doesn’t really solve a problem. People tend to think of floating spines, floating heights, you know, an overlay that tells you where to put a catheter in the liver. Honestly, it’s all unnecessary because we already do that pretty well. What we don’t do really well is stay organized.”
Other XR Apps for Healthcare
In a news release, Apple showcased other healthcare apps for its Vision Pro platform.
Epic Systems, an electronic health record (EHR) system developer, has an app called Epic Spatial Computing Concept that allows clinicians “to easily complete charting, review labs, communicate using secure chat, and complete in-basket workflows through intuitive gestures, like simply tapping their fingers to select, flicking their wrist to scroll, or using a virtual keyboard or dictation to type,” Apple stated in the news release.
Stryker, manufacturer of Mako surgical robotic arms for joint-replacement procedures, has an Apple iOS app called myMako that “allows surgeons to visualize and review patients’ Mako surgical plans at any time in a brilliant, immersive visual experience,” Apple said.
Cinematic Reality, from Siemens Healthineers, is an Apple iOS app that “allows surgeons, medical students, and patients to view immersive, interactive holograms of the human body captured through medical scans in their real-world environment,” Apple said.
New Era in Technology
For the past 20 years, manufacturing companies have installed systems at workstations with audio and video that show each step in a work process and with written checklists on the computer screen. This allows workers to check off each required step as proof that each required work element was performed.
This is similar to professional pilots who use checklists at every step in a flight process. One pilot will read the checklist items, the other will perform the step and confirm it was complete.
These procedures are generally completed on computer displays, but with the advent of XR headset technology, these types of procedures are evolving toward mobility.
To prepare for the emergence of XR-based healthcare apps, the US Food and Drug Administration (FDA) has organized a research team to devise best practices for testing these headset devices, CNBC reported.
It will be some time before XR headset technology finds its way into histology laboratories, clinical laboratories, and pathology practices, but since the rate of technology adoption accelerates exponentially, it might not take very long.
In both the hospital market and the ambulatory market, Epic has the best-selling electronic health records system, according to data issued by ONCHIT
Across the nation, clinical laboratories and pathology groups are busy interfacing their laboratory information (LIS) systems to the electronic health record (EHR) systems of their client hospitals and physicians. Yet, few lab managers know which EHR systems are dominating the market and which EHR systems are barely surviving.
In fact, it can be a challenge to understand market share by vendor. That is because market share can be determined in multiple ways. Dark Daily found three different rankings of EHR vendors. Each was based on slightly different sets of data. (more…)
Clinical pathology laboratories will keep busy interfacing their LISs to these EMRs
Tis the season of electronic health records (EHR), now that both hospitals and physicians can qualify to earn incentives from the federal government when they implement these solutions and meet “meaningful use” criteria.
It is possible for individual hospitals to receive incentives totaling as much as $2 million for implementing a certified EHR. This is powerful motivation for cash-strapped hospitals. For that reason, pathologists and clinical laboratory managers of hospital laboratories can expect to be busy ensuring that their laboratory information system (LIS) interfaces properly with the EMR of their parent hospital.
