The EMEA market for electronic health record (EHR) IT is estimated to have been worth $3.7B in 2018 (both acute and ambulatory applications) according to Signify Research’s 2019 global EMR market report. However, only one vendor, Cerner, is estimated to have had a double-digit revenue share in 2018. In terms of suppliers the EMEA market is highly fragmented with a mixture of local and international vendors addressing individual countries with few vendors having a truly region-wide footprint.
The table below shows estimated revenue shares in 2018 for the acute & health system EHR market in EMEA (excluding revenues for ambulatory only solutions), alongside the countries/sub-regions where each vendor had a significant share of its EMEA business.
|Acute/Network EHR Estimate Revenue Share – EMEA – 2018|
|2018 Rank||Company||2018 Revenue Share||Key Countries/Sub-Regions|
|1||Cerner||16%||DACH, UK/Eire, Middle East|
|2||Agfa Health||8%||DACH, France|
|4||CompuGroup Medical||5%||DACH, Nordics, Eastern Europe|
|5||InterSystems||4%||UK/Eire, Middle East, Spain/Portugal|
|7||DXC Technology||3%||Benelux, UK/Eire, Spain/Portugal|
|9||Dedalus||3%||Italy, France, Spain/Portugal|
|13||Epic||2%||Benelux, Nordics, UK/Eire, Middle East|
|Source: Signify Research||Note: Does not include ambulatory only revenue/vendors|
Examining several major countries/sub-regions:
- The acute market in UK/Eire is served by many suppliers with Cerner, InterSystems, iMDsoft, System C, Allscripts and DXC Technology having the largest acute trust businesses in the UK in 2018 and MEDITECH, DXC Technology and Cerner dominating Eire.
- The French market is highly fragmented with Maincare Solutions, Agfa, CEGI, SIB and Berger Levrault having the largest share in 2018. Some consolidation is forecast as procurement moves to the Territorial Hospital Groups (GHTs).
- In the DACH region (Germany, Austria, Switzerland), CompuGroup Medical had the largest revenue share in 2018 across both the acute and ambulatory sectors, with Agfa, Cerner, Telekom Health and Nexus also significant players. Gematiks Telematics Infrastructure demands are redefining EHR solution requirements in Germany and CompuGroup Medical was able to leverage first-mover advantage here in 2018.
- Cerner and DXC Technology have historically benefited from large EHR contracts in several autonomous regions in Spain/Portugal. However, other international and local vendors such as Indra, InterSystems, everis, Alert, Oesia and Dedalus also had sizeable shares. Integrated care initiatives will drive market growth in Spain; however, significant vendor consolidation is not forecast.
- The Nordic region has regionalised much of its EHR procurement over recent years with several countries focusing on integrated care initiatives. This has resulted in consolidation in the supplier base with local vendors such as Tieto, Systematic, DIPS, Evry and Cambio Health holding the greatest share. That said, international vendors (e.g. Cerner and Epic) did gain significant share in 2018.
- The Italian EHR market is served by local IT generalists that largely just operate in Italy, such as Engineering Ingegneria, Reply and GPI Group. Dedalus, has also had success with regionalisation and is the exception in that it’s the only Italian vendor to have a sizeable international EHR business.
- The Middle East & Africa region bucks the trend for local vendors to some extent. Cerner, DXC Technology, InterSystems and Epic all having won sizeable contracts in recent years, particularly in the UAE and Saudi Arabia.
Outlook for International EHR Market Competitive Environment
As the US market for core-EHR solutions starts to saturate, vendors are increasingly looking to geographic expansion to maintain their historic growth rates. This will lead to increased levels of competition across EMEA. Some vendors will succeed; however, expanding into new international markets is a strategy that has many pitfalls and vendors need to understand the nuances of local markets in terms of product requirements, government initiatives and local vendors’ strengths if they are to succeed.