Does EHR Have a “Big 5”?

I was recently reading something that referenced the Big 5 EHR vendors. I thought the reference was really interesting. It obviously comes from what was commonly referred to as the Big 5 accounting firms. For those following along at home, the big 5 are currently the big 4 after Arthur Andersen’s demise following its involvement in the Enron scandal. The question I have is whether there’s a Big 5 when it comes to EHR vendors.

Much like everyone has to have an accounting firm, it’s becoming very clear that every healthcare organization will have an EHR vendor. The problem is that I don’t think we’ve really gotten to where we can say there are 5 (or some other number) EHR vendors that get all of the top business.

In the large hospital space, I’ve heard some argue that there’s a Big 2 (Epic and Cerner). Beyond that, I think there’s a bloody battle going on between EHR vendors. I think this is true in the small hospital space and in the ambulatory space. Plus, we’re somewhere between 40-60% EHR adoption and so that still leaves a large amount of ground for a smaller EHR vendor to still capture market share.

Everyone has been preaching that EHR consolidation is going to happen. I’ve suggested that we won’t see widespread consolidation until at least after MU stage 2. I don’t know many EHR vendors that don’t have enough cash to see it through MU stage 2. We could see some fall off from those vendors post-MU stage 2.

The real challenge is that it’s not easy to bring together two EHR companies. If you don’t believe me, ask Allscripts about it. It’s not a sure bet that the users of an acquired EHR will just move to the acquiring companies EHR. Often it means that users will leave and find a new EHR.

Certainly our current plethora of EHR vendors is unsustainable, but I don’t believe we’ll ever get to a Big 5 EHR list either. You can still have a great EHR business model with 1000 or so doctors.

About the author

John Lynn

John Lynn

John Lynn is the Founder of, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

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