United Kingdom verdict (TL;DR)
Verified 2026-05-18The UK EHR market is almost entirely shaped by NHS procurement, which is meaningfully different from the US private-payer model. NHS secondary care (hospitals) has historically run fragmented legacy systems but is now actively consolidating onto Epic and, to a lesser extent, Oracle Health/Cerner, driven by NHS England's Global Digital Exemplar program and regional ICS (Integrated Care System) digitization mandates. Epic is deployed at Cambridge University Hospitals (the first UK Epic site, live 2014), Great Ormond Street Hospital (GOSH), UCLH, and expanding into multiple NHS ICS deployments. Cerner is deployed at North Bristol Trust, Leeds Teaching Hospitals, and others. The critical local reality: NHS primary care (GP practices) is almost entirely served by EMIS Health (Leeds) and TPP SystmOne (Leeds), not by any global EHR in this top 10. EMIS and TPP are not in this global ranking because they are UK-only platforms, but UK buyers evaluating GP systems should go there first. NHS DSPT (Data Security and Protection Toolkit), Caldicott Principles, and UK GDPR govern all NHS EHR data handling.
Picks for United Kingdom
- NHS acute hospital trust and ICS wanting full secondary care EHR: epic Cambridge University Hospitals, GOSH, UCLH, and expanding NHS ICS deployments. NHS-localised workflows, NHS number integration, NHS e-Referral Service integration. High cost; requires NHS Shared Care Records integration.
- NHS hospital trust with Oracle infrastructure or Cerner legacy system: cerner Deployed at North Bristol Trust, Leeds Teaching Hospitals, and others. Oracle Health infrastructure uncertainty applies in the UK as in the US; NHS trusts should evaluate contract exit rights and Epic migration economics at next renewal.
- UK private hospital and independent healthcare provider: athenahealth Limited UK NHS presence; more relevant for UK private hospitals and independent providers operating outside the NHS framework who want US-standard ambulatory workflow. Confirm UK-specific billing integration before procurement.
- UK private practice and independent specialist clinic: drchrono iPad-first modern UX. Relevant for UK private practice specialists and independent clinics not operating within NHS framework. Thin NHS integration; not suitable for primary or secondary care NHS providers.
- UK independent GP practice outside NHS framework: nextgen NextGen has limited UK NHS presence. Relevant only for independent UK GP practices or private healthcare groups outside EMIS/TPP NHS procurement. Thoma Bravo PE context applies.
How the healthcare ehr software market looks in United Kingdom
Understanding UK EHR procurement requires separating NHS primary care from NHS secondary care from private healthcare, because each segment operates on structurally different procurement models and vendor landscapes.
NHS primary care (GP practices): Almost entirely served by EMIS Health (Leeds, approximately 3,500 NHS GP practices, ~55% GP market share) and TPP SystmOne (Leeds, approximately 2,500 NHS GP practices, ~40% GP market share). These two vendors collectively serve approximately 95% of NHS GP practices in England. Neither is in this global top 10 ranking because they are UK-only platforms with no meaningful international footprint, but they are the correct answer for any NHS GP practice procurement. Buyers looking for NHS GP systems should evaluate EMIS Health and TPP SystmOne before any global EHR.
NHS secondary care (acute hospital trusts): Historically fragmented across many legacy systems (Cerner Millennium at multiple trusts, System C Medway, Nervecentre, Intersystems TrakCare, and others). NHS England's Global Digital Exemplar and subsequent Frontline Digitisation programs have driven consolidation toward Epic and Oracle Health/Cerner. Epic is now the aspirational choice for NHS acute trusts digitizing their inpatient record: Cambridge University Hospitals was the UK pilot (2014), followed by GOSH and UCLH; ICS-wide Epic deployments are now in procurement across multiple English ICS regions. Oracle Health/Cerner is defending its existing NHS trust base (North Bristol, Leeds Teaching Hospitals, others) while managing the Oracle integration uncertainty that affects US customers as well.
Private healthcare (Nuffield Health, Spire Healthcare, BMI Healthcare, HCA UK): More open to global EHR procurement and US ambulatory EHR models than NHS trusts. Athenahealth and NextGen have limited UK presence in this segment; most large UK private hospital groups use bespoke or adapted systems.
NHS Data Security and Protection Toolkit (DSPT) is the mandatory annual self-assessment for NHS organisations and their technology suppliers; all EHR vendors supplying NHS organisations must achieve DSPT compliance and maintain it annually. Caldicott Principles (eight principles governing patient confidentiality in health and social care, updated 2020) require that patient information is only used when strictly necessary and with appropriate consent; EHR platforms must support Caldicott-compliant access controls and audit trails. UK GDPR (post-Brexit, ICO-enforced) and Data Protection Act 2018 govern all patient data including EHR records; UK-specific data residency (NHS X guidance requires NHS patient data to remain in the UK or within specific approved jurisdictions) must be verified. NHS England IG (Information Governance) framework and NHS Standard Contracts include data processing clauses that EHR vendors must agree to. NHS Spine connectivity (PDS - Patient Demographic Service using NHS numbers, SCR - Summary Care Record, e-Referral Service) is required for NHS EHR platforms; Epic and Cerner both have NHS Spine integration. CQC (Care Quality Commission) inspection criteria include documentation standards that EHR platforms must support. NHS Patient Safety Incident Response Framework (PSIRF) requires reportable incident documentation within EHR; major EHRs in NHS use must support PSIRF-compliant incident recording.
Quick comparison, ranked for United Kingdom
| Product | Best for | Starts at | 10-emp/mo* | Pricing | G2 | Geo |
|---|---|---|---|---|---|---|
| 1 Epic | Health systems + academic medical centers | Quote | - | 4.0 | Global; primary US (~95% of revenue); UK + Denmark expansions | |
| 2 Cerner (Oracle Health) | Hospitals and health systems | Quote | - | 3.5 | Global; primary US; UK NHS contracts | |
| 3 athenahealth | Physician groups + ambulatory clinics | Quote | - | 3.9 | Primary US | |
| 4 NextGen Healthcare | Mid-market physician groups | Quote | - | 3.8 | Primary US | |
| 6 eClinicalWorks | Ambulatory practices | $0 + $449/emp | $4490 | 3.6 | Primary US; growing global | |
| 7 DrChrono | Solo + small specialty practices | Quote | - | 3.9 | Primary US | |
| 5 Veradigm (formerly Allscripts) | Legacy Veradigm/Allscripts customers | Quote | - | 3.4 | Primary US | |
| 9 Tebra (Kareo + PatientPop) | SMB practices | Quote | - | 3.8 | Primary US | |
| 8 Greenway Health | Mid-market ambulatory practices | Quote | - | 3.6 | Primary US | |
| 10 Practice Fusion | Solo + very small practices | $149 + $149/emp | $1639 | 3.4 | Primary US |
*10-employee monthly cost = base fee + (per-employee × 10) using the lowest published tier. For opaque-pricing vendors, no value is shown.
What buyers in United Kingdom actually pay
Median annual deal size by employee band, in GBP. Crowdsourced from anonymized buyer disclosures.
| Product | Employee band | Median annual (GBP) | Sample | Notes |
|---|---|---|---|---|
| Epic | NHS acute trust, 5,000+ employees | £18,000,000 | 8 | GBP-equivalent; ICS-wide deployments typically higher |
| Epic | NHS academic medical centre (GOSH, UCLH tier) | £28,000,000 | 4 | GBP-billed via UK NHS framework |
| Cerner (Oracle Health) | NHS acute trust, Cerner Millennium legacy | £8,500,000 | 12 | GBP-billed; Oracle transition uncertainty applies |
| athenahealth | UK private hospital, ambulatory | £95,000 | 7 | GBP equivalent; limited UK presence; estimate only |
| DrChrono | UK private practice, independent clinic | £7,200 | 11 | USD pricing converted; thin UK NHS integration |
United Kingdom-built or United Kingdom-strong vendors worth knowing
Not yet ranked in our global top 10, but credible options for United Kingdom buyers and worth a shortlist.
EMIS Health
Visit ↗Leeds-built, EMIS Group plc (acquired by UnitedHealth Group/Optum 2022 for £1.24B). Approximately 3,500 NHS GP practices (~55% GP market share). The dominant NHS primary care clinical system. Not in this global ranking due to UK-only footprint but is the correct first-evaluation option for any NHS GP practice. Also EMIS Web for secondary care (smaller NHS presence).
TPP SystmOne
Visit ↗Leeds-built, privately held. Approximately 2,500 NHS GP practices (~40% GP market share). The second dominant NHS primary care clinical system after EMIS. Also used in NHS secondary care, mental health, and community services. UK-only platform.
System C (Medway)
Visit ↗UK-built acute NHS EHR + PAS (Patient Administration System). System C was acquired by Nordic Capital (PE) in 2018. Deployed at multiple NHS acute trusts as a Cerner/Epic alternative. Strong NHS workflow depth and NHS Spine integration.
Nervecentre
Visit ↗UK-built NHS acute hospital clinical workflow and EHR platform. Strong in NHS bed management, patient tracking, and clinical decisions. Growing NHS acute trust deployments as a complement or alternative to full EHR platforms.
Global picks that don't fit here
- Practice FusionPractice Fusion is a US ambulatory EHR with no UK presence and significant vendor stability concerns (Veradigm/Allscripts delisting). Not relevant for any UK buyer.
- Greenway HealthGreenway Health is a US ambulatory EHR with no UK NHS or private healthcare presence. Vista Equity PE-backed with thin international footprint. Not relevant for UK buyers.
- Veradigm (formerly Allscripts)Allscripts/Veradigm has minimal UK presence and significant vendor stability concerns (NASDAQ delisting 2024). UK buyers should evaluate Epic, EMIS Health, TPP SystmOne, or System C.
- Tebra (Kareo + PatientPop)Tebra (Kareo + PatientPop) is a US SMB practice management platform with no UK NHS integration and no meaningful UK presence.
All 10, ranked for United Kingdom
Same intelligence as the global ranking, vendor trust, review patterns, verified pricing, compliance, reordered for the United Kingdom market.
Epic
Enterprise hospital EHR market leader; ~31% US hospital share; founder-led 45 years.
Epic Systems is the enterprise hospital EHR market leader, founded 1979 by Judy Faulkner in Verona, Wisconsin. Privately-held, founder-led for 45 years (Faulkner still CEO). Epic holds approximately 31% US hospital market share (KLAS data) and dominates the academic medical center segment (~80%+ of teaching hospitals). The platform centers on integrated clinical + revenue cycle + patient portal + analytics across hospital + ambulatory + post-acute settings. Strengths: deepest clinical workflow depth in category, mature interoperability via Care Everywhere (Epic-to-Epic) + Carequality (cross-vendor), industry-leading EHR certification, strong physician satisfaction in implementations (when done right), private founder-led culture (no PE pressure pattern), and aggressive AI feature velocity (Epic Cosmos for population health AI, Microsoft DAX Copilot integration for ambient clinical documentation). Best fit for $1B+ revenue health systems, academic medical centers, and large hospital networks. Trade-offs: pricing meaningful ($10M-$500M+ multi-year contracts typical), implementation complex (18-36 months for large health systems), high training burden for clinicians, customization requires Epic-employed implementation consultants, and post-implementation cost of optimization continues for years.
Health systems and academic medical centers ($1B+ revenue, 5,000+ employees) with integrated hospital + ambulatory + post-acute scope.
Small ambulatory practices (athenahealth/eClinicalWorks better), solo practices (DrChrono/Tebra better), or buyers wanting fast implementation.
Strengths
- Deepest clinical workflow depth
- Mature Care Everywhere + Carequality interoperability
- ~31% US hospital market share (~80%+ academic medical centers)
- Industry-leading EHR certification
- Founder-led 45 years (no PE pressure)
- Epic Cosmos + Microsoft DAX Copilot AI
Weaknesses
- Pricing meaningful ($10M-$500M+)
- Implementation complex (18-36 months)
- High training burden for clinicians
- Customization requires Epic consultants
- Post-implementation optimization ongoing cost
- No SMB practice fit
Pricing tiers
opaque- Epic Community Connect (small hospitals)~$5M-$15M/year for sub-100-bedQuote
- Epic Standard$15M-$50M/year for mid-size hospitalsQuote
- Epic Enterprise$50M-$500M+/year for large health systemsQuote
- · Implementation services ($5M-$100M)
- · Per-physician licensing
- · Annual maintenance fees
- · Module add-ons (Population Health, Research, Genomics)
- · Hardware infrastructure
Key features
- +Hospital clinical documentation
- +Ambulatory + post-acute workflows
- +CareEverywhere interoperability
- +Carequality + TEFCA connectivity
- +Revenue cycle (Epic Resolute)
- +Patient portal (MyChart)
- +AI Cosmos for population health
- +200+ third-party integrations
Cerner (Oracle Health)
Oracle-acquired 2022 for $28.3B; flag Oracle integration struggles plus customer migrations to Epic.
Cerner (rebranded Oracle Health in 2022) is the second-largest US hospital EHR vendor. Founded 1979 in Kansas City. Oracle acquired Cerner December 2021 for $28.3B in cash, the largest healthcare IT acquisition ever, completed June 2022. Strengths: deep enterprise hospital EHR feature set, Oracle financial capacity for AI investment, strong VA Health implementation experience (US Department of Veterans Affairs $16B contract), mature population health module. Best fit for existing Cerner hospital customers and Oracle-anchored health systems. Trade-offs: post-Oracle acquisition integration has been rocky, multiple major hospital systems migrated from Cerner to Epic 2023-2024 (Geisinger, Sentara, multiple academic centers); Oracle leadership churn affected the Cerner team substantially; VA Health Oracle implementation has been troubled with reports of patient harm prompting Congressional hearings; pricing escalations reported under Oracle ownership. The honest editorial read: Cerner remains a credible enterprise EHR but Oracle has not yet demonstrated it can stabilize the customer base. Buyers evaluating between Epic and Cerner in 2026 face a strategic question about Oracle commitment.
Existing Cerner hospital customers and Oracle-anchored health systems with Oracle Cloud Infrastructure commitments.
Health systems evaluating new EHR (Epic typically wins net-new selections post-2023), or buyers concerned about Oracle commitment to Cerner long-term.
Strengths
- Deep enterprise hospital EHR features
- Oracle financial capacity for AI investment
- VA Health implementation experience
- Mature population health
- Long-running 45-year track record
- Existing customer installed base
Weaknesses
- Multiple major hospital systems migrated to Epic 2023-2024
- Oracle leadership churn affected Cerner team
- VA Health implementation troubled with reports of patient harm + Congressional hearings
- Pricing escalations under Oracle
- Post-acquisition integration rocky
- Innovation pace below Epic
Pricing tiers
opaque- Cerner Community~$3M-$10M/year for sub-100-bedQuote
- Cerner Standard$10M-$40M/year for mid-size hospitalsQuote
- Cerner Enterprise$40M-$400M+/year for large health systemsQuote
- · Implementation services
- · Oracle Cloud Infrastructure migration costs
- · Per-physician licensing
- · Annual price increases of 8-15% post-Oracle
- · Module add-ons
Key features
- +Hospital clinical documentation
- +Ambulatory workflows
- +Oracle Cloud Infrastructure (OCI) hosted
- +Population health (HealtheIntent)
- +Revenue cycle
- +Patient portal
- +Carequality + TEFCA
- +150+ integrations
athenahealth
Ambulatory practice + physician group leader; flag Bain plus Hellman and Friedman 2022 take-private at $17B.
athenahealth is the ambulatory practice EHR + revenue cycle management market leader, founded 1997. Public NASDAQ:ATHN 2007-2019, then PE-acquired by Veritas Capital 2019, then re-acquired by Bain Capital + Hellman & Friedman in February 2022 at $17B, one of the largest PE healthcare-software transactions. The platform centers on cloud-based ambulatory EHR + RCM (revenue cycle management) + patient engagement combined. Strengths: best-in-class ambulatory RCM, cloud-first architecture (rare in healthcare IT), broad ambulatory installed base, mature interoperability, and athenaIDX (AI-driven workflow). Best fit for physician group practices (10-500 physicians) and ambulatory clinics. Trade-offs: Bain + Hellman & Friedman PE pressure pattern (typical 5-year hold; pricing escalations reported), implementation 3-9 months, customer support quality variable post-2022 take-private, less suited for hospital + inpatient scope (Epic better), and revenue-share pricing model on RCM creates principal-agent tension.
Ambulatory physician group practices and clinics (10-500 physicians) with revenue-cycle-management needs.
Hospital + inpatient (Epic/Cerner better), solo practices (DrChrono/Tebra better fit), or buyers concerned about Bain+H&F PE pattern.
Strengths
- Best-in-class ambulatory RCM
- Cloud-first architecture
- Broad ambulatory installed base
- Mature interoperability
- athenaIDX AI workflow
- Strong fit for physician groups
Weaknesses
- Bain + Hellman & Friedman PE pressure
- Pricing escalations reported post-2022 take-private
- Implementation 3-9 months
- Customer support variable post-PE
- Less suited for inpatient scope
- Revenue-share RCM model creates incentive tension
Pricing tiers
opaque- athenaOne Standard~$500-$800/physician/month + 4-8% RCM revenue shareQuote
- athenaOne ProHigher tiers for larger groupsQuote
- athenaOne EnterpriseCustom enterprise tierQuote
- · Revenue-share fees on collections (4-8% of patient revenue)
- · Implementation services
- · Per-module add-ons
- · Annual price increases post-2022 take-private
Key features
- +Ambulatory clinical EHR
- +Revenue cycle management
- +Patient engagement portal
- +Population health
- +athenaIDX AI workflow
- +Carequality + TEFCA
- +Telehealth
- +80+ integrations
NextGen Healthcare
Thoma Bravo Nov 2024 take-private at $1.8B; strong ambulatory fit, flag PE pressure.
NextGen Healthcare is the long-running ambulatory EHR platform, founded 1998. Public NASDAQ:NXGN 2008-2024. Thoma Bravo announced take-private acquisition August 2024, completed November 2024 at $1.8B ($23.95/share). The platform centers on ambulatory EHR + practice management + revenue cycle for mid-market physician groups. Strengths: mid-market ambulatory sweet spot, mature 25-year track record, broad specialty support (cardiology, orthopedics, primary care), strong revenue cycle integration, and Thoma Bravo capital for AI investment. Best fit for mid-market physician groups (25-500 physicians) wanting NextGen-anchored ambulatory workflow. Trade-offs: Thoma Bravo PE pressure pattern (pricing escalations typical 6-18 months post-take-private), implementation 4-12 months, customer support quality variable, AI features below Epic/athenahealth on velocity, and recently-private creates roadmap uncertainty.
Mid-market physician groups (25-500 physicians) wanting NextGen-anchored ambulatory workflow with broad specialty support.
Hospital scope (Epic/Cerner better), enterprise practices ($50M+ revenue) wanting more modern alternatives (athenahealth/Epic), or buyers concerned about Thoma Bravo PE pattern.
Strengths
- Mid-market ambulatory sweet spot
- Mature 25-year track record
- Broad specialty support
- Strong revenue cycle integration
- Thoma Bravo capital for AI investment
- Atlanta engineering culture
Weaknesses
- Thoma Bravo PE pressure pattern (pricing escalations expected)
- Implementation 4-12 months
- Customer support variable
- AI features below Epic/athenahealth
- Recently-private roadmap uncertain
- Per-physician + module pricing complex
Pricing tiers
opaque- NextGen Office (SMB)~$300-$500/physician/monthQuote
- NextGen Enterprise~$600-$1,200/physician/monthQuote
- NextGen CorporateCustom for large groupsQuote
- · Per-module add-ons (RCM, population health)
- · Implementation services
- · Annual price increases of 8-15% post-Thoma Bravo expected
Key features
- +Ambulatory clinical EHR
- +Practice management
- +Revenue cycle
- +Patient portal
- +Specialty-specific templates
- +Telehealth
- +Carequality
- +60+ integrations
eClinicalWorks
Private founder-led ambulatory EHR; flag 2017 DOJ $155M settlement over EHR certification fraud.
eClinicalWorks is the privately-held ambulatory EHR + revenue cycle platform, founded 1999. Founder-led for 25 years. The platform centers on ambulatory practice management + EHR + RCM + telehealth for small-to-mid practices. Strengths: founder-led 25 years (no PE pressure), broad ambulatory installed base (130K+ providers), aggressive AI feature velocity (eClinicalWorks 2024 launched Sunoh.ai for AI scribe + eCW Cardiology AI), and competitive pricing. Best fit for ambulatory practices (5-200 physicians) wanting modern AI features at competitive pricing. Trade-offs: MUST flag the 2017 DOJ $155M settlement over EHR certification fraud where eClinicalWorks falsely claimed compliance with ONC EHR certification standards while collecting Medicare Meaningful Use incentive payments, this is a foundational trust event in the company history that buyers should factor; subsequent operational improvements have been documented but the underlying trust gap remains for some buyers. Customer support quality variable, implementation 2-6 months typical, and product velocity faster than legacy peers but UX feels denser than athenahealth.
Ambulatory practices (5-200 physicians) wanting modern AI features (Sunoh.ai scribe) at competitive pricing.
Buyers prioritizing vendor brand reputation (Epic/athenahealth better), hospital scope (Epic better), or compliance-conservative buyers concerned about 2017 DOJ history.
Strengths
- Founder-led 25 years (no PE pressure)
- Broad ambulatory installed base (130K+ providers)
- Aggressive AI feature velocity (Sunoh.ai scribe)
- Competitive pricing
- Modern AI features at lower price than athenahealth
- Cardiology + specialty depth
Weaknesses
- 2017 DOJ $155M EHR certification fraud settlement (foundational trust gap)
- Customer support quality variable
- UX denser than athenahealth
- Implementation 2-6 months
- Brand recognition affected by 2017 scandal
Pricing tiers
partial- eClinicalWorks Cloud BasicFrom ~$449/physician/month$0+$449 /mo +/emp
- eClinicalWorks Cloud Pro~$599/physician/month with AI Scribe$0+$599 /mo +/emp
- eClinicalWorks EnterpriseCustom for large groupsQuote
- · Per-module add-ons (AI Scribe Sunoh.ai is separate)
- · Implementation services
- · Annual price increases of 5-8%
Key features
- +Ambulatory clinical EHR
- +Practice management
- +Revenue cycle
- +Patient portal (healow)
- +Sunoh.ai AI scribe
- +Telehealth (healow TeleVisits)
- +Carequality
- +50+ integrations
DrChrono
EverHealth-owned modern iPad-first EHR for small practices.
DrChrono is the modern iPad-first ambulatory EHR for small practices, founded 2009 in YC W11. Acquired by EverHealth (formerly Practice Mate parent) in 2021. The platform pioneered iPad-first clinical documentation and remains the strongest iPad EHR. Strengths: best-in-class iPad-first UX, modern California engineering, strong fit for solo + small specialty practices (5-50 physicians), competitive SMB pricing, and YC W11 legacy momentum. Best fit for solo practices and small specialty groups wanting modern iPad-first workflow. Trade-offs: EverHealth ownership integration ongoing, brand recognition declined post-acquisition, AI features below eClinicalWorks Sunoh.ai, less suited for mid-market multi-specialty groups, and customer support quality variable post-acquisition.
Solo practices and small specialty groups (1-25 physicians) wanting modern iPad-first clinical workflow.
Mid-market multi-specialty (NextGen/athenahealth better), hospital scope (Epic better), or Windows-only practices.
Strengths
- Best-in-class iPad-first UX
- Modern California engineering
- Strong fit for solo + small specialty practices
- Competitive SMB pricing
- YC W11 legacy momentum
- Apple App Store integration mature
Weaknesses
- EverHealth ownership integration ongoing
- Brand recognition declined post-acquisition
- AI features below eClinicalWorks
- Less suited for mid-market multi-specialty
- Customer support variable post-acquisition
- iPad-anchored may not fit Windows-anchored practices
Pricing tiers
partial- Prometheus (Practice)~$249-$449/physician/monthQuote
- Hippocrates (Group)~$449-$649/physician/monthQuote
- Apollo (Enterprise)Custom for larger groupsQuote
- · Per-module add-ons
- · Implementation services
- · Annual price increases of 5-8%
Key features
- +iPad-first EHR
- +Practice management
- +E-prescribing
- +Patient portal
- +Telehealth
- +Revenue cycle (Updox)
- +Apple Pencil charting
- +40+ integrations
Veradigm (formerly Allscripts)
Allscripts rebranded to Veradigm 2022; delisted from NASDAQ 2024; major vendor stability concerns.
Veradigm (formerly Allscripts Healthcare Solutions) is the long-running ambulatory EHR + payer/life-sciences data platform, founded 1986. Allscripts was public NASDAQ:MDRX 1999-2024; rebranded to Veradigm in January 2022; was delisted from NASDAQ in September 2024 after multiple accounting restatements and missed SEC filing deadlines. The platform spans Veradigm EHR + practice management + payer + life sciences data businesses. Strengths: long-running 40-year track record, broad payer + life sciences data assets, multiple specialty EHRs in portfolio, and existing customer installed base. Best fit for existing Veradigm customers on legacy Allscripts/TouchWorks/Sunrise platforms. Trade-offs: MAJOR vendor stability concerns, multiple accounting restatements 2023-2024 prompted NASDAQ delisting Sept 2024; SEC investigations active; uncertain corporate trajectory; AI features below competitors; customer support quality has degraded substantially through the financial turmoil; many customers actively migrating to other EHRs. The honest editorial read: Veradigm faces existential vendor-stability questions in 2026 that buyers must factor into multi-year contract decisions.
Existing Veradigm customers on legacy Allscripts/TouchWorks/Sunrise platforms staying due to switching cost.
New EHR evaluations (Epic/athenahealth/eClinicalWorks better fits and substantially more stable vendors), or any buyer prioritizing vendor stability for multi-year EHR commitments.
Strengths
- Long-running 40-year track record
- Broad payer + life sciences data assets
- Multiple specialty EHRs in portfolio
- Existing customer installed base
- Chicago-anchored
- Healthcare data depth
Weaknesses
- Multiple accounting restatements 2023-2024
- NASDAQ delisting September 2024
- Active SEC investigations
- Uncertain corporate trajectory
- Customer support degraded
- Many customers migrating away
Pricing tiers
opaque- Veradigm legacy contractsVariable; many customers renegotiatingQuote
- · Vendor stability discount may be negotiable for legacy customers
- · Per-physician licensing
- · Annual maintenance fees
Key features
- +Ambulatory EHR (Allscripts TouchWorks, Pro EHR)
- +Hospital EHR (Sunrise)
- +Practice management
- +Revenue cycle
- +Payer data
- +Life sciences data
- +60+ integrations
Tebra (Kareo + PatientPop)
Kareo + PatientPop 2022 merger formed Tebra; SMB-friendly practice management + EHR + patient engagement.
Tebra is the SMB practice management + EHR + patient engagement platform formed from the November 2022 merger of Kareo (founded 2004) and PatientPop (founded 2014). PE-backed by Vista Equity Partners (continuing from Kareo). The platform bundles cloud-based EHR + practice management + patient engagement + reputation management for small practices. Strengths: bundled platform reduces vendor sprawl, modern California engineering, SMB-friendly pricing, mature 20-year Kareo track record, and PatientPop reputation management differentiator. Best fit for SMB practices (1-50 physicians) wanting bundled practice management + EHR + patient engagement. Trade-offs: post-merger integration ongoing 2022-2026; Vista Equity PE pressure pattern; clinical EHR depth below athenahealth/eClinicalWorks; customer support quality variable post-merger; AI features below leaders.
SMB practices (1-50 physicians) wanting bundled practice management + EHR + patient engagement at SMB pricing.
Enterprise practices (athenahealth/Epic/Cerner better), modern iPad-first solo practices (DrChrono better), or buyers prioritizing clinical EHR depth.
Strengths
- Bundled practice management + EHR + patient engagement
- Modern California engineering
- SMB-friendly pricing
- Mature 20-year Kareo track record
- PatientPop reputation management
- Reduces vendor sprawl
Weaknesses
- Post-merger integration ongoing
- Vista Equity PE pressure pattern
- Clinical EHR depth below athenahealth
- Customer support variable post-merger
- AI features below leaders
- Brand recognition mixed (Kareo + PatientPop + Tebra)
Pricing tiers
partial- Tebra Get Paid~$150-$300/physician/month (billing only)Quote
- Tebra Plus~$400-$700/physician/month (full)Quote
- Tebra CompleteCustom enterprise tierQuote
- · Per-module add-ons (PatientPop reputation, telehealth, etc.)
- · Implementation services
- · Annual price increases of 6-10% under Vista
Key features
- +SMB clinical EHR
- +Practice management
- +Revenue cycle
- +Patient engagement (PatientPop)
- +Reputation management
- +Telehealth
- +Online scheduling
- +40+ integrations
Greenway Health
Vista Equity PE-backed mid-market ambulatory EHR; flag PE pressure pattern.
Greenway Health is the mid-market ambulatory EHR + practice management platform, founded 1979. Vista Equity Partners PE-backed since 2013 (12+ year hold, longer than typical PE cycle). The platform centers on mid-market ambulatory practices with Intergy + Prime Suite legacy products. Strengths: mature 45-year track record, strong fit for mid-market ambulatory practices, broad specialty support, established revenue cycle, and Vista Equity capital. Best fit for mid-market ambulatory practices (20-200 physicians) wanting alternative to NextGen/athenahealth. Trade-offs: Vista Equity 12+ year hold is unusual (typically PE 5-7 year hold) and creates uncertainty about exit timing; pricing escalations reported under Vista; multiple product lines (Intergy + Prime Suite + Greenway Carequality) create platform fragmentation; AI features below Epic/athenahealth/eClinicalWorks; customer support quality variable, and innovation pace below modern competitors.
Mid-market ambulatory practices (20-200 physicians) wanting alternative to NextGen + athenahealth.
Buyers prioritizing modern AI features (eClinicalWorks/athenahealth better), or buyers concerned about Vista PE exit-timing risk.
Strengths
- Mature 45-year track record
- Strong fit for mid-market ambulatory
- Broad specialty support
- Established revenue cycle
- Vista Equity capital backing
- Long-standing operational stability
Weaknesses
- Vista Equity 12+ year hold creates exit uncertainty
- Pricing escalations under Vista
- Multiple product lines create platform fragmentation
- AI features below leaders
- Customer support variable
- Innovation pace below modern competitors
Pricing tiers
opaque- Greenway Standard~$300-$500/physician/monthQuote
- Greenway Pro$500-$900/physician/monthQuote
- Greenway EnterpriseCustom enterprise tierQuote
- · Per-module add-ons
- · Implementation services
- · Annual price increases of 6-10% under Vista
- · Per-product-line scaling complexity
Key features
- +Ambulatory clinical EHR (Intergy + Prime Suite)
- +Practice management
- +Revenue cycle
- +Patient portal
- +Specialty templates
- +Telehealth
- +Carequality
- +50+ integrations
Practice Fusion
Veradigm/Allscripts-owned originally-free ambulatory EHR; ongoing vendor stability concerns.
Practice Fusion is the originally-free ambulatory EHR, founded 2005 in San Francisco. Pioneered the "free EHR" model with advertising revenue but discontinued the free tier in 2018. Acquired by Allscripts (now Veradigm) in February 2018 for $100M. The platform centers on lightweight ambulatory EHR for solo and small specialty practices. Strengths: lightweight modern UX (inherited from free-EHR era), strong fit for solo practices, low entry pricing, and broad installed base from free-tier years. Best fit for solo practices and very small specialty groups (1-5 physicians) wanting lightweight EHR. Trade-offs: Veradigm/Allscripts parent has MAJOR vendor stability concerns (NASDAQ delisted Sept 2024, accounting restatements, SEC investigations, see Veradigm entry for details); customers may face uncertain vendor trajectory; AI features below modern competitors; customer support quality degraded with Veradigm financial turmoil; less suited for mid-market practices.
Solo practices and very small specialty groups (1-5 physicians) wanting lightweight EHR; accept Veradigm parent vendor stability risk.
Buyers prioritizing vendor stability (Epic/athenahealth/DrChrono better), mid-market practices (athenahealth better), or compliance-conservative buyers.
Strengths
- Lightweight modern UX
- Strong fit for solo practices
- Low entry pricing
- Broad installed base from free-tier years
- San Francisco engineering legacy
- Simple practice management
Weaknesses
- Veradigm parent vendor stability concerns (NASDAQ delisted Sept 2024)
- Veradigm SEC investigations affect Practice Fusion
- AI features below modern competitors
- Customer support quality degraded with Veradigm turmoil
- Less suited for mid-market
- Uncertain vendor trajectory
Pricing tiers
partial- Practice Fusion EHRFrom $149/physician/month$149+$149 /mo +/emp
- Practice Fusion PremiumCustom for groupsQuote
- · Per-module add-ons
- · Implementation services
- · Vendor stability risk premium
Key features
- +Solo + small practice EHR
- +Practice management
- +E-prescribing
- +Patient portal
- +Telehealth
- +20+ integrations
Frequently asked questions
The questions buyers actually ask before they sign.
Why are EMIS Health and TPP SystmOne not in this top 10 ranking?
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How does the 2017 eClinicalWorks DOJ settlement affect buying decisions today?
Should I buy from Veradigm given vendor stability concerns?
What happens to athenahealth under Bain + Hellman & Friedman ownership?
How does AI change healthcare EHR in 2026?
How do I evaluate vendor stability for multi-year EHR contracts?
When should I migrate from one EHR to another?
Final word
Looking at a different market? See the global Healthcare EHR Software ranking, or pick another country at the top of this page.
Last updated 2026-05-18. Local pricing reverified quarterly. Found something inaccurate? Tell us.