United States verdict (TL;DR)
Verified 2026-05-18Epic (Verona WI, founder-led 45 years, private) is the unchallenged US enterprise EHR leader at approximately 31% US hospital market share and 80%+ of US academic medical centers. Oracle Health (Cerner, acquired December 2021 for $28.3B) is a distant second and has lost share to Epic in every year since the acquisition; Oracle integration struggles are well-documented and should be flagged in any Cerner evaluation. Athenahealth (Bain + Hellman and Friedman, 2022 take-private at $17B) remains the ambulatory practice leader. Thoma Bravo took NextGen Healthcare private in November 2024 for $1.8B; PE-pressure patterns apply. Allscripts rebranded to Veradigm, was delisted from NASDAQ in 2024, and presents significant vendor stability concerns. eClinicalWorks has a 2017 DOJ $155M settlement for EHR certification fraud that should appear in every evaluation. Tebra (Kareo + PatientPop merger, 2022) is the SMB practice default. HIPAA + HITECH compliance, ONC EHR certification (required for Medicare/Medicaid billing), and 21st Century Cures Act information-blocking rules are non-negotiable requirements.
Picks for United States
- US health system and academic medical center ($1B+ revenue, 5,000+ employees): epic Private, founder-led, ~31% US hospital share. Best clinical workflow depth, mature Care Everywhere interoperability, ~80%+ US academic medical center penetration. No PE pressure pattern.
- US Oracle-anchored enterprise hospital: cerner Oracle Health post-acquisition. KLAS data shows ongoing share loss to Epic 2022-2026. Flag Oracle integration struggles and customer migration risk; negotiate contract exit rights.
- US ambulatory practice and physician group: athenahealth Default for ambulatory practices and physician groups. Network-based revenue cycle model. Bain + H&F 2022 take-private at $17B; flag PE renewal-pressure patterns at next contract renewal.
- US ambulatory practice, Thoma Bravo PE context: nextgen Thoma Bravo take-private November 2024 at $1.8B. Strong ambulatory EHR for specialty-heavy physician groups; flag PE-pressure patterns over the 24-36 months post-acquisition.
- US mid-market ambulatory, long-track-record EHR: eclinicalworks Private founder-led, large ambulatory installed base. Flag: 2017 DOJ $155M settlement for EHR certification fraud (false claims to the federal government). Require current ONC certification documentation before evaluation.
- US solo and small specialty practice, modern UX: drchrono EverHealth-owned since 2021. iPad-first UX, modern API, strong for solo and small specialty practices. Lighter implementation than enterprise options.
- US SMB practice management + patient engagement combined: kareo-tebra Kareo + PatientPop 2022 merger formed Tebra. SMB-friendly EHR + practice management + patient engagement + online reputation. Best for solo to 10-physician practices.
- US ambulatory, free/freemium entry point: practice-fusion Veradigm/Allscripts-owned since 2018 ($100M acquisition). Originally free model; now subscription. Significant vendor stability concerns given Veradigm/Allscripts delisting. Evaluate carefully before long-term commitment.
How the healthcare ehr software market looks in United States
The US EHR market is the most consolidated software category covered on Zendikt: Epic's march toward 35%+ US hospital market share continues through every Oracle/Cerner contract expiration, and the 2022-2026 PE-acquisition cycle has placed the three largest non-Epic ambulatory vendors (athenahealth, NextGen, Greenway) under private equity ownership with renewal-pressure implications.
The Oracle Health (Cerner) situation warrants direct framing. Oracle acquired Cerner for $28.3B in December 2021, closing June 2022. The integration has been difficult by any objective measure: multiple hospital systems have publicly announced migration to Epic post-acquisition; KLAS data shows continued Cerner-to-Epic conversion rate higher than at any point in the previous decade; Oracle has attempted to rebuild Cerner on Oracle's cloud infrastructure (branded "Oracle Health"), creating uncertainty for existing Cerner customers about platform continuity. Buyers currently on Cerner should independently model both a stay (with realistic Oracle Health migration costs and timeline) and a switch (Epic migration cost vs. avoided Oracle price escalation) before the next major contract renewal.
21st Century Cures Act information-blocking rules (effective April 2021) prohibit certified EHR vendors from blocking patient access to health information without a statutory exception. ONC has begun enforcement (first civil monetary penalties proposed 2024). Buyers should verify current ONC certification status and information-blocking compliance documentation from every EHR vendor, not just take the vendor's word.
AI-driven clinical documentation is the 2025-2026 differentiator. Epic Cosmos (population health AI), Microsoft DAX Copilot (ambient documentation, now integrated in Epic and expanding to Cerner), and Abridge (UPMC-backed, ambient documentation specialist) are the leading implementations. The ability to reduce clinician documentation burden (a major driver of physician burnout) is now a material factor in US health system EHR decisions.
HIPAA (Health Insurance Portability and Accountability Act) + HITECH (Health Information Technology for Economic and Clinical Health Act) compliance is non-negotiable; all platforms in this ranking maintain HIPAA Business Associate Agreements and Security Rule safeguards. ONC EHR certification (formerly Meaningful Use, now the ONC Health IT Certification Program) is required for billing Medicare and Medicaid; buyers must verify current 2015 Edition Cures Update certification status for any platform under evaluation. 21st Century Cures Act information-blocking rules (45 CFR Part 171) prohibit practices that interfere with access, exchange, or use of Electronic Health Information (EHI) without a statutory exception; enforcement by ONC began 2024. HIPAA Minimum Necessary standard applies to all patient data access within the EHR; role-based access controls and audit logs are required. Joint Commission and DNV healthcare accreditation bodies require EHR documentation audit trails. Drug Enforcement Administration (DEA) Electronic Prescribing for Controlled Substances (EPCS) certification is required for e-prescribing controlled substances; all major EHRs in this ranking support DEA EPCS. Surescripts network connectivity is required for e-prescribing to retail pharmacies; verify current Surescripts network status for any platform under evaluation.
Quick comparison, ranked for United States
| 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 | |
| 5 Veradigm (formerly Allscripts) | Legacy Veradigm/Allscripts customers | Quote | - | 3.4 | Primary US | |
| 7 DrChrono | Solo + small specialty practices | Quote | - | 3.9 | 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 States actually pay
Median annual deal size by employee band, in USD. Crowdsourced from anonymized buyer disclosures.
| Product | Employee band | Median annual (USD) | Sample | Notes |
|---|---|---|---|---|
| Epic | Small hospital, 500-1,500 employees | $8,000,000 | 28 | Community Connect or standard; multi-year contract |
| Epic | Mid health system, 1,500-10,000 employees | $32,000,000 | 38 | Standard enterprise; implementation additional |
| Cerner (Oracle Health) | Community hospital, 500-2,000 employees | $4,500,000 | 34 | Oracle Health Community; flag migration risk |
| athenahealth | Ambulatory practice, 5-50 physicians | $72,000 | 87 | Network-based % of collections model; per-physician equivalent |
| NextGen Healthcare | Specialty group, 20-100 physicians | $110,000 | 43 | Enterprise tier; Thoma Bravo PE context |
| eClinicalWorks | Ambulatory, 5-50 physicians | $48,000 | 61 | Per-physician-per-month; flag DOJ settlement history |
| Tebra (Kareo + PatientPop) | SMB practice, 1-10 physicians | $9,600 | 94 | Per-provider subscription; Tebra post-merger pricing |
| DrChrono | Solo to small practice, 1-5 physicians | $7,200 | 52 | Per-provider-per-month; EverHealth pricing |
United States-built or United States-strong vendors worth knowing
Not yet ranked in our global top 10, but credible options for United States buyers and worth a shortlist.
Microsoft DAX Copilot
Visit ↗Azure-hosted ambient clinical documentation AI. Not an EHR; integrates with Epic and expanding to Oracle Health/Cerner. The leading AI documentation assistant for reducing clinician charting burden. Adopted by 300+ US health systems as of 2026.
Abridge
Visit ↗Pittsburgh-based (UPMC-backed) ambient clinical documentation AI. Integrates with Epic. Series B funded. Growing fast in US academic medical centers and large health systems as a Microsoft DAX alternative.
Modernizing Medicine (ModMed)
Visit ↗Boca Raton-built specialty-specific EHR for dermatology, orthopedics, ophthalmology, ENT, gastroenterology, plastic surgery, and urology. Best US ambulatory EHR for these specialties; specialty-specific workflow depth exceeds generic EHR alternatives.
All 10, ranked for United States
Same intelligence as the global ranking, vendor trust, review patterns, verified pricing, compliance, reordered for the United States 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
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
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
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.
Epic vs Oracle Health (Cerner) for a US 300-bed community hospital in 2026?
What is the eClinicalWorks DOJ settlement and should it affect my EHR evaluation?
HIPAA Business Associate Agreement: what should I require from my EHR vendor?
What does ONC EHR certification require and how do I verify it?
Why is Epic the unchallenged enterprise hospital EHR leader?
What happened with Oracle Cerner acquisition?
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.