EHR+ — Patient Engagement & Portal Platforms

Epic holds 43.7% of acute hospitals and 56.9% of beds, and was the only vendor chosen by large health systems in 2025. Its position is reinforced by clinician training investment rather than contract terms, and certification (ONC in the US, provincial conformance in Canada) is a multi-year floor before a single seat is sold. There IS visible instability — roughly 30% of Oracle Health customers say the platform is not in their long-term plans and another 35% are considered vulnerable — but that displaced demand flows to Epic and Meditech, not to a new entrant. Note also that EHR purchase decisions fell 40% in 2025: the buying window itself is narrowing.

What this category is. These are online booking marketplaces. A patient searches by specialty, location and insurance, reads reviews and books a slot. The practice pays a subscription that bundles its public profile, an online calendar, reminders that cut no-shows and light practice-management software. The coded customer is the physician's office (6211), but the same product is sold to dentists, physiotherapists, psychologists and other independent practitioners. How it differs from the neighbouring records. Electronic health records and practice management (6211, Epic and the ambulatory EHRs) sell the clinical record. A booking marketplace sells patient acquisition, and scheduling is the hook that gets it into the practice. The marketplace holds the patient demand, not the chart. Telehealth (6219) sells the visit itself. The dental (621210), chiropractic (621310) and behavioural-health (621330) records cover single-profession practice software. Jane appears there as a multi-discipline clinic system, and its online booking serves the clinic's own patients rather than a marketplace of competing practitioners. The leaders are regional, and each holds its own geography. Docplanner (Warsaw) runs ZnanyLekarz in Poland, Doctoralia in Spain and Latin America, MioDottore in Italy and jameda in Germany across 13 countries. It claims 300,000 active doctors and 100 million monthly patient visits [C, vendor]. It merged with Doctoralia in 2016 alongside a $20M Series C led by Target Global, raised a €15M Series D in 2017 (ENERN lead) and an €80M Series E in 2019 (One Peak and Goldman Sachs Private Capital), then took a 2021 round at more than $1B whose amount was not disclosed [B]. By its own account it had raised about €300M by November 2021, when it bought jameda from Hubert Burda Media [B]. Its Polish subsidiary filed PLN 212.5M of 2024 revenue and PLN 50.7M of net profit, and management talks of about $300M of group revenue in 2026 and a listing in two to three years [B, wirtualnemedia.pl]. Doctolib (Paris) holds France, Germany and Italy. It raised €150M at $1.13B in 2019 (General Atlantic) and €500M of equity and debt at €5.8B in 2022 (Eurazeo lead), about $815M in all [B]. It now claims 520,000 health professionals [C, vendor], and a reported 2026 secondary priced it near €3.6B [C, via secondary report]. Zocdoc (New York) holds the US: $130M at $1.8B in 2015 (Baillie Gifford and Atomico) and $150M of growth financing from Francisco Partners in 2021, when it said it was profitable after moving from flat subscriptions to a fee per booking [B]. Practo (Bengaluru) holds India and sells its Ray clinic software alongside the marketplace [A for the product; B for the $55M 2017 and $32M 2020 rounds]. Why a newcomer cannot get in. The practice pays for patients, so a marketplace with no patient traffic has nothing to sell. Building that traffic means years of consumer search and review content, and each incumbent's moat is one country's patients. Below the marketplaces the field is crowded with scheduling-and-reminder software that has no demand side of its own: Jane (North Vancouver, valued at about $1.8B), Cliniko (Melbourne, bootstrapped, $45 to $395 a month), Tebra (Kareo plus PatientPop), NexHealth ($125M Series C at $1B) and Solv (urgent care, over $80M raised) [B/C]. The Canadian gap is structural, not open. No national doctor-booking marketplace leads in Canada. Medically necessary physician services are publicly insured, so a GP cannot pay a marketplace to buy demand the way a private practice in Warsaw, Paris or New York can. The paying customers are allied-health and private clinics, and Jane already serves them. This is analyst judgment, not sourced. Distribution decides it: the asset is the patient audience, and every geography that pays for one already has a funded owner.

What this category is. The back office between a care provider and whoever pays: eligibility checks, claims and the clearinghouse that carries them, coding, denials and appeals, payer-to-provider payments, patient statements and collections, and the credentialing and enrolment that let a clinician bill a plan at all. The coded customer is ambulatory care (621): physician groups, clinics, labs and home health. But the largest buyers of several segments are hospitals and health systems (outsourced revenue cycle, inpatient coding) and health plans (payer payments, provider data, credentialing). How it differs from the neighbouring records. Electronic health records and practice management (6211) sells the chart and scheduling; athenahealth appears here only for its revenue-cycle business, and its funding is not re-researched. EHR+ patient engagement (6211) sells the portal and intake. Patient booking (6211) sells patient acquisition. HIPAA compliance (6211) sells security and audit. Medical imaging (621510) sells PACS. This record is the money and paperwork layer. Who owns the rails. Optum completed its combination with Change Healthcare on 3 October 2022 [A, Optum]. The February 2024 ransomware attack on Change touched about 192.7 million individuals, the largest US healthcare breach on record [B, CyberInsider citing the HHS OCR filing], and stopped claims for providers across the country. That shows how much of the network runs through one company. Availity says it connects over two million providers to every US health plan and handles over 13 billion transactions a year; its shareholders include Anthem (Elevance), Humana, HCSC and GuideWell, and Novo Holdings bought Francisco Partners' stake in July 2021 [A, Novo Holdings]. Waystar (Nasdaq: WAY) earned $1,099M of revenue in 2025, up 17%, from about 30,000 clients representing over 1 million providers [A, Waystar release]. Experian Health sells patient access, eligibility and identity inside Experian plc. Zelis runs the payer-to-provider payment side: 725 payer clients, 850K+ providers and $300B+ of payment volume by its own count [C]. Bain Capital and Parthenon sold a minority stake to a Mubadala-led group that closed on 26 November 2024 [A, Kirkland & Ellis]; the reported $17B valuation is Bloomberg's, not opened here. Who owns the outsourced work. R1 RCM was taken private by TowerBrook and CD&R at about $8.9B, closing 19 November 2024 [A, CD&R]. Ensemble Health Partners began as Bon Secours Mercy Health's revenue-cycle arm; Golden Gate Capital bought 51% in 2019 in a deal reported at about $1.2B [B, Becker's]. athenahealth, bought by Bain Capital and Hellman & Friedman for $17B [B, Healthcare Dive], bundles billing with its ambulatory record. The AI wave is already funded. AKASA (inpatient coding for 500 hospitals, by its own count) raised a $60M Series B led by BOND in 2021 [A]. Adonis raised a $40M Series C led by Quadrille Capital in March 2026, over $95M in total, and claims more than 4x revenue growth in 2025 [A, company release]. Candid Health raised a $52.5M Series C led by Oak HC/FT, $99.5M in total [B, HLTH]. Infinitus raised a $51.5M Series C led by Andreessen Horowitz, $102.9M in total, for AI agents that call payers [B, Pulse 2.0]. In credentialing, Medallion has raised $130M (latest $43M led by Acrew Capital, August 2025) and has acquired Andros [A]. CertifyOS raised a $40M Series B led by Transformation Capital in June 2025 [A]. Uno Health (Medicaid and benefits enrolment) was bought by Findhelp in October 2025 [B]. Canada. Provincial plans pay physicians, so the US claims-and-denials problem mostly does not exist. Billing is bundled with the record: more than 40,000 Canadian health professionals use a TELUS Health EMR [A, TELUS], and TELUS's CHR files OHIP claims through MDBilling [A, TELUS help centre]. mdbilling.ca now redirects to Dr.Bill, which claims 13,000+ physicians across OHIP, MSP and AHCIP [C]. TELUS eClaims covers direct billing to private insurers for allied health. Why a newcomer cannot get in. The clearinghouse and payment rails are owned by Optum, Availity (owned by payers), Waystar and Zelis. Each depends on connections to thousands of payers and on volume pricing. The outsourced hospital work is owned by private-equity platforms worth billions. Every point task an AI startup might attack (coding, denials, payer calls, credentialing, patient billing) already has a venture-backed player with $50M–$130M raised, and the incumbents are buying or building the same AI. Waystar's acquisition of Iodine is one example. In Canada the pain is small and the record vendors bundle it. Incumbent vulnerability decides it.