Vertical software32% entry signalMarket screen8 sourced figuresStructure decidesentry cost

Electronic Health Records & Practice Management

Prepared 2026-09-09

The buyer population — Offices of physicians

Base industry report for 6211 →
Establishments · CanadaA
51,358
with employees
Under 10 employeesA
96%
most common size: 1–4
Establishments · USA
210,756
Employment · USA
2,643,587
13 per establishment
Payroll · USA
$268.5B
$102k per employee

Of 51,358 Canadian establishments with employees, 96% have fewer than ten — an industry of very small operators. Each of those is one potential account, before any filter for size or fit.

Entry signal — what decides who wins here

Structure decides
Structure decides One thing must be true Execution decides

The binding constraint is not executional. Being better than the incumbent does not, by itself, get you in — this one is cleared with capital, an asset, or a permission.

What you would have to beat

Raise or borrow the entry ticket, or buy an operator who has already paid it. The barrier is money rather than permission, so it yields to a balance sheet — and an acquisition is usually cheaper than a start.

How it was read
Binding constraintUNVERIFIEDentry cost — Capital — being better does not, by itself, clear it.
Measured inputsUNVERIFIEDnot applied — This is a software market. The industry’s business counts describe its BUYERS, not the market being entered, so they are left out of the signal.
How many new establishments are still tradingA
Health Care and Social Assistance, US · opened 2020
84%
1 year
65.3%
3 years
52.6%
5 years
36.4%
10 years
opened 2015

Measured, not forecast: the share of US establishments opening in one year that were still active later. It counts good operators and bad ones together, which is exactly why it is the honest answer to “what are the odds”. It is for the whole sector rather than this market, and the ten-year figure comes from an older cohort because no younger one has reached ten years.

This is not a probability of success, and it is not a verdict on you. No survival probability is published per market, and inventing one would be worse than saying so. What the bar reads is how much of the outcome sits inside an operator's control: green means the hurdles are ones a better operator clears, red means the binding constraint is capital, an asset or a permission rather than execution. Someone arriving with an advantage this screen did not assume can win a market shown in red.

Companies named in this market · 12

The binding constraint — entry cost

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.

Angel-backed companies39
in the Canadian portfolio dataset
Province mixAB 12, ON 10, QC 8, BC 3, NB 2, SK 1, YT 1, NL 1, NS 1

Sectors joined: HealthTech · Healthcare · Health SaaS · Health Tech · Healthcare/AI · Healthcare/VR

[UNVERIFIED] Sector-to-NAICS mapping is analyst judgment — see data/angel-sector-map.json. Counts are a per-record cross-reference and are not additive across records.

I

The incumbent

Who owns this market and who is coming for it. Fields a screen never reached say so rather than guessing.

Incumbent
Epic Systems
Scale
Privately held. Gained a net 568 hospitals since 2021 while the nearest competitor lost 173
Share
43.7% of acute care hospitals and 56.9% of beds — and the only vendor selected by health systems with 10+ hospitals in 2025
Challengers
Oracle Health (Cerner), athenahealth, eClinicalWorks, NextGen, Veradigm, Elation, Tebra, Canada Health Infoway-aligned regional systems
Lock-in mechanism
Not assessed — screened before diligence
Price movement
Not assessed
Open-source alternatives
OpenEMR, OpenMRS, Bahmni — genuinely used, mostly in low-resource and global-health deployments rather than as competitive substitutes in North America
Is the buyer consolidating?
No
F

Financials & market size — sourced

Figures that came from a filing, a results release or reputable reporting, each carrying its evidence tier.

Epic share of acute care hospitalsB 43.7%
Epic share of hospital bedsB 56.9%
Epic net hospitals gained since 2021B +568 (77 hospitals and 18,679 beds added in 2025)
Oracle Health shareB 21.9% of hospitals, 20.4% of beds
Oracle Health net hospitals lost since 2021B −173 (−56 hospitals in 2025)
Remaining fieldB Meditech 14.7% · TruBridge 7.6% · Altera 2.9%
Oracle Health customers saying it is not in their long-term plansB ~30%, with another 35% considered vulnerable
Change in hospitals making an EHR purchase decision, 2025 vs 2024B −40%
V

The field

Every vendor named on this record, and what each one discloses. Most disclose nothing, which is why the market is not sized.

Competitor set · 5 named · 0 disclose revenue · 5 with a published share

NameRevenueShareNote
Epic SystemsB not disclosed 43.7% Private, revenue not disclosed. 43.7% of acute hospitals, 56.9% of beds
Oracle Health (Cerner)B not disclosed 21.9% Not separately disclosed since acquisition
MeditechB not disclosed 14.7%
TruBridgeNASDAQ: TBRGB not disclosed 7.6%
Altera Digital HealthB not disclosed 2.9%

Nobody here publishes revenue. The market is not sized for that reason — an estimate built on nothing would only look like knowledge.

S

Startups & challengers

Newer and smaller vendors going at the incumbent — funded challengers first. Named, not researched to the depth of the field above; a company with a page here links to it.

CompanyStageWhat it doesRaised
Epic Funded challenger Hospital and health-system EHR, revenue cycle and MyChart —
Hint Health Funded challenger Membership billing and practice platform for direct primary care clinics —
Tebra Funded challenger EHR, billing and patient engagement for independent practices. $65m
Canvas Medical Startup Developer-friendly EMR for virtual-first and value-based care providers —
Develo Startup EHR and practice management for independent pediatric practices. —
Pario Startup EMR and patient engagement built for OB-GYN and women's health clinics —
Procision Scrappy competitor EHR and practice management for ambulatory surgery centers —
UrgentIQ Scrappy competitor EHR, billing and patient flow for urgent care clinics. —

Evidence

Evidence. Incumbent financials and market-share figures on this record ARE sourced (tier A/B, see the financials block). The cut factor and reasoning remain analyst judgment and were not tested against customers.

#

Where the industry talks

The associations, forums and events where people in this trade actually talk shop — where to listen before entering, and where the first customers are found. Each link was opened on the date shown.

AssociationCanadaA
Digital Health Canada
digitalhealthcanada.com

National professional association for digital-health people; runs the Chief Executive Forum, MentorLink and awards. No member count on its membership pages.

Checked 2026-09-22
EventCanadaA
e-Health Conference & Tradeshow
e-healthconference.com

Canada's main digital-health conference (e-Health27: May 16-18, 2027). Co-hosted by Digital Health Canada, Canada Health Infoway and CIHI. No attendance figure on the site.

Checked 2026-09-22
AssociationOntarioA
OntarioMD
ontariomd.ca

Ontario Medical Association subsidiary that certifies EMRs for Ontario practices and runs the OMD Digital Health Conference (DHC 2026) and vendor spotlights. Not a membership body.

Checked 2026-09-22
EventInternationalA
HIMSS Global Health Conference & Exhibition
himssconference.com

HIMSS27: April 5-8, 2027, Chicago. The largest health-IT show; the page states HIMSS has 125,000+ individual members. himss.org itself blocks automated access.

Checked 2026-09-22
AssociationUSA
MGMA (Medical Group Management Association)
mgma.com · 70,000 members (2026-09)

Individual members ('more than 70,000' practice administrators, representing 15,000+ organisations) per its Overview & Mission page. The practice-management buyer side.

Checked 2026-09-22
PublicationInternationalA
KLAS Research
klasresearch.com

Research firm publishing Best in KLAS vendor rankings and the Arch Collaborative on clinician EHR satisfaction; the source most buyers cite when comparing EHR vendors.

Checked 2026-09-22
PublicationInternationalC
Healthcare IT News
healthcareitnews.com

Blocked automated access (Cloudflare). Search results show live 2026 coverage; a HIMSS Media publication.

Checked 2026-09-22
SubredditInternationalC
r/healthIT
reddit.com

Blocked automated access (RSS 429). Search results show an active subreddit for health-IT staff discussing EHR, PACS and careers.

Checked 2026-09-22

CHIME (chimecentral.org, CIO body) blocks automated access and was not verified by search, so it is omitted. Vendor user groups (Epic UserWeb, Oracle Health) are closed to members.

↔

The businesses it sells to

Operating-business records filed along the same branch of NAICS — the customers of this software, screened as businesses in their own right.

No operating-business record has been written along this branch yet. The base industry report says what the subsector typically runs on.

Other software on this branch

Vertical softwareScreenedsame industry
EHR+ — Patient Engagement & Portal PlatformsOne thing must be true
binding constraint: incumbent vulnerability
Incumbent Epic Systems (MyChart)

What this category is. The layer of software the patient touches: the portal and app, digital intake and check-in, reminders and two-way texting, online bill pay and the personal health record. It sits on top of the chart and writes back into it. The coded customer is the physician's office (6211), but the biggest buyers are health systems and clinic networks, and the same products are sold to dentists, optometrists and specialists. How it differs from the neighbouring records. Electronic health records and practice management (6211) sells the record itself. Patient booking and doctor marketplaces (6211) sells patient acquisition: a marketplace of competing practitioners. Telehealth and remote patient monitoring (6219) sells the visit. This record covers what happens between a practice and the patients it already has. Two names the brief proposed fall into those neighbours. TELUS Health MyCare is a direct-to-consumer virtual clinic (telehealth, 6219). Medeo, owned by Loblaw through QHR Technologies, does offer booking, messaging and video visits for a patient's own clinic, so it stays on this record. The incumbent is the record vendor, not a portal company. Epic's MyChart says it serves over 190 million patients [A, mychart.org]. It comes with the Epic record, so a health system on Epic does not buy a separate patient portal. The ambulatory record vendors have done the same thing. eClinicalWorks ships healow. ModMed bought Klara in February 2022, and klara.com now redirects to ModMed's patient-engagement page [A/B]. Tebra sells patient experience alongside its record. In Canada, WELL Health bought CognisantMD's Ocean platform (booking, messaging, reminders, digital forms, kiosks and eReferral) in December 2021. At the time Ocean supported about 8,000 physicians and had about $4M of annual SaaS revenue [B, WELL release]. The independents that have scale. Phreesia (NYSE: PHR) earned $480.6M of revenue in fiscal 2026, its first full year of GAAP net income. It averaged 4,514 healthcare-services clients that year [B]. Part of that revenue comes from pharmaceutical manufacturers who pay to reach patients at intake, not from the practices. Phreesia cut its fiscal 2027 outlook to $510–520M because of reduced visibility into that spending [B]. Weave (NYSE: WEAV) earned $239.0M in 2025, up 17%, from 39,625 customer locations. Most are small dental, optometry and medical practices [A, Weave release]. Luma Health raised a $130M Series C led by FTV Capital in November 2021, $160M in total, and claimed 550+ health systems and clinic networks [B]. Artera (formerly WELL Health Inc., renamed October 2022) had raised just under $100M by then and is reported to have added a $65M Series D led by Lead Edge Capital in December 2025 [B/C]. Relatient has been majority-owned by Brighton Park Capital since November 2019 and raised more than $100M of growth equity before buying Radix Health in 2021 [B]. Kyruus Health (provider search plus scheduling; it bought HealthSparq and Epion Health) and Solutionreach (Summit Partners since 2012) complete the field [B/C]. PocketHealth (Toronto; $33M Series B led by Round13 Capital in March 2024) is a niche: patients' access to their own medical images [B]. Why a newcomer cannot get in. The patient's login belongs to whoever holds the chart. For a health system on Epic, MyChart is already paid for, and any standalone tool must integrate with the record and justify itself on top of what is bundled. For a small practice, the record vendor bundles reminders and a portal, and Weave and Solutionreach already sell texting and payments. The standalone vendors with scale have found a second payer (Phreesia's pharma network) or a payments attach (Weave). That tells you a practice will not pay much for engagement on its own. Canada. Ocean (WELL Health) leads physician-office engagement and eReferral, Medeo is bundled with Loblaw's Accuro record, and portals from the provincial systems and hospitals cover the rest. The paying customer is a publicly funded practice with limited budget for add-ons, which is analyst judgment, not sourced. Incumbent vulnerability decides it: the record vendor owns the patient's login and bundles the layer, and the independent field is crowded and funded.

NAICS 621114 vendors named4 sourced figuresOpen →
Vertical softwareScreenedsame industry
Patient Booking & Doctor MarketplacesExecution decides
binding constraint: distribution
Incumbent Docplanner (Doctoralia, ZnanyLekarz, MioDottore, jameda)

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.

NAICS 621110 vendors named5 sourced figuresOpen →
Vertical softwareScreenedfiled at 621
Healthcare Revenue Cycle & Admin SoftwareOne thing must be true
binding constraint: incumbent vulnerability
Incumbent Optum (Change Healthcare)

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.

NAICS 62115 vendors named6 sourced figuresOpen →