Arena: Market Conditions Before Veradigm (Allscripts)
US hospitals, health systems and physician groups · 2009 · United States
Regulatory shiftDisconnected workflowsEntrenched systems
In 2009 a US hospital system that also ran physician practices could use one vendor's software in its hospitals and another's in its practices VRDX-10, and joining hospital and practice products into one patient record meant making them work off the same database VRDX-8. The HITECH Act of 2009 put about $30 billion behind electronic records, and buying surged after the Meaningful Use proposals of spring 2010 VRDX-8 VRDX-6. Providers were consolidating into integrated delivery systems and large physician groups, and a system that acquired a practice could require it to replace its records software with the one the larger enterprise already used VE3. Whatever a system chose would be costly to leave, so clients unhappy with a vendor often waited rather than switch VRDX-10.
How each step happened
Step 1 of 5 · 2008–10
Hospital and practice products assembled by merger
Epic's innovation was one clinical and financial system in which every module shared the same architecture, applications and data, all written by Epic. Judy Faulkner started the company with $70,000 after clients asked her to build patient data systems, and Epic never made an acquisition or took outside investment VRDX-7 VRDX-6. Faulkner argues that tuning separate parts does not tune the whole, and says customers find one connected system cheaper to run than linked separate ones; in 2015 half of Epic's 9,000 staff worked in research and development VRDX-6.
Allscripts, founded in 1986, built its breadth by merger VRDX-24. It combined with Misys's healthcare business in 2008 and with Eclipsys, a hospital software company, in 2010 in a deal valued at $1.3 billion VRDX-19. The deal paired Allscripts' physician-practice products with Eclipsys's hospital products, but the two lines still had to be made to run off the same database before customers got a single patient record VRDX-8.
Rivals Epic Systems grew organically, with no acquisitions, and kept every module on one shared architecture and data VRDX-7 VRDX-6.
Novel Architecture
Step 2 of 5 · 2010–13
Integration troubles while large systems bought whole
Epic sold that system whole, from the top of large health systems, and installed it by its own method. Kaiser Permanente chose Epic in 2003 for a $4 billion records program that became Epic's reference site VRDX-6. Epic had seven or eight salespeople, dealt directly with boards and senior executives and set no sales quotas VRDX-6 VRDX-7. Its prescriptive implementation method required senior commitment, Epic selected its customers carefully, and Faulkner says it has had no failed installations VRDX-6. When HITECH money arrived in 2009, large systems could buy a proven installation, and by 2015 two thirds of US academic teaching hospitals used Epic VRDX-6.
Allscripts met the same buying wave while absorbing Eclipsys VRDX-8. By 2012 lawsuits alleged misleading statements about progress in linking the two companies' technologies, chairman Phil Pead was ousted in April and the CFO left after weaker bookings VRDX-9. John Bosco, CIO of North Shore-LIJ, its biggest client, said the cultural differences were far greater than expected VRDX-9. In December Paul Black replaced Glen Tullman, and clients asked him to finish the integration VRDX-10. First-quarter 2013 bookings fell to $177.7 million from $194.6 million a year earlier, and Black called 2013 a rebuilding year VRDX-11.
Rivals Epic Systems grew to 2017 revenue of $2.7 billion and more than 200 million patient records without sales quotas or acquisitions VRDX-7.
Top-Down SellingImplementation Services
Step 3 of 5 · 2013–18
More platforms bought while hospitals left Sunrise and Paragon
Hospital systems replacing records software kept choosing one platform. In 2015 Epic won more than 70% of competitive decisions by multihospital systems, 22 decisions covering 118 hospitals, and lost two hospitals, both through an acquisition VRDX-22. Cerner was the only other vendor to add hospital market share every year from 2010 until 2019, and in 2018 it signed more new hospitals than any other vendor VRDX-23 VRDX-20.
Allscripts kept buying. It acquired dbMotion in 2013, McKesson's Enterprise Information Solutions business, which brought the Paragon hospital system, in 2017, and Practice Fusion, a practice EHR for independent physicians, in 2018 VRDX-19 VRDX-21. It now carried two hospital platforms, Sunrise and Paragon, and was phasing out McKesson's Horizon VRDX-23 VRDX-21. In 2018 it lost 33 hospitals: 14 left Sunrise, all for Epic, and 16 left Paragon for Cerner, Epic, Meditech or CPSI, while the three hospitals that replaced Horizon went to other vendors VRDX-20 VRDX-21. Customer consolidation caused 15% of those losses, and Sunrise won only one small system and one standalone hospital that year VRDX-20 VRDX-21.
Rivals Epic Systems took all 14 Sunrise hospitals that left Allscripts in 2018, and Cerner, which signed the most new hospitals that year, was among the vendors that took Paragon hospitals VRDX-21 VRDX-20.
End-to-End Workflow
Step 4 of 5 · 2019–21
Hospital share falls as systems standardize on Epic and Cerner
As systems merged, they standardized on one record, and Epic gained most. KLAS found that standardization to Epic was one of the two largest reasons organizations left Cerner in 2019, and just under half of Epic's wins that year came from standardization and acquisitions VRDX-23. Seven small hospitals chose Epic's Community Connect offering in 2019, and KLAS saw many smaller hospitals do so in 2021 VRDX-23 VRDX-1. Epic's share of US hospitals rose from 29% in 2019 to 32.9% in 2021 VRDX-24 VRDX-1.
Allscripts stayed strong in physician offices, where IQVIA ranked it first in ambulatory market share in 2019 VRDX-24. KLAS reported steady losses on both Sunrise and Paragon and said Allscripts' recent work on Paragon felt more like maintenance than product development VRDX-23. Its share of US hospitals fell from 7% in 2019 to 4.3% in 2021, and 75% of the customers that left it in 2021 went to Epic, with the rest going to Cerner, Meditech or CPSI VRDX-24 VRDX-1. Its own annual report later named the mechanism: consolidation "may also lead integrated delivery systems to require newly acquired physician practices to replace their current Veradigm products with those already in use in the larger enterprise" VE3.
Rivals Epic Systems reached 32.9% of US acute care hospitals in 2021 and Cerner held 24.4%, against Allscripts' 4.3% VRDX-1.
Distribution Partnerships
Step 5 of 5 · 2022–26
Hospital unit sold; data business later delisted over missed filings
Customers that move onto Epic stay. Northwell Health, a longtime Allscripts client, chose Epic in March 2023 in a multi-year regional rollout starting in 2025 VRDX-12 VRDX-13. In 2023 Epic added 153 acute care clients and lost none, and in 2024 it won nearly 70% of hospitals affected by EHR decisions and ended the year with 42.3% of US acute care hospitals VRDX-4 VRDX-2.
Allscripts sold its hospitals and large physician practices business, including Sunrise, Paragon and TouchWorks, which had produced $928 million in 2021, about three-fifths of revenue VRDX-16. The sale closed on May 2, 2022 for $670.0 million in cash, and the retained company became Veradigm on January 1, 2023 VE3 VRDX-16. Under Altera the products held 3.0% of hospitals at year-end 2024 and lost Sunrise in 17 hospitals that year VRDX-2 VRDX-5. Separately, Nasdaq suspended Veradigm's shares effective February 29, 2024 for not filing its 2022 annual report or 2023 quarterly reports VE2. Its late 2022 annual report restated 2020 and 2021 results and disclosed material weaknesses in internal control VE3. Revenue fell to $594 million in 2024 from $626 million in 2023 VRDX-17. On October 14, 2026 its shares traded at $5.00 over the counter, where Stock Analysis listed a market value of $851.43 million on 170.29 million shares; on the 109.0 million common shares Veradigm reported in May 2026, that comes to about $545 million VRDX-18 VRDX-17.
Rivals Epic Systems won nearly 70% of hospitals in 2024 EHR decisions, while Altera, which bought the Allscripts hospital products, signed no net-new contracts VRDX-2 VRDX-5.