Health IT vendors Epic and Cerner have combined to capture more than 75 percent of new large-hospital electronic health record (EHR) contracts, while the other vendors struggled to keep pace, according to the latest report from the Orem, Utah-based research and consulting firm, KLAS Research.

The report, “Clinical Market Share 2013: More than Meaningful Use,” shows that the Verona, Wis.-based Epic has the most new hospitals (47) for the fifth year in a row—including many prominent health systems—while Cerner (Kansas City) continues its upward trend with the second-most new hospitals (23). Epic’s 2-to-1 lead over Cerner in new hospitals represents a narrowing gap from 5-to-1 in 2010.

McKesson (San Francisco) signed the third-most hospitals due to the move from its Horizon product to its Paragon system. Paragon’s appeal to 200+ bed hospitals is mostly limited to existing Horizon customers wanting to continue their McKesson relationship, as only 1 out of 12 hospitals switched to Paragon from a competitor’s solution in 2012.

Allscripts (Chicago), Meditech (Westwood, Mass.), and Siemens (Washington, D.C.) were all squeezed out according to the report, as none gained enough new hospitals in 2012 to suggest a market share rebound, and each lost more hospitals than the handful they gained. For the first time since KLAS has tracked market share, Allscripts did not gain any hospitals in the 200+ bed space.

Since the introduction of the HITECH Act, 405 out of nearly 1,500 hospitals with more than 200 beds have selected a new, currently marketed EHR. Still, another 443 are running legacy systems or have no EHR at all, and will face decisions in coming years—a majority of these hospitals are running McKesson Horizon or Meditech Magic. Even currently marketed products will not be immune to turnover, as 39 percent of multihospital systems have heterogeneous environments and may eventually follow peers in standardizing on a single EHR, according to the report.

"The HITECH Act that started this mass migration is clearly not over,” report author Colin Buckley said in a statement. “There are over 400 large hospitals that still do not utilize a currently marketed EHR and thus still face a decision. The question is, ‘Which way they will go and which factors will guide that decision?"