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ONC issues final data brief on EHR adoption, highlights market consolidation

ONC will end EHR adoption tracking now that near-universal use has been achieved; its final analysis showed a market dominated by a few vendors.

Jill Hughes
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Published: 02 Jul 2026

Non-federal acute care hospital EHR adoption grew from less than 10% in 2008 to 99% by 2018. By 2024, differences in certified EHR adoption across hospital characteristics observed from 2010 to 2018 had disappeared. These insights were gathered by the Office of the National Coordinator for Health Information Technology and included in its latest, and final, brief on EHR adoption.

Thomas Keane, the national coordinator for health IT, outlined these findings in ONC's first Coordinator's Quarterly, a new publication that will provide updates on ONC policies and happenings from the previous quarter, as well as research.

This quarter's theme was EHR adoption.

"You might ask why we would start with a topic that hasn't been at the center of ONC's work for more than a decade. The answer is simple: this inaugural issue is about closing an important chapter," Keane wrote.

"Going forward, we will no longer track EHR adoption among hospitals and ambulatory care providers because the country has effectively reached universal adoption."

Universal EHR adoption, Keane wrote, has become a catalyst for "the technology evolution now unfolding," including the use of AI in healthcare and the industry-wide push toward interoperability.

To mark the end of an era, ONC released data on EHR adoption from 2008 to 2024, both in non-federal acute care hospitals and at office-based physician practices.

EHR adoption over the years

The data included in ONC's brief came from the American Hospital Association's annual survey from 2008 to 2024. ONC funded the survey's IT supplement portion in order to track EHR adoption.

ONC's report demonstrated the journey toward universal EHR adoption over the years. In 2008, fewer than 10% of hospitals reported using an EHR that met the "basic" EHR definition -- an early measure of EHR adoption that included the core functionalities considered essential to an EHR system.

By 2018, 99% of hospitals reported using an EHR that met the basic EHR definition.

At physician practices, nine in 10 physicians reported the use of a certified EHR in 2024, up from four in 10 in 2008.

There has also been a notable increase in the number of hospitals using the same EHR developer across inpatient and outpatient settings, from 62% in 2010 to over 90% in 2024. Now, nearly all hospitals use a single EHR.

The report also detailed the steadily increasing concentration of the EHR developer market.

In 2010, Meditech was the leading EHR vendor with 23% of the market share. A series of mergers and acquisitions led the market to move from moderately concentrated between 2009 and 2014 to highly concentrated from 2016 on, according to the Herfindahl–Hirschman Index, which measures market competitiveness.

By 2024, just three developers provided EHR technology to four in five hospitals, with Epic serving half of all hospitals.

"Although we do not examine other market forces, like broader consolidation of independent health care organizations into corporate systems, and how that played a role in technology selection over time, other research has found a relationship," the report noted. "Future research should investigate the drivers of consolidation and the impacts of a highly concentrated EHR market on patients and care delivery organizations."

At physician practices, 90% of physicians who practice in groups of more than 50 physicians used an EHR from one of the five market leaders. Solo practices were more likely to adopt an EHR from a small developer versus a market-leading one.

"While EHR adoption laid the foundation, it is not a finish line," the report stated. "The hope is that EHRs will not simply be medical record databases, but rather platforms on which new, innovative applications can be built to supplement and improve care delivery."

Now that EHR adoption is widespread, ONC stressed the importance of continuing to share data under the legal bounds of the 2016 Cures Act. The department set its sights on tackling information blocking and continuing to ensure the free flow of health data.

Jill Hughes has covered health tech news since 2021. Her coverage areas include cybersecurity, HIPAA compliance, interoperability, AI and EHRs.

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