Cerner owns the greatest market share among electronic health record (EHR) vendors, topping competitors McKesson and Epic, while a number of smaller competitors are “thriving,” according to a Kalorama Information report.

The market share is based on 2016 revenue related to EHR hardware, software and services, such as consulting and training. The top three were unchanged from last year, with No. 1 Cerner being followed by second-ranked McKesson and No. 3 Epic. Allscripts came in fourth.

Below them were 600 other vendors, including Athenahealth, GE Healthcare and Meditech. The report said those companies could “disrupt the market” by taking advantage of changes in government policy and frustration from clinicians towards other vendors’ products.

"A few companies have more than half the market, but it's still true to say no company, not even the largest healthcare IT firms, have even a fifth of this market,"  Kalorama publisher Bruce Carlson said in a statement. "We think that is because there's still usability, vendor-switching, lack of mindshare in the market and customers are aching for better.  Healthcare still involves a lot of local markets and then with EMR there is a web opportunity to sell direct to smaller hospitals and physicians."

The rankings are separate from the latest EHR market share report from KLAS, which was based on purchasing decisions at hospitals with 200 or fewer beds. In that report, Epic was No. 1, followed by Cerner and Meditech.

As for grabbing the top spot in the Kalorama report, Cerner was praised for “continuing to add new business” in 2016 with products like Cerner ITWorks and Cerner RevWorks.

“The company is very strong in the hospital IT market,” the report said.

Also mentioned was Cerner landing a 10-year contract with the U.S. Department of Defense. More government business could be on the way, as a recent Black Book report named the company the most likely vendor for the U.S. Department of Veterans Affairs, assuming it decides to adopt a commercial EHR product.