A new study has found that the German IT market remains extremely fragmented, with Agfa in the number one position.

The comprehensive survey of the German Hospital Information Market (HIS) market shows that despite much consolidation over recent years there remain a large number of suppliers in what remains a fragmented market.

According to the results, Agfa with its hospital information system (HIS) Orbis is the clear market leader in Germany with a share of nearly 25%.

While this is not a surprise, what is unexpected is the big difference between Agfa and the number two HIS vendor, Siemens. Despite having three HIS products ‘Medico’, ‘ishmed’ and ‘Soarian’, the company has only secured a 15% market share.

Also unexpected, iSoft comes third with 7%, followed by the Finnish TietoEnator with 6.5% and the two German HIS vendors Nexus and Fliegel, a CompuGroup company, with 4.2% each. Meierhofer, another German vendor, comes at 2.4%.

The remainder, comprising roughly a third of the market, is made up of niche providers, each with very few systems installed.

Produced by kon.m, a consulting group with a focus on market research, management consulting and executive consulting, the survey has provided a picture that industry associations have been unable to deliver for years.

“What really surprised us was that there are still hospitals out there that use self-programmed HIS-software”, Ulrich Schwanke, kon.m healthcare analyst told E-Health Europe. He said this applied to one out of every 25 hospitals. About the same number uses non-medical information systems instead of a professional HIS.

The survey was completed over telephone: “We have worked with a professional callcenter to get either the hospital’s chief administrators or the heads of the IT department on the phone”, said Schwanke.

Of the 2,119 German hospitals listed in the statistical yearbook of the German Federal Statistical Office, 1147 were reached.

“It means that we cover 54% of all German acute care hospitals. When we look at how the different federal states and the different hospital owners are represented, we can state that it is fairly representative”, said Schwanke.

At one point, though, the results seem to lack preciseness. SAP is given a 14% market share. Though in the strictest sense SAP is not a HIS provider but rather a software company that offers enterprise resource planning software and a number of other information systems to hospitals – excluding the clinical modules.

There were 17 hospitals in the survey that were said to use SAP and an additional HIS. This number looks low. So it seems likely that close partners of SAP are slightly underrepresented.

What is interesting is how size matters for the information systems used. Agfa, in particular, is strong in small and medium sized hospitals of up to 400 beds, while Siemens covers all sizes. SAP in contrast, becomes indispensible for hospitals with more 600 beds, with a market share of nearly 50% in the biggest institutions with over 1,000 beds.

According to the survey, hospitals continue to be willing to invest in modern HIS. While health IT companies regularly complain about how few of them are willing to modernize their HIS, the survey paints a different picture.

Some 15% – more than 300 hospitals Germany wide – said they were planning to buy a new HIS within the next two years. Another 30% are considering updates for existing HIS systems.

A furtehr finding was that in recent years, up to 37% of the new HIS installations were done by small local providers and not by global providers like Siemens, Agfa, iSoft or TietoEnator – indicating that a substantial number of hospitals are yet convinced by the merits of a globalised health IT product.

The survey also highlighted the propensity of hospitals to switch vendor, market share does not seem to correlate with customer loyalty. According to the survey, this was highest among customers of Agfa and of Meierhofer.

60% of Meierhofer’s and nearly 50% of Agfa’s customers said they were considering switching to a different provider in the future.