It was the best of times, it was the worst of times….With apologies to Charles Dickens, this sums up the current landscape for Electronic Health Records in the US at the current time. Strong competitors like Epic and Cerner have become dominant in the large organization space. Market consolidation has narrowed the number of competitors, and eliminated small players. Barriers to entry are high, if you don’t come with a brand already established. This can be the best of times if fewer superior products are winning deals and remaining responsive to the marketplace. It can be less welcome if innovative approaches, ideas, and solutions slow to a trickle. Let’s unpack these drivers.
ARRA and Meaningful Use created momentum and adoption for Provider organizations and they had a heavy incentive to get onto a certified platform. The largest players at that time included names like Allscripts, Epic, Cerner, Meditech, Siemens, GE, McKesson, IDX, and Eclipsys. Those vendors won the selection competitions and gained customers. If you look at the same space today, Siemens, GE, Mckesson, IDX, and Eclipsys, no longer offer an EHR product. In other words, the majority of the list is gone, and only a few vendors would respond today to an RFP for an integrated EHR at a larger organization.
Merger and acquisition activity has certainly played a major role. Siemens, IDX, and Eclipsys, all became part of other competitors. Although their products remain in organizations today, they are all on a path to retirement in favor of the succeeding product, or a competing one. Allscripts has purchased Eclipsys, Practice Fusion, and a piece of McKesson, among other purchases. Cerner acquired Siemens Healthcare division. GE Healthcare acquired IDX, and will now be spun off from GE as a separate entity. This has been true amongst ambulatory and specialty EHRs as well. Many of the features and functions of those acquired entities make their way into subsequent product offerings.
Today there are significant barriers to entry. Healthcare is a complex and conservative industry, so it is unlikely that a new major player in this space will pop up suddenly. The most probable scenario is that a giant like Google or Amazon or Apple introduces a disruptive solution with instant appeal. More likely is that employers disrupting the marketplace (eg: Amazon-Berkshire-JP Morgan), or a technology (eg: Block Chain), force a different kind of solution. Gains in interoperability are also at a point where room for niche solutions is enhanced. Healthcare is an attractive worthwhile space that continues to attract innovators as evidenced by Venture Capital activity. That innovation will make its way to the market either within established leaders by acquisition and R&D, or by disruption.
IT Strategy, Governance, and EHR selection, are key areas where Culbert Healthcare Solutions provides assistance to organizations across multiple EHR platforms.