Massive Consolidation is Freezing out EHR's.

[ivaldes]

While Cerner might be going out of VA, it is proliferating elsewhere such as Psychiatric Hospital behemoth https://uhs.com  When I started in Psychiatry in 2002 all of the local Psychiatric hospitals were independently owned. Now all but 1 is independent and it is for sale. All of the others are now part of large chains. That means that the decision making on EHR's is massively centralized. Already only a very few EHR vendors control nearly all of the Psychiatric hospitals in the United States. As many have observed was going to occur, oligarchy is here. Probably all but a few of the largest EHR vendors are likely to go out of business in the coming years. 

-- IV

[ivaldes]

*Probably all but only a few of the largest EHR vendors are likely to go out of business in the coming years. 

[Nancy Anthracite]

I recall after 450 EHRs passed Meaningdul Use stage I that an ONC official said
that there needed to be consolidation of EHRs. In other words, ONC is
complicit in driving other EHRs out of business.

--
Nancy Anthracite

[ivaldes]

EHR cores are now commodities that are relatively the same. There is even a startup that I can no longer find that will generate a EHR core on demand. Interesting but in my opinion a pointless exercise as the cores themselves are clearly no longer worth much but the data, user memory, support, business processes, certifications, and connectivity are where the value is. That is why VistA in VA is very difficult to replace. That is also why incumbent EHRs and ancillary systems like eRX and lab anywhere are very difficult to replace. Unfortunately, big systems nearly always favor other big systems due to perceived safety. Astronaut has pitched  https://uhs.com and other chains for years but it was like a fly talking to an elephant.