I’m not as close to the EHR space as I used to be when I covered it on the sellside from 2004-2007. I believe Epic is primarily on-prem, which puts it at a cost disadvantage to CERN/Oracle as a result of having to maintain multiple versions. I know that CERN is both cloud and on-prem, but I believe it is migrating to become primarily a cloud offering. Epic not having a massive database business to subsidize the EHR business is also a disadvantage.
I believe the larger threat is from AWS, Azure and Google Cloud which store patient data. Each company could offer an EHR as each company already stores patient data. For example, Cerner stores its patient data on Amazon’s data lake – Amazon HealthLake (This was true as of 2020, I’m not sure if this remains the case).
From an Analytics standpoint, I can’t imagine that Epic will be able to invest in Cosmos to make it competitive with the ML-derived insights that Oracle, Google, AWS and Azure may glean from their data repositories. It’s less about access to medical records, which Epic obviously has, it’s more about labeling the data for ML, (a relatively new process for Epic), and processing capability. Epic’s balance sheet can’t compare to ORCL, AMZN, MSFT and GOOGL.
I’m not sure what happens to Epic when Judy Faulkner is no longer running the company.
I remember Practice Fusion, I may have called on them circa 2014. If I recall, they were generating revenues from the Pharma companies at that time and also from Ads on the docs-side, as well as from offering the docs a premium version. Tough to get profitable as a challenger on that business model.
I recall meeting the Allscripts guys back in 2006. I hated MDRX’s valuation back then.
The eClinicalWorks founder would never take my call years ago. Much of their processing was done manually in India.
Meditech was another firm that was too cool to take my call back in 2005-2006 when Neil Pappalardo was still running the day-to-day.
I always liked Athenahealth. Jonathan Bush knew the health side of the EHR business inside and out. I remember he did a monologue on Salesforce circa 2004 about how the cloud would be the future of the business. I always thought he would try to scale a massive cloud business to serve as the world’s largest health data repository 15 years ago. I also know Bob Segert who now runs Athena. Bob is a good software executive, but he’s not a healthcare guy and he’s not going to solve the puzzle from Dallas.
Your examples of corruption are not surprising. I wish they were outliers, but some of these guys will do anything to win. I hate when companies cheat. I want to win on merit, not because I used black bag diplomacy.
For sure it is a fragmented space that is relatively early days. Lots of unknown companies will drive innovation and disruption, likely piggybacking off of the patient data sets housed in AWS, Azure and GCP.
I’m not as close to the EHR space as I used to be when I covered it on the sellside from 2004-2007. I believe Epic is primarily on-prem, which puts it at a cost disadvantage to CERN/Oracle as a result of having to maintain multiple versions. I know that CERN is both cloud and on-prem, but I believe it is migrating to become primarily a cloud offering. Epic not having a massive database business to subsidize the EHR business is also a disadvantage.
I believe the larger threat is from AWS, Azure and Google Cloud which store patient data. Each company could offer an EHR as each company already stores patient data. For example, Cerner stores its patient data on Amazon’s data lake – Amazon HealthLake (This was true as of 2020, I’m not sure if this remains the case).
From an Analytics standpoint, I can’t imagine that Epic will be able to invest in Cosmos to make it competitive with the ML-derived insights that Oracle, Google, AWS and Azure may glean from their data repositories. It’s less about access to medical records, which Epic obviously has, it’s more about labeling the data for ML, (a relatively new process for Epic), and processing capability. Epic’s balance sheet can’t compare to ORCL, AMZN, MSFT and GOOGL.
I’m not sure what happens to Epic when Judy Faulkner is no longer running the company.
Google was quite brazen a few years ago in the manner in which it took patient medical records hostage: https://tek2day.com/2019/11/11/google-and-ascension-act-brazenly-with-patient-medical-records/
I remember Practice Fusion, I may have called on them circa 2014. If I recall, they were generating revenues from the Pharma companies at that time and also from Ads on the docs-side, as well as from offering the docs a premium version. Tough to get profitable as a challenger on that business model.
I recall meeting the Allscripts guys back in 2006. I hated MDRX’s valuation back then.
The eClinicalWorks founder would never take my call years ago. Much of their processing was done manually in India.
Meditech was another firm that was too cool to take my call back in 2005-2006 when Neil Pappalardo was still running the day-to-day.
I always liked Athenahealth. Jonathan Bush knew the health side of the EHR business inside and out. I remember he did a monologue on Salesforce circa 2004 about how the cloud would be the future of the business. I always thought he would try to scale a massive cloud business to serve as the world’s largest health data repository 15 years ago. I also know Bob Segert who now runs Athena. Bob is a good software executive, but he’s not a healthcare guy and he’s not going to solve the puzzle from Dallas.
Your examples of corruption are not surprising. I wish they were outliers, but some of these guys will do anything to win. I hate when companies cheat. I want to win on merit, not because I used black bag diplomacy.
Thank you for your informative comments!
Glen Tullman was Allscripts CEO back when I covered them, 2003-2007.
For sure it is a fragmented space that is relatively early days. Lots of unknown companies will drive innovation and disruption, likely piggybacking off of the patient data sets housed in AWS, Azure and GCP.