[dm8]

More tangential q. I always wonder - why Epic is not disrupted yet? In same vein similar Q can be asked, why Bloomberg is not disrupted yet?

I guess software is inherently monopolistic (or oligopolistic) market especially in highly regulated markets (healthcare, finance etc.).

So going back to earlier question -- why can't someone start an open source alternative? And may be sell it something along the lines of Redhat business model. It looks like support (training, maintenance) costs are way more in healthcare. Why can't be Epic disrupted?

P.S. One of my physicians uses Epic, and he is pretty old guy. And once he showed me the interface, my first reaction, "oh god, that software is designed by committee". I really sympathize with doctors who have to work several hours everyday to work on Epic.

[Artistry121]

I worked with Epic's main competitor. The main fact is that this type of software is sold alongside consulting and training solutions with custom options.

This allows IT teams at hospitals to have say and power over best practices but also requires massive investments in custom software and consulting and training.

Add in they've been doing it with patchwork for so many years and it's difficult and there's little incentive to build a new system. When consulting revenue for implementation outpaces licensing... You're going to have a bad time.

[yumraj]

Well, there is/was an open source EHR called Vista and VA uses it. However, even that is being replaced by VA at a cost of $10 Billion over 10 years to Cerner (https://www.ehrm.va.gov/news/article/alias/va-signs-contract...)

[Fins]

What Artistri121 said (I also worked for a major competitor of Epic).

Also, this isn't wi-fi based juicer machines or Uber for llama rentals nonsense that SV is so good at disrupting. This is a very complex business that often makes no sense (American medical billing is insane to put it mildly) and usually requires heavy customization for every client, and have pretty heavy switching costs.

It would be an interesting project to disrupt them, but it's nowhere near as easy as it seems, and it is doubtful that you'd get any of the big clients EPIC, Cerner, or GE Healthcare care about.