[pragone]

I’m not at all surprised.

As a semi retired software engineer and currently 4th year Med student, I still maintain a dream of building a usable EHR that puts the clinical, patient-focused side of things first. Currently implementations allow for increased billing recovery, but at a cost to both doctors and patients.

I just don’t know how you’d start in competing with something like Epic or Cerner, from a business side of things.

[ndonnellan]

Speaking as someone still working at a big non-epic/cerner EHR company-that-might-have-just-gone-private: it's not easy. When the money is controlled by large insurers who care about government and billing minutiae, and big hospital/health-care groups choose which software solutions to use, it's an uphill battle to make stuff that is really, truly patient centric.

Everyone I work with cares really strongly about making a really good product. We have great designers/UXers, a lot of experience in building different pieces of the workflows that tens of thousands of doctors and hundreds of thousands of nurses, MA, PAs, front-office staff _and_ patients, but when you spend a whole year readying for ICD-10 and then some yokels in DC push the deadline back a year... I belabor my point.

Engineers wanting to start a health care company should try working for a big EHR company first. Then go start somewhere else using modern technology, modern development practices with just a little more wisdom. Maybe.

[Para2016]

Epic lets you change provider context to Emergency department, internal medicine, etc. I think they just need to make the provider context suck a whole lot less. Epic Haiku (mobile) is a pathetic joke as well. Nevermind, I think you're right actually, the whole thing needs to be burned to the ground and built completely different. The only thing Epic has going for it is that it's not Cerner.

[fencepost]

The only thing Epic has going for it is that it's not Cerner.

They also have that they're not eClinicalWorks or descended from Medical Manager (Intergy), that has to count for something!

[warent]

I worked for a little bit with these guys on this product called phrHero which focuses on making these EHRs more much more patient-friendly using the new FHIR protocol. https://www.phrhero.com/

I don't work with them anymore due to some fundamental differences (it's been almost a couple of years) but thought it was related to what you're talking about and possibly something you'd be interested in.

Possibly the only way you could compete with Epic or Cerner is to innovate on things in a way that can't be denied. It wouldn't be the first time slow giant companies fall because they did not advance, but it is much harder because the barrier to entry is absolutely enormous.

[chapium]

Dont beat them, join em. Build a solution to a problem and integrate it into one of their html5 modules. Both systems offer breadth, not depth when it comes to solving problems.

[qudat]

Healthcare is a heavily regulated industry and as such only large companies are able to successfully navigate the bureaucracy. The only way to usurp coercive monopolies is by creatively destroying it (e.g. uber)

[EpicEng]

It's more nuanced than that. I've spent 13 years working for two successful healthcare/biotech companies, both having attained FDA clearance (one class I and two class III devices) while I was there. I was brought on as the 21st employee and then the 17th employee. At no time could these have ever been considered large companies.

Products like LIMS and hospital systems are hard to replace because of vendor lock in and the cost to replace it all, not regulatory hurdles.

[nradov]

The regulatory requirements for security and interoperability are all things that every EHR vendor ought to be doing anyway. Regulations aren't a significant obstacle to new market entrants.