[baran]

The problem is Epic has effectively locked-in the top end of the market. Their strategy, which is brilliant, is to only go after the biggest, most well-known clients (I know nothing groundbreaking, but it works). They say they only focus on whales, academics, and children (hospitals). Due to this, they have been able to capture 265 of the most prestigious hospitals in the country (and soon in the world). With the lock-in they have, I can't see them giving up this market. It would take a lot to justify replacing that half a billion dollar system for someone else, especially after the hell the administrators have gone through to get the systems up in the first place. Also, in many ways Epic is becoming the de-facto standard, which is leading to network effects that would have to be broken down. I don't think you can fight Epic at their game and win.

Added to that they will likely begin to move downstream (recently heard a rev. projection $8.4B in 2016, up from $1.2B today) as the mid-size players would love to have an Epic install if only to mimic the respected healthcare organizations.

The most secure place from Epic is the small practices. The IT/intemplmentation/costs requirements of Epic are far too high, in its current form, to sell to them. The problem becomes selling. It recently talked with a VP of Sales at a HIT vendor and he said of 10 hours spent selling a doctor, 9 hours are spent trying to get a hold of him. Difficult.

[Skeletor]

That's the exact way the market looked to Salesforce.com when Seibel system only went after large markets and told their salesforce to "run" not "walk" away from smaller customers. Salesforce.com definitely killed Seibel in the enterprise space after building a better product with feedback from smaller sales forces.

[Kadrith]

My understanding of Epic's approach, to some extent, is that they know approximately how much it will cost to support an organization. When we were going live they had reservations due to our size at the time; if we were not big enough they did not want us as a client since the cost of support would be greater than what we honestly afford.

I really like how they have structured the support concerning Forums, UGM and Good Maintenance; for an enterprise software company it is the best approach I've seen.