I'd argue they are at disadvantage. Small startups can't eat the cost of spending 2 years developing for a particular standard just to have it changed on the due date.
That's a fair argument but in practice isn't true. The pace at the larger health IT shops is FUCKING GLACIAL. I've been through getting an EMR through two meaningful use stages in a fifth the time combined than a typical larger shop might've gotten one done, with a tenth the manpower.
In verticals like this don't dismiss the advantage of being lean, nimble, and wholly stocked with incredible and enthusiastic people.
In verticals like this don't dismiss the advantage of being lean, nimble, and wholly stocked with incredible and enthusiastic people.