[sswaner]

You could replace every instance of Epic with Siebel and find hundreds of similar quotes when Salesforce prepared to take out the leader in enterprise CRM.

As a consumer, the EHR space seems ripe for revolution. 5 years from now, they may not be the leader, but I expect they will own a sizable share of the market and introduce a serious competitive threat to existing players.

I would count the following in their favor: 1- Their cloud design makes rollout easy compared to a data-center installed product. 2- Their existing and growing mobile offerings could be a disruptive option for both health care providers and consumers. 3- The AppExchange Marketplace allows a wide spectrum of 3rd parties to easily integrate into the core platform. This has proven to be a very powerful added benefit in other markets (disclosure: I presented on this topic at Dreamforce earlier this month). 4- Low overall cost of adoption. It is very easy to develop custom solutions on Salesforce. I could see some potential customers opting for a small pilot that proves the value of Salesforce over an existing install. 5- A provider still adapting to changes from ACA could use this as an opportunity to make a change. Ideally, Salesforce would have done this a few years ago, but there may still be enough Obamacare disruption to gain traction.

[lnanek2]

As someone who writes for one of the big EHRs, writing a CRM is like generating a Rails CRUD template app, throwing out an open beta, then convincing some people to try it out. Writing EHR is like then having to do the same then white box test it with unit tests and integration tests, black box test it, UI automation test it, meet ridiculous amounts of regulations like defects per amount of code and auditing requirements about design and meetings for every code change, getting certifications, deploying it to half a dozen test environments before it hits production, live test runs at clients who are all trying to competitors as well, and absolutely massive amounts of bureaucracy in place for handling incidents and remediation and all the legal mumbo jumbo and required response times that go with them, then finally maybe getting someone to use it for real. Writing medical software is a nightmare and difficult to enter into.

[sswaner]

Yea, very similar to rolling out Salesforce in financial services...

[mericsson]

fwiw Salesforce announced Merrill Lynch as their biggest customer in 2007 and have added a few more since then.

http://www.zdnet.com/blog/btl/why-salesforce-coms-merrill-ly...

http://www.computerworlduk.com/news/cloud-computing/2049/mer...

[ch4s3]

While that all may be true, Healthcare is a completely different space. Importantly Epic is years ahead on meaningful use requirements, and they seem to have a seat at the table so to speak deciding what those requirements might be.

They also have lock in, once you're an Epic hospital, it might bankrupt you trying to switch. The training costs, testing equipment interfaces, building new data interfaces, HL7 engines, and on and on.

Additionally, if you try to switch to a 2nd or 3rd EMR in 10 years the doctors will riot.

AND... if some you new EMR should ever be implicated in killing someone, well you're done.