(I'm new to the field and genuinely curious... I haven't heard anybody saying anything nice about any of them...)
In an independent practice, there are more options, and some are quite good (I work for one that I happen to think is pretty great in that regard, and most of our users seem to agree)
What concerns me most about the larger players in the field is their dedication to minimizing interoperability to lock people into their software.
Hard agree. There's also an incentive for hospital systems to "hold onto" patient data, which is not great.
- Home-grown systems which were fit for purpose but not operable or available outside the organisation for which they were designed. The Birmingham (UK) University Hospitals system [1] is a great example of these.
- "Enterprise" (pejorative) systems which generally came from the US and focused almost entirely on billing capture, and had almost no thought put into clinicians workflow. This encompassed Epic, Cerner Millenium and so forth.
- "New" systems which were UX first, but were often little more than front-end mockups. A good example was "Alert", a Portuguese system written in Flash which had almost nothing in the way of basic medicine management safeguards, and the team demonstrated zero aptitude for the ability to build them.
In the end the hospital in question used paper-based prescribing.
[1]: https://www.digitalhealth.net/2017/05/birmingham-childrens-g... is a reasonable story about this.
Epic was by far the jankiest. i.e. if you tried to cancel a recurring appointment the wrong way it crashed the entire system. Athena and Nextech were among the least disliked
* The Cerner hospital will duplicate medications for a single visit. It also classifies a bunch of vital signs as lab test results, so things like blood pressure don’t get merged in with other sources of data.
* The Epic system seems to use more recent/complex FHIR structures, so occasionally there’ll be more info in the raw data (this is more a knock on Apple Health though).
The Epic system has a big advantage with MyChart though. It’s their app and website for accessing your records at various hospitals. Through the app you can get push notifications of test results and schedule procedures. The latter was nice as I’d get roughly 15-30 minutes of advance notice before having a procedure done. The discharge instructions being made available in the app is also very helpful. Finally, being able to browse the raw clinical notes through the website, and request a dump of all of my data is appreciated.
EMR is a difficult field to "disrupt" IMO because a hospital comprises so many departments with wildly different requirements for a software system, that it's basically only the big players who can do it all. And if you're a CIO for a hospital looking for an EMR system to purchase, one system that handles everything sounds much more appealing than trying to cobble together something yourself.
It's also why there's only a few major ERP players.
That’s an optimistic assessment of what Epic does.