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Comment by ch4s3 | Hacker News Reader

Well, Epic is the #1 EHR in the country (and several others), with something like 30-40% of the market. They will absolutely crush anyone that tries to go head to head with them. One of their top competitors did abour $1.2bn in revenue last year and lost over $300m trying to compete with Epic. Their EHR works well enough, but doctors hate it, and it costs a literal fortune to install and maintain. So who know what will happen in 10 years.

However, my personal opinion as a healthcare software developer is that SalesForce has gravely miscalculated if the intend to produce an EHR/EMR system. Product lock in is on the order of a decade.

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I took traning like a decade ago to become Epic systems admin. They use Caché database, a hierarchical db. MUMPS and visual basic are a couple of languages they use.

Kaiser permanente is a big customer of Epic. At one point, Kaiser wanted equity in privately held Epic systems, because Kaiser thought it is the market maker for Epic systms. Epic systems did not budge to Kaiser's demands.

Unless salesforce comes with a solid product to compete with Epic, no big hospital would buyt Salesforce product. If I were the decision maker, I would rather go with a product that can be successfully implemented; otherwise, I would end up loosing the job like those bad $1B SAP implementations.

What is the impact of cloud in healthcare EHR. Not much, healthcare is like banks, finance. Lots of regulations like HIPAA, audits, etc.

Yes, Epic and non-epic systems can be interfaces via HL7, which is like XML.

When banks move to cloud, thats when we expect healthcare IT to move to clound. Until then, it is gonna be in the datacenters managed by hospitals.

>Yes, Epic and non-epic systems can be interfaces via HL7, which is like XML.

Epic has a Restful(ish) system now too. And most of the others have full on JSON APIs now.

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.

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.

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

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...

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.

What'll happen in 10 years?

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