50 EMR Markets Instead of 1 EMR Market

John Moore at Chilmark Research said, “So Many EHRs, So Little Time: Simply amazing that this market can support so many EMR/EHR companies. How they all survive or will survive is a mystery to me and rationalization will occur. ”

It really is pretty stunning that 300+ EMR vendors are still trying to carve their niche in the EMR market. That’s a lot of friendly (or not so much) competition.

However, I can’t help but sit back and wonder if we’re looking at this the wrong way. Maybe there’s not actually 1 EMR market out there. Maybe there are actually 50 EMR markets.

The case for 50 EMR markets is simple. There is an EMR market for every specialty. Add in regional differences, countries, and I think you could get close to 50 markets. However, the number of markets doesn’t really matter. What matters is that there’s more than 1 EMR market.

Almost every EMR vendor I’ve seen has had the challenge of deciding how they want to market their EMR software. It’s not an easy choice, but more and more we’re seeing EMR vendors focus on specific markets. I think that they’ve found that they can’t be all things to all doctors. Doctors in different specialties are unique and that by focusing on a certain specialty they can provide a real value added service to the doctors in that specialty.

Assuming there’s 50 EMR markets, that means that there’s only 6 EMR vendors per market. That’s a much more reasonable number to consider.

Now there’s no doubt that EMR vendors are working in more than one EMR market. Some of the larger EMR vendors are doing a great job focusing on a number of specialties. So, maybe it’s 10-20 real players in each specialty market. Still too many, but we’ll definitely see a lot of consolidation in this regard.

In fact, I’m a little surprised that we haven’t seen more EMR vendors purchasing up these specialty specific EMR vendors and having them work as kind of subsidiaries of the other company. Then, the large company can provide a variety of very targeted EHR products. The key for that company would be to build amazing interfaces between the various EHR products you own. Show true EHR interoperability between these products and you can sell them as a great package to even the larger hospital owned ambulatory practices. Could be a really interesting play for an EMR vendor I think.

Now, I’m sure that someone will say in the comments that one EMR vendor can serve all 50 markets. They can just build “modules” (or some other similar term) that customizes the EMR to meet the needs of that specialty. The problem is that the “modules” are always limited and lacking. Focusing a “module” of an EMR on a specialty and focusing an EMR on a specialty ends up with very different results.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • John,

    I am certain there is more than one market for EMR. A while back I even wrote a blog post about this.

    There may even be more room than any of us can conceive at this point. The innumerable permutations and combinations of types and sizes of practices will necessitate the explosion of these markets. And like you said, don’t forget about the international market.

    I know from my client’s experience that the Oncology specialty EMR market is VERY immature, with lots of room for competition. That’s why we are writing our own oncology EMR.

    And don’t forget the ‘meta’ market, with companies specializing in the space that connects all of these EMRs (HIE). We aren’t only counting the nodes on the graph but the edges, as well.

    You are also right about interoperability being key to winning over an EMR market. If your product can transcend boundaries to other markets, your influence will grow beyond your own market.

    And if you modularize well, your product will only be more attractive for potential acquisition.

    One potential market splitter might be the platform on which the EMR is based. My guess is that hard clients are not easily merged with web/intranet-based clients. There could definitely be segmentation there.

  • Excellent points, both in blog and comment. The market does appear very saturated at the moment, which always means you have to step back and look at where there is room for you and your possible niche innovation.

    My supervisor is fond of saying there’s the “300-pound gurilla” type outfits, or the Swiss army knife models, which try to be all things to all people. There’s definitely a market for them, and some wouldn’t be satisfied with anything less. But then there’s the people who don’t want/need all those options, and are craving some simplicity or a function their specific specialty needs.

    @Nick: Interesting hypothesis about hard clients v. web clients. We’re actually trying to do both, since our existing software we developed in-house (like you, for a smaller specialty) is “hard” but we’re building a web portal option to offer it as a service in the cloud. We’ve been able to feed the same data/libraries to both, using Eclipse (not the EMR) and GWT.

  • Your analysis is common but somewhat simplistic (no offense intended.) The reason there are so many EMRs vendors is because there is a LOT of money to be made – potentially. The reason there are speciality EMRs is because an EMR is VERY complicated – and the designer/programmers can not conceptualize the logic required completely.

    As an example, EVERY EMR requires an e-prescriber. There is only Surescripts – supported by the pharmacists and used in many EMRs as a module- and Medscribbler (RXscribbler) Some others have basic drug lists. Surescripts most say has multiple problems – speed and reliability mainly. Medscribbler is totally self contained and owned by the doctor in the EMR purchase.

    An EMR without e-prescribing is not. An e-presxcriber is simply too complicated for most vendors to program and make it useable for an everyday doctor.

    Medscribbler now has half a million lines of code. When we finish all the features it will have well over a million – the largest code base of any EMR currently on the market. But a family doctor (and most specialties) can load Medscribbler and be operational with-in 5 to 10 minutes – no training. Just as most people can use Microsoft Office within minutes – but there are schools who teach Office as a course because there is such power. Medscribbler is the only EMR vendor with this goal. The logic and code is just too great for others to have an universal EMR.

  • I thought I would clarify my comment a bit. An EMR is medical logic codified in a computer program. People who are in the top 1 to 3% of the population in IQ spend years learning medcial logic. While there are a lot of people that can “program” only the top 3 to5% in IQ get to go to a school like MIT. So the medical and computer logic required is extremely high for this type of automated process.

    Medscribbler’s lead programmer has a PHD in mathematics from the University of Moscow.

  • CEO Mike,

    I don’t wish to malign you or your company, but as the lead developer of an EMR project, I would like to address your comments for John’s readers from a developer’s position.

    The IQ of a programmer is far less important than being able to collaborate and communicate with doctors and nurses. I would probably agree that one programmer cannot hold the entirety of logic of a medical practice flow(and the MDs can’t hold the entirety of the techincal workflow). He has to depend on being able to communicate with the experts around him. It is a distributed knowledge base.

    I’m sure the handwriting recognition algorithms are very complex and require PHDs, but making productive, relevant and agile software is a social practice, not a technical one.

  • Simplistic on purpose. The simple concepts illustrate the best points.

    I’m with Nick on the PhD point. Especially having worked in the University system for the past 10 years. PhD does not always equal street smarts. In fact, a lot of it is fortitude to keep going (which is a good value in and of itself).

    Not to say that a PhD is worthless, but it’s also not true that if you don’t have a PhD you can’t make software that is simple and highly effective.

    I’d say that more important than education is the background and culture of the company creating the software. Their core principles and how fanatical they (all the company) are about implementing those core principles are a better indication of the end product.

  • John,

    By market share, there are probably only a handful. That is, only a few collectively have any significant market share.

    I’m in touch on a daily and weekly basis with many of the major sofware development companies (most now use some variation of off-shore outsourcing) around the world. We help them make sense of MU and help to deflect the arrows flying their way. We know first hand that there are many hundreds more systems, and probably thousands more systems on the way.

    Your advertising model blog should be getting better and better as the tidal wave of systems comes on shore. Sort of like financial services. More money is made giving financial advice than taking it. 🙂

  • Nick and John,

    To complement, the PHD is my Masters in missiology -(a divity subspeciality concerned with sociology, culture and change management) My wife is the medical officer, having practiced on two continents and three systems for 35 years. The PHD has experience in biometrics software in the Russian space program.

    Medscribbler is half a million lines of code currently, and we consider it rudimentary still – we are working on incorporating AI to finally kill template “pick lists” (which were designed in the 90s – obviuosly legacy to us) Final code base will be just over 1 million lines. A simple undergraduate, no matter how experienced, is a junior programmer for Medscribbler. In fact our junior programmers are top undergraduates. Even sales are Microsoft Certified Professionals, a requirement of employment.

    I believe this is what it takes to get the 85% of doc’s who don’t like what they see now to buy Medscribbler.

  • Axeo,
    Medscribbler does not outsource overseas because that adds another layer of communication to a complicated medical architechure. Everyone in the same culture talking with the same English nuances have enough trouble getting EMR software right. It is impossible to move EMR software foreward if outsourced. Outsourcing is done for cost not quality. Anyone who has got out sourced “tech support” should be able to understand this.

  • John,

    Yup — and I am referring prospects to you.
    Not sure how many will see the light of day, but many will try.

    Your forum and forums like yours are helpful for us in return.

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