4 ms·

The key to making money: find something with extreme regulatory capture.

nradov 3y ago
There is actually not much regulatory capture in the EHR market. The FDA doesn't classify most of those products as regulated medical devices. Provider organizations are required to implement certain open interoperability standards so that authorized parties can securely access patient charts so they are unlikely to buy an EHR without those features. But the required APIs are fairly easy for any competent engineering team to build, and there are open source libraries like HAPI FHIR which already get you halfway there. https://www.healthit.gov/topic/oncs-cures-act-final-rule https://www.healthit.gov/topic/oncs-cures-act-final-rule The real barrier to entry is relationships. Epic has made huge investments in direct sales and consulting services to give the decision makers in large provider organizations exactly what they want.
- zdw 3y ago
  > huge investments in direct sales and consulting services Ever been to the Epic campus? It's literally like Disneyland - they have a whole section that is entirely made up like Alice in Wonderland: https://www.nytimes.com/2018/12/20/business/epic-systems-campus-verona-wisconsin.html https://www.nytimes.com/2018/12/20/business/epic-systems-cam... They also wanted to build tunnels into the facility that were too low for the local fire department's trucks to get through, so they just... bought them all new trucks that were shorter. That's where your medical dollars are going folks...
  - cosmojg 3y ago
    Alt link: https://archive.ph/PSQL4 https://archive.ph/PSQL4 Jeez, these people are like the supervillains of mundane Kafkaesque bureaucratic evil.
    - FireBeyond 3y ago
      In a grand fit of irony, https://open.epic.com/Home/InteroperabilityGuide https://open.epic.com/Home/InteroperabilityGuide Look at your options for "Who are you?"
  - CamperBob2 3y ago
    I especially liked, "The company’s dress code is that when visitors are on campus, wear clothes."
  - walterbell 3y ago
    HN discussion: https://news.ycombinator.com/item?id=18735023 https://news.ycombinator.com/item?id=18735023 Related, "Why Doctors Hate Their Computers" (2018), https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers https://www.newyorker.com/magazine/2018/11/12/why-doctors-ha...
- shigawire 3y ago
  What do you mean by huge investments? The sales team is about 7 people. Only in recent years have they begrudgingly expanded their consulting wing - but hospitals IT teams manage the software themselves. Mostly it is driven by the fact that as bad as people like to think Epic is... All the direct competitors are magnitudes worse.

There is actually not much regulatory capture in the EHR market. The FDA doesn't classify most of those products as regulated medical devices. Provider organizations are required to implement certain open interoperability standards so that authorized parties can securely access patient charts so they are unlikely to buy an EHR without those features. But the required APIs are fairly easy for any competent engineering team to build, and there are open source libraries like HAPI FHIR which already get you halfway there. https://www.healthit.gov/topic/oncs-cures-act-final-rule https://www.healthit.gov/topic/oncs-cures-act-final-rule The real barrier to entry is relationships. Epic has made huge investments in direct sales and consulting services to give the decision makers in large provider organizations exactly what they want.

zdw 3y ago
> huge investments in direct sales and consulting services Ever been to the Epic campus? It's literally like Disneyland - they have a whole section that is entirely made up like Alice in Wonderland: https://www.nytimes.com/2018/12/20/business/epic-systems-campus-verona-wisconsin.html https://www.nytimes.com/2018/12/20/business/epic-systems-cam... They also wanted to build tunnels into the facility that were too low for the local fire department's trucks to get through, so they just... bought them all new trucks that were shorter. That's where your medical dollars are going folks...
- cosmojg 3y ago
  Alt link: https://archive.ph/PSQL4 https://archive.ph/PSQL4 Jeez, these people are like the supervillains of mundane Kafkaesque bureaucratic evil.
  - FireBeyond 3y ago
    In a grand fit of irony, https://open.epic.com/Home/InteroperabilityGuide https://open.epic.com/Home/InteroperabilityGuide Look at your options for "Who are you?"
- CamperBob2 3y ago
  I especially liked, "The company’s dress code is that when visitors are on campus, wear clothes."
- walterbell 3y ago
  HN discussion: https://news.ycombinator.com/item?id=18735023 https://news.ycombinator.com/item?id=18735023 Related, "Why Doctors Hate Their Computers" (2018), https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers https://www.newyorker.com/magazine/2018/11/12/why-doctors-ha...
shigawire 3y ago
What do you mean by huge investments? The sales team is about 7 people. Only in recent years have they begrudgingly expanded their consulting wing - but hospitals IT teams manage the software themselves. Mostly it is driven by the fact that as bad as people like to think Epic is... All the direct competitors are magnitudes worse.