In economic terms, a monopoly means, quite literally, one seller.
By this definition, Epic’s 36% market share of U.S. hospitals is far from meeting the monopoly threshold. Oracle, Cerner, athenahealth, MEDITECH, and eClinicalWorks are just a handful of the hundreds of vendors selling EHR software to healthcare providers, with a number of well-funded new entrants (Elation Health, Canvas Medical, and Healthie) collectively raising nearly $100M in the past 18 months to bring modern technology approaches to ambulatory providers.
While there is no hard and fast market share threshold rule, case law supports that “market share at or less than 50% is inadequate as a matter of law to constitute monopoly power.”
Accordingly, one might suppose that this renders Epic’s position as a non-issue. This take might also be wrong, based on a deeper examination. As part of a broader examination, this first article in a series delves into: what’s driving Epic’s dominant market position; how Epic has cultivated and continues to grow its position, especially among health systems and academic medical centers; the implications of monopolistic tendencies on healthcare innovation; Epic’s seven potentially “anti-competitive sins”; and considerations for healthcare executives and healthcare IT regulators, who – since the introduction of federal incentives (and penalties) that blazed the path for nationwide EHR adoption and fueled Epic’s current position – have been following wherever CEO Judith “Judy” Faulker leads.
