The electronic health record (EHR) is the operating system of a modern hospital. It holds the chart, places the orders, runs the pharmacy and the lab, drives the bill and controls what every clinician sees. The US went from roughly one hospital in ten having even a basic EHR in 2008 to near-universal adoption within a decade, paid for in large part by the HITECH Act's incentive payments. That subsidy created a winner-take-most market dominated by Epic, with Oracle Health (Cerner) a distant second, and it left a second problem behind: records that do not move easily between systems. This section explains how EHRs are built, bought and paid for, the standards that carry data between them (HL7 v2, C-CDA, FHIR, X12, DICOM), the policy stack built to force data to flow (Meaningful Use, the 21st Century Cures Act, information-blocking rules, TEFCA, CMS API mandates), and the landmark cases from Kaiser Permanente's Epic bet to the VA's troubled Oracle rollout. The supporting files compute a stylized EHR replacement business case and tell the Epic vs Cerner story in detail.
What the study covers
- 1Overview: why health IT is different from other enterprise software
- 2A short history
- 3Mechanics: how an EHR works and how it is bought
- 4Market structure
- 5Interoperability: the standards
- 6Interoperability: the policy stack
- 7Key numbers
- 8Landmark companies and cases
- 9Pitfalls
- 10How an expert thinks about it
- 11Glossary
Technical exhibits
Worked examples, checklists and case studies included with this study.
Ehr Replacement Tco Worked Example
Ten-year total cost of ownership, go-live revenue dip and break-even benefit for a stylized 900-bed health system replacing its EHR (computed in Python)
Epic vs Cerner Case Study
How two companies founded in 1979 diverged: product philosophy, sales model, HITECH, the DoD and VA contracts, Oracle's 2022 acquisition and the market-share outcome