@Seasoning, moving my answer to your question to the forum.

"How likely is it for the winner to become a standard? Is this an environment where one becomes the absolute winner or is this an environment where multiple winners are possible?"

IMO, multiple leaders.

Investing in an EMR in the public hospital sector is a 20 year endeavour at a minimum, so customers are sticky with low churn. Unless mandated or purpose built by governments (e.g. Singapore), there will always be competition.

EMR is to an extent, not unlike billing software providers Hansen and Gentrack, in that once a customer is locked in, they are committed unless a disaster happens.The other thing to note is that Alcidion is firmly in the secondary/tertiary and state health space, so they are looking at long term big $$$ public sector contracts.

There are a gazillion EMR providers in primary care and individual private practices, with perhaps five or six leaders in Australia, all private companies (to my knowledge). There will never be a dominant oligopoly in this sector of the EMR market, because there is so much inertia in moving. Its not like switching from QuickBooks to Xero.

Cerner and Orion are the two biggest players.

I am specialist doctor and work across multiple public and private health services in two states/territories. The biggest problem with any EMR system is that the needs of each individual clinic or subspecialty service are unique, and it is simply not possible for any one health records provider to meet the needs of every single department in a large service. This is why within any EMR, you still need cross compatability with pathology, imaging, critical care and other software packages.

I agree with the analyses here that customers are sticky. It's a huge undertaking to train a workforce of >2000 clinicians (a typical number of bodies for a small capital city hospital), you don't want to be doing that often unless there is a substantial cost saving to justify the increased level of risks that are involved with any transition. The respective Health Ministers won't accept that there is an inherent risk on transitioning from one health system to another beacuse it involves re-learning how to do things like access notes/test results/etc, and clinicians are resistant because we all know the first thing a health service will do when there is a disaster is blame the clinician for being incompetent, rather than accept that rolling out new clinical systems is a hugely dangerous and risky undertaking where mistakes are unavoidable.

With Alcidion, in short, I think there there is growth here, but there is no way will it become a competitor to the main players. The most likely scenario is that once there is sufficient traction in the global market, it will become an acquisition target.

Apathy, ignorance and a reduced budget are Alcidion's biggest competitiors!

I work in the health care industry, in Emergency departments.

I have looked at their product and played around on demos, and love it.

I am, however, not hopeful about the possibility of using it in my workplace in the foreseeable future. Governments are broke, Health authorities are being told to cut budgets by 10% (in Oz, but I dont see it being any different anywhere else) and software upgrades do not figure very highly on the list.

To give you an example: for managing basic patient notes, ordering tests and visualising departmental occupancy, I use a version of software that is 20 years old. It does not sync with any of the other IT systems I need to access (radiology, pathology, other hospital notes, outpatients, general practice -  any other system you can imagine). It is a dinosaur. All the other IT sytems I use are dinosaurs as well. All hospitals I have worked with, also use dinosaur systems (UK, NZ, multiple states in Oz)

And ultimately thats why I lost faith as an investor. In healthcare there is always a fire to be put our somewhere. Managers move in for a few years and have a specific set of criteria against which they are judged. They then move on to some other hospital or department, much like CEOs in public companies. the unintended consequences are that budgeting is always short term. No one wants to invest in a software efficiency that makes my life and patients' lives  better at extra cost. I know a number of people have been excited by the contracts in the UK, but these are really small trusts, they havent won a big health authority, and I am sorry to say I dont think things are likely to get any better for a few years. There just wont be the money for software upgrades, when we are being told to cut staff numbers.

It might change if we get back to a budget surplus.

Love to be wrong.