@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.

Nervecentre in the UK are a formidable competitor.

They are going to have a webinar on November 17 to push EPR as a service.

Probably a good idea to watch what the UK market leader is doing -> they have more NHS trusts and are developing new products like the Night solution to upsell

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.

Microsoft are advertising "Microsoft Cloud for Healthcare" should we be concerned these guys are some big competition?