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Each week, electronic health records (EHRs) become more ubiquitous and an increasingly important part of our nation’s $2.7 trillion health economy [1]. While the promises of increased efficiency, cross facility interoperability, and point-ofcare benefits have been modestly fulfilled [2, 3], it is clear that adoption of EHRswill only increase for the foreseeable future. However, tremendous market consolidation has resulted in a small number of programs obtaining a large share of installed systems. This effective monopoly by a group of vendors has stifled innovation and made disruptive innovation very difficult. In order to combat this problem, EHR vendors should be required to open systems up to allow for more clinical innovation. Adoption of EHRs is being driven by a multitude of factors. In February 2009, President Obama signed into law the American Recovery and Reinvestment Act (AARA), a $789 billion economic stimulus package, which includes the Healthcare Information Technology for Economic and Clinical Health Act (HITECH Act). The HITECH Act is designed to encourage investment in health information technology so that both healthcare delivery and patient care can be improved. As a consequence of the HITECH Act, which allocates $25.9 billion to hospitals and physicians who demonstrate meaningful use of electronic health records, many hospitals have adopted digitalized technology. Eligible providers are now able to obtain up to $63,750 in payments from the government for demonstration of the use of certified systems [4]. Additionally, pay-for-performance contracting with private insurers has spurred many physicians and hospitals to adopt EHRs in order to be able to participate in these programs [5]. The increasing need for external data reporting, such as statebased reporting programs, along with a general desire to utilize technology to facilitate quality improvement have also helped drive adoption [6]. EHR system use among officebased physicians increased from 18 % in 2001 to 57 % in preliminary 2011 estimates [7]. As the number of physician practices using EHRs increases, there has been a simultaneous decline in the variety of systems installed. Market consolidation has steadily increased, as evidenced by data now available from CMS. Although several hundred unique EHR systems have been certified for use by CMS, according to CMS attestation data, 15 vendors represented 75 % of the systems among all providers attesting to meaningful use. Among inpatient EHRs, this consolidation is even more pronounced with just 6 vendors representing 75 % of all hospital attestations [8].

Innovation & Market Consolidation Among Electronic Health Record Vendors: An Acute Need for Regulation