3 of the biggest health IT rivalries: The cloud, EHRs & wearables

From startups to established conglomerates, health IT is a vast field with nearly limitless options. With demand for technology-driven solutions on the rise, fierce competition for market share amongst those that provide those solutions is inevitable. Here are three of the biggest health IT rivalries between some of the industry's major giants.

The cloud: Amazon vs. Google vs. IBM vs. Microsoft  
The cloud is emerging as a cost-effective and efficient platform for healthcare providers. As a relatively new option, cloud computing is ripe for innovation. Amazon, Google, IBM and Microsoft have all made forays into this area.  

Amazon Web Services is Amazon's cloud solution for healthcare. The Google Cloud Platform is the technology behemoth's answer to the cloud. IBM has arguably made the most significant inroads in healthcare-specific cloud computing with its IBM Watson Health business unit, which features the Watson Health Cloud. Microsoft's cloud platform Azure is also one of the competitors at the forefront of the battle for healthcare's attention. Each of the companies offers a cloud-based, HIPAA-compliant IT infrastructure that supports data storage and analytics.  

As of the second quarter of 2015, the four rivals collectively held 54 percent of the worldwide cloud infrastructure service market, according to Synergy Research Group. Here is how that 54 percent breaks down between the competitors:

•    Amazon: 29 percent
•    Microsoft: 12 percent
•    IBM: 7 percent
•    Google: 6 percent

Though IBM is not the overall top market leader, the company is confident IBM Watson pushes the company ahead of the competition in what could evolve into a neck-and-neck race. Robert LeBlanc, IBM's corporate vice president, told Business Insider the cloud is no longer just about IT infrastructure. Mr. LeBlanc believes IBM Watson's "cognitive computing" capabilities set IBM apart from Amazon, Google and Microsoft. Additionally, IBM is aggressively pursuing natural language processing, which the company expects to be the next step in cloud computing.

IBM may be confident of its place in the cloud market, but this isn't stopping the other contenders from pushing forward. Google has made significant efforts to catch up to AWS when it comes to cloud computing. Google board member Diane Greene was named the head of the company's cloud computing business in November. Ms. Greene is tasked with helping Google gain market share in the cloud space.

The Google and AWS cloud rivalry reaches beyond just general healthcare. The two companies are vying for dominance in the DNA storage market as well. Google Genomics and AWS both offer cloud storage and host data from the 1000 Genomes Project. The two companies offer comparable prices – AWS charges $4 to $5 per month to store a single human genome, and Google charges $3 to $5 per month for the storage of a single genome. Each company also has clients active in genomic research. Multiple Myeloma Foundation and the Alzheimer's Disease Sequencing Project work with Amazon. Autism Speaks and Tute Genomics are Google clients.   

EHRs: Epic vs. Cerner
Epic and Cerner are behemoths in the EHR world with a highly publicized rivalry. In fiscal year 2014, Cerner had $3.4 billion in revenue. Privately traded Epic had $1.8 billion in revenue during the same period, according to Forbes. Epic dominates the physician practice market with an 11.6 percent piece of the pie. Cerner trails behind Epic and several other EHR vendors with a 3.6 percent market share. Epic also leads the pack in the ambulatory EHR space with 20 percent of the market. Cerner has a 14 percent market share, but breaks even with Epic when it comes to mindshare, according to a peer60 report. As of March 2015, 931 hospitals reported using Cerner's EHR to attest to meaningful use. On the other hand, 835 hospitals reported using Epic's, according to ONC data.

Cerner has a large global presence with approximately 400 facilities outside the United States using its Millennium EHR. A recent KLAS report found Cerner, along with InterSystems, was a top-performing multiregional EHR vendor. Though Epic has largely focused on building its footprint within the U.S. borders, the same KLAS report indicated Epic performed best in larger organizations across the globe.  

This year, both Epic and Cerner vied for a multibillion dollar contract with the U.S. Department of Defense. Cerner came to the table with Leidos and Accenture on its team and beat out the Epic, IBM and Impact Advisors partnership. The contract, initially estimated at $4.3 billion, has the potential to reach a value of $9 billion over 18 years. Cerner and its partners are tasked with overhauling the military's health records. Many in healthcare were surprised Cerner walked away with the coveted deal. Epic's own employees expressed mixed feelings. A current Epic employee compared the loss to Big 10 football, telling The Capital Times, "It's like we're the Badger football team and a top recruit went to Minnesota, [and you say], 'Why would you go to Minnesota? That makes no sense,' and then you take a step back and go, 'They're a great football team, too.'"

Another Epic employee took the opposite side. "Epic's current customers are probably breathing a sigh of relief," he said. "Their [research and development] request aren't going to be put on the back burner because of the Department of Defense."
Epic is well-known for its limited interaction with the media, but Cerner is more vocal about its operations — and its competition. During a third quarter 2015 financials call, Cerner President Zane Burke made a number of remarks on his company's "primary competitor."

"A key element of our success is driven by our track record for delivering projects on time and on budget, as well as creating measurable value, which aligns well with our clients' focus on making ROI-based decisions," Mr. Burke said. "I believe [our primary competitor's] list of clients, where the significant costs of deploying and maintaining their system has been cited as a key reason for financial challenges, is starting to impact them in the marketplace. This not only differentiates us in the sales process, it has also contributed to some of their existing clients switching to Cerner, even after having spent $100 million-plus on their system."

Epic and Cerner consistently battle one another for market share and mindshare across healthcare, but a clear winner has yet to be distinguished.

Wearables: Fitbit vs. Apple Watch  
Fitbit and Apple were once on track to be collaborators, but in 2014 Fitbit announced its fitness trackers would not be integrated with Apple's HealthKit mobile program. Within the same month, Apple announced plans to pull Fitbit products from its shelves.

The two are now the top competitors in the wearables market. In the third quarter of 2015, Fitbit held 22.2 percent of the market, while Apple was not far behind with 18.6 percent of the market, according to a Venture Beat report. Fitbit shipped 4.7 million wearables worldwide for the quarter; Apple shipped 3.9 million wearables in the quarter. Fitbit's shipments have grown 101.7 percent year-over-year. With Apple Watch being released just seven months ago, a year-over-year comparison is not yet possible.

Fitbit's products include the:

•    Zip
•    One
•    Flex
•    Charge
•    Charge HR
•    Surge

The number of capabilities increases with each product, with Zip being the most basic and Surge the most comprehensive. Fitbit Surge is the most direct competition for Apple Watch. Apple Watch has just one iteration, which offers a wide range of fitness tracking capabilities, but release date rumors for the second generation of the wearable are beginning to pop up.

Both Apple and Fitbit are public companies — Fitbit completed its initial public offering in June. Both companies have also begun to tackle HIPAA requirements. In September, Apple introduced AirStrip, a third-party monitoring app that can relay healthcare information between users and providers that adheres to HIPAA regulations. In the same month, Fitbit announced new privacy and security features for its Fitbit Wellness division. The new features will align the company's division with HIPAA requirements.

Fitbit has had more time in the market and remains on top, but Apple Watch has had an impressive first year. The neck-and-neck competition will likely continue into 2016.

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