OBJECTIVE The objective of this study was to quantify both the competitiveness of the EHR vendor market in the United States of America (US) and the degree of fragmentation of individual Medicare beneficiaries' medical records across the differing EHR vendors found in the US healthcare system. METHODS AND MATERIALS We determined the Part A and Part B Medicare-expenditure weighted market shares of EHR vendors and estimated the rate of attestation of meaningful use (MU) for EHRs among Medicare Part A & B providers from 2011 to 2016. Based on these data we calculated the annual Herfindahl-Hirschman Index to quantify the competitiveness of the EHR market as well as the number of vendors individual Medicare beneficiaries' medical records were stored in for the period 2014-2016. RESULTS We find that as of 2016 the EHR vendor environment was competitive but trending towards becoming highly concentrated soon. We also found that patient medical records were highly fragmented as only 4.5 % of expenditure-weighted individual Medicare beneficiaries had their MU medical records associated with a single vendor, while 19.8 % of expenditure-weighted beneficiaries had their MU medical records stored in 8 or more vendors. DISCUSSION These results indicate that there are tradeoffs between EHR market competition, and the challenges associated with achieving interoperability across numerous competing vendors. CONCLUSION Uncertainty of interoperability among different EHR vendors may make transmission of medical records among different providers challenging, mitigating the benefit of vendor competition. This highlights the critical importance of current interoperability efforts moving forward.

中文翻译：

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量化电子病历市场的竞争力及其对互操作性的影响。

目的本研究的目的是量化美国EHR供应商市场的竞争力，以及在美国医疗保健系统中发现的不同EHR供应商中各个Medicare受益人医疗记录的分散程度。方法和材料我们确定了EHR供应商的A部分和B部分Medicare支出加权市场份额，并估计了2011年至2016年Medicare A和B部分提供者中EHR的有效使用证明（MU）的比率。基于这些数据我们计算了年度Herfindahl-Hirschman指数，以量化EHR市场的竞争力以及2014-2016年间医疗保险受益人个人病历的存储供应商数量。结果我们发现，截至2016年，EHR供应商环境竞争激烈，但很快趋向高度集中。我们还发现，患者医疗记录高度分散，因为只有4.5％的支出加权个人Medicare受益人的MU医疗记录与单个供应商相关联，而19.8％的支出加权受益人的MU医疗记录存储在8个或更多中供应商。讨论这些结果表明，在EHR市场竞争与众多竞争对手之间实现互操作性相关的挑战之间存在折衷。结论不同EHR供应商之间互操作性的不确定性可能使不同供应商之间的病历传输具有挑战性，从而削弱了供应商竞争的利益。