by Paul Roemer
The national EHR market is ripe for the taking by a big three like Microsoft, Google and Oracle. Heck, I'll even go so far as to suggest that when the dust settles in about five or seven years, the National Health Information Network will be a regulated combination of a handful of those firms.

As for the other firms offering or planning to offer PHRs, permit me to suggest the following scenario: Let's say I am in charge of Google's somewhat non-existent healthcare line of business. One of my goals would be to have more users of my PHR than any other firm.

Why does this model make sense? Two ways, both of which come from the cable/telco business model.

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Rule No. 1: Content is king. In cable, it is channels such as HBO and Discovery. In healthcare it is data--patient data, effectiveness data, disease data.

Rule No. 2: The cable/telco model values the businesses based on the number of assets (subscribers--you and me). Each body adds somewhere between $5,000 and $10,000 to the valuation model of a Comcast or a Verizon. Downstream, some valuation will be placed on each PHR subscriber.

So, back to the example of me running Google's healthcare offering. (If you don't like Google as an example, insert your favorite firm.) If I'm Google, am I troubled by the fact that other firms are building their own solutions? No, because the difficult part of the business model is adding users, adding subscribers. Why not let a bunch of firms do the business development work for me, do the dirty work to get the users, and then just devour those firms? Once I own them, I convert them to my platform. Do I then get some 'ownership' or right to use the data? That would certainly be the business goal.

One million users valued at $5,000 adds $5 billion in valuation. Ten million adds $50 billion. Ten billion is about 2.5 percent of the U.S. market. Do I stop at the border? Of course not.

By the way, while all this is going on, Google, Microsoft, or some other company will also be creating standards and building or buying up EHR firms.

Paul is a healthcare strategist and the managing partner of Healthcare IT Strategy, which helps health care providers solve business problems using EHR, workflow improvement, and change management.