The further a step sits from the EHR, the more a third-party vendor has moved in to own it.

This was a neat takeaway in a 2024 HFMA survey of hospital leaders. I've been obsessed with revenue cycle, and while digging in, I found these stats and put my own chart together. It maps where hospitals rely on outside solutions versus their own EHR across the entire revenue cycle – front end, middle, back end.

The closer a function sits to clinical documentation, the more the EHR has swallowed it up. Patient scheduling sits close to the chart note, so Epic's Cadence dominates the hospital scheduling. Eligibility verification has to talk to hundreds of payer systems in real time. No single EHR can do that cleanly, so the market fragments. The further it drifts toward payers, employers, and administrative complexity, the more the market has fragmented into specialized vendors fighting for a slice (will include market sizing data soon).

This is one of the things I find most interesting about the revenue cycle space. It's actually a dozen micro-markets layered on top of each other – each one determined by how far it sits from the chart note. Yet it also has high lateral dependency across front-end, middle, and back-end (aka impacts to one process affect upstream and downstream).