Review of Industrial Organization

, Volume 53, Issue 1, pp 57–79 | Cite as

Does Competition Lead to Agglomeration or Dispersion in EMR Vendor Decisions?

  • Seth Freedman
  • Haizhen Lin
  • Jeffrey Prince


We examine hospital Electronic Medical Record (EMR) vendor adoption patterns and how they relate to hospital market structure. As in many network technology adoption decisions, hospitals face countervailing incentives to coordinate or differentiate in their choice of vendors. We find evidence of substantial agglomeration on EMR vendors, which increases as hospital markets become more competitive. These findings suggest that incentives to coordinate dominate incentives to differentiate overall, and the relative balance grows stronger in favor of coordination as markets become more competitive. Our findings also have important implications regarding antitrust policy. A potential downside of hospital consolidation—increased obstacles in information sharing due to vendor differentiation—should be taken into account in evaluation of hospital mergers.


Competition Health information technology Network industries 

JEL Classification

I12 O33 



This work was supported by a NET Institute ( research grant. We thank seminar participants at the School of Public and Environmental Affairs and the Department of Business Economics and Public Policy at Indiana University for helpful comments. We also acknowledge the Health Information Management Systems Society (HIMSS) for providing access and assistance to their data and Jean Roth for assistance with the AHA data. We are responsible for all remaining errors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Public and Environmental AffairsIndiana UniversityBloomingtonUSA
  2. 2.Kelley School of BusinessIndiana UniversityBloomingtonUSA

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