Payment reform & ACOs. As the song goes, "Your lovin' gives me such a thrill/ But your lovin' don't pay my bills." (If the Beatles covered it, it can't be wrong, right?) In more businesslike terms, however, "Now that Obamacare is going to be around, there's a lot of movement in this space now," says Khan. What many people don't realize, he says, is that when one organization decides to become an accountable care organization (ACO), all of the other organizations around it are affected by that and have to change their own business models to respond. He says that there are "about 300 ACOs in various stages of organization, and as far as we can tell there are 400 in the pipleline for 2013." Khan says these "ripple effects" are forcing other organizations to jump in to the fray, even if it's not on the top of their to-do list for 2013.

Meaningful use. "Stage 1 was not all that ... robust isn't the right word, but it certainly didn't demand much from the end user," says Khan. "Stage 2 is starting to tighten the screw a little." With organizations sweating over the second stage of meaningful use implementations, can we expect a maelstrom of grief when Stage Three drops? One change that the marketplace will see some turmoil, possibly squeezing out some of the smaller players. "It will be much tougher for smaller EHRs to deploy this technology," says Khan. "It's definitely getting much more stringent and much more complex." He notes as well that the market is pretty well saturated, and that as new regulations are imposed and developments are adopted, it is "only a matter of when" many smaller EHRs lose out. Khan notes that there are 700 unique EHRs today, "and the industry can't support that."

Pennic agrees, adding that, "Providers are going to have to spend more money, which is a bad thing because they're tapped out." He also predicts that a focus on better design in EHR software will be a trend in 2013.