Certain vendors may find Stage 2 more of a challenge to manage. As Rob Tagalicod, director of the eHealth Standards and Services office at the Centers for Medicare & Medicaid Services said during a recent meeting of the Health IT Policy Committee, HITECH "has allowed 1,000 flowers to bloom."

But "the question remains," he added, "which of these blooms will be hardy enough to meet the challenges of summer," referring to Stages 2 and 3.

But some companies have aced the past decade, taking every advantage of the opportunities presented by meaningful use.

"You really can't say anything without saying something about Epic," says Moore. "They have done a very good job on capitalizing on this. Their technology is fairly dated. But they've really focused on things that tend to be pretty important in this market: issues around workflow, and trying to have systems that are somewhat consistent. A lot of vendors have paid less attention to that and have suffered as a result."

Cerner is another winner. "Ten years ago, they understood the perspective of the hospital but I think underestimated the complexity of the ambulatory environment," says Weiland. "And they figured that out. They also figured out the value of a single platform across inpatient, outpatient, clinical and billing. Over the past 10 years, Cerner has absolutely caught up with Epic."

And so we've gone from "a six-horse race 10 years ago" – Epic, Cerner, Eclipsys, GE, McKesson and Siemens – to what "has consolidated now to a two-horse race," says Wieland.

"I gotta throw Meditech in there, so call it a seven-horse race," he adds. "But in terms of competing for new marketshare today, I still think its a two-horse race."

There have been stumbles, too. "The first one that comes to mind is Allscripts," says Wieland.

The company's growth-by-acquisition strategy – most notably with its $1.3 billion merger with Eclipsys in 2010 – has not worked out as planned. "I don't think they truly appreciated the challenges of trying to make these systems interoperable," says Moore.

All in all, it's been an interesting 10 years – especially the past five.

"It’s fascinating to see what’s transpired, because I don’t think anyone would have expected how this turned out," says Kent Gale, founder of KLAS. "In 2004, I can’t imagine any executive of any of the major EHR companies saying, 'This is where it would be in 2013.'

"There's been billions of dollars poured into this industry the last 10 years. Huge amounts of money. Some of it’s gone to great success, and some of it has been wasted."

No question, though, we're in a better place than we were 10 years ago.

"In the aftermath of the stimulus, we are now seeing an acceleration in the innovation cycle here, because these companies can afford to invest their money in R&D," says Wieland. Specifically, he's referring to Epic and Cerner, who have become "the Coke and Pepsi of this market."

Not long ago, health IT was a fragmented space, with a miniscule penetration base. "Now what we have is a more concentrated marketshare, so these companies invest the appropriate amount of money in research and development to drive innovation," he says.

"This industry has based its innovation on what today is a five-year-old piece of government regulation," he says. "Meaningful use was written before the cloud and mobile were really invented. As this industry evolves, there's going to be more innovation over the next 10 years as there has been over the past 10 years."