There's also some structural reasons. Why is it that larger practices don't write their own software? Well, maybe a few do, but:
a) nearly all states require that ownership in medical practice be restricted to those licensed to practice. This reduces access to capital, and more or less ensures that practices remain small businesses.
b) nearly all care in the US is fragmented across specialists in different practices.
c) healthcare in the US is largely paid for by parties fairly disinterested in actually transacting. While most folks on HN might A/B test UI improvements looking at click through rates, the implicit idea in insurance billing software is that submitting claims is someone else's expense to deal with.
When you look at places where there is a scale to medical practice, opportunity for software opens up. VA and DoD both operate and staff their own health care facilities, and have software systems they've implemented. But even DoD has problems receiving and retaining records from outside care providers (if Wikipedia is to be believed).
If there were fewer, larger medical practices in the US, it would both be easier to agree on standardized data sharing protocols, and more likely for patients to see multiple doctors working for the same employer, thus never necessitating a data transfer. Admittedly, it'd be harder entrepreneurs like yourself to break in. Perhaps you'd be an employee or Engineering manager working on the problem instead. Or perhaps you'd be selling a plugin to a larger EMR.
In my observation, I've found that there are quite a few larger healthcare providers, and that even the "smaller" hospitals are pretty big in terms of IT needs.
In my hometown alone, there's Kaiser Permanente, Sutter Health, and UC Davis. Sure, none of them are quite nationwide, but they're by no means "small", either.
Part of the challenge is that hospitals represent only one portion of the care chain. My mom's GP, for instance, has never used a hospital as their office. There are dozens of hospitals within 30 minutes driving distance, of which few are owned by the same company / non-profit.
KP is in the vein of what I'm suggesting though, just wish it was more widely available.
a) nearly all states require that ownership in medical practice be restricted to those licensed to practice. This reduces access to capital, and more or less ensures that practices remain small businesses. b) nearly all care in the US is fragmented across specialists in different practices. c) healthcare in the US is largely paid for by parties fairly disinterested in actually transacting. While most folks on HN might A/B test UI improvements looking at click through rates, the implicit idea in insurance billing software is that submitting claims is someone else's expense to deal with.
When you look at places where there is a scale to medical practice, opportunity for software opens up. VA and DoD both operate and staff their own health care facilities, and have software systems they've implemented. But even DoD has problems receiving and retaining records from outside care providers (if Wikipedia is to be believed).
If there were fewer, larger medical practices in the US, it would both be easier to agree on standardized data sharing protocols, and more likely for patients to see multiple doctors working for the same employer, thus never necessitating a data transfer. Admittedly, it'd be harder entrepreneurs like yourself to break in. Perhaps you'd be an employee or Engineering manager working on the problem instead. Or perhaps you'd be selling a plugin to a larger EMR.