Hacking Healthcare

Chapter 2. An Anatomy of Medical Practice

“When you’ve seen one medical practice, you’ve seen one medical practice.”

We can’t think of an expression that better embodies the difficulties of understanding medical operations than the one heading this chapter. Regardless of how much a facility might think it embodies the “typical operations” and “common practices” respective to the lines of care it delivers and region in which it is located, our collective experience finds few if any typical operations and common practices exist. This diversity is frequently true of facilities even in the same buildings and campuses.

A quick look at the market share of various technological systems sheds light on the variety of software and hardware out there. The largest vendor in EHR systems holds only a self-reported 12% of the market by provider count and 16% by patient count. If you contrast that with operational software in every other major industry, healthcare is extremely fragmented with respect to IT. The authors aren’t aware of any research that fully explains the reasons for fragmentation, but market forces in healthcare are very different from those in other industries. It is possible to speculate that because institutions that might be forced to close in other industries are sustained by many different forces manipulating the market in healthcare, the longevity of intact facilities is much longer compared to an industry such as retail. That longevity is a barrier to change and leads to ...