Health Care has few standard processes among the buying institutions and even fewer between physicians who rely on personal knowledge, experience and, in some cases, intuition to determine what to do and how to do it. I don't want to over dramatize this point, but I do need to point out that any vendor who produces Health Care Industry software invests a disproportionate amount, when compared to other industry software, to support process variability that applies to this industry only. Clinical Health Care Data is extremely complex and heavily codified. These are significant technical challenges for anyone trying to build a database to hold clinical information. There is clear overlap in some of these items.
Technology is complex and changes rapidly.
The HIS vendors require a significant amount of time to design and implement solutions for processes as complex as the medical record. In short, the technology industry is based on relatively simple consumer applications. The HIS vendor community has not been able to capitalize on these changes and get them to market before the next wave of changes hits. There is insufficient evidence that some of these technologies can support the scale of application deployment that a ubiquitous medical record will require. In fact, one can arguably state that the largest single commercially available electronic medical records system is only supporting about 4,000 devices at one of Kaiser Permanente's smaller regional groups.