I used to work with a healthcare company and dealt the 837 file format and FTP batches and wrote a pretty neat-o parser for it, the reason is simple- inertia. And it's not like people aren't trying because there's been a huge push to get REST-like APIs in place, but when you have close to 40 years of software infrastructure in place it's non-trivial to explain to the boss why you need to spend money on something that gets everyone paid either way.

I think it would be truly revolutionary if we could change the format, but what I think would be almost a better step is to write open source parsers that can accurately translate X12 into something sane and keep the interchange the same so that everything can be balanced out like a checkbook. Check out the 835 format for this part as it's supposed to be a data stream of transactions. Too bad the dozens of flavors of X12 are locked behind licensing and thousands of dollars of books for the rules :/

Additional reading on this god-awful data format: https://docs.oracle.com/cd/E19398-01/820-1275/6ncv5s178/inde...

oh man I'm having flashbacks to one of my first jobs after school. I spent a year writing a parser for that abomination of a format. Before I left I'd build a front-end and processing queue that did X12 -> XML and several modules to output the same data in various formats and flavors to suit the taste of various insurance companies... Parsing X12 was definitely among the least enjoyable things I've ever had to do. At the time I did it for way too little pay.

Short answer: hospitals, insurance companies, governments

Long answer: It's not like people don't understand that the current situation is suboptimal. It's that any kind of change implemented unilaterally will leave you unable to communicate with your counterparties. The severe consequences of this (not getting paid, being out of compliance with HIPAA) means that any kind of change to health-care IT at a system-wide level requires an absolutely massive amount of politicking and often fails to improve the situation.

The problem is that health care institutions are so interlinked that driving any kind of global change is a process best measured in decades. Combine this with the fact that the culture in health care is very conservative, and people tend to be hostile towards change by default and you have a situation where it's often easier to leave the industry and save your sanity than to remain and continue bashing your head into a brick wall over and over again.

The more interconnected the greater the energy required to change from the groundup but trivial to change at the top (submit in this format or no payment)

Except that health care has no "top". If an insurance company tried to unilaterally impose a new standard, they'd quickly lose support among hospitals, and then they'd lose their subscribers shortly thereafter.

With a [mostly-]single-payer system (i.e. pretty much everywhere in the world except the US) there is a clearly defined "top" that can unilaterally require particular standards for e.g. electronic health records.

Also, for USA, legal requirements (such as HIPAA) are universal and can impose certain standards on the whole industry, as long as there's political will to do so.

> Solve the data format problem. Make it easier for everyone to exchange data in meaningful, efficient ways.

https://xkcd.com/927/

The whole field feels like such a mess to deal with what basically boils down to text/numerical data. You could probably spend the rest of your life just writing parsers to consolidate different data formats. I truly don't believe healthcare will be solved by technology until there is a single ubiquitous format. It's really a problem of policy, and I won't purport to know the answer or who should be solving the issue, but I don't think it's ever going to be solved by one person at a keyboard.

There are standards such as HL7/FHIR, but in my experience, most companies incorrectly or partially implement the spec, and then it might as well be something else.