Re:Ask HN: How did you decide what problems to solve in your...
by wolco on Monday January 07, 2019 @12:45AM
(#18843061)
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)
Re:Ask HN: How did you decide what problems to solve in your...
by quanticle on Monday January 07, 2019 @03:37PM
(#18849763)
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.
Re:Ask HN: How did you decide what problems to solve in your...
by PeterisP on Monday January 14, 2019 @12:00PM
(#18904418)
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.
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.