Introducing standards across many companies is incredibly difficult but your main problem is that a lot of healthcare IT systems are very old and not actively maintained, they're essentially on life support. So changing the format of a file, or requiring new import cleaning, is going to break integrations and data sharing in many places. Basically it'd create far more problems than it's attempting to solve.

That is understandable.

I guess it depends on which country and which specific part of healthcare you are active in. In the 'care' domain in the Netherlands I also see that some of our integrations are one-off, but the most important ones do have industry wide standardization that receives updates based on law.

Although make sure to not use that for the first column heading, an uppercase I will make excel think it's a SYLK file and then refuse to open it.

Good catch! The Wikipedia page confirms it.

Nothing in software development is as straightforward as we might hope.

https://en.wikipedia.org/wiki/Symbolic_Link_(SYLK)