My wife is in 30s but has had a lot of women's health stuff going on the last decade. We stay completely within the same "healthcare network" of hospitals precisely because they actually use the same system and all doctors can access it (obviously we like the providers as well!) But even for basic procedures we could save a little on like lab work or imaging by going out of this network we've learned it doesn't really work as promised. It's still hard to get your records to stay together unless they're in the same company's database is what we've learned.

Yes. All the systems are set up this way.

The problem is: how do you allow departments to retain their fiefdoms in a world of centralised data? The answer is to spend a fortune on management consulting.

Or nationalize the documentation infrastructure. This is not a problem in the developed world. i give my doctor my tax ID and they can see my entire patient history, all of my medication, and relevant notes from other providers.

That won't happen in a federation like US or Canada, sadly. The states (provinces) would have to either agree on an infrastructure (hah!) or agree to give that power to the federal government (OMG lol).

I work in EHR as of this year. About a week into the new job, one of the older software engineers made a comment about how what we do should really just be a function of the federal government. I was like, "but wouldn't we be out of a job of they did?" And he said, "sure, but we'll probably be dead by the time they figure it out anyway".

If you're in the US, the federal government actually created one one of the most widely used EHRs and set of clinical applications in the world, called VistA. It was made for the VA but is used outside of it.

https://en.m.wikipedia.org/wiki/VistA

It's actually public domain and open-source. Unfortunately the VA is in an ongoing project to replace it with Cerner Millennium.

A project that's not going well. VA system might be MUMPS based, but it's very good, as you say.

The big issue from my EHR-adjacent vantage point is that all the money is in making giant, entrenched EHRs, whereas the future should be in lighter-weight services that conform to standards, and competition is between those services. That way you could gradually slice off VA functionality piece by piece, and have a successful, more efficient, gradual migration.

The UK has the NHS and does not have this in the slightest : - )

We do the same. My wife sees tons of suboptimal healthcare delivery due to lack of doctors having the necessary information. In our current area, it is easy to find doctors they use mychart and interface with local hospital, so if we were to end up in the hospital, our medical history is immediately available.