How about fixing the format? Something that is obviously broken and resulting in patient deaths should really be considered a top priority. It's either malice or masskve incompetence. If these protocols were open there would definitely be volunteers willing to help fix it.

Incompetence at this level is intentional, it means someone doesn't think they'll see RoI from investing resources into improving it. Calling it malice is appropriate I feel.

If there is no ROI, investing further resources would be charity work. I don’t think it’s accurate to call a company not doing so malicious.

Not actively malicious perhaps, but prioritising profits over lives is evil. Either you take care to make sure the systems you sell lead to the best possible outcomes, or you get out of the sector.

The company not existing at all might be worse though? I think it’s too easy to make blanket judgments like that from the outside, and it would be the job of regulation to counteract adverse incentives in the field.

Agree that most companies prioritize profits over lives in an unconscionable manner, but there's a point of diminishing returns where eventually you can save a few more lives, but at an astronomical cost. Auto manufacturers have the same dilemma: spend a few hundred million dollars adding safety features, or nix the features and hope to lose less than that in lawsuits?

Eventually the question will be, how far do we really need to go, i.e. how much profit do we allow ourselves before it's morally untenable and we should plow it back into R&D? Unfortunately, as long as health care is for-profit, and absent effective regulation, companies will always err on the side of profit.

You seem to think that the default assumption is that fixing the format is easy/feasible, and I don't see why. Do you have domain knowledge pointing that way?

It's a truism in machine learning that curating and massaging your dataset is the most labor-intensive and error-prone part of any project. I don't why that would stop being true in healthcare just because lives are on the line.

I think there are more options than malice or incompetence. My theory is difficulty.

There’s multiple countries with socialized medicine and no profit motive and it’s still not solved.

I think it’s just really complex with high negative consequences from a mistake. It takes lots of investment with good coordination to solve and there’s an “easy workaround” with pdfs that distributes liability to practitioners.

Healthcare suffers from strict regulatory requirements, underinvestment in organic IT capabilities, and huge integration challenges (system-to-system).

Layering any sort of data standard into that environment (and evolving it in a timely manner!) is nigh impossible without an external impetus forcing action (read: government payer mandate).

You're making a lot of unsupported assumptions. There's no reliable evidence that this is causing patient deaths, or that a different format would reduce the death rate.