[angersock]

> The crux you may not realize is how customized every major hospital system expects their EHR software to be.

The crux that you may not realize is that this customization was done mostly to boost profits and promote vendor lock-in. This was aided by the .gov failing to make public and standardized requirements for things like medical records (and no, referring to an AAMI or whatever doc that costs serious coin to view doesn't count!).

> . There was no "one-size-fits-all" solution unless your solution includes "Destroy the entire industry, and use force of government to destroy a half dozen major software companies in favor of the government mandated and almost assuredly inferior option"

BULLSHIT. Epic is built on MUMPS, arguably one of the worst languages ever designed. Hyperspace is garbage. Their systems are garbage. They get by because they've attached like gigantic leeches to hospitals. Cerner, Allscripts, and others aren't much better.

> Many hospitals used paper-only system with very little software even into the 2000's and 2010's.

Feature not bug--notice how much more physicians and nurses seemed to like those systems.

~

Look, your entire industry is fucking cancer and the sooner the .gov decides to use truly open standards the sooner some hungry companies can clean out all the garbage you and others have managed to clog institutions with. You should be ashamed.

[FLUX-YOU]

>Cerner, Allscripts, and others aren't much better.

Allscripts is a dumpster fire. I'm quitting my job that deals with them in the next 6 months and traveling.

Most of the EMRs established lock-ins when interface design was still pretty primitive compared to today: before WPF, C#, decent browsers, and javascript libraries. This sucks because we have to deal with extremely verbose code in laying things out. Meanwhile, modern web and desktop design has skyrocketed ahead of these old beasts, so they look extremely dated when we'll soon have a new generation of med students walking in who have grown up with mobile phones, tablets, Chrome, FireFox, IE11, and Win 7 and their beautiful interfaces and design by comparison.

[nradov]

That's simply false. Hospitals and other large provider organizations often do insist on extensive customization and non-standard configuration during EHR implementations. I've seen it happen. They'll spend weeks going around in circles about ridiculous issues like the placement of a logo and the format of a lab result document. You really can't blame the vendors for that.

[Spooky23]

All enterprise customers are stupid about COTS customization.

That doesn't change the fact that the software surrounding the entire medical industry is largely ridiculous legacy crap maintained by a little cartel of fat & lazy vendors with a captive market.

With good reason btw... these systems were the earliest big data processing shops. Blue Cross and Medicare was doing centralized billing for healthcare since before fax machines were popular.

[nradov]

Labeling something as "legacy" is a lame basis for criticism. Customers don't care about the age of a product's code base. What matters is price, functionality, and support. If you want a non-legacy EMR just for the sake of novelty then there are plenty of options available. But they aren't necessarily any better.

[Spooky23]

Legacy isn't a dirty word.

But the fact is that these ancient systems are nightmarish to work with, and because they are so ancient, they predate many of the standards and capabilities that modern systems have.

I spent a decade working around a big legacy system originally built on a Sperry mainframe in the mid 70s. The system was awesome in some ways -- amazingly performant, efficient and well tuned. But the reason it was so awesome was it's downside as well... it is almost static, changes are difficult/impossible to make. In the EMR space, things have to change, but because it uses an ancient/domain specific set of artifacts, you're stuck with a small number of incumbent vendors with whatever functionality they are willing to do.

[angersock]

> You really can't blame the vendors for that.

To quote the great Henry Ford: "Any customer can have a car painted any color that he wants so long as it is black."

They've empowered the clients to keep doing stupid things because it's good for business.