[jeremylee]

Both Epic and Cerner are making at least some strides toward opening up their platforms (Epic with App Orchard, and Cerner with Ignite, SMART on FHIR etc.) Athena has MDP ("More Disruption Please.") I get the feeling these organizations have at least come to the realization that they need to open up--granted their denial up to this point leaves them with a lot of catching up to do. But access to the data that exists in those systems is a pretty big carrot for integration partners to help push adoption.

[methehack]

Sorry, dude, but I think you fell for it. These entities try to make you think they're open, but really they are keeping entrants at bay.

Here's an interesting episode of the weeds podcast that gives some context by exploring why the fax machine is still so prevalent in US healthcare.

https://player.fm/series/voxs-the-weeds/fax-reform-bonus

[nradov]

You haven't addressed the point that jeremylee made about the SMART on FHIR platform now available in those EMRs. It's not a complete solution but it works today and people are building real applications on it. Take a look at the demos from the latest HL7 FHIR Applications Roundtable. https://www.hl7.org/events/fhirapps.cfm

[marktangotango]

But access to the data that exists in those systems is a pretty big carrot for integration partners to help push adoption.

The scary reality is, they don't even have access to the data in those systems. I had a friend contracted at cerner working on a FHIR api end point. Something as simple as answering the question "what medications have been administered to a patient" was extremely difficult to pull out of their system. One would think there'd be a simple report for that information, but they didn't have it. The domain/system knowledge wasn't there either. That one simple api endpoint drug on for months as new data was "found" in the 5000+ table schema. Oh, and they don't use foriegn key constraints in production either.

[NoNotTheDuo]

I can vouch for some of that as well, although I disagree with some of it. The domain/system knowledge is there, but there's likely a relatively small group of people that know all of the ins and outs. And the group that knows about inpatient medications likely isn't the the same that knows about outpatient medications. And maybe the ordering of meds is different from the administration of meds.

I think the point about FK constraints is perhaps a little too generalized. In a 5000+ table schema (which is entirely accurate!), I'm sure there are some tables which don't have FK constraints enabled. But I know for a fact that there are FK constraints on some of the tables (because I created them!)