[brap]

Every time I dip a little into healthcare tech I want to throw up. It's so bizarre, and even offensive, how convoluted and outdated these systems are. It's patches on top of patches on top of patches for decades. To the brave engineers working on maintaining these systems, I salute you.

Hospitals, banks, government... just think of the tech these heavily regulated industries could have had, and how it could have improved our experience, if they actually had a strong incentive to improve. And it goes far beyond the tech stack.

In the long term, regulation often kills competition, which inevitably kills innovation.

[adolph]

As someone working in this arena, I offer an alternative perspective for your consideration: healthcare was an early adopter of information technology and as a result many of its most core technologies come from a nearly unrecognizable time in computing. These systems are “outdated” as a result of success.

The current prevalence of these venerable technologies may be in part due to regulation, but more often has to do with their success.

HL7v2 is just token delimited ascii. Not unlike the similarly primitive but ubiquitous csv. The fields within it are defined by standards documents and once you use it a little, you can read enough to get the gist of most messages. As you might guess, modules in your language of choice are used to parse and compose HL7v2 so its detail isn’t that important.

[Edit: looks like the project has written Synthea out in favor of an integrated data generator]

Something I’d like to point out about Google Hospital is that under the hood it uses MITRE’s Synthea to generate synthetic patient data.

https://www.healthcareittoday.com/2017/09/13/open-source-too...

https://synthetichealth.github.io/synthea/

[dalbasal]

That's a thoughtful perspective.

It's also useful for expecting similar in future industries. Ultimately, I think it doesn't even matter if the reason is regulatory complexity, industry rigidity, or technical debt.

The question is how do we dig out of such holes.

If we were starting from scratch, it's almost certain we'd have better software, better firms, norms, standards and such within a short period of time.

How do we do that when not starting from scratch?

[dalbasal]

> In the long term, regulation often kills competition, which inevitably kills innovation.

So does non-regulation, often. A lot of this carp is "emergent" bureaucracy between insurers, other insurers, hospitals, etc. Regulation and monopolies often support eachother, merging into a nasty complex such as this... it's impossible to tell where one begins and the other ends.

I see financialization as a bigger factor currently than regulation. It's not a coincidence that "medical billing" is the epicentre.

I just don't buy the idea that less regulation means less mindless complexity.

The best if the early neoliberal/austrian economists was IMO Schumpater. Creative destruction. Complexes evolve into cludges over time.

Creative destruction is often presented as a feature of free markets... But that's theoretical. Irl, we see firms and complexes become effectively immortal... Immune to market forces and moated from competition. These tend to be the massively inefficient ones.

Regulated or not, insurance consortiums are much more like a government department than they are like a local restaurant. There are a lot more "private" regulators in the mix than public ones.