[gmarx]

Except a huge reason they refuse to conform to standards is because you are asking them to do a lot of extra work for no extra pay. The EMR systems, by and large, are not good. The user interfaces do not make it easy to conform to standards. It is not reasonable to expect docs to do it under those circumstances.

[seanwoods]

When I say "they" I don't mean the doctors, I mean the hospital administration. They operate on a different set of incentives and motivating factors. The doctors are usually not involved in the process in a very substantive way. It's this fundamental disconnect, which is so common in enterprise software, that's brought us to where we are today.

I know people on HN have fire in their breast to change the world but the rock is harder to move then many think. I tried to do it for almost 5 years and didn't get very far.

[knightofmars]

You need to motivate them where it counts, the almighty $. I want to add I'm not saying this sarcastically at all. The motivation of hospital administration comes down to a bunch of numbers on paper. If you can _prove_ that they will have _significant_ gains by implementing one of these standards they will move. However, most of them have been around long enough to see the standards come and go and are aware that HL7v2 is still in use 99% of the time. To them it is truly a case of, "If it ain't broke, don't waste the money fixing it." My hope is that FHIR and its approach to solving the problem of a bloated unwieldy standard with extensions will gain ground. If hospital administrations can be convinced to implement a simpler and cheaper standard to start, which has the potential for extension in the long-term. It will go over far better than the current approach of, "We'll implement this new standard for you that will take nearly 2 years, cause budget overruns, and never really see adoption." (The only people that end up benefiting are the consultants implementing the spec.)

Additionally, there's still an emotional component of "You're not getting our data because we don't trust you know how to secure it properly." From the personal experience of having worked with the IT staff at various medical institutions there is often a level of paranoia around their data. Which, in some regards is fully justified given the regulations (HIPPA, HITECH, etc) they are required to meet. The issue is that it often moves beyond meeting the regulations into a place of attempting to exceed the regulations. Which, seems like a smart move until it is too late and you've only succeeded in adding extra bureaucracy into your internal processes. These added burdens are then foisted upon external parties who are attempting to integrate with the system and therefore, by the nature of the regulations, the processes which have been previously set forth by the implementing institution.

All of that said, I agree with your statement, "I know people on HN have fire in their breast to change the world but the rock is harder to move then many think.". However my take is that we are attempting to move the wrong rock. Healthcare institutions need to learn the correct way to introduce and enforce secure yet flexible processes and policies in regards to technology. After that occurs then the technology rock will be much easier to move.

I'm going to add that I've been a Medical Software Engineer for just shy of 10 years and it has been both an extremely frustrating and also extremely rewarding ride.