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Is this something where a public competitor might help? It surely can't be worse than private industry.
by FwarkALark 3y ago
Is this something where a public competitor might help? It surely can't be worse than private industry.
- YetAnotherNick 3y agoIs there any industry in which public competitor is better than private one?
- FwarkALark 3y agoI mean, all industries? The profit margin guarantees this. Anyone who has worked in private industry will verify its utter incompetence in the long term.
- YetAnotherNick 3y agoCan we talk about particular examples? I know for a fact that in my area private train ticket booking app is vastly better than government one. So at least there is an exception.
- gdfgfdjfd 3y ago[flagged]
- JusticeJuice 3y agoThis the most dramatic HN comment I've ever read I've been laughing for like 10 mins straight hahaha.
- timekiller 3y agoOh it could be much worse. You should see how bad government run HIE’s are.
- happytiger 3y agoTo back you up. They are profoundly worse. It’s an area where private dominates entirely, as the government HIEs are almost unusable.
- FwarkALark 3y agoAgain, I don't see how a private industry per se could even possibly be worse given the demand for a profit margin. Your beef is with some other aspect of this process.
- pas 3y agothe same higher-level forces shape the public project's fate into certain doom that led to hospitals buying the absolutely shittiest tech. because there's no clear signal (in the private sector there's some drive for sales, market share, profit), only made-up hyperpoliticized bullshit requirements and maybe some barely coherent vision. as long as there's not a clear technocratic organization with sufficient independence and competence these projects are rudderless yellow duckies on the sea of tragisocial medicine mismanagement madness. no party involved really has enough resources to deliver something nice. it's like high speed rail in the UK or the US. as a public project it's already stillborn, because it's too expensive to do it right (or if it would get the right amount of funding it immediately attracts unlimited scope creep, and the usual vultures show up, it becomes a typical everything bagel project, solve EMR but also education and childcare and whatnot), and to do it efficiently it would require draconian standardization and heroic amount of data migration work. and on top it gets over promised and under staffed and so on
- nradov 3y agoThere is (or was) a public competitor. VistA was largely developed by the federal government. Some organizations still use it and it's available for free, but independent reviews have generally rated it as worse than the private industry products. https://worldvista.org/AboutVistA https://worldvista.org/AboutVistA
- tpmoney 3y agoInterestingly the linked article seems to be singing praises of VistA, though it's unclear whether the author has actually used the system themselves. They link to an unsourced article with that claims it tops reviews, but clicking through to the various related articles seems to have a consistent theme of people not liking VistA all that much.
- mr_toad 3y agoI have to wonder how independent those reviews are when medical staff consistently rate it higher than commercial products, the system has won multiple awards, and when the VA tried to implement a commercial replacement it failed. Vista is public domain, so there’s no money in it and no-one to take management out for expensive lunches.
- FirebornX 3y agoPeople generally like VistA a lot more than what the DoD has been pushing the VA to replace it with: EHRM. https://www.gao.gov/products/gao-23-106685 https://www.gao.gov/products/gao-23-106685 https://www.moaa.org/content/publications-and-media/news-articles/2021-news-articles/advocacy/whats-next-for-vas-troubled-electronic-health-records-program/ https://www.moaa.org/content/publications-and-media/news-art...
- phonon 3y agoVA is moving to Oracle Cerner. https://fedscoop.com/va-still-has-significant-concerns-as-oracle-works-to-get-ehr-modernization-back-on-track/ https://fedscoop.com/va-still-has-significant-concerns-as-or...
- JusticeJuice 3y agoThe UK government tried this, wasted 12.4 billion pounds over 10 years, and ultimately wrote most the project off. The dream of an EHR is just deceptively tricky, so many smart, well-funded, well-connected teams have tried and failed. ref: https://barnett.surge.sh/welcome/intro.html https://barnett.surge.sh/welcome/intro.html
- deleted 3y ago[deleted]
- dieortin 3y agoIf I’m not mistaken, the Spanish healthcare system has a fully electronic medical record.
- dgellow 3y agoGermany too
- Naijoko 3y agohahahahahahahahahahahahahahahaha This is a joke. We want to have this but its like everything in germany if its about something digital. Its a fucking mess. Everyone can read it. Most doctors dont use it and even many insurance dont use it... its a fucking mess
- 3y ago
- thaumasiotes 3y agoPrivate industry is already worse than the older system of keeping notes with pen and paper. (Source: my mother operated her own medical practice and applied for a government subsidy to switch over to electronic medical records, then complained about how it reduced the functioning of her practice.)
- redsoundbanner 3y agoWhy was the government subsidizing that?
- thaumasiotes 3y agoThey decided that medical records should be electronic rather than paper. Why do they do the other things they do?
- cfu28 3y agoProbably as part of the meaningful use policy in the US. Early adaptors were initially incentivized to move to EMRs off paper charts. Today the incentive no longer exists. Instead theres a penalty in the form of reduced Medicare/medicaid reimbursement for practices that don’t comply.
- redsoundbanner 3y agoGreat answer. Thanks for not just downvoting me.
- thaumasiotes 3y agoIn what sense is that an answer to "why were they doing that?" The entirety of the answer does nothing but give a name to the policy. "Why" would usually be understood as a question about the reasons behind the policy. "The government was subsidizing the abandonment of paper medical records because they had a program in place to do that" is something you knew before you asked the question.
- 3y ago
- boxed 3y agoIn Swedens capital region they failed with this too. It's dominated by a system that is largely quite well polished but has some scaling issues that has lead to down times. The region decided to develop their own in cooperation with other regions, but instead of just hiring two-three developers and putting them in a room inside some small hospital, they decided to make a Grand Political Project out of it. Billions of Swedish crowns later, having written ZERO lines of code, they quietly cancelled the entire thing. This enormous boondoggle didn't even make the news because the waste was all man-hours and consultancy, and not a building or something the media found sexy. I think a big problem is that politicians need Grand Political Projects to get reelected, but that's not how you build software. Or make meaningful small incremental improvements to science, infrastructure, schools, etc. The incentives are wrong...
- kakoni 3y agoInteresting, what was this project called?
- atlasunshrugged 3y agoI believe the Estonian government has long had at least a basic EHR that they use across their public and private medical facilities that is part of their larger e-government system https://e-estonia.com/solutions/healthcare/e-health-records/ https://e-estonia.com/solutions/healthcare/e-health-records/