Comment by leakycap

Spending money is what drives the economy. No diverse expensive healthcare software means thousands of employees don't get paid and don't spend earned money within the economy.

There are in fact multiple data exchange formats published by standards development organizations including HL7 (V2 Messaging, CDA, FHIR), DirectTrust, NCPDP, DICOM, and X12. Some such as HL7 and DirectTrust are very open, others may require a paid licensing agreement. Usage of some of those standards is mandated by CMS interoperability regulations and/or ASTP (ONC) Health IT Certification requirements.

Beyond the wire formats, in order to eliminate the need for paperwork provider organizations also have to participate in data exchange networks. These include TEFCA, Carequality, eHealth Exchange, and some smaller regional HIEs. It all works fairly well when used correctly but many provider organizations continue to waste administrative effort and abuse their patients by failing to take advantage of the available technology. Like in many cases the necessary functionality is already built in to their EHR/PMS software but they simply don't turn it on or train their users.

Wasn't that in fact apropriated, launched and funded in the US under the Obama administration?

https://xkcd.com/927

I'd love it if my government created a civil reserve for technology workers. Let me volunteer every weekend to help fix infrastructure so I don't have to give up my existing job.

Sadly, very sadly, I cannot imagine it. I have seen the inside of NHS IT.

In the US, the Veteran's Administration wrote their own EHR (Vista) which was released as public domain. They've been trying (and mostly failing) to migrate to a commercial EHR for the last seven or eight years.

I can't. There are engineers advocating for open source in the NHS but management is mostly non technical and will go for a big corporate product every time.

Typing in ALL CAPS does not make your argument stronger, this isn't Truth Social.

> hospitals use EHR to maximize billing

As a person who has worked extensively with hospitals and CHCs helping them integrate technology, this is false.

EHR is being used because it's required - both by payors and regulation/law. I can think of zero instances where an organization switched to EHR without being forced by a deadline from an outside source.

> Who do I sue, and who has insurance, if something goes wrong?

You sue the Red Hat-like support company with whom you ostensibly signed a contract.

If your question is who does the Red Hat-like support company sue if they want accountability for the code they are leveraging, I guess I don't understand the question or its relevance. E.g., with regard to proprietary code, who does Microsoft microsoft when Microsoft microsofts Microsoft? (Fun to write, but I don't think that sentence really makes sense.)

Do you think a small mom-and-pop dentist can win a lawsuit against Google?

There's absolutely no way that dentist will have a well-negotiated contract with SLA's and damage compensation with Google. The extent of their business relationship is that the dentist clicked a checkbox and put in their credit card details. Google does not even know they exist.

If Gmail loses all your email and accidentally kills your entire business, the absolute best outcome is a refund of your $10/month business subscription fee. The idea that they could in any way be held responsible is ludicrous.

> The problem open-source [...] has never overcome is accountability.

There are lots of organizations that provide a throat-to-choke-as-a-service, e.g. Red Hat.

> just pay Gmail, don’t spend the required amount of time to self host

Are you seriously suggesting a business put their contacts in the hands of Google, who has reportedly been totally capricious with account actions in the past and is notoriously difficult to contact when problems arise?

> and open-source is stuck at being hobbyists if there is no corporate sponsorship

Corpo sponsorship required for success? I guess I better tell all the open-source projects being used by millions that they're just hobbyists now.

> The problem [...] everything digital [...] Who do I sue, and who has insurance, if something goes wrong?

I have heard of analog world nostalgia, but you refer to the pre-digital age as if you didn't live through it. It's easier to locate someone today than ever before.

I'd say if you take software that doesn't cost you anything, either

(1) you carry the risk or

(2) find someone that operates the software for you (on premise or SaaS) and they may also carry the risk for the premium you pay them.

This isn't a problem with open source. For many of us with startups that have low stakes (worst we can do is have no users) a lack of support is fine, we can do it ourselves and save the money.

And there's plenty of consultancies which will support OSS and give you support if you need it and be your scapegoat. Red Hat, Suse, IBM come to mind and there's many others...

You're being downvoted but yes, this is about risk mitigation. The IT department at a health care organization has to balance matching the requirements of payers, admins and clinical staff, do so in a way that fits inside the allocated budget, and de-risk the unknowns as much as possible.

Even if the vendors are only half accurate about the solution they offer, by being paid suppliers, they are on the hook (to varying degrees). These systems are highly customized and serious headaches arise from interoperability and security. If some of that can be shifted to a vendor, it's a net positive insofar as the IT department and the compliance departments are concerned.

Some healthcare organization have invested in the technology side and become leaders in innovation but those are the exception.

The person implementing the system for the hospital is accountable. I don’t see why this is difficult because it would be the same if that person built their own product from scratch.

There’s no vendor here that they can sue if they were paying for a product and deploying that, but that’s a different situation and the hospital, frankly, won’t care about that. Who their supplier subsequently sues isn’t their problem.

You sue the developers. It’s how it works in general. So basically you’d comb the commit history for the project and name everyone in the lawsuit that you could.