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Comment by fnid2 | Hacker News Reader

The problem the startup will face is finding programmers who would put up with all the irrationality in the medical field. The reason the software is so bad is because the field is dominated by business types who can push papers through until their software is approved or bought, but can't find good programmers to make good software.

There are a lot of legal issues too, so the risk can actually take you negative very easily -- like jail time or fines, so it's a different equation for investors, entrepreneurs and programmers.

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That "irrationality" is fundamental to many types of enterprise software, which is a big reason why most of it sucks. You're codifying hundreds of years of established precedent, often heavily legally regulated in slightly different ways by all 50 states (not to mention foreign countries). The more established precedent there is, the more history in the industry, and the more regulation, the harder it is to write decent software.

That is more true for EHR than for a lot of the more specialized systems in radiology, pharmacy, lab, etc. For those, it's much more clearly a CS problem, with a UI component, and then some interaction with existing crappy systems (mainly the EHR).

The EHR itself is the black hole of suck. It almost always ends up being like an ERP package, with either an off the shelf package (e.g. SAP) where the workflow is changed to accomodate the package, or a semi-custom consulting product built around specific workflow.

Luckily, the more specialized stuff is actually vastly simpler.

Sounds about right . . . any time you're solving a particular problem, things get a lot simpler. You need something to do x and y, so you make something do x and y, and it's pretty easy to tell whether what you've made sucks and x and y or not.

Once you have to handle anything workflow-ish or manage any sort of business process, or any time you have to handle integration to arbitrary external systems, it's very difficult to make anything that doesn't suck. The "right" thing becomes very fuzzy, and there's no one purpose or problem you can use as your rightness criterion, so it all becomes very fuzzy. Things then get worse when some standards committee tries to please everyone, or when business users insist that they want everything to work exactly the way it used to just, you know, with a computer know. And since there's no easy criterion against which to judge the solution, it's an easy slope down towards even more suck.

The technical issues are challenging, but the problem space is intrinsically motivating if you "believe in" the space. EHR is one of those rare opportunities where you can "do good" and be rewarded for it. Further, there is a HUGE amount of bizdev that goes into partner integrations, and you basically can't meet "meaningful use" (a requirement for ARRA money) going it alone. HIPAA compliance, security review, and on and on. Learning about the way healthcare really works in this country has been incredibly eye-opening.

Thankfully, I work with really smart people who are all motivated and our company has a few unique strategic advantages. If any great rubyists want to join a company that is iterating our test-driven way to launch, my contact info is in my profile.

Yeah, it is nice to be able to work on something where you can be at a party and someone mentions a motorcycle accident or something, and you can point out how the product you work on was involved in saving his life. More meaningful than yet another social network game.

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