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Comment by megiddo | Hacker News Reader

DICOM exists for two reasons:

One - As an industry, healthcare tends to employee and retain the bottom quintile of software talent. It's like the "bell curve" of development. For every unicorn out there hiring the best of the best, there's yet another healthcare IT firm making sure the other side of the curve has good insurance, neckties, a 9-5 and a $39,000/year salary.

Two - Because the healthcare industry never met a technical challenge it couldn't solve poorly and support in perpetuity through federal regulations.

DICOM is dumb. This is a commercial piece to push whatever the hell innolitics sells. Innolitics has a business model because federal bureaucracies guarantee it.

Whatever.

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Co-founder of Innolitics chiming in here

While this is undoubtedly one take on the subject, allow me to give you another perspective:

One of my friends had an MRI taken for suspected nasopharyngeal cancer. The physician that read the scan did not find cancer. Thankfully, his ENT physician did not believe the diagnosis and took another look at his MRI, which happened to be in DICOM format. He was able to load the images on a DICOM compliant image viewer and saw the tumor right away. My friend underwent surgery and was confirmed to have cancer by microscopy.

I think DICOM saved his life. It allowed his ENT physician to take another look, which would have probably been significantly harder with a proprietary file format.

Yujan Shrestha, MD

If any of this were true you'd have tech giants, with their armies of "top" developers and massive legal teams disrupting the status quo but instead they announce a foray into healthcare, with much fanfare, only to scrap the project or have it fade into obscurity a few years later.

Turns out healthcare is hard, both the practice itself and the industrial/government bureaucracy. Probably why the better EHR shops pay just as well as top tech companies.

Having worked on a MVP for a healthcare company in Europe I can tell you that the users are not looking for better solutions. The doctors I worked with wanted a better pencil not some fancy solution. In our case it was improved traceability of medical implants and one doctor, when asked in private, told me that the current status quo suites them fine as it allows for more creative answers when the sh*t hits the fan. After that meeting I decided that the healthcare business was not the most healthy to work with.

Agreed, but this is slowly changing. Of the doctors/nurses I've worked with (hundreds at this point), I'd say only half of them know how to type. The younger docs though, they can be real power users. Europe is notable in how low tech they can be, which is why they've been the biggest new market in recent years for a lot of health IT companies. The idea of a hospital system doing all of their charting on paper is unheard of in the US, but there's still plenty of places doing that in Europe.

Healthcare in Europe is weird you end up with a lot of parallel systems, all healthcare data in Europe have to be digitized and there is a standard for digital EU healthcare records including mandated interoperability between all providers in various member states.

Even within the same healthcare system you can have drastic differences and a layer that sorts (or tries too) the entire mess out.

Oh, man. Who lied to you about healthcare compensation?

Just go check glassdoor.

Major IT companies bail on healthcare because margins suck and it's enormously regulated.

I give you, for instance, DICOM, Hl7, Meaningful Use, Infobutton, or any of the other half-useless dead-letter, best of the 80s-era mainframe technologies that are required to meet healthcare regulatory burden.

The best thing that's come out lately if FHIR, which is 9 years old and still doesn't qualify an EHR for meaningful use. Instead, it's all pipe-delimited TCP/MLLP and WTF.

I work in health IT and I've turned down offers from two big-n companies because they couldn't match my current compensation. I'm sure there's some no-name health system in the middle of nowhere paying $40k/year for dev work the same I'm sure there's some android fart app paying some developer peanuts as well. Be fair and compare the exceptions to the exceptions.

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