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Comment by Phaedor | Hacker News Reader

Norway has recently changed our health software to Epic and it has been a huge failure. Pretty much everyone using it seem to be very unhappy. One of the many complains is that it just doesn't fit the Norwegian system since we have free healthcare while Epic is based on the American insurance system. Interesting to hear that it doesn't work well in the US either.

A couple of sources, can be viewed with google translate: https://www.cw.no/debatt-helse-it-bransjen/helseplattformen-... https://tidsskriftet.no/2023/01/helseplattformen-en-it-skand...

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> Norway has recently changed our health software to Epic

Why? I'm assuming corruption and lobbying by Epic.

There were huge epic deployments in Denmark and Finland before this. And Oracle/Cerner going on in Sweden.

All of these entities had working EHR systems.

So why change?

There’s one major feature request that triggered the change: being able to see patient journal notes made by other branches of the public health service.

Norway has a "tender" system (not sure if that is the right word) where the public entity create a list of requirements and firms bid on getting the contract. Doing some research it seems that there were few bidders and in the end only Epic:

https://www.dagensmedisin.no/helse-midt-norge-rhf-helseokono...

To me this system just seems destined to fail because there is no chance the public entity is able to write comprehensive requirements. Creating the bid is also a huge undertaking, and large suppliers and consulting companies will have a large edge by having experience with creating such systems and with creating bids, so they usually win. I dont know how to solve this though.

How about if public software had an atomic structure, and required open source, with copyright owned by the public entity? Having smaller suppliers make changes to one area would then be possible, there would be a little less lock-in, perhaps?

This is exactly how government consulting in the US works, often with a US gov employee writing the requirements with a specific vendor in mind. Oh, that's illegal as hell, but how else does Deloitte stay in business?

Mandated to choose them due to cargo cult process.

They were the only vendor capable of submitting the «objective» tender that is madated by law, and the decisionmakers are too stupid and chickenshit to consider that this process is in itself guaranteed to produce a worse outcome than alternative approaches.

I’ve lived through 2 hospital transitions to Epic. Everyone hates it for the first two years and then when they learn it they generally love the benefits it provides (much faster chart review, documentation and billing).

As a physician, using Epic is a pre-requisite for me to consider working at a hospital.

Yes it has flaws (ordering and encounters are still very annoying but make sense for billing purposes), but it’s also incredibly powerful and once you learn how to use it there isn’t really a better alternative (in my opinion).

Not all Norway btw, just central.

The funny thing is they started this project even though there were earlier catastrophic Epic implementation examples from Denmark and Finland.

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