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Comment by righthand | Hacker News Reader

Medical information system vendors only care about making a profit, not implementing actual solutions. The discrepancies between systems can lead to bad information which can cost people their life.

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As an analogy, imagine if the consequence of Oracle doing Oracle-as-usual things was worse medical outcomes. But they did them anyway for profit.

That's basically medical information system vendors.

The fact that the US hasn't pushed open source EMRs through CMS is insane. It's literally the perfect problem for an open solution.

It's worse than that. VistA is a world-class open source EMR that the VA has been trying to kill for decades.

VistA was useful in it's time but it's hardly world class anymore. There were fundamental problems with the platform stack and data model which made it effectively impossible to keep moving forward.

Since Oracle bought Cerner a few years ago, no imagination needed. Sadly, since Cerner has lots of good people who want to make good products.

It wouldn't be appropriate for the federal government to push any particular product. They have certified open source EHRs. It's not at all clear that increased adoption of those would improve patient outcomes.

https://chpl.healthit.gov/#/search

I love open source EMRs, but has any major country adopted open source EMRs?

I know OpenMRS exists but is mainly used within developing nations.

The US has Vista, made by VA, and it is a beast and no one really wants to use it.

If I understand correctly, Estonia made their own EMR/EHR from scratch. The government produced (and commissioned?) software is all open source. https://koodivaramu.eesti.ee/explore

EMR software seems like something that shouldn't be that hard. It's fundamentally a CRUD. Sure, there's a lot of legacy to interface with, but medical software seems like a deeply dysfunctional and probably corrupt industry.

It’s a famous “should be easy” use case. I think this is wrong only because no one does it.

I'm sure there's a lot of work, but hundreds of millions per deployment is not justifiable. The Finnish EPIC deployment has cost almost a billion euros.

Estonia's from-scratch system was reportedly about 10 million euros.

>The fact that the US hasn't pushed open source EMRs through CMS is insane. It's literally the perfect problem for an open solution.

It's not insane, it's because the US is an oligarchy. And it's about to go even more oligarchy on steroids in the next year.

What explains most other democracies not doing it?

Is Sweden an oligarchy, too? Or France? Etc etc

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