Why is healthcare IT so often bad? And why does it take so many years for medical research to be implemented and reach patients? And most importantly: how are these two questions connected?
Just a stupid layman here wondering out loud why the platforms were not standardized from the beginning. Mostly rhetorical except for the Captain Obvious part.
That question isn't stupid in any way. Other types of IT solutions and segments have been standardized over time, so it's wise to wonder why that hasn't happened to EHRs. I believe there are several reasons.
First, coordination problems due to fragmented markets:
- EHR vendors have limited incentives to standardize. Providers in different countries often have different views on how an EHR should work. EHR vendors therefore most often focus on their home market and optimize after that, rather than a certain standard
- Health care systems have historically struggled to require EHRs to follow certain standards as
(a) there hasn't always been consensus about which standard to follow
(b) difficulties in demanding a standard which no vendor fulfills (as it takes a lot of work to reprogram a whole system to follow a certain standard)
Second, long sales cycles. This means it takes longer time for the whole industry to shift to a new paradigm (of EHRs designed for interoperability), as well as for buyers to coordinate the introduction of a new standard.
However, today there are leading standards (FHIR, SNOMED CT, HL7 etc), and in certain countries, an increasing number of EHRs adhere to such standards. So it's not entirely unsolveable, but it will most likely take a long time. And even when certain standards are introduced I fear the dynamics underlying ubiquitous bugs will persist
Thanks Jonathan. Your response might suggest there are separate challenges for addressing it on a global level compared to solving it separately in the USA. I have some experience in global consensus dynamics so I am guessing you agree, but I am open to learning. My objectivity is compromised here, because I am having a really rough conflict with Big Health in the USA at the moment. EHRs are central to the conflict so I am trying to figure out what is broken. Your writing is very helpful.
Just a stupid layman here wondering out loud why the platforms were not standardized from the beginning. Mostly rhetorical except for the Captain Obvious part.
That question isn't stupid in any way. Other types of IT solutions and segments have been standardized over time, so it's wise to wonder why that hasn't happened to EHRs. I believe there are several reasons.
First, coordination problems due to fragmented markets:
- EHR vendors have limited incentives to standardize. Providers in different countries often have different views on how an EHR should work. EHR vendors therefore most often focus on their home market and optimize after that, rather than a certain standard
- Health care systems have historically struggled to require EHRs to follow certain standards as
(a) there hasn't always been consensus about which standard to follow
(b) difficulties in demanding a standard which no vendor fulfills (as it takes a lot of work to reprogram a whole system to follow a certain standard)
Second, long sales cycles. This means it takes longer time for the whole industry to shift to a new paradigm (of EHRs designed for interoperability), as well as for buyers to coordinate the introduction of a new standard.
However, today there are leading standards (FHIR, SNOMED CT, HL7 etc), and in certain countries, an increasing number of EHRs adhere to such standards. So it's not entirely unsolveable, but it will most likely take a long time. And even when certain standards are introduced I fear the dynamics underlying ubiquitous bugs will persist
Thanks Jonathan. Your response might suggest there are separate challenges for addressing it on a global level compared to solving it separately in the USA. I have some experience in global consensus dynamics so I am guessing you agree, but I am open to learning. My objectivity is compromised here, because I am having a really rough conflict with Big Health in the USA at the moment. EHRs are central to the conflict so I am trying to figure out what is broken. Your writing is very helpful.