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I've worked in the space for a few years and I'd discourage anyone from trying to build a career as a software dev in the Healthcare IT / EMR space. It's extrem

• erichurkman 6y ago
  You're thinking of https://www.drchrono.com/ https://www.drchrono.com/
  • xattt 6y ago
    All these hip, cool EMRs always show a glamour of a patient. I have yet to see a medical practice or health care facility that has a photo studio as a side business!
    • mhink 6y ago
      Maybe not a side business, but it's not as ridiculous as it sounds! A friend of mine was an in-house photographer and graphic designer (I think he had some sort of managerial role, too) for the local hospital network until he got laid off when COVID hit. Basically, in addition to being a good photographer, he had to be aware of the various patient-privacy regulations involved and also have a practical working knowledge of the hospital so he and his team wouldn't be getting in the way.
    • topkai22 6y ago
      I think most US hospitals have offer in house newborn photos. I know ours did :)
• BadInformatics 6y ago
  Not all healthcare systems are beholden to private insurance (my own country's included) and that shows in where these systems are deployed. Also, compliance doesn't fully explain why competitors are able to convince clinicians to switch systems. Word-of-mouth means that people will know your EMR is a flaming piece of garbage, but (as you noted) companies would much rather cut up-front prices so they can milk an extended contract than improving product quality. All that said, I think there's a bit of a chicken-and-egg thing going on here. Good people don't join the space because the culture sucks and the pay is bad, but those are because those with the talent and drive all self-selected out of it. I get it, health IT is a huge drag and not at all sexy. But just look at how often folks on HN ask about "doing social good" and how many complaints there are about healthcare delivery. Trying to run a "disruptive" VC-backed startup is IMO pretty crazy, but contributing to an OSS project is far less risky and more achievable.
  • yellowapple 6y ago
    > Word-of-mouth means that people will know your EMR is a flaming piece of garbage The problem is that the Venn diagram between the people who actually have to use or administer the EMR and the people who decide which EMR to implement is basically two entirely-disconnected circles.
    • BadInformatics 6y ago
      That's often but not always true. With the caveat that is in a non-US country, hospital EHR purchases are usually done the way you describe, while doctors will often personally make EMR purchasing decisions for their own office or private practice. Government procurement and small business sales seem to be two very different beasts in this regard.
      • yellowapple 6y ago
        Yeah, my experience with healthcare IT was in a two-hospital rural provider in the US, so that definitely colors my observations there. That said, I don't really recall the doctors themselves using an EMR much, either; they'd usually punt that to assistants and/or nurses. Probably different in smaller practices/clinics.
• floatrock 6y ago
  > It's extremely sales driven... and the systems you write are mostly for the benefit of insurance companies / compliance than doctors or patients. This. Once I worked making healthcare software that would basically save costs by avoiding complications. We were bidding into a large hospital network. After the long sales cycle, we checked the most boxes, clinicians liked the feel of ours the best, they said ours was the most intuitive, helped them do their job the fastest, etc. The clinicians weren't the ones writing the check though. Our competitor approached the main insurance provider in the area and convinced them they could save x% in additional claims if the hospital network would adopt their software. Competitor's deal was to split the bill between the insurance company and the hospital network. To the admins writing the checks, they had the choice between two vendors that more or less did the same thing but one came in at half the cost. Clinicians' preferences didn't matter, it was a no brainer for them. No amount of software engineering would have saved that deal.
  • duffpkg 6y ago
    I have seen in healthcare more "bribery" than in any other industry I've ever worked. Whether quasi-legal in the shape of various kickbacks to outright illegal gifts of cash and goods. It is sadly endemic to the industry. In part I think it happens more commonly because there is so much "other peoples money" in healthcare. Everyone is spending from someone elses checkbook and so transactions seem very distant.
    • oogetyboogety 6y ago
      Accountable care models are the next step now that HMOs are widespread. restoring financial burden to the patient seems backwards when considering systems like universal healthcare, but ends up reducing inefficiency (identifying genuine surplus, not things that end up costing in the end like reducing preventative care)
• hanklazard 6y ago
  That's depressing. I feel like the regulatory side needs to be changed so that options like OpenEMR can become viable.