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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 d

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.

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.