* Lack of standard, OPEN, free to implement formats; for everything.
* That are required as a native format for all vendors considered for selection.
* Ironically, HIPPA, which correctly makes collecting data a liability.
However this also makes releasing that data to patients difficult.
It makes patients authorizing the release to other entities even more difficult.
It contributes to making critical data during emergency situations difficult to locate.
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Some kind of standard civil contract singing PKI might be a technical solution, but
That's beyond the scope of healthcare solutions, it's a national ID / notary issue
* Lack of a central registry to at least annotate where patient records exist and can be located.
* A multitude of private healthcare cost management organizations (HMOs)**
* Artificially constrained supply in non-emergency contexts
* No shopping at all during emergency contexts (nor should there be)
(HMOs) which seem mostly to focus on for-profit results rather than actually improving quality of care, patient outcomes or actual medical costs; at least in most cases.
In fairness, even HN can't get people to stop using monospace for quoting or prose, so one can understand why it's hard to get providers to adhere to a consistent standard.
Indeed. I think I am going to start downvoting posts that quote by (or otherwise use) indention. It's unreadable on mobile. Why is this so hard to fix?
Mostly because HN has a custom markup solution and attempts to reformat single-line breaks, requiring the use of monospace for ANY level of control over formatting at all, and otherwise restricting everything to separated paragraphs that are difficult to read.
If I'm wrong and it allow either limited BBcode, white-listed HTML entities for markup, or some flavor of Markdown please let me know.
I would love to have ACTUAL bullet points and text that flow wraps per line, with any newline I enter becoming either a P block if it's a paragraph, or a <br> tag if it's not followed by a second newline.
I don't try to get real work done on mobile; it just isn't a good media for reading or composing anything complex, and a large threaded forum IS complex.
Mobile is good for getting and sending small updates, and consuming videos at lunch.
OP is talking about writing long-form comments on HN. I guess you could consider this "entertainment" too, but it doesn't change the fact that smartphones are bad for this task.
> Lack of standard, OPEN, free to implement formats; for everything.
I was surprised when I talked to a doctor family member awhile back and learned that this was not part of the ACA. A big sweeping re-write of the health care regulatory structure would have been a good time to require data interoperability.
Maybe the new plans both parties are supposedly interested in getting done this time around will include this. I won't hold my breath though.
A strong requirement for interoperability appears in the 21st Century Cures Act of 2016. The ONC is now in the process of writing regulations to implement that law.
HL7 has had open standards for moving data between systems for 30+ years. But actually building those interfaces takes a lot of work. Every EHR has its own propriety internal data model so there's always some data mapping and conversion needed.
Standards created before any software ecosystem exists to give feedback and evidence on what the standards should be, seldom turn out well.
If they had just created all of those standards and central systems _before_ rolling out EHR to everyone, I doubt it would have gone any better, honestly.
The articles does go into some of the social/political influences that led to a requirement or incentives for everyone to have EHS before anyone knew what it was going to look like, at a speed that prevented incremental piece-by-piece development of the ecosystem and adjustments to requirements, standards, and best practices based on what was found.
Without such an incremental process, I think it would be doomed no matter what.
