To be fair to Epic engineers, I don't think many of them want the system to be that way either--they may not be super-experienced, but that shit's more a product of ossification from decades of refusing to change much of anything (the company seriously considered forking VB6 to avoid going to .NET).
Individuals don't have much power to change an organizational culture riddled with NIH syndrome (the goddamn ticketing system, timekeeping system, and at some point in the dark past, the email system used internally were ALL written on top of the core EMR codebase) and cargo cult development (the people that /do/ stick around have a healthy share of people that couldn't easily get hired elsewhere on their merits, but do thrive in an environment where accumulating and regurgitating questionable tribal knowledge is crucial).
The system is a testament to the inertia of enterprise software: you can muddle along with a product end users hate while making a damn good profit because the system does deliver on its promises to its actual customers, the hospital admins that are primarily charged with reducing costs and increasing revenue.
The US medical system is so flush with cash and has such high barriers to entry that it doesn't really matter if software isn't great in some (important, but not important in a way that matters to decision makers) ways. The money keeps flowing, and continues concentrating power in the hands of major players. Something like the HITECH act /was/ needed, but lol if you think the people that bought a seat at the table to design it (but totally didn't--that would be corruption, and we don't have that in America!) didn't have a vested interest in pushing certain provisions. Save money by putting an EMR in place sooner, and accelerating vendor lock-in with the existing players? Sure, why not, everyone (for certain values of everyone) wins!
Thanks for posting this -- I didn't know this was the system we bought (am Danish).
The back story (for Denmark) is that we have been building our very own system since the 1990's at massive cost without getting very far, so by now the biggest commercial offering probably looks like a safe heaven.
Reasons the "in-house" systems never got far are a good story.
First, there is the normal insanity of hiring consultancies on cost-plus contracts to design and build a system that is "spec'd" by collecting wish lists from everywhere.
Despite this, things might have worked: A lot of my friends from uni started work at these consultancies and the story is that there was not much naked greed and cynicism, and that people really tried to come up with good systems.
The real killer was that Denmark, despite being a completely homogeneous country of 5m people with state-funded healthcare, did not opt to build a single system!? Healthcare is provided by the "regions", and the regions could not agree on buying a single system. Since Danes expect their medical records available across regions, the ministry of health then had to step in and provide a data interchange standard. Picture an insane XML-schema for every conceivable piece of medical information, coupled with granular access controls and origin metadata. And then mapping this schema faithfully to 5 different alternative representations...
We have the regions in Sweden too, and they too do their own thing. I think it might be better in 5 to 10 years, because the national parliament decided to integrate the software.
Individuals don't have much power to change an organizational culture riddled with NIH syndrome (the goddamn ticketing system, timekeeping system, and at some point in the dark past, the email system used internally were ALL written on top of the core EMR codebase) and cargo cult development (the people that /do/ stick around have a healthy share of people that couldn't easily get hired elsewhere on their merits, but do thrive in an environment where accumulating and regurgitating questionable tribal knowledge is crucial).
The system is a testament to the inertia of enterprise software: you can muddle along with a product end users hate while making a damn good profit because the system does deliver on its promises to its actual customers, the hospital admins that are primarily charged with reducing costs and increasing revenue.
The US medical system is so flush with cash and has such high barriers to entry that it doesn't really matter if software isn't great in some (important, but not important in a way that matters to decision makers) ways. The money keeps flowing, and continues concentrating power in the hands of major players. Something like the HITECH act /was/ needed, but lol if you think the people that bought a seat at the table to design it (but totally didn't--that would be corruption, and we don't have that in America!) didn't have a vested interest in pushing certain provisions. Save money by putting an EMR in place sooner, and accelerating vendor lock-in with the existing players? Sure, why not, everyone (for certain values of everyone) wins!
https://www.motherjones.com/politics/2015/10/epic-systems-ju...