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Comment by seehafer | Hacker News Reader

> Between insurance companies, doctors, hospitals, patients, governments, and every middleman inbetween

You can eliminate middlemen if you can show cost reductions for a player larger than the middleman. The big players are providers, payors and technology (pharma/device) companies. Plenty of middlemen in between those that can be made irrelevant.

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You would think that's the case but from experience it's not. I can name two hospitals in NYC that were supposed to see savings from EHR implementations but ended up having multiple competing EHRs that don't speak to each other because of conflicts of interest. You forget there in many cases there are many payors, tech vendors and providers within a single institution.

That's been my experience as well. EHR providers have no incentive to exchange data with each other and will do everything in their power not to. There are regional efforts towards interoperability but there needs to be more political will to mandate cooperation.

What about HL7? When I last worked with an EHR system (2? years ago), implementing HL7-based interop with other providers was all the rage so that they could eliminate fax machines when transferring patient records.

HL7 is a massive farce. It is an impossibly large standard that's difficult to understand and rarely used for interoperability.

Eh, Epic and Cerner interface fine, and offer HL7 interfaces, and Epic in particular bends over backwards to do what their customers want for implementations. My impression was that hospitals are (understandably) reluctant to allow their direct competitors direct access to information they've collected.

I wouldn't go that far with Epic. They always have some unadvertised module they try to push on hospitals the minute they want to interface with a third party.

You can eliminate middlemen if you can show cost reductions for a player larger than the middleman.

You'd be surprised. Weak decision-makers -- and they are legion -- fear what they don't understand. They'll justify paying a more for a known entity than even entertain a small risk of chaos or disruption.

In a rational world, you'd be right. We don't live there, unfortunately.

Firefly's "Malcolm Reynolds", S1E10 "War Stories":

    It wasn't a bad idea, Wash, but eliminating the middleman is never
    as simple as it sounds. ... 'Bout 50% of the human race is middlemen,
    and they don't take kindly to being eliminated.

While it is obviously possible to bypass middlemen, people tend to react strongly against anything that appears to be threatening their livelihood.

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