There are just some things that “throw devs (of any quality) at it” just doesn’t work. The health care industry is one of them.
And yes things are changing at a glacial pace, but they are changing. For example, my province is developing a new patient portal [1] out in the open. AFAICT, they seem to be doing everything aboveboard: CI, code quality standards, documentation and proper testing, etc. Yet if you look at another team in the same org (ministry of health), you'll find non-existent dev practices, oodles of VBA, or (even worse) some slow+buggy third party system put in place by one of the procurement vampires (IBM, CGI, Deloitte, you know the bunch). The biggest difference? The former project has a dedicated, US Digital Service-style team of skilled and hopefully better-compensated dev(ops) people who know how to deliver good software.
These people have three things on their mind (in no particular order): 1) does this product meet this organization's requirements under our regulatory compliance policies; 2) does this product (including installation, maintenance, and training costs) fit within my budget; 3) is this product widely known and trusted by my peers at other medical practices.
Notice something? The word "software" doesn't appear in that even once. They literally don't care. The result is that companies develop products (software) on the cheap, and that results in the quality issues that exist.
Improving the quality of the code base and development practices is solving a problem the purse-holders (customers) don't have.
Some complaints/feedback I did receive from doctors and clinic admins while working for an EMR vendor:
1. Your system is buggy/unintuitive and we hate using it.
2. We're not upgrading or moving to your new system because of 1).
3. We're moving to competitor X because they have Y feature.
4. [conversely] We came from competitor X because their EMR is slow/buggy/lacks features.
5. We signed up because the docs/office assistants liked [hero feature] in the sales demo.
So yes, 0 mentions of the word "software". However, all of these are directly related to the software itself. There's a reason flashy new companies can swoop in and steal some market share (at least where I am). Even more importantly, there are many tech-related reasons why some companies start floundering and drop out of the market:
- bad foundations (most EMRs were created by doctors with limited dev experience)
- rampant tech debt driven by feature-driven development
- lack of knowledge about testing/CI
These are not theoretical problems. More than once, we incurred regulatory fines and SLA penalties in excess of the "cost of doing business" threshold. After a pretty major patient data screw-up, upper management even relented and gave the dev(ops) team time/money to clean up their act. Regulatory and bureaucratic inertia may insulate health IT companies from software engineering issues, but there's a limit to everything and they can sure as hell bleed.
Just want to add: I work with (ex-)FAANG folks on a daily basis, too. Not all of them have egos bigger than their britches. But the ones who think “this industry just needs better software, and I can write it” sure as hell do.
Epic will _happily_ interconnect with other systems for data sharing.
I mean Epic will happily _sell_ you interconnects with other systems, and will generally bill you on top a per patient, per export fee.