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Comment by jemfinch | Hacker News Reader

Why is my tax money subsidizing software that should have to fight in the free market like the software most other developers write?

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I think you might have misunderstood the article. Doctor's aren't being paid to use this particular software. Doctor's are being paid to convert to electronic records. To be eligible for that payment, they have to use systems that have been certified. Drchrono has been certified.

Anyone else is free to write a competing application, get it certified, and compete in the same market.

Ah, that makes more sense. I can see how the public good would be served by having doctors use electronic records; having them use this specific software (which is what I thought was being subsidized) seemed too specific to justify in terms of the public good.

https://www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.a...

Certification isn't cheap though. It's a definite barrier to entry at the outset. CCHIT seems to be structured to favor monolithic companies with deep pockets, and startups with lots of funding. The certification process also dictates to a degree the functionality of the app, which to my way of thinking may inhibit innovation.

I believe it runs around 20k.. which is a pretty small number compared to cost of labor to build something that would pass the certification. That said, I'd certainly love it if it were cheaper :)

Certification costs have been going down as the Federal government has become the accreditor of new certifying bodies. Previously there was only 1 certifying body. Now there are 6 that all have to conform to the same standards. As a result, certifying costs have come down and will likely trend down for sometime.

Medical records being computerized imposes short term costs on the providers (who are small offices -- the big guys moved to EHR years ago), bur provides private and public goods.

I'm basically a libertarian, but this is one of the least wasteful government programs. As a plus, it was built around open standards vs. trying to have a government standard ehr.

I'd like to see insurers match the meaningful use payments.

Why should I have to pay for-profit pharmaceutical companies, hospital companies, and insurance companies for worse quality healthcare than I could be getting for pennies on the dollar from my taxes?

Medical service providers work in something that's only vaguely like a free market.

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