<story><title>Simulated Hospital</title><url>https://github.com/google/simhospital</url></story><parent_chain><item><author>duffpkg</author><text>I am frequently asked about why systems in institutional healthcare are so hard to modernize, this has come up a lot related to pricing transparency. While HL7 is in theory a standard, in practice it is a semi-parseable &amp;quot;email&amp;quot; between two parties that know each other.&lt;p&gt;Widely used systems like EPIC have bugs and quirks that have existed so long that the bugs themselves have become their own standard. Because HL7 relationships typically happen between longterm consistent partners both parties tend to evolve the format to suit localized needs and this business logic and the reasons for it are lost to time. It isn&amp;#x27;t that rare to find HL7 interfaces that have been in use for 20+ years that have become vital black boxes. HL7 2.x, still widely used, was originated in 1989.&lt;p&gt;In a lot of case modernization like FHIR is nothing more than taking the old garbage and putting it in a new fancier bag.&lt;p&gt;As whacky as HL7 may seem it is really nothing compared to its much bigger uglier older brother, X12 837&amp;#x2F;835, used for communication of billing information from performing entity to insurer.</text></item></parent_chain><comment><author>ethbr0</author><text>I don&amp;#x27;t have enough fingers to count the times I was doing automation in healthcare, implemented the process to spec, and then had a bunch of test cases flagged as failing.&lt;p&gt;Turns out, for large known counterparties, there are indeed de facto processes that incorporate each party&amp;#x27;s eccentricities and are &amp;quot;known&amp;quot; on the floor (processors typically have long tenures in their jobs) but unknown above a certain level of management.&lt;p&gt;E.g. a large children&amp;#x27;s hospital that reliably spit out misformatted requests to the local payer, but which the payer papered over on their side by converting them to payable requests (naughty, but kept them from bouncing back and requiring resubmission)... and had been doing so for 10+ years.</text></comment>
<story><title>Simulated Hospital</title><url>https://github.com/google/simhospital</url></story><parent_chain><item><author>duffpkg</author><text>I am frequently asked about why systems in institutional healthcare are so hard to modernize, this has come up a lot related to pricing transparency. While HL7 is in theory a standard, in practice it is a semi-parseable &amp;quot;email&amp;quot; between two parties that know each other.&lt;p&gt;Widely used systems like EPIC have bugs and quirks that have existed so long that the bugs themselves have become their own standard. Because HL7 relationships typically happen between longterm consistent partners both parties tend to evolve the format to suit localized needs and this business logic and the reasons for it are lost to time. It isn&amp;#x27;t that rare to find HL7 interfaces that have been in use for 20+ years that have become vital black boxes. HL7 2.x, still widely used, was originated in 1989.&lt;p&gt;In a lot of case modernization like FHIR is nothing more than taking the old garbage and putting it in a new fancier bag.&lt;p&gt;As whacky as HL7 may seem it is really nothing compared to its much bigger uglier older brother, X12 837&amp;#x2F;835, used for communication of billing information from performing entity to insurer.</text></item></parent_chain><comment><author>ArtWomb</author><text>Bizarro-world that doctors actually defend EPIC! They all complain about the  ASP.NET 1.0 UI. It&amp;#x27;s just the convenience of viewing all patients from all hospitals in one virtual &amp;quot;chart&amp;quot; ;)</text></comment>