<instructions>Your goal is to analyze the following comment and estimate how highly it will be upvoted by the Hacker News community.</instructions><comment><author>analog31</author><text>I&amp;#x27;m sure I&amp;#x27;m being naieve, but could we just get rid of billing altogether if we nationalize the health care system? I have to recount an anecdote. My mom was hiking in a foreign country, and got injured. She hobbled to the next town, and found a clinic. They treated her and were ready to let her go. She said:&lt;p&gt;Q: Okay, how do I pay?&lt;p&gt;A: You don&amp;#x27;t &lt;i&gt;pay&lt;/i&gt; for health care.&lt;p&gt;Q: I&amp;#x27;m American. I&amp;#x27;m not part of your health care system.&lt;p&gt;A: That&amp;#x27;s all well and good, but we have no way of knowing how much to charge you, how to take your money, or where to send it. Have a nice vacation.&lt;p&gt;The clinic probably maintained some accounting records, but they simply had no billing system.</text><parent_chain><item><author>oomkiller</author><text>Unfortunately the problem is much greater than engineers not understanding doctors and other clinical staff, in my experience. For startups that want to sell to health systems and similar-sized&amp;#x2F;larger entities (really this is the minimum size that can work for most startups, practice sales usually have more friction than value), you unfortunately have to focus on the buyer, which is very rarely someone who is &amp;quot;in the trenches.&amp;quot; Best case scenario, having software that is compelling to the end users can help you get your foot in the door early on, but actual adoption will only happen if you can convince the business stakeholders of your value.&lt;p&gt;In the US healthcare system, clinicians and the business often have opposing objectives and values. This is starting to change with value based care becoming more popular, but it&amp;#x27;s still all about providing what the business wants, it just happens to align with the clinicians more these days. You&amp;#x27;ll still need to support IE9 due to that botched Vista upgrade, build out a custom EMR integration, and deliver whatever random feature the sales folks promised (can you automatically fax things?) before you can move on to the features that the clinicians actually want.&lt;p&gt;The system itself is how we ended up with billing-driven documentation EHRs like Epic. Paradoxically, due to massive adoption, I think Epic and Cerner are some of the only places where real innovation could happen. I think even huge companies like Apple, Amazon, and Google will have a hard time breaking into the space, no matter how much cash they throw at it. For them, the only answer is to go fully vertical like Kaiser-Permanente, but I doubt they have the stomach for this.</text></item></parent_chain></comment><story><title>Doctors ask engineers to spend more time in the hospital before building apps</title><url>https://www.cnbc.com/2018/12/27/doctors-are-asking-technologists-from-google-to-shadow-them-before-they-build-medical-apps-.html</url></story>
<instructions>Your goal is to analyze the following comment and estimate how highly it will be upvoted by the Hacker News community.</instructions><comment><author>bm98</author><text>Standards like SMART-on-FHIR [1] and CDS Hooks [2] have the potential to allow innovation developed outside of Epic and Cerner inside of those products. Both of those vendors even have &amp;quot;App Stores&amp;quot; [3] [4]. So far, though, there aren&amp;#x27;t a lot of apps in these stores, and none of my doctors (all of whom work for large academic medical centers and use Epic) have access to any third-party apps - so I do wonder whether the vendors (or their customers) may be putting up roadblocks that are slowing adoption.&lt;p&gt;[1] &lt;a href=&quot;http:&amp;#x2F;&amp;#x2F;docs.smarthealthit.org&amp;#x2F;&quot; rel=&quot;nofollow&quot;&gt;http:&amp;#x2F;&amp;#x2F;docs.smarthealthit.org&amp;#x2F;&lt;/a&gt; [2] &lt;a href=&quot;https:&amp;#x2F;&amp;#x2F;cds-hooks.org&amp;#x2F;&quot; rel=&quot;nofollow&quot;&gt;https:&amp;#x2F;&amp;#x2F;cds-hooks.org&amp;#x2F;&lt;/a&gt; [3] &lt;a href=&quot;https:&amp;#x2F;&amp;#x2F;apporchard.epic.com&amp;#x2F;&quot; rel=&quot;nofollow&quot;&gt;https:&amp;#x2F;&amp;#x2F;apporchard.epic.com&amp;#x2F;&lt;/a&gt; [4] &lt;a href=&quot;https:&amp;#x2F;&amp;#x2F;code.cerner.com&amp;#x2F;apps&quot; rel=&quot;nofollow&quot;&gt;https:&amp;#x2F;&amp;#x2F;code.cerner.com&amp;#x2F;apps&lt;/a&gt;</text><parent_chain><item><author>oomkiller</author><text>Unfortunately the problem is much greater than engineers not understanding doctors and other clinical staff, in my experience. For startups that want to sell to health systems and similar-sized&amp;#x2F;larger entities (really this is the minimum size that can work for most startups, practice sales usually have more friction than value), you unfortunately have to focus on the buyer, which is very rarely someone who is &amp;quot;in the trenches.&amp;quot; Best case scenario, having software that is compelling to the end users can help you get your foot in the door early on, but actual adoption will only happen if you can convince the business stakeholders of your value.&lt;p&gt;In the US healthcare system, clinicians and the business often have opposing objectives and values. This is starting to change with value based care becoming more popular, but it&amp;#x27;s still all about providing what the business wants, it just happens to align with the clinicians more these days. You&amp;#x27;ll still need to support IE9 due to that botched Vista upgrade, build out a custom EMR integration, and deliver whatever random feature the sales folks promised (can you automatically fax things?) before you can move on to the features that the clinicians actually want.&lt;p&gt;The system itself is how we ended up with billing-driven documentation EHRs like Epic. Paradoxically, due to massive adoption, I think Epic and Cerner are some of the only places where real innovation could happen. I think even huge companies like Apple, Amazon, and Google will have a hard time breaking into the space, no matter how much cash they throw at it. For them, the only answer is to go fully vertical like Kaiser-Permanente, but I doubt they have the stomach for this.</text></item></parent_chain></comment><story><title>Doctors ask engineers to spend more time in the hospital before building apps</title><url>https://www.cnbc.com/2018/12/27/doctors-are-asking-technologists-from-google-to-shadow-them-before-they-build-medical-apps-.html</url></story>