Comment by logfromblammo

I worked at Epic, and while I was there, I can confirm that a huge number of workers were fresh out of college and making crap customizations, for every single customer we had. If a salesperson ever told a customer "no, that can't be customized", they might go with another EMR vendor. So every bit of user choice added by the developers and the staff physicians was eventually taken away by customizing administrators turning optional into either mandatory or forbidden. It was completely ludicrous. One part of the company was building software to be used at theoretically any medical facility, and another part was busy turning it into many shards of software that could each only be used in one location for one customer.

And on top of this, the software used to customize the base software was esoteric and required extensive training just to change the resource strings. This was before i18n, of course, but I have no reason whatsoever to believe that made anything better.

The whole thing was--and probably still is--held together by huge gobs of money. If Epic were in any industry other than US healthcare, it would have been bankrupt a long, long time ago. My experience has led me to believe that if software developers had any significant union membership in the 80s and 90s, able to enforce minimum standards for development practices, health care costs today could have been 3/4 of what they actually are now. We are now paying for jobs that could have been completely automated by 2000, and its because Epic and Cerner and GE and all their competitors have been shoving technical debt--in the form of bullshit customizations--into every deployment for decades, at the behest of administrators who were understandably reluctant to authorize the purchase of any product that would automate them out of their own jobs.

And it just gets worse when you add billing integration, because then Medicare and the private insurers get involved...

Got out, didn't look back. Don't work in medical software if you love programming and don't want to spoil that.