Comment by mexicocitinluez
6 hours ago
Also anecdotally, I've had a handful of software development positions throughout the years (never at a position with more than 200-300 person company) and have yet to be laid off due to money. I've yet to be laid off at all, but that's irrelevant.
I truly believe that these new tools will actually hurt the bigger companies and conversely help smaller ones. I'm in healthcare. The big players in the EMR space are Epic and Cerner. They are one-size-fits-all behemoths that hospitals have to work against than with. What if, instead of having to reach out to the big players, the economics of having a software developer or 2 on staff make it such that you could build custom-tailored, bespoke software to work "with" your company and not against?
Aren't they still going to need to reach out to the big players because of the regulatory environment? And for good reason, as it happens. We don't need hospitals handing over the public's health data to the cheapest person they can find to prompt it all into Claude.
You can be a small player and still deliver immense value in health care I work at a firm in a niche with about 30 employees. We follow all regulations and go above and beyond them in regards to security.
Just anecdotally, my experience was the total opposite. I didn't work in the health care industry long though and I think you're probably right in general. But you might also find there's a lot of variation between small companies too and a lot of failures for every success I suppose.
Absolutely. I'm in the same boat (a bit bigger with around 200).
It's crazy the underlying business has succeeded despite being boxed in by the software they're currently using. And at least in my niche, you only have a few options. Each with their own unique quirks.
Instead, EMR's could position themselves as more of a "data provider" where you build bespoke software on top of the underlying storage. And to that end, having the abiliy to pump out small, focused apps can be really beneficial.
> Aren't they still going to need to reach out to the big players because of the regulatory environment?
First, saying "We can now build software faster" doesn't imply that "we" won't eventually include professionals. There is nothing stopping someone from building up an app and having people come in to polish it up.
Second, "regulatory environment" doesn't actually mean somethin because every part of the industry has different regulations and requirements. There are different standards for what big hospitals can use and the software requirements than there are for home care software. So trying to wave this "you can't because of regulations" wand doesn't make sense if you're actually in the business.
Third, I was speaking more to the small-medium sized agency.
Fourth,
> We don't need hospitals handing over the public's health data to the cheapest person they can find to prompt it all into Claude.
Means absolutely nothing since you don't need to feed health data into a Claude instance to build healthcare apps. It sounds like you aren't in the field or familiar with it.
And lastly, if you're a Microsoft customer with a BAA, then you're already covered by HIPAA. Again, not something you would know if you weren't in the industry, but now you do.
What if, instead of having to reach out to the big players, the economics of having a software developer or 2 on staff make it such that you could build custom-tailored, bespoke software to work "with" your company and not against?
Because the hospitals those practices want to associate with say "we're on Epic and expect you to be as well"?
Wife in healthcare management...overhear this conversation once or twice a week.
Also the nurses in the floor learn the system and many are not great at adapting to different interfaces. Travel nurses who come in and only worked with GE or Cerner and now having to use Epic causes all kinds of issues.
Also from what I’ve seen is big city hospitals use a mix of all three. Which I believe actually creates an opening as it shows a willingness to use different walled gardens.
However I think there are a lot of opportunities to just build on top of these systems rather than wholesale replace. Because they’re one size fits all and the people who work on them haven’t a single designer bone in their body the interfaces are terribly clunky and slow. Macros exist but seemingly no one is aware of them. It’s rife to build better interfaces tied into macros behind the scenes.
> What if, instead of having to reach out to the big players, the economics of having a software developer or 2 on staff make it such that you could build custom-tailored, bespoke software to work "with" your company and not against?
It's probably risk and liability and not development costs that keep things from moving in house. Not things AI is great at mitigating.
Hospitals are huge liability sinks. Doctors are constantly sued for killing, injuring, or traumatizing patients, because it's impossible to consistently save everyone.
Which is why they don't food liability when they can. Is it worth saving $100,000 a year if it allows the lawyer to say "if they had used industry standard software would the medical error have happened?"
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That's not actually true. It might be for the bigger companies, but certainly not the smaller ones.
And "risk" in this industry could mean any number of different things. We, as a medium-sized provider, have a BAA with Microsoft for HIPAA. That means that I can utilize information I've gotten from my EMR and build line-of-business apps that bridge the gaps between other systems they may have to work in. In fact, our Microsoft tenant has a much higher level of security than the underlying EMR.
I'm quite literally living what I spoke about above. The reason why I was brought in was because teh current CEO has a very tech-focused mindset, otherwise agencies usually can't afford a full-time software developer. Now, those economics are changing.
Also, I haven't heard of an agency that didn't want custom reports built because they found the default ones unsuitable. So even something like the ability to mainline Power BI reports would be compelling.
> What if, instead of having to reach out to the big players, the economics of having a software developer or 2 on staff make it such that you could build custom-tailored, bespoke software to work "with" your company and not against?
The behemoths exist especially, but not exclusively, in that space because regulations (correctly) are steep. In the case of hospital systems you're talking both the management and protection of both employee and patient data. That's not to say of course that the behemoth's are particularly good at that, it's merely that if the hospital rolls it's own solution, as you suggest, they then take on the liability should that system go wrong. On the other side, if Epic has a data breach, every hospital shrugs it's shoulders. It isn't their problem. And, even more fundamentally, if Epic as a product sucks ass... well. The employees didn't choose it, neither did the patients, leadership did.
You see these relationships (or lack thereof) all over the place in our modern world, where the people doing the work with these absurdly terrible tools are not given any decision-making power with regard to which tools to use. Hell, at my workplace, we actually have some in that leadership asks if we're happy with our various HR softwares and things, but fundamentally, they all pretty much suck and we're currently sitting at the least shitty one we could find, which is far from a solid fit for our smaller company. But it's the best we can do because none of these suites are designed to be good for people to use, they're designed to check a set of legal and feature checkboxes for the companies they sell to.
Honestly I don't know how you fix this, short of barring B2B SAAS as an entire industry. Time was, when you wanted to run a sales company, you had to run your own solution to keeping track of internal data. Salesforce didn't exist. You had rows upon rows of file cabinets, if there was a fire data was a lost, if a disgruntled worker stole your sales list and sold it to a competitor, that was it's own issue to deal with. Now crooks can crack the locks off of NetSuite and steal your whole fucking business without even knowing where the hell your HQ even is or caring for that matter, and our business universe if you will is bifurcated all to hell as a result. Companies are engaged in constant games of "pin the legal responsibility on someone else" because to compete, they need internet and software based sales and data management systems, but building those systems is a pain in the ass, and then you're responsible if they go wrong.