[acveilleux]

I work in healthcare integration. I have interfaced with EPIC and Cerner and pretty much all the other main EHR platforms and seen my clients struggle with their IT.

You sir are absolutely spot on.

As for single-payer, well yes it does make a huge difference on the billing side which is often the biggest IT/tech user of an hospital. My canadian clients still have to worry about billing but they only have 1 insurance carrier to deal with and they know precisely how much everything will earn them upfront. Everyone else (tourists, out of region people, folks who let their healthcare ID lapse) pays cash at basically the same rates, thank you.

Fun fact, the oldest healthcare products like Meditech started from Billing and grew from there, it shows throughout the software still (and not just because they're written in MUMPS / InterSystems Caché). In Meditech results don't actually need a patient ID to be accepted (via electronic messaging/HL7), they need an account number so they can be billed on the right invoice. Nope the software will not figure out from the Order ID which account it goes to... Downstream systems are expected to keep those account numbers around and up to date, a patient might have 2-4 of them at the same time.