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Epic Tells Customers It Will Stop Google Cloud Integrations

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Re: Epic Tells Customers It Will Stop Google Cloud Integrations

#211

Post by microcolonel »

metafizikal wrote: post #209

everyone has conspiracy theories about what is "really going on here", this is to stamp out a competitive threat in google, or whatever, but I do think this story probably is just that hospitals (and "traditional enterprises" broadly) are not using GCP for their cloud infrastructure and are instead going with AWS or Azure.

I still don't see why they have to be tied to a single provider. Seems like a major weakness of large customers in this space, that they're unwilling to demand standards or protect themselves from exploitation in this way. Obviously there will be new APIs for services which are not yet a commodity, but there are some highly standardized offerings from every major "cloud" vendor which should be configurable in roughly the same way; many of them even have similar limitations, like AWS and Azure (last I tried) not having the option to expose their VPSes directly over IPv6.

Re: Epic Tells Customers It Will Stop Google Cloud Integrations

#212

Post by TheCoelacanth »

briandear wrote: post #89
deanCommie wrote: post #66

Earlier quoted context omitted.

The difference is Amazon won't use confidential AWS data to drive their other verticals. Google's very business model is selling their users to their customers.

With HIPAA business associates agreements, it’s literally illegal for Google to sell or use health data from a Google Cloud integration.

Which doesn't mean they definitely won't do it. Businesses do illegal things all the time for competitive advantage. Literally the entire advertising industry, including Google, is flagrantly violating GDPR.

Re: Epic Tells Customers It Will Stop Google Cloud Integrations

#213

Post by JshWright »

Herodotus38 wrote: post #120
JshWright wrote: post #78

Earlier quoted context omitted.

My clinical experience with Epic is limited to emergency care, but I've yet to meet a clinical user that "likes" Epic.

I'll be the first, then. I've used two versions of Cerner (the first was heavily modified by the University where I did residency and the second is a more recent version), Soarian, Epic, CPRS, and had brushings with half a dozen outpatient EMRs. Epic is bad, but it's unfortunately still miles better than anything else I have ever used so far.

I think you and I have different definitions of "like"...

Re: Epic Tells Customers It Will Stop Google Cloud Integrations

#214

Post by OliverJones »

leoh wrote: post #140

Google is absolutely doing the right thing. Anything that can be done to enhance the efficacy of EMR software will help lead to better patient outcomes. As far as I can tell, Google is approaching the problem foremost from the perspective of "how can we make people healthier by making software more effective." Epic and Cerner are simply not doing that. Somewhere in the comments here someone mentioned that most EMR so…

I just don't understand how Google, as a server and storage provider for any EMR, could use the data themselves for anything. Because HIPAA. Yes, it's possible to anonymize patient data for use in research. But the anonymizing techniques are subject to review by the researcher's Institutional Review Board. They review the purpose of each study, the use of the data, and the ways the study preserves patient confidentiality.

Institutional Review Boards are responsible for ethical scrutiny of research involving human subjects. Informed consent, safety, etc.

As long as HIPAA is intact, I'm not sure any panic about misuse of patient data is justified, by any cloud provider.

That being said, systems like Cerner and EPIC definitely serve the interests of fee-for-service medical providers. Read this article by Atul Gawande. https://www.newyorker.com/magazine/2018/11/12/why-doctors-ha...

Re: Epic Tells Customers It Will Stop Google Cloud Integrations

#215

Post by ocdtrekkie »

v7p1Qbt1im wrote: post #193
raxxorrax wrote: post #162

Earlier quoted context omitted.

The income of the owning company comes to 85% from advertising. It is pretty save to say that they are an ad company. It is also very likely that any data collected is used to reinforce and consolidate their main business.

Oh come on. There are contracts with GCP customers in place. There is a massive set of regulations around data misuse. Do you really think Google would risk the company-destroying liability of being caught using data improperly (something that‘s not in their T&c)? Who‘s to say there wouldn‘t be whistleblower tomorrow. A company can do more than one thing. It probably would be a decent idea to make GCP a subsidiary, j…

Actually a lot of people point out that Amazon abuses it's storefront data as market research for it's own first party products on a scale nobody else can match. (And then, in turn, gives its first party products better placement in the store, to then crush the competition.)

The difference is, Amazon hasn't demonstrated a massive desire to collect and use health data, and fundamentally, isn't an ad company.

The other thing you're forgetting is that Google regularly changes the terms of the agreements it makes. When it bought DoubleClick, it swore that DoubleClick would never be able to access people's Google account data and that there would be a clear firewall of ad personalization information. Up until they changed their terms of service so that they could: https://www.propublica.org/article/google-has-quietly-droppe...

Google literally embodies the classic "I am altering the deal. Pray I do not alter it any further." Just because they claim they won't abuse the health data they are zealously collecting today doesn't mean they won't change their mind tomorrow.

An ad company should not be allowed to hold your health data.

Re: Epic Tells Customers It Will Stop Google Cloud Integrations

#216

Post by parasubvert »

tomrod wrote: post #199
parasubvert wrote: post #174

Earlier quoted context omitted.

FHIR is nice but doesn’t completely reduce the complexity of integrating the underlying data itself considering the mess that is HL7 and mess that occurred with v3. The situation is sort of like moving from SOAP+XML Schemas to REST/JSON. Easier to develop, but the underlying data structures are still extremely complicated and tricky to get right. This is especially true when dealing with ancient systems written in ni…

Do you feel OMOP helps to resolve this?

YES! If only people in healthcare IT would adopt things in years rather than decades...

Re: Epic Tells Customers It Will Stop Google Cloud Integrations

#217

Post by XaspR8d »

marcinzm wrote: post #195
leoh wrote: post #140

Google is absolutely doing the right thing. Anything that can be done to enhance the efficacy of EMR software will help lead to better patient outcomes. As far as I can tell, Google is approaching the problem foremost from the perspective of "how can we make people healthier by making software more effective." Epic and Cerner are simply not doing that. Somewhere in the comments here someone mentioned that most EMR so…

>In most implementations, neither Cerner not Epic encourage structured data recording except for billing codes. This means that if a patient comes through the medical system frequently, doctors have to read pages and pages of unstructured text to get a sense of what's going on for the patient. The software is designed to be sold to administrators and, as currently designed is unquestionably leading to worse outcomes…

Even to the extent that it creates an entirely new job area! (medical scribes)

Re: Epic Tells Customers It Will Stop Google Cloud Integrations

#218

Post by loceng »

fauigerzigerk wrote: post #166
leoh wrote: post #140

Google is absolutely doing the right thing. Anything that can be done to enhance the efficacy of EMR software will help lead to better patient outcomes. As far as I can tell, Google is approaching the problem foremost from the perspective of "how can we make people healthier by making software more effective." Epic and Cerner are simply not doing that. Somewhere in the comments here someone mentioned that most EMR so…

The problem is that Google has the most obvious conflict of interest of all cloud and AI providers when it comes to data use. Many people simply don't believe anything Google says, and even those who do believe them to some degree know that others won't. Google has become a reputational hazard in fields that deal with sensitive data such as healthcare. Some decisions made by current management don't help at all. Inst…

It's data ownership laws and adequate monitoring (including whistle blower laws with adequate rewards) and enforcement that is necessary. Replace "Google" with any unknown or known bad actor that can be taken over by a bad actor, and we return to the same problem.

Re: Epic Tells Customers It Will Stop Google Cloud Integrations

#219

Post by logfromblammo »

> "This is not us mining somebody’s records to sell ads, to learn from it, to do machine learning, to develop products. We developed this on de-identified data."

"De-identified data" is "somebody's records".

Also, for all the PR put behind the patient, Epic (and likely Cerner too) focus all their bizdev efforts on what the hospital and HMO administrators want, because they're the ones that sign the checks. Back when I worked there, they threw huge stacks of employees at customizing every installation, and significant developer effort at making broad customization possible. If patient care were the primary issue, every Epic implementation would be identical at the keyboard shortcut level. Hospital admins would have had to backdoor their customizations in by forcing their physicians and nurses to demand them as features. But instead, I saw page after page of customizations, inserting arbitrary administrator-created workflows on the staff via the software.

Re: Epic Tells Customers It Will Stop Google Cloud Integrations

#220

Post by logfromblammo »

tallgiraffe wrote: post #136

Epic is ruthless and takes competition out by any means necessary. They are a dinosaur that avoided competition for decades, and Google is a massive thread. This is good news because they are scared, and Google has an infinite runaway to take them out. Epic should have worked tirelessly to innovate and improve US healthcare, but instead chose to stay still and to profit. They won’t be for long.

If you think Google can break into the healthcare software space just by being technically better at it, you haven't worked in the healthcare software space.

Google could develop the best electronic medical record the world has ever seen, and still not take business from the companies that have been honing their dirty tricks since 1979.

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