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The Billionaire Who Controls Your Medical Records (2021)

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21–30 of 58 posts

Re: The Billionaire Who Controls Your Medical Records (2021)

#21

I always wondered why so many hospitals adopted EPIC, it's got the worst UI I've ever seen. This article provides insight to complete the picture: network effects, and lock-in. It's likely resulted in many deaths. When my friend worked ER, any time Epic went down, they simply switched back to paper forms, the ER waiting room would empty within a few hours. EPIC is, in my opinion, a large fraction of why ER waiting ro…

That is simply misinformation. HIPAA rules do not prevent healthcare providers from following up with patients. You should read the actual HIPAA final rule.

Re: The Billionaire Who Controls Your Medical Records (2021)

#22
post #12
post #6

Earlier quoted context omitted.

[dead]

FHIR is about as far from what I'd call a standard as you can get. Each individual country/region/hospital/department/lab can define "profiles" that configure the data to their specific use case and no-one else's. Not exactly the aim of a standard in the usual computing sense.

The baseline HL7 FHIR standard is more of a toolkit than something intended for real-world interoperability. Fortunately there are multiple FHIR accelerators such as CodeX, Argonaut, Da Vinci, etc which write detailed Implementation Guides for specific use cases. Any organization can follow those IGs and be confident of achieving meaningful interoperability. Some of them are even mandated by federal regulations.

http://www.hl7.org/about/fhir-accelerator/index.cfm

Re: The Billionaire Who Controls Your Medical Records (2021)

#23
post #5

This software is the epitome of a roach motel, or Hotel California - data enters, but can never leave. Epic software is so proprietary and customized for each customers that two hospitals using it can't even exchange records, or have the same interaction methodology (source: I have family that worked at two large hospitals, both with Epic). People had a fit over Windows in the 90's and 2000's being proprietary lock i…

This is not universally true, but I don’t know where your family works or in what capacity. There are a lot of issues with epic but unfortunately it is the best out of all the garbage out there. Out of all the EMR’s I have used, Epic is the easiest to share information both within different hospitals using epic and sharing from epic to other emrs like Cerner. Source: Am physician who has worked in many different hosp…

Yeah, I'm starting to see records from different medical organizations showing up in each other's EPIC MyChart logins. Not terrible!

Re: The Billionaire Who Controls Your Medical Records (2021)

#24
post #6
post #5

This software is the epitome of a roach motel, or Hotel California - data enters, but can never leave. Epic software is so proprietary and customized for each customers that two hospitals using it can't even exchange records, or have the same interaction methodology (source: I have family that worked at two large hospitals, both with Epic). People had a fit over Windows in the 90's and 2000's being proprietary lock i…

[dead]

My favorite way to describe the issues with FHIR is semantic vs syntactical interoperability.

Using FHIR means syntactically interoperability. Same structure, uses json, things generally in the same place.

Semantic interoperability means that the 2 systems can understand each other… just using FHIR is NOT enough for this. Different value sets and ways of representing the same information mean that 2 systems view of the same data may be very different.

I liken this to when I walked into a bar in a small town in Northern Ireland. I was speaking English, the bartender was speaking English, but we could not understand each other. We eventually figured things out but it was TOUGH to communicate even though we were ostensibly speaking the same language.

This is what FHIR apis from 2 different vendors are like. Same “language” remarkably different dialects

Re: The Billionaire Who Controls Your Medical Records (2021)

#25
post #5

This software is the epitome of a roach motel, or Hotel California - data enters, but can never leave. Epic software is so proprietary and customized for each customers that two hospitals using it can't even exchange records, or have the same interaction methodology (source: I have family that worked at two large hospitals, both with Epic). People had a fit over Windows in the 90's and 2000's being proprietary lock i…

This is not universally true, but I don’t know where your family works or in what capacity. There are a lot of issues with epic but unfortunately it is the best out of all the garbage out there. Out of all the EMR’s I have used, Epic is the easiest to share information both within different hospitals using epic and sharing from epic to other emrs like Cerner. Source: Am physician who has worked in many different hosp…

FWIW, two separate deployments of Epic done in the last 15 years at two hospitals, from the perspective of folks working in the pharmacy.

Re: The Billionaire Who Controls Your Medical Records (2021)

#26
post #6
post #5

This software is the epitome of a roach motel, or Hotel California - data enters, but can never leave. Epic software is so proprietary and customized for each customers that two hospitals using it can't even exchange records, or have the same interaction methodology (source: I have family that worked at two large hospitals, both with Epic). People had a fit over Windows in the 90's and 2000's being proprietary lock i…

[dead]

Those standards are the equivalent to JSON or XML.

They still require massive amounts of implementations.

Re: The Billionaire Who Controls Your Medical Records (2021)

#27
post #20

The key to making money: find something with extreme regulatory capture.

There is actually not much regulatory capture in the EHR market. The FDA doesn't classify most of those products as regulated medical devices. Provider organizations are required to implement certain open interoperability standards so that authorized parties can securely access patient charts so they are unlikely to buy an EHR without those features. But the required APIs are fairly easy for any competent engineering…

> huge investments in direct sales and consulting services

Ever been to the Epic campus? It's literally like Disneyland - they have a whole section that is entirely made up like Alice in Wonderland: https://www.nytimes.com/2018/12/20/business/epic-systems-cam...

They also wanted to build tunnels into the facility that were too low for the local fire department's trucks to get through, so they just... bought them all new trucks that were shorter.

That's where your medical dollars are going folks...

Re: The Billionaire Who Controls Your Medical Records (2021)

#28
post #5

This software is the epitome of a roach motel, or Hotel California - data enters, but can never leave. Epic software is so proprietary and customized for each customers that two hospitals using it can't even exchange records, or have the same interaction methodology (source: I have family that worked at two large hospitals, both with Epic). People had a fit over Windows in the 90's and 2000's being proprietary lock i…

On the contrary: when I moved from Kaiser to Sutter, it was a single push-button to move my entire EHR over (once I consented to the doctor). The doctor told me it's generally that easy when you have two Epic instances (note: I'm not directly denying what you say, because I know enough about Epic and EHRs to be suprised at my doctor's ease).

Re: The Billionaire Who Controls Your Medical Records (2021)

#29
post #27
post #20

Earlier quoted context omitted.

There is actually not much regulatory capture in the EHR market. The FDA doesn't classify most of those products as regulated medical devices. Provider organizations are required to implement certain open interoperability standards so that authorized parties can securely access patient charts so they are unlikely to buy an EHR without those features. But the required APIs are fairly easy for any competent engineering…

> huge investments in direct sales and consulting services Ever been to the Epic campus? It's literally like Disneyland - they have a whole section that is entirely made up like Alice in Wonderland: https://www.nytimes.com/2018/12/20/business/epic-systems-cam... They also wanted to build tunnels into the facility that were too low for the local fire department's trucks to get through, so they just... bought them all…

Alt link: https://archive.ph/PSQL4

Jeez, these people are like the supervillains of mundane Kafkaesque bureaucratic evil.

Re: The Billionaire Who Controls Your Medical Records (2021)

#30
post #6

Earlier quoted context omitted.

[dead]

Those standards are the equivalent to JSON or XML. They still require massive amounts of implementations.

Look at the maturity level of the HL7 resource. Those that are higher (5-6) are going to have more agreement on standards and have more turnkey setup.

For example, condition in the US is likely to use ICD-10. Procedures, especially those billed are going to use CPT or HCPCS.

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