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The Billionaire Who Controls Your Medical Records (2021)

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

#31

Post by shigawire »

nradov wrote: post #20
master_crab wrote: post #4

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…

What do you mean by huge investments?

The sales team is about 7 people. Only in recent years have they begrudgingly expanded their consulting wing - but hospitals IT teams manage the software themselves.

Mostly it is driven by the fact that as bad as people like to think Epic is... All the direct competitors are magnitudes worse.

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

#32

Post by CamperBob2 »

zdw wrote: post #27
nradov wrote: 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…

I especially liked, "The company’s dress code is that when visitors are on campus, wear clothes."

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

#33

Post by walterbell »

zdw wrote: post #27
nradov wrote: 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…

HN discussion: https://news.ycombinator.com/item?id=18735023

Related, "Why Doctors Hate Their Computers" (2018), https://www.newyorker.com/magazine/2018/11/12/why-doctors-ha...

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

#34

Post by FireBeyond »

zdw wrote: 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…

It really is. And it's not good software. The UI looks decidedly amateur, and some of the modules are absolute garbage amateur hour (one I see a lot in my job is the ED track board, which captures information from the ED charge nurse about incoming ambulances, bed holds and cleaning needs, and gives a picture on what the ED might look like in the next hour or so).

It looks like a VB app from the 90s. Text layout is poor, often overflowing boxes, it's not customizable.

Epic is where it is because hospitals are so fucking locked in.

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

#35

Post by FireBeyond »

pajushi wrote: post #6
zdw wrote: 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]

Epic provides support for their implementation of the standard.

Any person working in healthcare software, which I did for 15 years, knows that for every standard there is a myriad of vendor implementations, bugs, hacks, workarounds, and just saying "System A speaks FHIR and System B does too" does not mean you can just load an EHR dataset from A into B and have all the information usable.

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

#36

Post by FireBeyond »

mikewarot wrote: post #15

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…

> Then you're not allowed to follow up on patients and complete the feedback loop of care, because they're no longer an ER patient, and you're not allowed to inquire any more.

This is factually incorrect. Healthcare providers are allowed to share information about the specifics of care provided to a patient, and, crucially, they are allowed to do so, within limitations, without the explicit consent of the patient (many practices will have you sign consent paperwork for CYA).

It does not require a responding provider to share information upon request with other providers, but they absolutely are allowed to do so.

To be very clear:

> Yes. The Privacy Rule allows covered health care providers to share protected health information for treatment purposes without patient authorization, as long as they use reasonable safeguards when doing so.

Source: https://www.hhs.gov/hipaa/for-professionals/faq/482/does-hip...

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

#37

Post by FireBeyond »

cosmojg wrote: post #29
zdw wrote: post #27

Earlier quoted context omitted.

> 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.

In a grand fit of irony, https://open.epic.com/Home/InteroperabilityGuide

Look at your options for "Who are you?"

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

#38

Post by iancmceachern »

zdw wrote: 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…

True facts.

Source - I design medical devices

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

#39

Post by iancmceachern »

mikewarot wrote: post #15

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…

It's not HIPPA, as others have stated HIPPA does not require that your software sucks. It just requires that it doesn't leak sensitive (or any) personal healthcare information.

Source - I design medical devices that are HIPPA compliant and our software does not suck.

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

#40

Post by iancmceachern »

Anyone want to take a serious stab at dethroning them?

I've designed medical devices for 20 years, many of which directly interfaced with and fed information to EPICS.

Email me at address in my bio if you're interested in starting an exploration party.

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