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The Billionaire Who Controls Your Medical Records (2021)

forbes.com

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

#51

Post by lapcat »

user6723 wrote: post #43

Epic is the result of obamacare. Such terrible software would never see production in a market-driven environment. No one wanted it but the surveillance industrial complex control freaks.

Epic Systems was founded in 1979. The Affordable Care Act was passed in 2010, and the Health Insurance Marketplace — a market-driven system — opened in 2014. Epic is not the result of "Obamacare".

Also, Epic deals with medical records, while the ACA deals with health insurance. These are two separate domains.

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

#52

Post by x0x0 »

FireBeyond wrote: post #34
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 p…

Epic was a 10m+ loc vb6 app in the 90s.

That said, lots of the problems with Epic is it is used so differently between hospitals/installs. It's less a EMR + scheduler + hospital management app than a toolkit used to construct those for big enough medical companies. That inevitably doesn't lead to nice software: see all enterprise software everywhere.

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

#53

Post by nradov »

majormajor wrote: post #19

You can't just blame to tools for annoying hospital policy, but similarly to https://chrisgagne.com/1255/mary-poppendiecks-the-tyranny-of... there's a nasty feedback loop that the provisioning of software for administration and tracking (vs direct use as tools) unlocks and enhance. The perceived ability to have more detailed documents means all the effort goes into the detail of the documents and, with finite effort…

Hospital documentation (charting) policies are driven mainly by payer coverage rules and government care quality metrics. Administrator desire for stats and trends is much less of a factor.

There is a huge amount of waste and inefficiency in most provider organizations so any attempts at process improvement should be encouraged. As the industry moves toward value-based care reimbursement models there will be more financial incentives to do so.

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

#54

Post by majormajor »

nradov wrote: post #53
majormajor wrote: post #19

You can't just blame to tools for annoying hospital policy, but similarly to https://chrisgagne.com/1255/mary-poppendiecks-the-tyranny-of... there's a nasty feedback loop that the provisioning of software for administration and tracking (vs direct use as tools) unlocks and enhance. The perceived ability to have more detailed documents means all the effort goes into the detail of the documents and, with finite effort…

Hospital documentation (charting) policies are driven mainly by payer coverage rules and government care quality metrics. Administrator desire for stats and trends is much less of a factor. There is a huge amount of waste and inefficiency in most provider organizations so any attempts at process improvement should be encouraged. As the industry moves toward value-based care reimbursement models there will be more fin…

If not for computers and software would those coverage rules and metrics have evolved to the same level of detail?

And then how do you keep insurance payers from considering things like "spent more than 5 minutes with a patient" that aren't "necessary" in the large majority of cases as "waste and inefficiency"?

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

#56

Post by FireBeyond »

hanklazard wrote: post #47
FireBeyond wrote: post #34

Earlier quoted context omitted.

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 p…

It’s total shit. I’m rooting for something like this in the long term: https://github.com/openemr/openemr

I love the idea of OpenEMR.

I desperately want it to gain some real traction.

Working in the enterprise world, including the enterprise healthcare world... it's not "right", but as long as it exists as a PHP webapp...

I don't see that happening. No matter how good a PHP webapp it is.

I really want it to succeed. But there is so much further to go. For example, on the subject of backing up your EMR data, there is this:

> Disaster can strike at anytime. Backing up will mean the difference between a mild inconvenience and a major imbroglio.

> Choose a method according to the operating system from this webpage.

> Windows users are advised not to rely on the built-in utility once their file size becomes too large. The reasons are discussed in this Forum thread.

That's it?? That's the extent of your backup discussion for a business critical application storing PHI? Oof.

Any CIO remotely considering OpenEMR, even one hugely cost-constrained, is going to run for the hills.

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

#57

Post by analogj »

Spooky23 wrote: post #41
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…

My wife is dealing with cancer and associated complications at three distinct hospitals and a national cancer center. The two hospitals on Epic are great - all of her records are immediately exchanged. The third hospital has a shitty cerner system and has problems sharing between departments. The cancer center has an excellent patient portal but doesn’t integrate. Ultimately these problems are difficult as the creati…

Sorry to hear about your wife's health issues, I hope she's on the mend. I had a similar experience when dealing with my chronic condition. Had to interact with almost a dozen different health portals, a couple of which were ok, the rest were awful.

I'm a software engineer, so I ended up creating my Personal Health Record (PHR) application, which I eventually open-sourced - https://github.com/fastenhealth/fasten-onprem

It's still a work in progress (and definitely not ready to be used as the primary source-of-truth), but I'm always looking for actionable feedback/contributors. I'd love to hear your thoughts

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

#58

Post by analogj »

HaZeust wrote: post #49
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…

"Open, simple, interoperable formats are the way out. We need more of these, especially in the health care sector." We're getting there quickly with FHIR!

I've been working on my own Open-Source Personal Health Record (PHR) that leverages FHIR & Smart-on-FHIR https://github.com/fastenhealth/fasten-onprem

Hopefully with the Cures Act Final Rule, interoperability will become the norm

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