[HN Gopher] The Billionaire Who Controls Your Medical Records (2...
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The Billionaire Who Controls Your Medical Records (2021)
Author : walterbell
Score : 36 points
Date : 2023-08-06 21:07 UTC (1 hours ago)
(HTM) web link (www.forbes.com)
(TXT) w3m dump (www.forbes.com)
| haspoken wrote:
| https://archive.is/xanUq
| jackvalentine wrote:
| And Larry Ellison's Oracle now owns Cerner.
| hooverd wrote:
| Oracle might actually be an improvement over Cerner.
| [deleted]
| mikewarot wrote:
| 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 rooms are
| always full these days.
|
| Between Epic and HIPPA privacy rule[1], the effectiveness of
| emergency care in the US can only spiral downward. You're forced
| to slow down and fill out a bunch of online forms before you can
| let a patient go, filling the ER. 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.
|
| [1]
| https://en.wikipedia.org/wiki/Health_Insurance_Portability_a...
| photonerd wrote:
| You're going to have to explain how HIPPA privacy slows things
| down because, frankly, it's one of the most important privacy
| laws for citizens I can can think of.
| [deleted]
| nradov wrote:
| That is simply misinformation. HIPAA rules do not prevent
| healthcare providers from following up with patients. You
| should read the actual HIPAA final rule.
| master_crab wrote:
| The key to making money: find something with extreme regulatory
| capture.
| nradov wrote:
| 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
| team to build, and there are open source libraries like HAPI
| FHIR which already get you halfway there.
|
| https://www.healthit.gov/topic/oncs-cures-act-final-rule
|
| The real barrier to entry is _relationships_. Epic has made
| huge investments in direct sales and consulting services to
| give the decision makers in large provider organizations
| exactly what they want.
| majormajor wrote:
| 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 (or at least finite amount the higher-ups are willing to
| spend on individual contributors to give them more time to do
| things), more effort is spent on record-keeping than on the
| actual job.
|
| Now that you have more record-keeping you can dig into "stats"
| and "trends" etc that may not have any statistical significance
| at the level you're inspecting them, but are suddenly much more
| visible, and pushes you towards tinkering with the process
| instead of the what of the work.
|
| And then that slows down the doing, which makes you more
| interested in tracking and improving the process, repeat repeat
| repeat.
| zdw wrote:
| 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 in, but it was never the OS that was the
| problem, it was MS Office format lock-in that caused all the
| issues, which is still a problem.
|
| Open, simple, interoperable formats are the way out. We need more
| of these, especially in the health care sector.
| pajushi wrote:
| Unless you have additional sources, you're not being very
| honest. Standards exist like FHIR, published by HL7 which sets
| global standards for healthcare. https://www.hl7.org/
|
| Epic provides support for these standards.
| https://fhir.epic.com/
| adwf wrote:
| 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.
| nradov wrote:
| 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
| ClumsyPilot wrote:
| Does it actually work in practice? I often see 'theoretical'
| support, you can export data but if you re-import it, it's
| all fucked.
|
| Like Zigbee, in theory like every company supports it but in
| practice moat imlementations is not compatiable with each-
| other
| nradov wrote:
| Yes, it works in practice. The trouble is more with the
| customers than the vendor. Some customers are still using
| obsolete versions that are missing the latest standards-
| based open interoperability features. Or they just haven't
| enabled those features.
| kQq9oHeAz6wLLS wrote:
| Yes; Epic participates in the CareEverywhere network which
| has a gateway to the CareQuality network, thus supporting
| decent interoperability with other hospitals and clinics
| using a variety of EHRs.
|
| Now, how _much_ they share is potentially open to debate.
| rawgabbit wrote:
| Is there any public documentation on Epic and how one can
| interact with it?
| nradov wrote:
| https://open.epic.com/
| Herodotus38 wrote:
| 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
| hospitals, and use Cerner currently, grabbing info from Epic
| most days.
| secabeen wrote:
| Yeah, I'm starting to see records from different medical
| organizations showing up in each other's EPIC MyChart logins.
| Not terrible!
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