Back To Faxes: Doctors Can't Exchange Digital Medical Records

nbauman writes: Doctors with one medical records system can't exchange information with systems made by other vendors, including those at their own hospitals, according to the New York Times. One ophthalmologist spent half a million dollars on a system, but still needs to send faxes to get the information where it needs to go. The largest vendor is Epic Systems, Madison, WI, which holds almost half the medical records in the U.S. A report from RAND described Epic as a "closed" platform that made it "challenging and costly" for hospitals to interconnect.

The situation is bad for patients and costly for medical works: if doctors can't exchange records, they'll face a 1% Medicare penalty, and UC Davis alone has a staff of 22 dedicated to communication. On top of that, Epic charges a fee to send data to some non-Epic systems. Congress has held hearings on the matter, and Epic has hired a lobbyist. Epic's founder, billionaire computer science major Judith Faulkner, said that Epic was one of the first to establish code and standards for secure interchange, which included user authentication provisions and a legally binding contract. She said the federal government, which gave $24 billion in incentive payments to doctors for computerization, should have done that. The Office of the National Coordinator for Health Information Technology said that it was a "top priority" and just recently wrote a 10-year vision statement and agenda for it.

Comments

It's time to fine.

[PlusFiveTroll]

Working with EMR systems for small clinics has shown me that unless fines are given out to these companies developing this software they will make it as difficult and expensive to exchange records with different systems as possible. It is far more profitable for them to make it hard to exchange and then make their clients convince other offices to use the same software if they want to make it easy.

Re:It's time to fine.

[_xeno_]

But because different systems have evolved differently over time, the schemas are different, and so transfers remain painful.

It's not even that. One thing I learned while working on a project that wanted to pull EMR data was that different hospitals could have their own schemas. One division in the hospital found that the standardized codes for what they were doing weren't robust enough and invented their very own coding system which was used in that single division of that single hospital and nowhere else.

Good luck translating that to any other coding system anywhere else.

I'm not sure I can even blame them for creating their own coding system. They're doctors who found that the tools available didn't meet their needs and found a solution. Down the line it makes data transfer more difficult, but is that something doctors should really be concerned about when they're trying to accurately record medical information about their patients?

Re:sounds like a job for

[Noah Haders]

here you go, internet. Epic working to bring data sharing with Apple Health:

EHR giant Epic explains how it will bring Apple HealthKit data to doctors
http://venturebeat.com/2014/09/17/ehr-giant-epic-explains-how-it-will-bring-apple-healthkit-data-to-doctors/

Epic Systems, the dominant EHR provider in hospitals and large medical groups, has been working with Apple on its HealthKit consumer health data initiative. But until now, the famously media-shy Epic and the famously secretive Apple have said very little about how the HealthKit ecosystem will work to the benefit of clinicians. But Epic has begun to talk.

Apple launched its new iOS 8 mobile operating system today, and a significant feature in that release is the Health app, which stores various types of our health data. You can think of HealthKit as a consumer health-information cloud data repository that connects to, and receives information from, a variety of consumer devices (connected scales, fitness trackers, smartwatches, etc.) and apps (food diaries, calorie counters, workout journals, and so on).

People in the health care industry hoped for more from Apple’s HealthKit platform than just amassing and sharing wearables data among app and device makers. They wanted HealthKit to make a difference. They wanted it to make people healthier.

A large platform collecting billions of data points about hundreds of aspects of our health on a daily basis might create a powerful information resource for health care providers and researchers. But in order for that to happen, the data will have to find a way into clinical systems, like the electronic health record (EHR).

“Apple’s HealthKit has tremendous potential to help close the gap between consumer collected data and data collected in traditional healthcare settings,” said Epic president Carl Dvorak in an email to VentureBeat. “The Epic customer community, which provides care to over 170 million patients a year, will be able to use HealthKit through Epic’s MyChart application—the most used patient portal in the U.S.”

The “customer community” Dvorak refers to is the hundreds of clinics and hospitals that use the Epic EHR. Patients use the Epic MyChart app to access elements of their own patient record from the Epic EHR. But note that the EHR accesses HealthKit data from the MyChart app, not via a direct integration with the HealthKit platform.

“While Apple will never mirror your Health data to iCloud (or allow another app to do that), once you provision access to another app, they may transport it elsewhere (e.g., to your provider’s EHR), but only if that particular endpoint allows access,” said Malay Gandhi of the accelerator Rock Health.

This may have been by design to avoid regulatory or privacy issues that might have arisen from Apple storing personal health data on its servers and then transmitting it past a health provider’s firewall and into clinical systems within. Here’s how Epic spokesman Brian Spranger describes the movement of data starting at the consumer device and ending at the Epic EHR.

“A consumer health app, like the Withings Scale, will notify HealthKit that it has a new weight and ask HealthKit to store that weight in the database on the iPhone,” he said.

Notice that the weight data that the scale collects doesn’t sit in the HealthKit cloud; it’s on the user’s phone.

“If the patient has given permission for the MyChart app on their phone to know about that data, HealthKit “wakes up” the MyChart app and tells it there’s new data,” Spranger said.

So in this regard, HealthKit acts more like a traffic cop, connecting to devices and directing them to send or store data, all guided by privacy rules.

“The MyChart app on the phone then transmits that weight back to the EpicCare EHR system where it

The problem is the market, not the maker

[quietwalker]

I've done some consulting in the realm of medical software and while I don't know every major in-and-out, the real problem is the market.

Here's an example of bringing a piece of software to the medical market:
    - Come up with the idea for some software, write, debug, document it. **This is not the problem**
    - Find a hospital or clinic, meet with the board (3+ months wait) to see if you can petition it's doctors/nurses/whomever to use your software.
    - Find a group of medical staff that is willing to use said software, free of charge, on the side. You probably have to 'pay' them to do it somehow - give it away for free, or discount, when you actually start selling the software, or just a lot of business lunches. These people cannot legally use your software for actual medical purposes. They're just doubling their workload by using your system next to whatever the current mechanism they use.
    - 6+ months go by. Now it's time to approach the board of directors of the hospital - make a presentation with the recommendations of the software users
    - Now, hire an independent software analyst to review your software, while working with a lawyer - who themselves will work with one or more of the hospital's lawyers - to ensure that you're following all the legal requirements and hopsital software requirements. 1-6 months before you're certified for that hospital.
    - Unfortunately, there may be other requirements that supersede the hospital's individual requirements, usually municipal, state, federal regs. You'll need to get certified on these (0-3 years duration).
    - Finally get it rolled out to the hospitals and sold in the wild (note: repeat the certification steps for each new hospital/hospital group, but they'll be expedited)

Okay, so that's the general process. One part software development, 82 parts legal wrangling, red tape, and butt kissing.

You're also not going to make this thing very open. You won't use public libraries, because they need to be certified. You won't have common data, because every hospital wants different things. You're not going to use new technology or standards because it takes years to get it live, and when you make changes like that you have to start over.

You're also not being paid to add the features to make this externally accessible to god knows what.

Imagine the extra requirements involved in providing legal access to medical records to third parties. It's not a technological barrier; it's almost all legal. They must be certified, the two must have a contract, etc, etc. You can't just give it to anyone who asks - you have to have a legal relationship with each asker. That will have to be signed off on by the board too. And so on, and so on.

The project I did some consulting on? They're basically a sort of spreadsheet with calculations. It's been ~4 years, and it's still bouncing around, not yet fully certified and ready to open for sale. If they went back and added 3'd party export functionality, it'd be another 4.

It is your legal right under HIPAA

[tommeke100]

Under HIPAA regulation (The Privacy Rule to be exact), you have the right to make changes to innacurate information of any PHI (Protected Health Information) they have about you.
So, yes, you may demand some information be removed by law, and they are legally obliged have a procedure in place for it.

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