Slashdot Mirror
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.
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.
We take the penalties. It's not worth dealing with all of the requirements the Feds throw at the small practice to try and comply.
The owner / primary provider has attempted to cut back on the number of federally insured patients in order to avoid dealing with all the crap they attach to their payments. Private insurance is easier to deal with.
As far as I'm concerned, the Federal government hasn't been able to effectively manage a large project since about the Second World War. I'm not entirely certain why anyone thinks they can manage health care, looking at all Federal projects past about the time of the Interstate Highway System.
The primary purpose of HL7 seemed to be enabling massive consulting hours clarifying the poorly-defined HL7 standard.
HIPAA is like HL7 version 2.0. They've dispensed with "poorly-defined" and moved up to "completely arbitrary". The boon this provides... for lawyers... cannot be underestimated.
~ Whence do you come, slayer of men, or where are you going, conqueror of space?
Note that the feds gave docs/hospitals $24 billion to digitalize, of which over half of went either directly to EPIC or to epic contractors.
And this is the source of success of EPIC. Their software is pretty much crap. They hire fleets of college grads, work them for 60+ hour work weeks, burn them out in under 2 years, and replace them with the next lot of inexperienced automatons. The genius isn't in the code, it's in cornering the market of a federally subsidized effort.
"Most people in the U.S. wouldn't know they live in a tyrannical state if it walked up and grabbed their junk." - MyFirs
Bitch, my Constitution is level 18, I shrug off insanely complex standards.
I'm a paladin, so I get my own free healthcare, too.
Looks like you need a saving throw versus sexy.
Complying with HL7 is right next to pointless. The HL7 standard is (despite its name) is NOT standard. One would think that patient demographics would be very easy to assign codes to. Unfortunately, there are many places the information can go and still be considered HL7 compliant. So if one system uses one of these sections and the other system uses another for the same data, they will be unable to effectively exchange information. Each of theses systems' companies will blame the other and insist the other one change their system or, better yet, that the facility using these systems dump the other and purchase their similar system. I believe this is intentional.
You don't see similar problems with electronic banking. As I am fond of saying: You can mess with peoples health and lives, but don't you dare mess with their money.
I would have a sig but I am too busy updating programs and restarting my computer
I have read a fair number of the comments posted here. And, the prevailing consensus is that there really isn't a standard when it comes to sharing health data and medical records between EMR systems.
Somebody mentioned HIPAA EDI in a previous post - those standards, however, are for passing information between entities for claims and not medical records. Why are the records themselves not specified in a publicly published format?
When I worked in the public safety software business, we were involved in many data sharing initiatives across the country. Many states had established their own platforms (Ohio and Wisconsin were pretty far along). But, on the federal level, they introduced GJXDM followed by the more comprehensive NIEM (National Information Exchange Model). The states moved towards this standard. While fairly big and deep, it make it fairly easy for NIEM compliant system to share data with one another. And, while the states built their own "free" records management systems, LE wanted their preferred vendors and the platforms with all the bells and whistles to support NIEM. So, we did.
Outside of this arena, we have HR-XML (for use by Human resources and NOT free). But, if you want to play in that game, you join the group and write systems compliant with it. At least there IS a standard.
What is criminal, in my mind, is that health care systems do not have a standard for describing this information. Nor, do they have a secure infrastructure for passing EMR data even if they did. It should have explicitly detailed as a provision in the ACA (aka Obamacare) so that healthcare providers and insurance carriers to interoperate. EMR vendors and insurance carriers should be REQUIRED and their software certified to comply with data interchange standards (which, may need to be formulated).
EPIC is in a position to set the standard. But, they won't because it means other vendors can get in the pool. So, somebody with really deep pockets and altruistic mindset needs to fund the development of a public standard, set the certification standards, and make it happen.