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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.
Invoke eminent domain to seize the right to share the data, for the common good of citizens health and safety
I live in Madison, Right next to Epic actually. Pretty much all medical facilities in the area use them of course.
The problem is, every time I go into the doctor they tell me about how they can now pull in all my medical history from every other system. It's so great! Yay! The doctors are sooo giddy and I roll my eyes because I know what's coming...
So according to this you have Herpes... no? Strange...
And multiphasic drug abuse? No?
Open heart surgery? Really? No?
and on an on it goes.
EVERY time I go in, all that stuff shows up under my name. No, I do not have a common name like John smith. My real name is very unique. Yet, records that have nothing to do with me get pulled in every time. But the only data transferred is the diagnoses. There is no info on where the data came from, when it happened... nothing. I'm pretty sure I'd remember heart surgery or herpes.
People lie about their names at hospitals all the time to avoid billing, law enforcement, etc... I suspect that's what happened to me. I had a rather unsavory roommate in college. But since the system lacks all detail of the event, I cannot even get it removed. This needs to die... and die theroughly. I should get to chose which records are kept about my health.
A lot of these vendors are locked into their own technologies.
I had interviewed at Epic once (didn't feel like moving to Wisconsin... sorry) and realized that they used M for most of what they did... not much interconnectivity there.
Quo usque tandem abutere, Nimbus, patientia nostra?
No, the reason it's hard has nothing to do with "cloud", and everything to do with "no adherence to a common data schema". If the data was forced to follow a standardized schema, and if standardized service interfaces were required for participating in the government health plan, transferring it would be dead easy. But because different systems have evolved differently over time, the schemas are different, and so transfers remain painful. And because the government funded EPIC without demanding the creation or implementation of industry standards, we crapped away all that money strictly to make one company very, very rich.
The lesson here, kids? If you've got a shot at an upcoming government contract, your best investment dollar is spent on a Congressman. Donate lots of money to his campaign, and you could easily see a 1000 X return on investment. You won't get odds like that gambling on Wall Street.
John
Ah, yes, Judith Faulkner:
http://dailysignal.com/2011/08...
A major donor to the Democratic Party has received favorable treatment from the Obama administration, including a choice appointment to a federal advisory committee, and lavish praise from the president himself.
Yet health information technology vendor Epic Systems Corp. opposes a key administration position on health IT. Its founder, Judith Faulkner, has spoken out on numerous occasions against “interoperability” in electronic medical records technology.
So why was Faulkner appointed to a 13-member panel charged with recommending how $19 billion in stimulus money be spent? One can’t help but notice that Faulkner and other epic employees have given nearly $300,000 to Democrats since 2006.
Read the rest of it.
Do you have ESP?
"HIPAA EDI" is ANSI ASC X12 (specifically committee "N") which is a collection of file formats for communicating business transactions (in this case, generally submitting charge or payment information among providers and insurers), and has very little to do with medical records.
HL7 has created the Consolidated Clinical Document Architecture which hopes and dreams to one day capture provider documentation in an electronic format. The government incentives mandate certain pieces of this document to be supported by certified software, with the pieces differing between the phase 1 (now "2011 Edition") and phase 2 ("2014 Edition") certifications.
These pieces are nowhere near enough to actually transmit something resembling a legal patient record.
Deep down, though, the problem with communication is that every provider has their own style, from the wet-behind-the-ear doc who writes out all their SOAP notes long form over two pages mentioning every little thing like they're still trying to impress their professor, to the 40 year old doc who has made up a single page template with 40 checkboxes for the most common exam findings, a few checkboxes for diagnosis, and a box to write a plan, to the 60 year old who writes "ros/pe:wnl,pt well,flu shot,rtc 1y" on the line below where the nurse wrote the vitals and calls it a day.
What all of the above doctors have in common is that they do NOT want to deal in "structured data". They do not want to deal with SNOMED (or ICD-10, or hell, most of them don't even use ICD-9 that's what they hire billers for). Nobody deals with LOINC (good luck finding out the process used for your urinalysis dipstick so you can code the results correctly. I've got two major national labs that use LOINC for their test results, zero local labs, and zero labs that use LOINC order codes at all. For vitals at least someone in the government bothered to arbitrarily pick codes for height, weight, blood pressure and a few others out of the list of different ways of measuring each of them).