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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.
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.
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?
Invoke eminent domain to seize the right to share the data, for the common good of citizens health and safety
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
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?
You say that with snark (I think) but I have a feeling that GoogleHealth would be far superior to anything offered by today's private shit. Though you'd likely have to watch Ads while in traction, or in the waiting room etc...
Considering that it is the informational infrastructure of a hospital system that is the weak point, not the care itself, Google is clearly pretty damn good at that.
AppleMed on the other hand would suck. Have fun paying 3x for premium couture band-aids. They'd likely excel in plastic surgery.
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
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'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.
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?
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.
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.
Change the penalty terms.
if doctors can't exchange records, they'll face a 1% Medicare penalty,
Make that read "If records produced by a medical record system cannot be read by another system, the vendors of the producing and reading systems will face a 1% Medicare penalty".
We could probably get that change legislated by slipping it in a farm subsidy bill someplace.
Have gnu, will travel.
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.
Sorry. Vision isn't covered by the ACA.
Have gnu, will travel.