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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?
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.
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?
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.