The current status of our free market economy and the healthcare industry is a cross between âoeFlip This Houseâ and X to the Z's âoePimp My Rideâ. The government insists (with sticks, ie penalties) that all physicians and hospitals start using IT for health records, but sets extremely minimal standards for its IT infrastructure roll out. With carrots (short term incentives) any startup can literally throw crap products together that barely meet the minimal requirements of the government requirements for that given year and contra-spray-gun sell them across the country with a 1-800 number to a clueless India call bank for any sort of support or training or installation.
This has resulted in a cacophony of Pimp-My-Ride EHR (Electronic Health Records) brands lipsticked up by the VC sector with the only intention to lock clients into a known garbage product they are going to flip anyways. For the low low price of $100,000 (they never tell you that up front) and $500/month maintenance contract, you literally get a CD or download, license key and phone number to India. The code, keys and clients are usually sold or merged with another organization within 2 years. Once flipped, clients (physician offices) are at the mercy of the new owner who just bought the code to the old, now sunset and unsupported product. Clients are now forced into buying the next product because it is the only way to preserve/extract their patient data, which physician offices have a legal obligation to maintain for 10 years. The new owners / mergers will never support a sunset product and always force a conversion that takes no less than two years for full roll out and the worthless support they all offer. Then that product gets bought, flipped and sunset... and clients are at the mercy of a new buyer and yet another costly conversion again. They do this every two years. None of these products are ever compatible or have any consistency to easily crosswalk data from one to the other; itâ(TM)s a custom migration solution for each client based on what they were package they were sold by the last owner of their EHR product. Itâ(TM)s a tough pill to swallow for any small business eating hand to mouth on dwindling Medicaid / Medicare reimbursements (another lecture all together). Each migration/ conversion is a fresh start, with usually a 20%-50% decrease in income for at least one year during the training / learning phase for each conversion and implementation of a new product they have just been forced into.
Clients have long spent the government carrots that forced them into this mess, two conversions ago. If you don't continue to ride the conversion wave and continue to go further into debt, government gets out the sticks slowly reduces your income or essentially closes your facility all together with poor quality measures and sanctions for non-compliance. Even if someone threw their hands in the air and said fuck it and closed up shop to become a Wal-Mart greeter, as stated above, physician offices have a legal obligation to maintain medical records for 10 years in an extractable, usable format or migrate to a new âoesupportedâ EHR. The new proud owner of that code and keys are the only people who can extract your data, and there is a fee for that. Itâ(TM)s yet another form legal extortion, or creating indentured servants out of independent physician offices across the country. Many people have tried to sue their EHR vendor, but when a small physicianâ(TM)s office is already in debt $250,000 to the banks for various EHR licensing scams and failed installations that India canâ(TM)t figure out, who could possibly afford years of attorneys fees and litigation?
Healthcare systems need to be able to talk to each other and report/extract meaningful data. There are no two ways about that, and I don't think anyone can argue any legitimate point as to why this isnâ(TM)t mission critical. Government had a great idea and stepped in, but not all the way in like it should have... and left it up to the
Various laws say they are the doctors, who is mandated to keep for ten years. You can get copies or get copies sent to the next guy, but the doc has to keep them.
hehe... ding ding ding. their most recent trick is something you could only write in an episode of Seinfeld. back on topic... the EHR software we used before this didn't play nice with Active Directory. It was essentially written to be run on XP Home boxes. My point is the software requiring that moronic users to have admin access to the local machine, no private practice running this thing on spinning disks can honestly attest to being HIPAA compliant, or having "good" HIPAA policy. Clueless users will stick PHI anywhere they are able. The fact that companies are allowed to fart out this stuff and sell licensing for it should be criminal. The point being all these small offices that have less than 400,000 patients (the threshold to get EPIC to talk to you) need something usable, but the shit software on the market leaves gaping holes that end up getting the client fined as the company that sold them the software, essentially got them in a position of having PHI on a laptop in the first place says "not my fault" and laughs all the way to the bank.
I am militant about an open source software based universal-single-payer healthcare system, having worked in the trenches of the industry for the greater of 20 years. the OSS VA system is one of the best systems in the world. why not just force the entire medical industry to install something similar to be "CMS EHR compliant", give them the software for free and let them find support on the open market. thousands of doctors are stuck holding the bag of debt, waiting to get fined for insecure systems because they've been conned into buying garbage from the proprietary market. not to mention we are now hundreds of billions of dollars spent later and no closer to getting our systems to talk to each other than we were before spending all this money. ffs, *FAXING* is still the only industry standard accepted medium for exchanging patient information between hospital, primary care, specialists and pharmacies.
I am going to assume the hospice is in a similar boat we are... and i will explain how its not as simple as the wand waivers above try to make it sound. I'm essentially the brat mentioned above. Small practice with about 7 providers and about 50 machines... Probably 50/50 desktops and laps. we use a shitbox EHR that was shoved down our throats because our old vendor sold the code to the highest bidder to acquire clients. Me and and 3,000 other clients are stuck with a "new" shit product, $100,000 in debt and India to call for "support". we don't have $22k for one line of SQL code. the EHR requires local users to be admins. Mind blowing. A gpo restriction against data to the local renders the box useless. No matter how many learning moments, hand slaps and write ups you have , users will never understand the difference between My Documents and the shared network drive where stuff is supposed to go. Ironically doctors are the worst. I wrote hundreds of pages of HIPAA policy and then tried to figure out how to encrypt and secure 50 xp machines running on aging dell 2350's/3000's and d510's. state hipaa auditor says we need essentially another $100,000 worth of new stuff and encryption. There is zero IT budget. I just yanked all the drives and am pxe booting thinstation to a terminal session. in the follow up, the auditor agreed it satisfies the encryption issue 100%, and she had never heard of that or seen it done but applauded me. There are thousands of office just like me who have no budget and are already drowning in debt from the non-free software rapists. The number one argument you will get from the business owners is no budget. dwindling reimbursements coupled with exponentially expensive responsibilities like this article make for a rough combo. I feel bad for the chaps in bumblefuck Idaho. They are probably barely scraping by, then this...
I'd pitch the same solution i used that passed the hipaa audit to any of these other offices out there you might find who need help but can't afford anything else. Pass it on./$.02
one of the only reasons that we are not still simple bacteria and stromatolites here on earth is because of the astroid/comet/massive volcano "reset button". every time a large "catastrophe" has taken place, evolution advanced. the strong survived and it spawned, or allowed for, change in our environment to what it is today. the same reason they purposely set forest fires, to allow for new life to seed. Are we advanced as we can possibly be? In the early 1900's the US patent office was almost closed because they thought everything we possibly could ever need was already invented. I think we are a bunch of whiny twats and a reset button might be good for the earth.
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google is your friend here. tldr: no medication or vaccination has 100% efficacy.
linus spoke
The current status of our free market economy and the healthcare industry is a cross between âoeFlip This Houseâ and X to the Z's âoePimp My Rideâ. The government insists (with sticks, ie penalties) that all physicians and hospitals start using IT for health records, but sets extremely minimal standards for its IT infrastructure roll out. With carrots (short term incentives) any startup can literally throw crap products together that barely meet the minimal requirements of the government requirements for that given year and contra-spray-gun sell them across the country with a 1-800 number to a clueless India call bank for any sort of support or training or installation. This has resulted in a cacophony of Pimp-My-Ride EHR (Electronic Health Records) brands lipsticked up by the VC sector with the only intention to lock clients into a known garbage product they are going to flip anyways. For the low low price of $100,000 (they never tell you that up front) and $500/month maintenance contract, you literally get a CD or download, license key and phone number to India. The code, keys and clients are usually sold or merged with another organization within 2 years. Once flipped, clients (physician offices) are at the mercy of the new owner who just bought the code to the old, now sunset and unsupported product. Clients are now forced into buying the next product because it is the only way to preserve/extract their patient data, which physician offices have a legal obligation to maintain for 10 years. The new owners / mergers will never support a sunset product and always force a conversion that takes no less than two years for full roll out and the worthless support they all offer. Then that product gets bought, flipped and sunset... and clients are at the mercy of a new buyer and yet another costly conversion again. They do this every two years. None of these products are ever compatible or have any consistency to easily crosswalk data from one to the other; itâ(TM)s a custom migration solution for each client based on what they were package they were sold by the last owner of their EHR product. Itâ(TM)s a tough pill to swallow for any small business eating hand to mouth on dwindling Medicaid / Medicare reimbursements (another lecture all together). Each migration/ conversion is a fresh start, with usually a 20%-50% decrease in income for at least one year during the training / learning phase for each conversion and implementation of a new product they have just been forced into. Clients have long spent the government carrots that forced them into this mess, two conversions ago. If you don't continue to ride the conversion wave and continue to go further into debt, government gets out the sticks slowly reduces your income or essentially closes your facility all together with poor quality measures and sanctions for non-compliance. Even if someone threw their hands in the air and said fuck it and closed up shop to become a Wal-Mart greeter, as stated above, physician offices have a legal obligation to maintain medical records for 10 years in an extractable, usable format or migrate to a new âoesupportedâ EHR. The new proud owner of that code and keys are the only people who can extract your data, and there is a fee for that. Itâ(TM)s yet another form legal extortion, or creating indentured servants out of independent physician offices across the country. Many people have tried to sue their EHR vendor, but when a small physicianâ(TM)s office is already in debt $250,000 to the banks for various EHR licensing scams and failed installations that India canâ(TM)t figure out, who could possibly afford years of attorneys fees and litigation? Healthcare systems need to be able to talk to each other and report/extract meaningful data. There are no two ways about that, and I don't think anyone can argue any legitimate point as to why this isnâ(TM)t mission critical. Government had a great idea and stepped in, but not all the way in like it should have... and left it up to the
Various laws say they are the doctors, who is mandated to keep for ten years. You can get copies or get copies sent to the next guy, but the doc has to keep them.
hehe... ding ding ding. their most recent trick is something you could only write in an episode of Seinfeld. back on topic... the EHR software we used before this didn't play nice with Active Directory. It was essentially written to be run on XP Home boxes. My point is the software requiring that moronic users to have admin access to the local machine, no private practice running this thing on spinning disks can honestly attest to being HIPAA compliant, or having "good" HIPAA policy. Clueless users will stick PHI anywhere they are able. The fact that companies are allowed to fart out this stuff and sell licensing for it should be criminal. The point being all these small offices that have less than 400,000 patients (the threshold to get EPIC to talk to you) need something usable, but the shit software on the market leaves gaping holes that end up getting the client fined as the company that sold them the software, essentially got them in a position of having PHI on a laptop in the first place says "not my fault" and laughs all the way to the bank. I am militant about an open source software based universal-single-payer healthcare system, having worked in the trenches of the industry for the greater of 20 years. the OSS VA system is one of the best systems in the world. why not just force the entire medical industry to install something similar to be "CMS EHR compliant", give them the software for free and let them find support on the open market. thousands of doctors are stuck holding the bag of debt, waiting to get fined for insecure systems because they've been conned into buying garbage from the proprietary market. not to mention we are now hundreds of billions of dollars spent later and no closer to getting our systems to talk to each other than we were before spending all this money. ffs, *FAXING* is still the only industry standard accepted medium for exchanging patient information between hospital, primary care, specialists and pharmacies.
I am going to assume the hospice is in a similar boat we are... and i will explain how its not as simple as the wand waivers above try to make it sound. I'm essentially the brat mentioned above. Small practice with about 7 providers and about 50 machines... Probably 50/50 desktops and laps. we use a shitbox EHR that was shoved down our throats because our old vendor sold the code to the highest bidder to acquire clients. Me and and 3,000 other clients are stuck with a "new" shit product, $100,000 in debt and India to call for "support". we don't have $22k for one line of SQL code. the EHR requires local users to be admins. Mind blowing. A gpo restriction against data to the local renders the box useless. No matter how many learning moments, hand slaps and write ups you have , users will never understand the difference between My Documents and the shared network drive where stuff is supposed to go. Ironically doctors are the worst. I wrote hundreds of pages of HIPAA policy and then tried to figure out how to encrypt and secure 50 xp machines running on aging dell 2350's/3000's and d510's. state hipaa auditor says we need essentially another $100,000 worth of new stuff and encryption. There is zero IT budget. I just yanked all the drives and am pxe booting thinstation to a terminal session. in the follow up, the auditor agreed it satisfies the encryption issue 100%, and she had never heard of that or seen it done but applauded me. There are thousands of office just like me who have no budget and are already drowning in debt from the non-free software rapists. The number one argument you will get from the business owners is no budget. dwindling reimbursements coupled with exponentially expensive responsibilities like this article make for a rough combo. I feel bad for the chaps in bumblefuck Idaho. They are probably barely scraping by, then this... I'd pitch the same solution i used that passed the hipaa audit to any of these other offices out there you might find who need help but can't afford anything else. Pass it on. /$.02
one of the only reasons that we are not still simple bacteria and stromatolites here on earth is because of the astroid/comet/massive volcano "reset button". every time a large "catastrophe" has taken place, evolution advanced. the strong survived and it spawned, or allowed for, change in our environment to what it is today. the same reason they purposely set forest fires, to allow for new life to seed. Are we advanced as we can possibly be? In the early 1900's the US patent office was almost closed because they thought everything we possibly could ever need was already invented. I think we are a bunch of whiny twats and a reset button might be good for the earth.