Clinical Rawlsian@pluralistic Something that deserves more attention is the massive consolidation and monopolization of the Electronic Health Record (EHR) industry. Every hospital or hospital system I've ever worked for used software from one of only two companies: Epic or Cerner. Despite their being only two major players left in the field, these systems are not at all interoperable. This both raises healthcare costs and is a massive impediment to care coordination.
Rob Hafner 
@MadMadMadMadRN @pluralistic plus they're just horrible systems to work with in general
Brian Pierce MD@tedivm @MadMadMadMadRN @pluralistic
All these problems and market concentration despite, or because, the feds spent millions to get physicians and hospitals to use #EMRs.
@brianpierce @tedivm @pluralistic The problem wasn't that the Feds required hospitals to use EHRs but rather that they didn't require those EHRs to be interoperable or put in place any standards about usability. So hospital execs bought systems that don't talk to each other (better to keep patients locked into one healthcare org) and that were optimized for insurance billings rather than good care.
@MadMadMadMadRN @tedivm @pluralistic
IIRC, there were interoperability requirements that EMRs had to meet to qualify for Fed. bonuses but the vendors had no interest beyond meeting the letter of the requirements.
I like tech , was an #EMR advocate but used to get nice notes faxed reliably. Now lucky to get 12 pages of crap with 2 paras of info half the time.
The primary customer for #ehr notes are Medicare and insurers who use them to determine complexity for billing, not communication.
@brianpierce @tedivm @pluralistic 100%. I think a big problem with the ACA and the HITECH act was an incredibly naive assumption that hospital executives would make decisions based on what was best for patients. In reality, hospital execs did, as they always do, what was best for their own bottom lines. It is always best to assume that hospital executives will need to be compelled or even coerced into doing the right thing.
Robert Prehn@MadMadMadMadRN @brianpierce @tedivm @pluralistic There's been some recent improvement in the space-- the 21st Century Cures Act more or less requires the EMR vendors to implement the FHIR API standard from HL7. None of the big players are 100% standards-compliant, but it has been getting better in recent releases.
@prehnra @brianpierce @tedivm @pluralistic That's good. To me, the big question is at what point will someone be able to change providers and have all the records from their previous provider imported seamlessly into the new provider's system?
@MadMadMadMadRN @brianpierce @tedivm @pluralistic Yeah, I would love to see that written into regulation as well. Technical standards should provide a standard format. And HIPAA makes the record request-able (mostly). BUT AFAIK, there's no requirement that your HIPAA request come with a machine-readable archive, nor (AFAIK) are EMR vendors required to implement an importer. That's the gap I see today.
iluXan 🤣@brianpierce @MadMadMadMadRN @prehnra @tedivm @pluralistic as someone who works on this, it’s getting there. The FHIR standards will include most of the core treatment info for patients, and every single EMR is required to have it available as of a few days from now :)
So for most patients there will be a straight-forward way to transfer all their data to another doctor if needed
Not sure what standards are involved but I currently get electronic notices from my local Epic using hospital directly into my own cloud based EMR.
The formatting and very low signal /noise ratio of those makes the crappy 12 page printed and faxed notes look wonderfully clear and concise by comparison. 🙄
I could easily miss something important in these.
When I complain, my EMR blames #EpicEHR and hospital isn't able or willing to fix with Epic