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.
Ray Ray@brianpierce @MadMadMadMadRN @tedivm @pluralistic can’t downplay that the hospitals also didn’t want to be interoperable. It’s just bad for business if someone can easily switch where they receive their care.
@prettiest_star @brianpierce @MadMadMadMadRN @pluralistic at the same time most hospitals work with dozens of other medical providers, which really does require solid interop
@tedivm @prettiest_star @MadMadMadMadRN @pluralistic Not the case in #maine at least. I share patients with several big hospital networks here and all of them suck at #EMR interoperability.