The Billionaire Who Controls Your Medical Records (2021)

It really is. And it's not good software. The UI looks decidedly amateur, and some of the modules are absolute garbage amateur hour (one I see a lot in my job is the ED track board, which captures information from the ED charge nurse about incoming ambulances, bed holds and cleaning needs, and gives a picture on what the ED might look like in the next hour or so).

It looks like a VB app from the 90s. Text layout is poor, often overflowing boxes, it's not customizable.

Epic is where it is because hospitals are so fucking locked in.

This is not universally true, but I don’t know where your family works or in what capacity. There are a lot of issues with epic but unfortunately it is the best out of all the garbage out there. Out of all the EMR’s I have used, Epic is the easiest to share information both within different hospitals using epic and sharing from epic to other emrs like Cerner. Source: Am physician who has worked in many different hospitals, and use Cerner currently, grabbing info from Epic most days.

My wife is dealing with cancer and associated complications at three distinct hospitals and a national cancer center.

The two hospitals on Epic are great - all of her records are immediately exchanged. The third hospital has a shitty cerner system and has problems sharing between departments. The cancer center has an excellent patient portal but doesn’t integrate.

Ultimately these problems are difficult as the creation of Medicare and Medicaid happened during the early days of computing. So we’re stuck with 75 years of legacy.

On the contrary: when I moved from Kaiser to Sutter, it was a single push-button to move my entire EHR over (once I consented to the doctor). The doctor told me it's generally that easy when you have two Epic instances (note: I'm not directly denying what you say, because I know enough about Epic and EHRs to be suprised at my doctor's ease).

"Open, simple, interoperable formats are the way out. We need more of these, especially in the health care sector."

We're getting there quickly with FHIR!

True facts.

Source - I design medical devices

Hospital documentation (charting) policies are driven mainly by payer coverage rules and government care quality metrics. Administrator desire for stats and trends is much less of a factor.

There is a huge amount of waste and inefficiency in most provider organizations so any attempts at process improvement should be encouraged. As the industry moves toward value-based care reimbursement models there will be more financial incentives to do so.

That may be because when something like Epic or PACS (or other tier 1 systems, or the network/data center/power/etc) is down longer than X time the hospital will go into diversion, meaning as many ED patients as possible are diverted to a different nearby hospital.

And paper workflows can be fast in the moment but cause absolute chaos for cleaning up, reconciliation, and moving data between departments.

Source: Worked with many hospitals, including ones with Epic.

> Then you're not allowed to follow up on patients and complete the feedback loop of care, because they're no longer an ER patient, and you're not allowed to inquire any more.

This is factually incorrect. Healthcare providers are allowed to share information about the specifics of care provided to a patient, and, crucially, they are allowed to do so, within limitations, without the explicit consent of the patient (many practices will have you sign consent paperwork for CYA).

It does not require a responding provider to share information upon request with other providers, but they absolutely are allowed to do so.

To be very clear:

> Yes. The Privacy Rule allows covered health care providers to share protected health information for treatment purposes without patient authorization, as long as they use reasonable safeguards when doing so.

Source: https://www.hhs.gov/hipaa/for-professionals/faq/482/does-hip...

You’re going to have to explain how HIPPA privacy slows things down because, frankly, it’s one of the most important privacy laws for citizens I can can think of.

It's not HIPPA, as others have stated HIPPA does not require that your software sucks. It just requires that it doesn't leak sensitive (or any) personal healthcare information.

Source - I design medical devices that are HIPPA compliant and our software does not suck.

That is simply misinformation. HIPAA rules do not prevent healthcare providers from following up with patients. You should read the actual HIPAA final rule.

Oracle might actually be an improvement over Cerner.

There is actually not much regulatory capture in the EHR market. The FDA doesn't classify most of those products as regulated medical devices. Provider organizations are required to implement certain open interoperability standards so that authorized parties can securely access patient charts so they are unlikely to buy an EHR without those features. But the required APIs are fairly easy for any competent engineering team to build, and there are open source libraries like HAPI FHIR which already get you halfway there.

https://www.healthit.gov/topic/oncs-cures-act-final-rule

The real barrier to entry is relationships. Epic has made huge investments in direct sales and consulting services to give the decision makers in large provider organizations exactly what they want.

Epic Systems was founded in 1979. The Affordable Care Act was passed in 2010, and the Health Insurance Marketplace — a market-driven system — opened in 2014. Epic is not the result of "Obamacare".

Also, Epic deals with medical records, while the ACA deals with health insurance. These are two separate domains.