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Comment by mikewarot | Hacker News Reader

I always wondered why so many hospitals adopted EPIC, it's got the worst UI I've ever seen. This article provides insight to complete the picture: network effects, and lock-in.

It's likely resulted in many deaths. When my friend worked ER, any time Epic went down, they simply switched back to paper forms, the ER waiting room would empty within a few hours. EPIC is, in my opinion, a large fraction of why ER waiting rooms are always full these days.

Between Epic and HIPPA privacy rule[1], the effectiveness of emergency care in the US can only spiral downward. You're forced to slow down(because of EPIC) and fill out a bunch of online forms before you can let a patient go, filling the ER.

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.

[1] https://en.wikipedia.org/wiki/Health_Insurance_Portability_a...

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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...

That may be what the law allows, but it wasn't what the hospital in question allowed.

Maybe, but you said "Between EPIC and the HIPAA privacy rule..."

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.

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