Doctors Find Barriers to Sharing Digital Medical Records | Hacker News Reader

Doctors Find Barriers to Sharing Digital Medical Records

nytimes.com

4 pointsandrewl4 comments

There are no enforceable standards and no governmental body has come together to figure out the standards for data transfer. I don't think its going to readily happen either. Currently, each company (the Epics, GEs, etc) will ALWAYS say that their product is the best and their standards should be the ones used. No one wants to give so they don't play nice with each other. They are leveraging the built in incompatibilities to make more money and there is nothing wrong with that. Plus, there are no economic reasons (like fines and quite frankly most patients don't need to go between large systems for care so there is no driving force from patients) to force them to play nice.

In this case, the free market can be the solution. In this fact, Judith Faulkner is wrong (and she is passing the buck). The government does not need to get involved and write standards. Especially if it is anything like the way the government has done other standards. If they did they would invite in the manufacturers to sit on a committee and each one would push and pull until the standard includes all of the features of their respective software systems. Before you know it, the standard is bloated, useless, and costly to implement. The solution is the free and open market. Some enterprising group of healthcare providers and practitioners, along with their IT teams, need to come together and form a group (away from the influence of the software manufacturers) to write the spec. They then need to form an alliance organization that calls on its members to require their systems to implement the group's specification. That way as a group (much like health insurance pooling) they have a large enough force to get manufacturers to listen to their needs. Because it costs millions to implement an EHR/EMR this path would not provide instant results for those who have already implemented a system or are in the process of implementing one. But as healthcare practitioners and providers upgrade to new versions they would gain the functions of their spec.

As someone who works in this field, there actually are government standards and working groups that involve all the vendors. I'm talking about in the U.S. - Europe has a much more varied ecosystem and standards appear harder to agree upon. In the U.S. the standard is the Consolidated Clinical Document Architecture (C-CDA)(http://www.healthit.gov/policy-researchers-implementers/cons...). The government body involved is the ONC (Office of the National Coordinator)(http://www.healthit.gov/newsroom/about-onc). The only problem at the moment is the finalization of the draft proposals and the vendor-specific interpretations of the standard. It's getting there but obviously the details are slow to work out.

Thats a good point. In the US the ONC/HIT at HHS has put out recommendations and rules for the schemas for data storage. Which is what the documents you reference are about they are about defining the building blocks used to store and capture health data. But, they do not define how they are transported or exchanged. The C-CDA even notes this, the "CDA DOES NOT specify how documents are transported, simply how critical data elements should be encoded for exchange and interoperability". Its the same thing for HL7 and all those great ICD9 and ICD10 codes. They are just building blocks not rules for transport. (I also know a thing or two about the field. We are magnetic buddies.)

Am I the only one who thought judith faulkner's quote was hillarious?

"Let’s say a patient is coming from U.C.L.A. and going to the University of Chicago, an Epic-to-Epic hospital. Boom. That’s easy"

Well no kidding! Your company wrote the software. Its like saying its easy to mix 2 packets of Grape Jello together to make a larger serving. Of course that will work! I would be slightly terrified if it wasn't possible. Plus, they wrote Epic Care Everywhere to exchange data between healthcare providers. Its part of the selling point of their software! "Buy us, we have half of 'Merica covered so you can exchange patient records like relz easy." (not an actual quote).

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