4 ms·

I actually work as a director of medical informatics at a large, well known, medical institution that field tested and uses patientkeeper. Sanj's assertions are

I actually work as a director of medical informatics at a large, well known, medical institution that field tested and uses patientkeeper. Sanj's assertions are spot on. I won't adress all of them individually, but they all speak to real problems in the "digitization" of healthcare. For those of you who think any singular device will be the electronic panacea people are waiting for in healthcare you are out of your minds and have no clue about the current state of medical informatics. Getting medical records systems into the healthcare environment with entrenched users is probably harder than getting the us legal system to use them. As I have said in other forums, it is not any singular device or platform that will make this work. The current landscape is that of a patchwork of systems silos, none of whom talk to one another. There is practically zero integration at a platform level and any integration that is done is ad-hoc and custom. If I were advising Obama, et al, I would Incentivise (with a capital I) data interchange over any specific data format or platform. Do not pick winners and losers, in my opinion it is kind of un-American. Let everyone have a fair shake in the market but encourage them to open their systems to integration from third parties through open read/write (bidirectional) api's. This would go a long way to getting new innovative systems into institutions with entrenched legacy systems. Speaking to integration costs, point 2, I could not agree more. Working at any institution other than a small sized private practice requires an untold amount of training, education and ongoing maintenance to get the users to use any system of even minimal complexity. "Wishlist" 1, again spot on. Doctors do not monitor vitals in real time. They just do not have the time, nor is it pertinent to quality of care. What doctors do want are intelligent alerts. But how do you get an intelligent, dynamic, real-time monitoring system that needs access to raw data? See my point above re open api's.

absconditus 17y ago
"The current landscape is that of a patchwork of systems silos, none of whom talk to one another. There is practically zero integration at a platform level and any integration that is done is ad-hoc and custom." I don't understand this part of your comment. I'm not aware of any hospital information system which doesn't support HL7 to some extent.
- siculars 17y ago
  HL7 is simply used as a data format, like json or XML. Newer versions of HL7 are actually XML-ish in format. Saying "HL7" on it's own is nowhere near a solution. What I mean is that systems/platforms need to be encouraged (incentivized) to support bidirectional data exchange in any data format or transport mechanism the market will adopt. Like, say, Twitter. An API that would create and read internal data elements on the individual platform. This would allow systems providers to maintain their proprietary advantages but expose their systems to larger integration. Trust me, the current state of affairs are anti-competition, anti-innovation and down right piss poor for patient medical care.
  - absconditus 17y ago
    The HL7 specification defines specific message segments for specific kinds of clinical data. It defines the events which should trigger different types of messages. It defines a minimal protocol to be used to transmit messages (which nearly everyone uses). It is not at all analogous to JSON nor XML. HL7 3.x isn't just XML-ish; it allows the use of standard XML (in addition to the classic delimited format). Again, I don't know of any hospital system which doesn't offer one or more specific HL7 interfaces (ADT, results, billing, etc.). It is very common for hospitals to have clinical document repositories which accept multiple formats. While I agree with your general sentiments about the state of the industry, I don't believe the problem to be a lack of standards or opportunities for integration. Additionally, the incentives you speak of will happen at the end of the year. See my comment elsewhere about CCD/CDA (CDA is part of the HL7 standards). ARRA funds will be available at the end of the year for systems which implement HITSP standards (I'm oversimplifying a bit).
    - absconditus 17y ago
      I wanted to add that I believe the industry's biggest problem to be a lack of software development talent. No top MIT graduate is torn between working for Google and working on automating the paper workflow of a hospital. Although there are several standards available for specific types of information exchange they are rarely implemented properly. They are also poorly designed. The CCD standard is quite atrocious.

absconditus 17y ago

"The current landscape is that of a patchwork of systems silos, none of whom talk to one another. There is practically zero integration at a platform level and any integration that is done is ad-hoc and custom." I don't understand this part of your comment. I'm not aware of any hospital information system which doesn't support HL7 to some extent.

siculars 17y ago
HL7 is simply used as a data format, like json or XML. Newer versions of HL7 are actually XML-ish in format. Saying "HL7" on it's own is nowhere near a solution. What I mean is that systems/platforms need to be encouraged (incentivized) to support bidirectional data exchange in any data format or transport mechanism the market will adopt. Like, say, Twitter. An API that would create and read internal data elements on the individual platform. This would allow systems providers to maintain their proprietary advantages but expose their systems to larger integration. Trust me, the current state of affairs are anti-competition, anti-innovation and down right piss poor for patient medical care.
- absconditus 17y ago
  The HL7 specification defines specific message segments for specific kinds of clinical data. It defines the events which should trigger different types of messages. It defines a minimal protocol to be used to transmit messages (which nearly everyone uses). It is not at all analogous to JSON nor XML. HL7 3.x isn't just XML-ish; it allows the use of standard XML (in addition to the classic delimited format). Again, I don't know of any hospital system which doesn't offer one or more specific HL7 interfaces (ADT, results, billing, etc.). It is very common for hospitals to have clinical document repositories which accept multiple formats. While I agree with your general sentiments about the state of the industry, I don't believe the problem to be a lack of standards or opportunities for integration. Additionally, the incentives you speak of will happen at the end of the year. See my comment elsewhere about CCD/CDA (CDA is part of the HL7 standards). ARRA funds will be available at the end of the year for systems which implement HITSP standards (I'm oversimplifying a bit).
  - absconditus 17y ago
    I wanted to add that I believe the industry's biggest problem to be a lack of software development talent. No top MIT graduate is torn between working for Google and working on automating the paper workflow of a hospital. Although there are several standards available for specific types of information exchange they are rarely implemented properly. They are also poorly designed. The CCD standard is quite atrocious.