6 ms·

As a programmer for an American EHR firm -- all of the market share already belongs to one of those companies you malign. You could not have had the government

by criley2 10y ago

As a programmer for an American EHR firm -- all of the market share already belongs to one of those companies you malign. You could not have had the government sponsor some new software which would eliminate a billion dollar software market. It's a non-starter. All the hospitals already are signed on multi-year contracts with those large providers. Some of the EHR providers began writing medical software for hospitals in the 1960s and 1970s. These companies have multi-decade relationships with the hospitals they service, and decades of patient data stored. What Obama and the Democrats did was to break the "paper cycle". Many hospitals used paper-only system with very little software even into the 2000's and 2010's. The point of investing in each company was to jumpstart their products into meeting the huge new regulations, and the point of giving clients money to buy this new software was to break the paper cycle. There is no "one size fits all" option in the American market. I find it funny that you malign our practice as "(idiotic)" when it is your plan, quite frankly, which is so ignorant to the complicated history and reality of medical providers and their software, that seems idiotic to me. Your opinion sounds to me like "The US Gov should, instead of using MS Windows, pay a company to invent a new operating system, then ban all use of Windows, OSX and Linux to ensure all firms must use the single new solution". We already had so many options that have existed for decades, with so many clients, and so much built-out software infrastructure. There was no "one-size-fits-all" solution unless your solution includes "Destroy the entire industry, and use force of government to destroy a half dozen major software companies in favor of the government mandated and almost assuredly inferior option" The crux you may not realize is how customized every major hospital system expects their EHR software to be. I don't think you realize the sheer level of customization these networks require, due to the size and scope of their businesses. It takes entire teams of my company to service certain major clients. The idea of a one-size-fits-all would have been laughed out of our country.

mtourne 10y ago
Not entirely related, but the pain of the "paper cycle" as a "customer" of health-care is real. It seems as if to avoid dealing with hipaa regulation it's all paper, fax machine, and come pick up your x-rays burnt on a cd during your work hours (cd that you have to buy). Having not grown in the states, this type of practices seems very primitive to me. Amongst many other aspects of the American healthcare, but that's another debate.
- vanattab 10y ago
  I am actually not opposed to the "CD you have to buy" policy. If I was hospital network admin I would not want people just plugging in random usb sticks into my network.
  - cmiles74 10y ago
    I think the expectation is that these organizations should be able to send this data to each other. That they was put the data on a disk and then give that to a patient who the drives it over to another part of town and hands the disk over is a ridiculous waste of everyone's time. It also highlights how far the entrenched vendors and hospitals will go to keep their customers "locked in."
    - nradov 10y ago
      And in most cases they can send that data to each other, at least in the sense that their existing systems are capable of interoperating based on open standards. But to make it work the provider organizations often have to configure and test data interfaces with other organizations. That's an expensive process and no one wants to pay for it.
- deleted 10y ago
  [deleted]
Brybry 10y ago
But most physicians don't work for hospitals. They work at small practices with 10 physicians or fewer (according to the AMA). There was a completely open market, made of the majority of physicians, regardless of existing provider contracts with hospitals. I know I talked to a few physicians (and other healthcare professionals) in the mid-2000s who lamented the paperwork they had to do every day and the lack of available computer automation.
- keltor 10y ago
  Unfortunately with the consolidation into medical "groups" that has been going on among doctors and with the hospitals offering "deals" along side those vendors they use for the doctors to adopt them, a lot of doctor's groups have adopted whatever system they are most integrated with's EHR. There's a ton of slimy dealings going on sadly.
- entee 10y ago
  The issue with small practices and even slightly larger physician's groups is that an EMR is often just a cost, with very little benefit. If you're a hospital with lab facilities, imaging facilities, surgical facilities etc. it's hugely useful to have medical records flow internally (quasi-)seamlessly. The EMR does that well, and the large cost of typing things into the EMR (it's slow, painful, annoying, never met a doc who preferred it to the old clipboard and notes system) is totally worth it. For a small practice, that intercommunication problem isn't anywhere near as large, but the cost of typing things in painfully is the same. So small practices hate it. And before you say, "but it's useful to share medical records between offices/specialists/hospitals when they move around", it turns out that a lot of these systems don't play very well with one another. Even between two healthcare systems that share the same software provider (in this case Epic, one of the big two, the other one is Cerner), I've heard people finding it easier to print it out, fax it over, and scan it back in. Yes there are people who want to solve that problem, (see YC's own https://www.patientbank.us https://www.patientbank.us), but it's a tough area because who pays for the service? How expensive is it to build software that interacts with all the 10 zillion different flavors of Epic? How do you harmonize the peculiarities in how people actually record the data in those systems? It's really really hard.
bebop 10y ago
I think that the big push to move to EHR's was actually started by Bush. I am sure that Obama continued this push though.
angersock 10y ago
> The crux you may not realize is how customized every major hospital system expects their EHR software to be. The crux that you may not realize is that this customization was done mostly to boost profits and promote vendor lock-in. This was aided by the .gov failing to make public and standardized requirements for things like medical records (and no, referring to an AAMI or whatever doc that costs serious coin to view doesn't count!). > . There was no "one-size-fits-all" solution unless your solution includes "Destroy the entire industry, and use force of government to destroy a half dozen major software companies in favor of the government mandated and almost assuredly inferior option" BULLSHIT. Epic is built on MUMPS, arguably one of the worst languages ever designed. Hyperspace is garbage. Their systems are garbage. They get by because they've attached like gigantic leeches to hospitals. Cerner, Allscripts, and others aren't much better. > Many hospitals used paper-only system with very little software even into the 2000's and 2010's. Feature not bug--notice how much more physicians and nurses seemed to like those systems. ~ Look, your entire industry is fucking cancer and the sooner the .gov decides to use truly open standards the sooner some hungry companies can clean out all the garbage you and others have managed to clog institutions with. You should be ashamed.
- nradov 10y ago
  That's simply false. Hospitals and other large provider organizations often do insist on extensive customization and non-standard configuration during EHR implementations. I've seen it happen. They'll spend weeks going around in circles about ridiculous issues like the placement of a logo and the format of a lab result document. You really can't blame the vendors for that.
  - Spooky23 10y ago
    All enterprise customers are stupid about COTS customization. That doesn't change the fact that the software surrounding the entire medical industry is largely ridiculous legacy crap maintained by a little cartel of fat & lazy vendors with a captive market. With good reason btw... these systems were the earliest big data processing shops. Blue Cross and Medicare was doing centralized billing for healthcare since before fax machines were popular.

by criley2 10y ago

mtourne 10y ago

Not entirely related, but the pain of the "paper cycle" as a "customer" of health-care is real. It seems as if to avoid dealing with hipaa regulation it's all paper, fax machine, and come pick up your x-rays burnt on a cd during your work hours (cd that you have to buy). Having not grown in the states, this type of practices seems very primitive to me. Amongst many other aspects of the American healthcare, but that's another debate.

vanattab 10y ago
I am actually not opposed to the "CD you have to buy" policy. If I was hospital network admin I would not want people just plugging in random usb sticks into my network.
- cmiles74 10y ago
  I think the expectation is that these organizations should be able to send this data to each other. That they was put the data on a disk and then give that to a patient who the drives it over to another part of town and hands the disk over is a ridiculous waste of everyone's time. It also highlights how far the entrenched vendors and hospitals will go to keep their customers "locked in."
  - nradov 10y ago
    And in most cases they can send that data to each other, at least in the sense that their existing systems are capable of interoperating based on open standards. But to make it work the provider organizations often have to configure and test data interfaces with other organizations. That's an expensive process and no one wants to pay for it.
deleted 10y ago
[deleted]

Brybry 10y ago

But most physicians don't work for hospitals. They work at small practices with 10 physicians or fewer (according to the AMA). There was a completely open market, made of the majority of physicians, regardless of existing provider contracts with hospitals. I know I talked to a few physicians (and other healthcare professionals) in the mid-2000s who lamented the paperwork they had to do every day and the lack of available computer automation.

keltor 10y ago
Unfortunately with the consolidation into medical "groups" that has been going on among doctors and with the hospitals offering "deals" along side those vendors they use for the doctors to adopt them, a lot of doctor's groups have adopted whatever system they are most integrated with's EHR. There's a ton of slimy dealings going on sadly.
entee 10y ago
The issue with small practices and even slightly larger physician's groups is that an EMR is often just a cost, with very little benefit. If you're a hospital with lab facilities, imaging facilities, surgical facilities etc. it's hugely useful to have medical records flow internally (quasi-)seamlessly. The EMR does that well, and the large cost of typing things into the EMR (it's slow, painful, annoying, never met a doc who preferred it to the old clipboard and notes system) is totally worth it. For a small practice, that intercommunication problem isn't anywhere near as large, but the cost of typing things in painfully is the same. So small practices hate it. And before you say, "but it's useful to share medical records between offices/specialists/hospitals when they move around", it turns out that a lot of these systems don't play very well with one another. Even between two healthcare systems that share the same software provider (in this case Epic, one of the big two, the other one is Cerner), I've heard people finding it easier to print it out, fax it over, and scan it back in. Yes there are people who want to solve that problem, (see YC's own https://www.patientbank.us https://www.patientbank.us), but it's a tough area because who pays for the service? How expensive is it to build software that interacts with all the 10 zillion different flavors of Epic? How do you harmonize the peculiarities in how people actually record the data in those systems? It's really really hard.

bebop 10y ago

I think that the big push to move to EHR's was actually started by Bush. I am sure that Obama continued this push though.

angersock 10y ago

> The crux you may not realize is how customized every major hospital system expects their EHR software to be. The crux that you may not realize is that this customization was done mostly to boost profits and promote vendor lock-in. This was aided by the .gov failing to make public and standardized requirements for things like medical records (and no, referring to an AAMI or whatever doc that costs serious coin to view doesn't count!). > . There was no "one-size-fits-all" solution unless your solution includes "Destroy the entire industry, and use force of government to destroy a half dozen major software companies in favor of the government mandated and almost assuredly inferior option" BULLSHIT. Epic is built on MUMPS, arguably one of the worst languages ever designed. Hyperspace is garbage. Their systems are garbage. They get by because they've attached like gigantic leeches to hospitals. Cerner, Allscripts, and others aren't much better. > Many hospitals used paper-only system with very little software even into the 2000's and 2010's. Feature not bug--notice how much more physicians and nurses seemed to like those systems. ~ Look, your entire industry is fucking cancer and the sooner the .gov decides to use truly open standards the sooner some hungry companies can clean out all the garbage you and others have managed to clog institutions with. You should be ashamed.

nradov 10y ago
That's simply false. Hospitals and other large provider organizations often do insist on extensive customization and non-standard configuration during EHR implementations. I've seen it happen. They'll spend weeks going around in circles about ridiculous issues like the placement of a logo and the format of a lab result document. You really can't blame the vendors for that.
- Spooky23 10y ago
  All enterprise customers are stupid about COTS customization. That doesn't change the fact that the software surrounding the entire medical industry is largely ridiculous legacy crap maintained by a little cartel of fat & lazy vendors with a captive market. With good reason btw... these systems were the earliest big data processing shops. Blue Cross and Medicare was doing centralized billing for healthcare since before fax machines were popular.