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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 mark

by 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.
- Herodotus38 10y ago
  So I am a physician with a large hospital system that uses Epic. I think your comments about poor communication (btw Epic systems) are outdated. For the last two years when I admit a patient I can easily access all Epic records not only in other hospitals in my state, but in the country through their system labeled "CareEverywhere". It is a game changer and is really the main reason why I rank Epic above other EMRs I've used.
  - fredsmith42 10y ago
    That is great for other accesing records from other hospitals that use Epic, but what happens if you want to access the records of a patient who also visits a VA or Cerner hospital? You are still in the dark.
    - Herodotus38 10y ago
      Absolutely, I still have to fax and it's ridiculous how low the bar is. I was just replying to the op that just the fact that Epic can talk to itself at other hospitals (for the record the VA can do this too, but it is slow) makes it relatively great.
  - deleted 10y ago
    [deleted]
  - ensignavenger 10y ago
    How do they prevent abuse? How does a patient know who is accessing their records?
    - Herodotus38 10y ago
      It is primarily through deterrence. Anyone allowed to use an EMR must go through training about HIPAA rules. A waiver is sometimes required that Epic asks you to print out and sign and put in the patient's chart (although they obviously can't prove you did this, it would be an issue if there was a problem later and it turns out you didn't do this, i.e. You would be liable for whatever penalties/prosecution). Furthermore, all usage is recorded and occasionally audited in my system. I'm not 100% sure the auditing is a requirement and true everywhere (definitely with any hospital or large clinic it will be).
nradov 10y ago
The small medical practices are rapidly disappearing. Providers are consolidating in order to have more negotiating power with payers (insurance companies), and the payers and in turn consolidating to have more negotiating power against providers, and so on.
Spooky23 10y ago
That's changing. Big hospital systems are swallowing up small practices. Old school medical practices are dinosaurs.

by Brybry 10y ago

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.

Herodotus38 10y ago
So I am a physician with a large hospital system that uses Epic. I think your comments about poor communication (btw Epic systems) are outdated. For the last two years when I admit a patient I can easily access all Epic records not only in other hospitals in my state, but in the country through their system labeled "CareEverywhere". It is a game changer and is really the main reason why I rank Epic above other EMRs I've used.
- fredsmith42 10y ago
  That is great for other accesing records from other hospitals that use Epic, but what happens if you want to access the records of a patient who also visits a VA or Cerner hospital? You are still in the dark.
  - Herodotus38 10y ago
    Absolutely, I still have to fax and it's ridiculous how low the bar is. I was just replying to the op that just the fact that Epic can talk to itself at other hospitals (for the record the VA can do this too, but it is slow) makes it relatively great.
- deleted 10y ago
  [deleted]
- ensignavenger 10y ago
  How do they prevent abuse? How does a patient know who is accessing their records?
  - Herodotus38 10y ago
    It is primarily through deterrence. Anyone allowed to use an EMR must go through training about HIPAA rules. A waiver is sometimes required that Epic asks you to print out and sign and put in the patient's chart (although they obviously can't prove you did this, it would be an issue if there was a problem later and it turns out you didn't do this, i.e. You would be liable for whatever penalties/prosecution). Furthermore, all usage is recorded and occasionally audited in my system. I'm not 100% sure the auditing is a requirement and true everywhere (definitely with any hospital or large clinic it will be).

nradov 10y ago

The small medical practices are rapidly disappearing. Providers are consolidating in order to have more negotiating power with payers (insurance companies), and the payers and in turn consolidating to have more negotiating power against providers, and so on.

Spooky23 10y ago

That's changing. Big hospital systems are swallowing up small practices. Old school medical practices are dinosaurs.