4 ms·

EMR is simply too messy for openEMR to put a dent in the issue. I truely wish it were different. If insurance carriers are permitted to operate across state l

EMR is simply too messy for openEMR to put a dent in the issue. I truely wish it were different. If insurance carriers are permitted to operate across state lines in the future, i think there is a chance of a Google or Microsoft getting into the space which I think is the right way to go. Right now, the large companies managing EMR and huge monoliths that simply don't care about innovation. They are like defense contractors to the military. If the market ever opens up and consumers have more choice, its clear that someone like google or MS would win and I honestly believe really give healthcare a boost in this country.

nradov 10y ago
That's not how the EMR market works. Insurance sales across state lines won't make much difference to EMRs either way. Google and Microsoft are horizontal vendors. They aren't likely to put a major effort into a vertical market, and even if they did there's no reason that they would do it any better than the existing vendors. It's not like Google and Microsoft have some sort of magic pixie dust that would allow them to overcome experienced vendors in a brutally competitive market.
- ipunchghosts 10y ago
  > It's not like Google and Microsoft have some sort of magic pixie dust that would allow them to overcome experienced vendors in a brutally competitive market. They have analytics, "moneyball" so to speak. There is a plethora of untapped data in these systems. I've worked with Gesinger in PA and you would not believe how far behind the curve they are and they are often touted to be on the forefront. What needs to happen is getting google or MS into health insurance. They could utilize all the data collected to benefit the patients and make a big profit. Additionally, they have the know how to set up a pharm lab for drug development. Insurance companies really should drive drug development. It makes sense for them to develop drugs for conditions costing them the most amount of money per patient. Instead, they are middle men who have to work with whatever big pharma give them.
  - nradov 10y ago
    I don't think you've been paying attention. All the major payers Health IT vendors have analytics as good as anything at MS or Google, to the point where it's almost becoming a commodity rather than a real differentiator. Yes provider organizations are behind the curve in actually using those tools due to misaligned incentives but adding another vendor to the market won't solve that problem. Payers have no interest in driving drug development. It wouldn't give them any competitive advantage. It's not like they could restrict sales of a new drug to only their own members! And most payers are providing very little "insurance" now anyway. Mostly they just process claims on behalf of self-insured group buyers. And the notion of those companies getting into medical insurance or drug development is just ludicrous. Their corporate boards would laugh the idea out of the room.
    - ipunchghosts 10y ago
      > I don't think you've been paying attention. All the major payers Health IT vendors have analytics as good as anything at MS or Google, I work with the Geisinger health system at a major US University doing analytics work for them. They are far ahead of most other systems and they are woefully behind.
entee 10y ago
To test this hypothesis, look to California. Here we have a very large healthcare system, a variety of insurance providers, a variety of care providers and no internal barriers to insurance competition. Still, practices/insurers use different EMRs, sometimes a little different from one another, sometimes radically so. Further, providers/insurers are loathe to move away from systems they already have because of some of the issues mentioned by @JusticeJuice (currently top comment). 1.) It's super complicated 2.) It's super risky 3.) It's super hard to buy and sell, in part because of 1.) and 2.). Even without barriers to competition, there's no consolidated EMR format or a software market with many competing players, what makes you think that opening it up nationally would revitalize the market?
tunesmith 10y ago
Insurance companies are already allowed to sell across state lines. http://www.modernhealthcare.com/article/20161010/NEWS/161019992 http://www.modernhealthcare.com/article/20161010/NEWS/161019... https://www.forbes.com/sites/brucejapsen/2016/10/10/sorry-trump-selling-health-insurance-across-state-lines-wouldnt-lower-costs/#26f4e0b15140 https://www.forbes.com/sites/brucejapsen/2016/10/10/sorry-tr...
JusticeJuice 10y ago
https://en.wikipedia.org/wiki/Google_Health https://en.wikipedia.org/wiki/Google_Health They did try actually
- clock_tower 10y ago
  They aren't even the only ones who moved into the EHR space, discovered that it's a nightmare, and moved back out. GE bought one of the smaller "big ten" vendors (IDX) in the late 2000s, then gave up and spun off the formerly-IDX EHR; even Siemens came, saw, and left.
swalsh 10y ago
Google actually gave it a shot, and then eventually gave up. https://en.wikipedia.org/wiki/Google_Health https://en.wikipedia.org/wiki/Google_Health
- FLUX-YOU 10y ago
  That sounds more like a patient portal used by patients. Building something for physicians, nurses, revenue personnel, lab personnel, and practice managers is a completely different game.
  - neandrake 10y ago
    I think the idea they were going for is that Google Health would be an EMR intended to be used by institutions except that the patient is in control of their record - enabling them to take their health record to any provider. The problem is that institutions have close to no reasons for investing into something like that. I think Microsoft HealthVault was more of what you describe, where it's a portal intended to be used by patients.
    - nradov 10y ago
      No, @FLUX-YOU has it right. Google Health was only ever intended as a patient portal (PHR) and was a direct competitor to Microsoft HealthVault. Google never added any EMR features. In fact after the initial release they never added any features at all; they just lost interest in it and shut it down.
  - entee 10y ago
    It turns out re. docs and nurses, not really. It's important to understand the who pays for what in healthcare, and how many links in the chain exist between payer, payee and who benefits. Physicians and nurses are not able to pick whatever software they want to view patient data because 1.) you need high security all around that data, and 2.) that data is primarily useful to someone else. It's useful to the doctor because they want to treat the patient. It's a lot more useful to the hospital because they want to get paid for what was done. So the hospital is willing to shell out a ton of cash so that they have a Very Secure system that helps them better manage their cash flow. If you walk in as a doc with (for example) a nifty phone app that lets you track your patients in real time, you'll confront 2 problems: 1.) the hospital won't let you connect because it'll assume (possibly incorrectly) that it's a huge security hole. 2.) even if they did let you connect, their EMR is non-standard (basically all of them end up non-standard) and there's no lingua franca protocol for medical data, so your app is incompatible. It's really really tricky to solve all those issues AND have it be cheap enough for a doc to be willing to shell out for it out of pocket. I personally you'd need that kind of consumer-side scale to get enough competition to get medical software to innovate more quickly. I will say a common interchange format would help a lot, that's one of the objectives FHIR had, and the industry has been slowly adopting it. You accurately point out revenue personnel and practice managers as key players here, and yes they're the ones that usually push EMRs etc. But the front line workers are kind of disconnected from the design and functionality of the EMR. Put another way you have software that's bought by one person (hospital/provider), it's used to collect data by a totally different person with different needs (docs/nurses), and it's paid for eventually by another person who has no idea how it works nor any direct pressing need for it (patient/but let's be real, insurance company/government). Without a tight connection between who pays for the software, who uses the software and who benefits from the software (most consumer software is a pretty tight loop), it's hard to have a good virtuous cycle of innovation coming from customer/user insight/observation/needs.
gmarx 10y ago
your faith in Microsoft and Google is heartwarming and hilarious. I've been hearing this for over 20 years, as soon as the real smart tech people get involved we'll have this problem solved lickity split. Well, both those companies have tried to lick healthcare and both ran away with their tails between their legs after they took a crap on the bed. Healthcare information tech sucks because it's innately more difficult than most other problem spaces

nradov 10y ago

That's not how the EMR market works. Insurance sales across state lines won't make much difference to EMRs either way. Google and Microsoft are horizontal vendors. They aren't likely to put a major effort into a vertical market, and even if they did there's no reason that they would do it any better than the existing vendors. It's not like Google and Microsoft have some sort of magic pixie dust that would allow them to overcome experienced vendors in a brutally competitive market.

ipunchghosts 10y ago
> It's not like Google and Microsoft have some sort of magic pixie dust that would allow them to overcome experienced vendors in a brutally competitive market. They have analytics, "moneyball" so to speak. There is a plethora of untapped data in these systems. I've worked with Gesinger in PA and you would not believe how far behind the curve they are and they are often touted to be on the forefront. What needs to happen is getting google or MS into health insurance. They could utilize all the data collected to benefit the patients and make a big profit. Additionally, they have the know how to set up a pharm lab for drug development. Insurance companies really should drive drug development. It makes sense for them to develop drugs for conditions costing them the most amount of money per patient. Instead, they are middle men who have to work with whatever big pharma give them.
- nradov 10y ago
  I don't think you've been paying attention. All the major payers Health IT vendors have analytics as good as anything at MS or Google, to the point where it's almost becoming a commodity rather than a real differentiator. Yes provider organizations are behind the curve in actually using those tools due to misaligned incentives but adding another vendor to the market won't solve that problem. Payers have no interest in driving drug development. It wouldn't give them any competitive advantage. It's not like they could restrict sales of a new drug to only their own members! And most payers are providing very little "insurance" now anyway. Mostly they just process claims on behalf of self-insured group buyers. And the notion of those companies getting into medical insurance or drug development is just ludicrous. Their corporate boards would laugh the idea out of the room.
  - ipunchghosts 10y ago
    > I don't think you've been paying attention. All the major payers Health IT vendors have analytics as good as anything at MS or Google, I work with the Geisinger health system at a major US University doing analytics work for them. They are far ahead of most other systems and they are woefully behind.

entee 10y ago

To test this hypothesis, look to California. Here we have a very large healthcare system, a variety of insurance providers, a variety of care providers and no internal barriers to insurance competition. Still, practices/insurers use different EMRs, sometimes a little different from one another, sometimes radically so. Further, providers/insurers are loathe to move away from systems they already have because of some of the issues mentioned by @JusticeJuice (currently top comment). 1.) It's super complicated 2.) It's super risky 3.) It's super hard to buy and sell, in part because of 1.) and 2.). Even without barriers to competition, there's no consolidated EMR format or a software market with many competing players, what makes you think that opening it up nationally would revitalize the market?

tunesmith 10y ago

Insurance companies are already allowed to sell across state lines. http://www.modernhealthcare.com/article/20161010/NEWS/161019992 http://www.modernhealthcare.com/article/20161010/NEWS/161019... https://www.forbes.com/sites/brucejapsen/2016/10/10/sorry-trump-selling-health-insurance-across-state-lines-wouldnt-lower-costs/#26f4e0b15140 https://www.forbes.com/sites/brucejapsen/2016/10/10/sorry-tr...

JusticeJuice 10y ago

https://en.wikipedia.org/wiki/Google_Health https://en.wikipedia.org/wiki/Google_Health They did try actually

clock_tower 10y ago
They aren't even the only ones who moved into the EHR space, discovered that it's a nightmare, and moved back out. GE bought one of the smaller "big ten" vendors (IDX) in the late 2000s, then gave up and spun off the formerly-IDX EHR; even Siemens came, saw, and left.

swalsh 10y ago

Google actually gave it a shot, and then eventually gave up. https://en.wikipedia.org/wiki/Google_Health https://en.wikipedia.org/wiki/Google_Health

FLUX-YOU 10y ago
That sounds more like a patient portal used by patients. Building something for physicians, nurses, revenue personnel, lab personnel, and practice managers is a completely different game.
- neandrake 10y ago
  I think the idea they were going for is that Google Health would be an EMR intended to be used by institutions except that the patient is in control of their record - enabling them to take their health record to any provider. The problem is that institutions have close to no reasons for investing into something like that. I think Microsoft HealthVault was more of what you describe, where it's a portal intended to be used by patients.
  - nradov 10y ago
    No, @FLUX-YOU has it right. Google Health was only ever intended as a patient portal (PHR) and was a direct competitor to Microsoft HealthVault. Google never added any EMR features. In fact after the initial release they never added any features at all; they just lost interest in it and shut it down.
- entee 10y ago
  It turns out re. docs and nurses, not really. It's important to understand the who pays for what in healthcare, and how many links in the chain exist between payer, payee and who benefits. Physicians and nurses are not able to pick whatever software they want to view patient data because 1.) you need high security all around that data, and 2.) that data is primarily useful to someone else. It's useful to the doctor because they want to treat the patient. It's a lot more useful to the hospital because they want to get paid for what was done. So the hospital is willing to shell out a ton of cash so that they have a Very Secure system that helps them better manage their cash flow. If you walk in as a doc with (for example) a nifty phone app that lets you track your patients in real time, you'll confront 2 problems: 1.) the hospital won't let you connect because it'll assume (possibly incorrectly) that it's a huge security hole. 2.) even if they did let you connect, their EMR is non-standard (basically all of them end up non-standard) and there's no lingua franca protocol for medical data, so your app is incompatible. It's really really tricky to solve all those issues AND have it be cheap enough for a doc to be willing to shell out for it out of pocket. I personally you'd need that kind of consumer-side scale to get enough competition to get medical software to innovate more quickly. I will say a common interchange format would help a lot, that's one of the objectives FHIR had, and the industry has been slowly adopting it. You accurately point out revenue personnel and practice managers as key players here, and yes they're the ones that usually push EMRs etc. But the front line workers are kind of disconnected from the design and functionality of the EMR. Put another way you have software that's bought by one person (hospital/provider), it's used to collect data by a totally different person with different needs (docs/nurses), and it's paid for eventually by another person who has no idea how it works nor any direct pressing need for it (patient/but let's be real, insurance company/government). Without a tight connection between who pays for the software, who uses the software and who benefits from the software (most consumer software is a pretty tight loop), it's hard to have a good virtuous cycle of innovation coming from customer/user insight/observation/needs.

gmarx 10y ago

your faith in Microsoft and Google is heartwarming and hilarious. I've been hearing this for over 20 years, as soon as the real smart tech people get involved we'll have this problem solved lickity split. Well, both those companies have tried to lick healthcare and both ran away with their tails between their legs after they took a crap on the bed. Healthcare information tech sucks because it's innately more difficult than most other problem spaces