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More interesting would be if anyone can find a physician who actually "appreciates" EHRs. I watched a few with 50+ years in practice decide to retire upon Epic

by apathy 9y ago

More interesting would be if anyone can find a physician who actually "appreciates" EHRs. I watched a few with 50+ years in practice decide to retire upon Epic rollout. EHRs are a farce. They've made a few people very wealthy at the cost of widespread misery for patients and doctors.

shishy 9y ago
Sorry, I'm a little confused by your comment. You saw a few physicians with 50+ years in practice retire upon the Epic rollout? Maybe they were of old age and near retirement? And also, how does that lead to your conclusion that they are a "farce"? Do you mean to suggest that we would be better off without EHRs, or do you specifically have issue with the implementation of EHRs as is right now? I'm surprised by you calling them a "farce" and causing "widespread misery for patients and doctors" because my understanding was that the clinical data collected by EHRs permitted improvements in the quality and delivery of care for patients within an institution. I will admit that - as mentioned elsewhere in these comments - lack of interoperability is a huge issue which drastically reduces the effectiveness of EHRs. But even though it isn't a perfect system -- 1) It is an improvement over the previous form of paper records, and 2) The industry is iteratively moving to resolve these issues. There are a lot of reasons for why these problems exist such as misaligned incentives, etc. but we have been trying to address this through both policy (e.g. the rise of accountable care organizations and how the ACA experimented with physician reimbursements). There also exist middleware solutions that I believe would help ensure that this data is not silo'd, and in doing so improve interoperability. Maybe I'm just misunderstanding something but if I am, could someone please point it out? I'm not saying that EHRs are perfect -- they have a way to go (both in UX design/interoperability). But, they were a step in the right direction and I am not convinced that they are as bad as you claim they are (though I recognize their limitations). What am I missing? EDIT: I've also heard from physicians and patients that because EHRs easily allow a doctor to read up on a patient's notes from their previous visits, it can actually improve their relationship because the doctor can go into the room for subsequent visits knowing something (or in some cases, everything) about the patient and speak to them with that information in mind.
- cepp 9y ago
  > But even though it isn't a perfect system -- 1) It is an improvement over the previous form of paper records, and 2) The industry is iteratively moving to resolve these issues. NOTE: My comments are only applicable to the US medical industry. This statement highlights your lack of knowledge about the general EHR/EMR landscape and current implementations. As someone that works parallel to a hospital operation, I both know and interface with people that have to use them on a daily basis and this could not be further from the truth. EMRs have helped to collect and make more data accessible, this is true, but they are not necessarily an improvement over the previous form of paper records. In most cases, they are simply a different representation of the same data. Take EPIC for example wherein you can search for a patients name but then you are provided with the digital representation of an analogue patient folder and/or chart. I think that most of the people on HN would have their opinion of the medical software landscape changed if they were ever granted the opportunity to use most of the current implementations for only a couple of minutes... It is also not true that the "industry is iteratively moving to resolve these issues". I was most put aback about 2 years ago when I heard that while every hospital may have EPIC, Cern, etc installations, that none of them are universal. Every hospital will have a customised EHR/MER installation, and therefore custom templates for each doctor, or unit. This means that the installations are almost never updated, or allowed to have new features introduced. In most cases, a patch, or update will require a field tech being sent from the providing company to the hospital where he will work with the onsite customized installation to complete the work. All in all, it is true that there are people in the field trying to push medical technology forward. Take PatientBank, Sprig, Stitch, etc as evidence that this happening. But what is certainly not true is that the incumbents are pushing to make major changes. Additionally, the regulations with regard to medical software, as well as the legal incentives make it very, very difficult to develop a product, let alone to bring it to market.
  - shishy 9y ago
    Thanks for your response! Most of my knowledge isn't personal experience, it's from speaking with other people and I will admit it isn't super comprehensive. I know that there is a distinction to be made from EMRs and EHRs right? (I thought EMR was the electronic version of the old paper medical record, while EHR was designed to create a more longitudinal view of the patient's care). Yes I did know that though two hospitals with EPIC's system will still face interoperability issues due to varying data dictionaries, but I didn't consider the difficulty in updating features, etc. I agree and recognize that the incumbents are not pushing to make major changes (after all, they don't have strong incentive to, right?). But I did notice companies like RedoxEngine which provide a layer of abstraction to address interoperability issues for health tech startups. And also projects like this which are moving to slowly consolidate rather than silo data: http://hospital-zsfg.medicine.ucsf.edu/research/homerun.html http://hospital-zsfg.medicine.ucsf.edu/research/homerun.html Anyway I will dig more into it to inform myself -- appreciate your response.

by apathy 9y ago

shishy 9y ago

Sorry, I'm a little confused by your comment. You saw a few physicians with 50+ years in practice retire upon the Epic rollout? Maybe they were of old age and near retirement? And also, how does that lead to your conclusion that they are a "farce"? Do you mean to suggest that we would be better off without EHRs, or do you specifically have issue with the implementation of EHRs as is right now? I'm surprised by you calling them a "farce" and causing "widespread misery for patients and doctors" because my understanding was that the clinical data collected by EHRs permitted improvements in the quality and delivery of care for patients within an institution. I will admit that - as mentioned elsewhere in these comments - lack of interoperability is a huge issue which drastically reduces the effectiveness of EHRs. But even though it isn't a perfect system -- 1) It is an improvement over the previous form of paper records, and 2) The industry is iteratively moving to resolve these issues. There are a lot of reasons for why these problems exist such as misaligned incentives, etc. but we have been trying to address this through both policy (e.g. the rise of accountable care organizations and how the ACA experimented with physician reimbursements). There also exist middleware solutions that I believe would help ensure that this data is not silo'd, and in doing so improve interoperability. Maybe I'm just misunderstanding something but if I am, could someone please point it out? I'm not saying that EHRs are perfect -- they have a way to go (both in UX design/interoperability). But, they were a step in the right direction and I am not convinced that they are as bad as you claim they are (though I recognize their limitations). What am I missing? EDIT: I've also heard from physicians and patients that because EHRs easily allow a doctor to read up on a patient's notes from their previous visits, it can actually improve their relationship because the doctor can go into the room for subsequent visits knowing something (or in some cases, everything) about the patient and speak to them with that information in mind.

cepp 9y ago
> But even though it isn't a perfect system -- 1) It is an improvement over the previous form of paper records, and 2) The industry is iteratively moving to resolve these issues. NOTE: My comments are only applicable to the US medical industry. This statement highlights your lack of knowledge about the general EHR/EMR landscape and current implementations. As someone that works parallel to a hospital operation, I both know and interface with people that have to use them on a daily basis and this could not be further from the truth. EMRs have helped to collect and make more data accessible, this is true, but they are not necessarily an improvement over the previous form of paper records. In most cases, they are simply a different representation of the same data. Take EPIC for example wherein you can search for a patients name but then you are provided with the digital representation of an analogue patient folder and/or chart. I think that most of the people on HN would have their opinion of the medical software landscape changed if they were ever granted the opportunity to use most of the current implementations for only a couple of minutes... It is also not true that the "industry is iteratively moving to resolve these issues". I was most put aback about 2 years ago when I heard that while every hospital may have EPIC, Cern, etc installations, that none of them are universal. Every hospital will have a customised EHR/MER installation, and therefore custom templates for each doctor, or unit. This means that the installations are almost never updated, or allowed to have new features introduced. In most cases, a patch, or update will require a field tech being sent from the providing company to the hospital where he will work with the onsite customized installation to complete the work. All in all, it is true that there are people in the field trying to push medical technology forward. Take PatientBank, Sprig, Stitch, etc as evidence that this happening. But what is certainly not true is that the incumbents are pushing to make major changes. Additionally, the regulations with regard to medical software, as well as the legal incentives make it very, very difficult to develop a product, let alone to bring it to market.
- shishy 9y ago
  Thanks for your response! Most of my knowledge isn't personal experience, it's from speaking with other people and I will admit it isn't super comprehensive. I know that there is a distinction to be made from EMRs and EHRs right? (I thought EMR was the electronic version of the old paper medical record, while EHR was designed to create a more longitudinal view of the patient's care). Yes I did know that though two hospitals with EPIC's system will still face interoperability issues due to varying data dictionaries, but I didn't consider the difficulty in updating features, etc. I agree and recognize that the incumbents are not pushing to make major changes (after all, they don't have strong incentive to, right?). But I did notice companies like RedoxEngine which provide a layer of abstraction to address interoperability issues for health tech startups. And also projects like this which are moving to slowly consolidate rather than silo data: http://hospital-zsfg.medicine.ucsf.edu/research/homerun.html http://hospital-zsfg.medicine.ucsf.edu/research/homerun.html Anyway I will dig more into it to inform myself -- appreciate your response.