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>The problem is that there is no organization which can provide a stable repository for every patient's data and build secure interfaces to thousands of differe

by dqv 8y ago

>The problem is that there is no organization which can provide a stable repository for every patient's data and build secure interfaces to thousands of different provider organizations. That's extremely expensive and there's no real business model. Where will the money come from? It would be a cool idea if a non-profit organization could handle it. Healthcare organizations would pay a "duty fee" for requesting or sending records. We just need a standard for transporting it. FHIR makes it de facto HTTPS.

nradov 8y ago
You haven't answered the question of where the money will come from. Healthcare provider organizations are generally unwilling to pay such duty fees. HL7 FHIR is great but it does nothing to address the cost structure. This is a political and economic problem, not a technical problem.
- tolien 8y ago
  I suppose the obvious answer is to require them to pay — as you say, it becomes a political problem for politicians to write law mandating it and the providers to lobby for it not to be forced. The closest analogy I can think of is the Data Communications Company that intermediates smart meter data in the UK between the energy suppliers and end users. As a monopoly, their prices are regulated (well or not is a political problem…) and all the providers have to use them. If the data exchange was the source of truth, the providers would presumably save some money not having to store their own copies (or at least, could store more summarised versions) with all the requirements that HIPAA/GDPR entail. However, there’s money to be had for a huge aggregated database of everyone’s health records, stored in consistent format for easy consumption…maybe we should be careful what we wish for.
  - nradov 8y ago
    Large provider organizations are never going to totally surrender control of their patient data to some hypothetical government-sponsored monopoly. They may outsource some aspects to cloud platforms or SaaS vendors, and they may be persuaded to share data with other organizations for the right incentives, but we'll never see a major hospital or clinic totally give up control of data that's essential to their business. So your proposal wouldn't produce any cost savings; costs would actually go up.
    - tolien 8y ago
      If the mandate (whether by regulatory or insurer/market force - we’ve established that the providers don’t want any kind of standardisation or data transfer, the hypothetical I’m proposing is that they’re dragged into doing it) is that they have to put their data into some data broker, if they want to keep their own copies too then the cost of doing that is their problem (or a calculation that the value outweighs the cost). In an ideal market, another player who didn’t want to hoard data could undercut them (not having that cost). Tuning either the cost/benefit of outsourcing or the nature of the incentives, I suppose, are the key.

by dqv 8y ago

nradov 8y ago

You haven't answered the question of where the money will come from. Healthcare provider organizations are generally unwilling to pay such duty fees. HL7 FHIR is great but it does nothing to address the cost structure. This is a political and economic problem, not a technical problem.

tolien 8y ago
I suppose the obvious answer is to require them to pay — as you say, it becomes a political problem for politicians to write law mandating it and the providers to lobby for it not to be forced. The closest analogy I can think of is the Data Communications Company that intermediates smart meter data in the UK between the energy suppliers and end users. As a monopoly, their prices are regulated (well or not is a political problem…) and all the providers have to use them. If the data exchange was the source of truth, the providers would presumably save some money not having to store their own copies (or at least, could store more summarised versions) with all the requirements that HIPAA/GDPR entail. However, there’s money to be had for a huge aggregated database of everyone’s health records, stored in consistent format for easy consumption…maybe we should be careful what we wish for.
- nradov 8y ago
  Large provider organizations are never going to totally surrender control of their patient data to some hypothetical government-sponsored monopoly. They may outsource some aspects to cloud platforms or SaaS vendors, and they may be persuaded to share data with other organizations for the right incentives, but we'll never see a major hospital or clinic totally give up control of data that's essential to their business. So your proposal wouldn't produce any cost savings; costs would actually go up.
  - tolien 8y ago
    If the mandate (whether by regulatory or insurer/market force - we’ve established that the providers don’t want any kind of standardisation or data transfer, the hypothetical I’m proposing is that they’re dragged into doing it) is that they have to put their data into some data broker, if they want to keep their own copies too then the cost of doing that is their problem (or a calculation that the value outweighs the cost). In an ideal market, another player who didn’t want to hoard data could undercut them (not having that cost). Tuning either the cost/benefit of outsourcing or the nature of the incentives, I suppose, are the key.