4 ms·

I wonder how burdensome it is to even get the tool fully integrated into the ehr. Like are the doctors not using it because it requires manual input of drugs an

by skwb 7y ago

I wonder how burdensome it is to even get the tool fully integrated into the ehr. Like are the doctors not using it because it requires manual input of drugs and insurance? Even then, the doctors aren’t necessarily getting paid more for doing this extra work; it’s the payer (insurance) company that is primarily benefiting. To be clear, I am acutely aware of just how hard it is to get this sort of thing working (MS in health Econ, phd in biomedical and clinical informatics). Just keeping track of all the formularies seems like a pain just to to begin with!

joe_the_user 7y ago
I too am aware of hard solutions are in reality (or "reality"). Still, I believe we should be acutely aware that the need for doctors to get "tools" just to deal with drug prices is an indication of how off-kilter our society's approach to health care has become.
delfinom 7y ago
Well due to the rise of EHR and other tech complexities, many doctors are just joining mega-groups/networks that handle their IT just so they don't have to deal things such as integration. The era of independent doctors is basically coming to a very fast end. Where I live, there are two competing networks of doctors now that have basically absorbed thousands of doctors in the last 4 years with their signs literally plastered everywhere now. Yay because arguably it's the only way doctor offices are going to keep up with ever changing tech. Nay because Americans are going to get fucked in the ass even more by uncontrollable healthcare when the doctors networks become cartels.
- ghaff 7y ago
  My long-time primary care doctor recently told me to find a new one. He’s going to continue practicing his specialty. But he said dealing with the computer systems was too much effort for his small office to continue handling primary care patients.
- skwb 7y ago
  There's a certain chicken or egg among health economists for the role of HITECH requirements resulting in consolidation [1, 2]. On one hand, these HITECH requirements put additional technological reporting, which may be a driver of consolidation (though this was in large part 'paid' for if you adopted early). On the other hand, centralization of IT services can produce economies of scale, especially if you're a small community hospital that has a small community hospital budget (aka narrow). Hell, you even see the trend of inter-UC health hosting the EHR instance for another UC [3]. In either case, the major role of healthcare consolidation has been to keep up with insurance consolidation, which is to keep up with hospital consolidation, and so on [4]. [1]. https://www.hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement-interim-final-rule/index.html https://www.hhs.gov/hipaa/for-professionals/special-topics/h... [2]. https://www.healthaffairs.org/do/10.1377/hblog20190304.998205/full/ https://www.healthaffairs.org/do/10.1377/hblog20190304.99820... [3]. https://cio.ucop.edu/making-epic-history-ucsd-and-uci-health-share-an-electronic-medical-records-system/ https://cio.ucop.edu/making-epic-history-ucsd-and-uci-health... [4]. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.6.77 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.6....
- biotech 7y ago
  > Yay because arguably it's the only way doctor offices are going to keep up with ever changing tech. Keeping up with the tech is not the problem, it's keeping up with the ever changing regulations, many of which do relate to EHR. You basically need dedicated staff to handle the bureaucratic processes, which is only affordable for large organizations.
IG_Semmelweiss 7y ago
It is not. For example, BlinkHealth created a widget for athena's EMR. The caveaat that it would only show Blink's price, which was actually not the insurance price (they are not insurance but instead a PBM pass thru, cheaper-than-usual cash price). The data point was not comprehensive, of course... But my point still stands

by skwb 7y ago

joe_the_user 7y ago

I too am aware of hard solutions are in reality (or "reality"). Still, I believe we should be acutely aware that the need for doctors to get "tools" just to deal with drug prices is an indication of how off-kilter our society's approach to health care has become.

delfinom 7y ago

Well due to the rise of EHR and other tech complexities, many doctors are just joining mega-groups/networks that handle their IT just so they don't have to deal things such as integration. The era of independent doctors is basically coming to a very fast end. Where I live, there are two competing networks of doctors now that have basically absorbed thousands of doctors in the last 4 years with their signs literally plastered everywhere now. Yay because arguably it's the only way doctor offices are going to keep up with ever changing tech. Nay because Americans are going to get fucked in the ass even more by uncontrollable healthcare when the doctors networks become cartels.

ghaff 7y ago
My long-time primary care doctor recently told me to find a new one. He’s going to continue practicing his specialty. But he said dealing with the computer systems was too much effort for his small office to continue handling primary care patients.
skwb 7y ago
There's a certain chicken or egg among health economists for the role of HITECH requirements resulting in consolidation [1, 2]. On one hand, these HITECH requirements put additional technological reporting, which may be a driver of consolidation (though this was in large part 'paid' for if you adopted early). On the other hand, centralization of IT services can produce economies of scale, especially if you're a small community hospital that has a small community hospital budget (aka narrow). Hell, you even see the trend of inter-UC health hosting the EHR instance for another UC [3]. In either case, the major role of healthcare consolidation has been to keep up with insurance consolidation, which is to keep up with hospital consolidation, and so on [4]. [1]. https://www.hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement-interim-final-rule/index.html https://www.hhs.gov/hipaa/for-professionals/special-topics/h... [2]. https://www.healthaffairs.org/do/10.1377/hblog20190304.998205/full/ https://www.healthaffairs.org/do/10.1377/hblog20190304.99820... [3]. https://cio.ucop.edu/making-epic-history-ucsd-and-uci-health-share-an-electronic-medical-records-system/ https://cio.ucop.edu/making-epic-history-ucsd-and-uci-health... [4]. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.6.77 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.6....
biotech 7y ago
> Yay because arguably it's the only way doctor offices are going to keep up with ever changing tech. Keeping up with the tech is not the problem, it's keeping up with the ever changing regulations, many of which do relate to EHR. You basically need dedicated staff to handle the bureaucratic processes, which is only affordable for large organizations.

IG_Semmelweiss 7y ago

It is not. For example, BlinkHealth created a widget for athena's EMR. The caveaat that it would only show Blink's price, which was actually not the insurance price (they are not insurance but instead a PBM pass thru, cheaper-than-usual cash price). The data point was not comprehensive, of course... But my point still stands