5 ms·

I talked to a doctor at Stanford and he mentioned to me one reason why the main Stanford Health and Stanford Children's Health have separate patient portals (no

I talked to a doctor at Stanford and he mentioned to me one reason why the main Stanford Health and Stanford Children's Health have separate patient portals (not unified) that you have to create separate logins for is because of the huge amount Epic wanted to charge to merge them. (They both run separate Epic instances as far as I can tell)

echelon 7y ago
How are leeches like this tolerated? The sooner they are driven out of business, the better.
- warent 7y ago
  They're not entirely tolerated fortunately. The US government has been taking action to tear down EHR walled gardens via the Cures Act[1] which is manifesting in public access APIs called FHIR. [1] https://en.wikipedia.org/wiki/21st_Century_Cures_Act https://en.wikipedia.org/wiki/21st_Century_Cures_Act
  - parasubvert 7y ago
    FHIR is nice but doesn’t completely reduce the complexity of integrating the underlying data itself considering the mess that is HL7 and mess that occurred with v3. The situation is sort of like moving from SOAP+XML Schemas to REST/JSON. Easier to develop, but the underlying data structures are still extremely complicated and tricky to get right. This is especially true when dealing with ancient systems written in niche languages/database hybrids (MUMPS comes to mind): https://en.m.wikipedia.org/wiki/MUMPS https://en.m.wikipedia.org/wiki/MUMPS
    - tomrod 7y ago
      Do you feel OMOP helps to resolve this?
      - parasubvert 7y ago
        YES! If only people in healthcare IT would adopt things in years rather than decades...
  - warent 7y ago
    Just a small correction my original post (better late than never). It's also (perhaps to a larger extent) due to the HITECH Act: https://en.wikipedia.org/wiki/Health_Information_Technology_for_Economic_and_Clinical_Health_Act https://en.wikipedia.org/wiki/Health_Information_Technology_...
- parasubvert 7y ago
  Same way any systems integrator or ERP vendor like SAP is tolerated? Integrating systems takes time and money.
- creaghpatr 7y ago
  The functionality of the competition isn't much better (google notwithstanding, hypothetically)
- franga2000 7y ago
  From what I understand this is the norm in the US. For another example, see credit reporting agencies. Control of critical infrastructure is given to private companies under the assumption that competition will make them do good. In practice, most competition goes away immediately and the maximization of profit destroys any remaining incentives to not be horrible for everyone involved.
- tomrod 7y ago
  I suppose because when tech, like Google, comes along Epic gaslight, obstructs, and projects their way in the media to becoming the good guy. Healthcare IT is full of deeply committed professionals who deeply dislike Epic.
transect 7y ago
I used to go to NYU medical, which uses Epic. As janky as their interface is, it was nice enough to use and see all my charts, etc, as well as communicate with doctors over email. So when I moved to another city I specifically chose a medical system that used Epic. Once I got my login I then logged into my NYU Epic to initiate a data transfer and wouldn't you know it... it was impossible. After digging around to no avail I contacted my new provider and they told me the best thing to do is print out a PDF of my medical history in NYU's Epic and they would scan it back into their Epic... with a complete loss in structured historical data (bloodwork, vitals etc). Insane.

echelon 7y ago

How are leeches like this tolerated? The sooner they are driven out of business, the better.

warent 7y ago
They're not entirely tolerated fortunately. The US government has been taking action to tear down EHR walled gardens via the Cures Act[1] which is manifesting in public access APIs called FHIR. [1] https://en.wikipedia.org/wiki/21st_Century_Cures_Act https://en.wikipedia.org/wiki/21st_Century_Cures_Act
- parasubvert 7y ago
  FHIR is nice but doesn’t completely reduce the complexity of integrating the underlying data itself considering the mess that is HL7 and mess that occurred with v3. The situation is sort of like moving from SOAP+XML Schemas to REST/JSON. Easier to develop, but the underlying data structures are still extremely complicated and tricky to get right. This is especially true when dealing with ancient systems written in niche languages/database hybrids (MUMPS comes to mind): https://en.m.wikipedia.org/wiki/MUMPS https://en.m.wikipedia.org/wiki/MUMPS
  - tomrod 7y ago
    Do you feel OMOP helps to resolve this?
    - parasubvert 7y ago
      YES! If only people in healthcare IT would adopt things in years rather than decades...
- warent 7y ago
  Just a small correction my original post (better late than never). It's also (perhaps to a larger extent) due to the HITECH Act: https://en.wikipedia.org/wiki/Health_Information_Technology_for_Economic_and_Clinical_Health_Act https://en.wikipedia.org/wiki/Health_Information_Technology_...
parasubvert 7y ago
Same way any systems integrator or ERP vendor like SAP is tolerated? Integrating systems takes time and money.
creaghpatr 7y ago
The functionality of the competition isn't much better (google notwithstanding, hypothetically)
franga2000 7y ago
From what I understand this is the norm in the US. For another example, see credit reporting agencies. Control of critical infrastructure is given to private companies under the assumption that competition will make them do good. In practice, most competition goes away immediately and the maximization of profit destroys any remaining incentives to not be horrible for everyone involved.
tomrod 7y ago
I suppose because when tech, like Google, comes along Epic gaslight, obstructs, and projects their way in the media to becoming the good guy. Healthcare IT is full of deeply committed professionals who deeply dislike Epic.

transect 7y ago

I used to go to NYU medical, which uses Epic. As janky as their interface is, it was nice enough to use and see all my charts, etc, as well as communicate with doctors over email. So when I moved to another city I specifically chose a medical system that used Epic. Once I got my login I then logged into my NYU Epic to initiate a data transfer and wouldn't you know it... it was impossible. After digging around to no avail I contacted my new provider and they told me the best thing to do is print out a PDF of my medical history in NYU's Epic and they would scan it back into their Epic... with a complete loss in structured historical data (bloodwork, vitals etc). Insane.