3 ms·

I worked in EMR company and the amount of monthly legislative changes was insane. Insurance companies always changed their data formats every month. I think the

by dvh 2y ago

I worked in EMR company and the amount of monthly legislative changes was insane. Insurance companies always changed their data formats every month. I think they did it because if hospital's monthly export contained some error they could hold their money for couple days more. So anyway when our country switched to euro, the deadline came and the insurance company still didn't publish format for the new month. They were too busy with the euro switch that they didn't have time to mess with the export format. Few hours later they published new format. They just switched orders of 2 columns. But back to churn. Month old EMR is useless. Forget about working 2 years on something, publishing it on GitHub and calling it a day. In a small 250k town we needed 7 full-time programmers and 5 servicemen to keep it going. Patient arrives at v7.13.148 and leaves two weeks later at v7.15.203 and you need to keep their data in some kind of consistent way.

lostlogin 2y ago
When you work in a a patient facing role, you battle the EMR (or Radiology Information System in my case) and hate it’s ancient, bug ridden mess of inefficiency. Why is it just as crap as it was 20 years ago? But if you ever see the billing side you realise that billing is where the bulk of the action happens and that the horror is even worse over there.
- ethbr1 2y ago
  Lack of data interface standards is the biggest thing holding healthcare technical efficiency back, from what I've seen. And I understand why it's hard! But it should be possible to make progress around the edges, on more defined use cases and subsets... like pricing. That said, the major system vendors have zero incentive to originate interoperability, so it'll have to come from HHS if anywhere.
  - nradov 2y ago
    There are existing interoperability standards covering just about every healthcare use case (including price transparency) from organizations like HL7, DirectTrust, ASC X12, NCPDP, CMS, etc. The trouble is that many payer and provider organizations have chosen not to fully implement those standards. Instead they just do the bare minimum to achieve regulatory compliance because it's a cost center, not a revenue driver. The major EHR vendors are all active participants in open industry standards development. You can literally read the meeting minutes from standards development organizations to see that. But just because they ship a new interoperability feature doesn't mean their customers actually turn it on.
tormeh 2y ago
Isn't there some legal action that could have been taken against this? These are not changing requirements - this is sabotage.
nradov 2y ago
In the USA at least there is a single mandated technical standard for providers to send claims to payers (insurance companies). Changes to the technical format are infrequent, although some payers do change their coverage rules all the time. https://www.cms.gov/priorities/key-initiatives/burden-reduction/administrative-simplification/hipaa/adopted-standards-operating-rules https://www.cms.gov/priorities/key-initiatives/burden-reduct...
- ethbr1 2y ago
  HHS/CMS is making forward progress, usually when mandated to do so by Congress. Granted, whenever a new requirement comes into play, cue frantic scrambling by underfunded provider/insurer IT departments to support, followed by a few years of waivers from HHS to allow everyone to implement, followed by support a decade later. But it is moving the system forward.
dopylitty 2y ago
Sometimes it feels like the pursuit of digitization has actually made them less efficient and lower quality overall. Instead of just having a doctor providing medical care and a government giving them a check suddenly you have a thousand programmers, data center management, managers of programmers, information security teams trying in vain to secure the whole mess, etc. And that's before you get into the fact that the doctor suddenly can't practice at all when some teenager decides to ransomware the whole business.

by dvh 2y ago

lostlogin 2y ago

When you work in a a patient facing role, you battle the EMR (or Radiology Information System in my case) and hate it’s ancient, bug ridden mess of inefficiency. Why is it just as crap as it was 20 years ago? But if you ever see the billing side you realise that billing is where the bulk of the action happens and that the horror is even worse over there.

ethbr1 2y ago
Lack of data interface standards is the biggest thing holding healthcare technical efficiency back, from what I've seen. And I understand why it's hard! But it should be possible to make progress around the edges, on more defined use cases and subsets... like pricing. That said, the major system vendors have zero incentive to originate interoperability, so it'll have to come from HHS if anywhere.
- nradov 2y ago
  There are existing interoperability standards covering just about every healthcare use case (including price transparency) from organizations like HL7, DirectTrust, ASC X12, NCPDP, CMS, etc. The trouble is that many payer and provider organizations have chosen not to fully implement those standards. Instead they just do the bare minimum to achieve regulatory compliance because it's a cost center, not a revenue driver. The major EHR vendors are all active participants in open industry standards development. You can literally read the meeting minutes from standards development organizations to see that. But just because they ship a new interoperability feature doesn't mean their customers actually turn it on.

tormeh 2y ago

Isn't there some legal action that could have been taken against this? These are not changing requirements - this is sabotage.

nradov 2y ago

In the USA at least there is a single mandated technical standard for providers to send claims to payers (insurance companies). Changes to the technical format are infrequent, although some payers do change their coverage rules all the time. https://www.cms.gov/priorities/key-initiatives/burden-reduction/administrative-simplification/hipaa/adopted-standards-operating-rules https://www.cms.gov/priorities/key-initiatives/burden-reduct...

ethbr1 2y ago
HHS/CMS is making forward progress, usually when mandated to do so by Congress. Granted, whenever a new requirement comes into play, cue frantic scrambling by underfunded provider/insurer IT departments to support, followed by a few years of waivers from HHS to allow everyone to implement, followed by support a decade later. But it is moving the system forward.

dopylitty 2y ago

Sometimes it feels like the pursuit of digitization has actually made them less efficient and lower quality overall. Instead of just having a doctor providing medical care and a government giving them a check suddenly you have a thousand programmers, data center management, managers of programmers, information security teams trying in vain to secure the whole mess, etc. And that's before you get into the fact that the doctor suddenly can't practice at all when some teenager decides to ransomware the whole business.