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Friday, June 14, 2019

June 2019 EHR interoperababble update

From THCB:
Electronic health records (EHRs) are a polarizing issue in health reform. In their current form, they are frustrating to many physicians and have failed to support cost improvements. The current round of federal intervention is proposed rulemaking pursuant to the 21st Century Cures Act calls for penalties for “information blocking” and for technology that physicians and patients could use “without special effort.”

The proposed rules are over one thousand pages of technical jargon that aims to govern how one machine communicates with another when the content of the communication is personal and very valuable information about an individual. Healthcare is a challenging and unique industry when it comes to interoperability. Hospitals spend lavishly on EHRs and pursue information blocking as a means to manipulate the physicians and patients who might otherwise bypass the hospital on the way to health reform. The result is a broken market where physicians and patients directly control trillions of dollars in spending but have virtually zero market power over the technology that hospitals and payers operate as information brokers...
The draft rules for interoperability, CMS, ONC, TEFCA, USCDI are over a thousand pages. Most of the complexity stems from a design that avoids direct patient direction and transparency the way we expect banking and other automated services. This approach fragments the patient and physician experience and poses privacy and security risks that may never be solved. On the other hand, an interoperability design based on patient-designated sharing with clinicians that voluntarily post their digital contact info (personal, group, or institution) works across the full range of patient data (behavioral, HIPAA, patient-generated) and provides patients and family caregivers the transparency and accountability over health services that we need. Allowing patients to specify their authorization server further simplifies things by enabling competition for the authorization service – a digital concierge – that would give market power to individuals and deliver the pro-competitive benefits the Rule seeks.
"Banking and other automated services?" I have to voice some dubiety with respect to that apples-to-oranges analogy. "Allowing patients to specify their authorization server further simplifies things by enabling competition for the authorization service." Right, so we'll still have multiple competing architectures.


A hardy perenennial.
No amount of calling point-to-point interfaced data exchange "interoperability" will make it so.

Interestingly, I've spent a good bit of the day trying (with frustratedly limited success) to download my medical records in anticipation of my first patient visit next week at Kaiser. Muir (my last provider system) is on Epic. Kaiser is on Epic. You'd think that would be easy. You'd be wrong. My hernia surgery a year ago was via a surgeon at Bass Medical Group. Owned now by Muir, but on a different platform still. The urologist who dx'd my prostate cancer in 2015 was with NorCal Urology. Bought by Muir, but using NextGen (I think they've now migrated). My radiation oncology tx group was Diablo Valley Oncology and Hematology. Yet another EHR platform, one whose patient portal is useless.

I'm just going to have to write my own summary "progress note," comprised of Active Problems, Active Meds, CC, PMH, PSH, HPI, FH, SH, etc., to save the new M.A. a bit of intake time.

More to come...

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