There should an option here for "lack of government leadership and intervention supporting interoperability."
As much as it pains me to put more of healthcare in the hands of the fed, the banking and travel businesses seemed to figure it out themselves. Healthcare's inability to solve this themselves screams for government intervention.
Clustered - 7 years ago
I hate to point it out, but: there is a business case *not* to use shared data. Facilities can bill for repeating a procedure/test, if they don't have access to the results (e.g., if an MRI exam was performed elsewhere). They can't bill for requesting and receiving prior medical records.
While the above may sound irresponsible to a clinician, it certainly makes sense to the CFO/CEO of a hospital. We're in the business of facilitating information sharing and we see it all the time ("yet another piece of software that will help me decrease revenues" -- sometimes we can almost see the thought bubble).
Anonymous - 7 years ago
Aren't "insufficient demand by patients" and "lack of a business case" hugely overlapping? Patients need to create the business case. If we had a health system where patients felt empowered to own their data, instead of feeling like Elaine in the Seinfeld episode where she just wants to be treated for her rash, I think the business case would be obvious.
Woodstock Generation - 7 years ago
I don't think there is a "lack" of standards. The existing standards are difficult and costly (person power) to implement and maintain. In addition, users interpret the standards differently, similar to versions of HL-7.
Ms CFO - 7 years ago
The questions you should ask is "why should hospitals share" and "who pays for it". There is no business case to do that (whether it is a competitor or not). We do send our data to registries, etc. when we are forced to do it. The software may be free but it still takes some manpower to get things done and running smoothly. Unless there is a carrot or a stick, it won't happen.
Harried clinician - 7 years ago
Can someone explain to me the reasoning behind the fixation on competitors? Very little of the information that I would share or would want shared with me is from a true competitor in my specialty. And even if it were, my understanding from my professional training is that we're ethically obliged to do right by our patients. If a patient chooses to go to a true competitor, I would graciously (and ethically) send the records. And then I would sit back and ask myself honestly if there is something in my practice that I need to change or if their reason for leaving had nothing to do with me (e.g. Change in insurer, move to a different town).
That being said, the current system doesn't make it easy to request or send records. Virtually everyone still wants patient authorizations which means the patient has to be sitting in front of me or I have to mail it to them to complete. Then, in virtually all circumstances, we have to print the info from our EMR and mail or fax it to the other location. All of the records that I've ever requested have come to me the same way. For locations where we send records often, our EMR is configured to fax the records directly (without the extra step of printing them out), which is a huge help. Even if we did have ways to easily connect with outside providers to send electronic transition of care info, most of the useful info is in the progress notes and full medication records, both of which have become much harder to wade through in the EMR era. So in my view, the hassles of exchanging clinical records have gotten worse rather than better with the advent of EMRs, having nothing at all to do with competition.
HITgeek - 7 years ago
Even though the standards for health data sharing have been defined for over 10 years, and are now entering a second generation with HL7 FHIR, the business cases for implementation are severely lagging. The key questions are who is going to invest up-front for implementation, and how will they realize an adequate return on their investment? The cash flow will ultimately come from the patients and payers, of course, but that will be indirect via taxes and/or bundled in health care costs. But patient and payer demand, and their willingness to bear the expense, is still insufficient to evaluate a business case or promote regulatory incentives. Meanwhile, the least trustworthy communication channel among providers, i.e., patients and their families, remains the principal one in use.
thb - 7 years ago
none of the above .... if the proper resources and budgeting were to occur .. we'd exchange everything with "nearly" everyone ... if tomorrow you were told that if you can't exchange with every hospital in a 50 mile radius ... you won't get paid ... period .... I guarantee you, it would be done
There should an option here for "lack of government leadership and intervention supporting interoperability."
As much as it pains me to put more of healthcare in the hands of the fed, the banking and travel businesses seemed to figure it out themselves. Healthcare's inability to solve this themselves screams for government intervention.
I hate to point it out, but: there is a business case *not* to use shared data. Facilities can bill for repeating a procedure/test, if they don't have access to the results (e.g., if an MRI exam was performed elsewhere). They can't bill for requesting and receiving prior medical records.
While the above may sound irresponsible to a clinician, it certainly makes sense to the CFO/CEO of a hospital. We're in the business of facilitating information sharing and we see it all the time ("yet another piece of software that will help me decrease revenues" -- sometimes we can almost see the thought bubble).
Aren't "insufficient demand by patients" and "lack of a business case" hugely overlapping? Patients need to create the business case. If we had a health system where patients felt empowered to own their data, instead of feeling like Elaine in the Seinfeld episode where she just wants to be treated for her rash, I think the business case would be obvious.
I don't think there is a "lack" of standards. The existing standards are difficult and costly (person power) to implement and maintain. In addition, users interpret the standards differently, similar to versions of HL-7.
The questions you should ask is "why should hospitals share" and "who pays for it". There is no business case to do that (whether it is a competitor or not). We do send our data to registries, etc. when we are forced to do it. The software may be free but it still takes some manpower to get things done and running smoothly. Unless there is a carrot or a stick, it won't happen.
Can someone explain to me the reasoning behind the fixation on competitors? Very little of the information that I would share or would want shared with me is from a true competitor in my specialty. And even if it were, my understanding from my professional training is that we're ethically obliged to do right by our patients. If a patient chooses to go to a true competitor, I would graciously (and ethically) send the records. And then I would sit back and ask myself honestly if there is something in my practice that I need to change or if their reason for leaving had nothing to do with me (e.g. Change in insurer, move to a different town).
That being said, the current system doesn't make it easy to request or send records. Virtually everyone still wants patient authorizations which means the patient has to be sitting in front of me or I have to mail it to them to complete. Then, in virtually all circumstances, we have to print the info from our EMR and mail or fax it to the other location. All of the records that I've ever requested have come to me the same way. For locations where we send records often, our EMR is configured to fax the records directly (without the extra step of printing them out), which is a huge help. Even if we did have ways to easily connect with outside providers to send electronic transition of care info, most of the useful info is in the progress notes and full medication records, both of which have become much harder to wade through in the EMR era. So in my view, the hassles of exchanging clinical records have gotten worse rather than better with the advent of EMRs, having nothing at all to do with competition.
Even though the standards for health data sharing have been defined for over 10 years, and are now entering a second generation with HL7 FHIR, the business cases for implementation are severely lagging. The key questions are who is going to invest up-front for implementation, and how will they realize an adequate return on their investment? The cash flow will ultimately come from the patients and payers, of course, but that will be indirect via taxes and/or bundled in health care costs. But patient and payer demand, and their willingness to bear the expense, is still insufficient to evaluate a business case or promote regulatory incentives. Meanwhile, the least trustworthy communication channel among providers, i.e., patients and their families, remains the principal one in use.
none of the above .... if the proper resources and budgeting were to occur .. we'd exchange everything with "nearly" everyone ... if tomorrow you were told that if you can't exchange with every hospital in a 50 mile radius ... you won't get paid ... period .... I guarantee you, it would be done