Getting information off the Internet is like taking a drink from a fire hydrant - Mitchell Kapor
image by: U.S. Department of Agriculture
"ObamaCare was always about paying for health care—costs have outpaced inflation for decades—but seldom about keeping people healthy. As Republicans repeal and replace, they need a vision for the path to better care. Technology now exists to provide cheaper and higher-quality health care, but giant roadblocks stand in the way.
That technology is artificial intelligence and machine learning. The algorithms behind AI are painfully complex, but the final product is simple—think Google Translate or Amazon’s Alexa. Saying a phrase and immediately having it translated is cool. Being told that your week of bad sleep and slight stomach pains could be cancer is life-altering.
Machine learning is already invading health care. Experts at Kaggle, an artificial-intelligence research firm, shared a few real-world applications of the technology with me: Predicting heart failure by looking at massive amounts of MRI scans, diagnosing diabetic retinopathy from eye imaging, and successfully predicting seizures with a machine analyzing electroencephalogram data.
The key is data. With more of it, accuracy gets better over time. At least on the surface, the Obama administration did something right—the Health Information Technology for Economic and Clinical Health, or Hitech, Act. Part of the 2009 stimulus largess, it set aside some $20 billion worth of incentives for hospitals and doctors to show “meaningful use” of electronic health records, or EHRs.
Tons of data come with medical records. Then there are digital scales, Fitbit steps, WellnessFX blood tests, Apple iWatch data and 23andMe genetic test results. Eventually there will be daily commode sensors measuring blood sugar and prostate-specific antigen levels, among other things. Now imagine all that data being crunched, in real time, by machines looking for patterns—which then put out a simple text message. “Your Hemoglobin A1c has spiked again. I thought we agreed to cut back on the linguine.”
Describe this to anyone in health care and you’ll get two words back: Dream on. Instead of advancing electronic health record “interoperability”—a fancy word for being able to share and access electronic health records—the Hitech Act ended up as a funding mechanism for electronic health-record firms like Epic Systems, Cerner and Allscripts. By 2016, the government scheduled $23.8 billion in payments for firms that could achieve full electronic access and true interoperability for the full calendar year. It was later changed to a much easier 90-day reporting period for a subset of patients. Call it meaningless use, but the money kept flowing.
If you try to transfer your records from one hospital to another or to a doctor, you’ll probably end up “walking with paper,” as they say in the industry. The average doctor still deals with reams of faxes every day. A friend tried to send records from a Boston hospital to Miami; both places use Epic Systems’ electronic files. The records were faxed.
In 2015, competitors Cerner, Allscripts, Athenahealth and others have set up a group known as CommonWell Health Alliance to ensure health IT interoperability. Epic, with annual revenues easily north of $1 billion, refused to join, citing the $1.4 million upfront fee and $900,000 annual payments. Oh, and Epic didn’t want to sign the nondisclosure agreement.
My industry sources tell me Epic won’t sign nondisclosure agreements with anyone but makes outsiders agree to them. The company doesn’t co-develop applications with outside companies. Third parties don’t have access to application programming interfaces, APIs, which are the gateway for record data. Hospitals and doctors can have access, if they beg hard enough, but then they must hire inside developers to customize their system.
The company avoids titles, but good luck contacting any of its 9,000 employees, who are forbidden to give out their cellphone numbers. Epic has one phone number to the main switchboard. It’s still the 1970s in many ways.
I called it. Eric Helsher, vice president of client success at Epic, responded: “Today 100% of health systems using Epic are sharing patient information to better care for patients. They exchange over 1.3 million patient records a day and interoperate with all major EHR vendors and government agencies.”
Epic is talking up something it calls the App Orchard, a portal for vendors to sell apps that dig into Epic’s electronic records. Except the proposed pricing comes to four cents per message sent. Machine learning would drive millions or billions of messages. The company might cap fees at 30% of the vendor’s revenue: Even Apple isn’t that greedy.
I’m trying to get my medical records from a hospital with Epic systems. The best I have been able to do is a PDF file, a modern way of walking with paper.
How do we fix this? Dr. Eric Topol at Scripps in San Diego proposes health records be patient-owned and controlled, perhaps on a flash drive or iPhone or in the cloud. Maybe next to health savings account info. It’s a start.
But forget government mandates. The real incentive is insurers paying for this data, and they are figuring out that early detection is worth it. It’s a lot cheaper to find a disease before it turns into expensive chronic care for heart disease or cancer. The machine learning output might be: “You may have pre-Stage 1 cancer in your pancreas, but no worries—we can zap it out for you.”
That’s how you bend the cost curve in medicine. Make firms like Epic look at interoperability as an incremental profit center rather than an opening for competitors. The dream of smart machines crunching health info is real. Don’t let the dream walk with paper."
Source: Andy Kessler, Siri, Am I About to Have a Heart Attack? The Wall Street Journal, January 9, 2017.
EMR/EHR: The Good, The Bad & The Uncertain
The future of EMRs is uncertain, but one thing remains clear: we ultimately still want to pursue the “one patient, one record” ideal and in order to achieve that we might need to head back to the drawing board.
Give Up Your Data to Cure Disease
HOW far would you go to protect your health records? Your privacy matters, of course, but consider this: Mass data can inform medicine like nothing else and save countless lives, including, perhaps, your own.
'Primitive,' 'Asinine:' What Real Doctors Think of Electronic Medical Records
I believe that there are both good and bad aspects of EMRs, as they have the potential to both improve and worsen patient care. They are likely a step forward but also a work in progress, as there are perils lurking. The key for the health care profession is to continue moving forward by recognizing the vulnerabilities and remedying them, rather than ignoring them.
9 Reasons Physicians Hate EMR - The 2013 RAND Study
Despite this damning report, the majority of physicians these days are dealing with one or more EMR systems to document their clinical activities these days. If you deal with more than one ... for instance one in the office and another in the Hospital ... the odds are they don't communicate with each other.
A good idea gone bad…
Speak up. Make some noise. Get doctors off the white screen and back to the business of doctoring. Now that would be meaningful.
Doctors lack an analytic engine: Why we need EMR 3.0
Although research into their impact on quality of care and patient safety remains modest and is often controversial, these tools have eliminated considerable issues related to poor physician handwriting and have greatly improved internal and external provider communications and reporting.
Why bad EMRs are forced on physicians
Sadly, the systems are very, very bad indeed. It is said that use of an EMR, versus paper charts or dictation, typically reduces physician productivity by about 30% right out of the box. It is also noted that now, young physicians in training spend more and more time at keyboards and less and less time looking at that pesky throwback to ancient times, the human patient. (How dare they not be pixelated!)
4PatientCare delivers industry leading multi-modal intelligent, interactive communication solutions that integrate administrative, clinical and health plan communication needs.
AdvancedMD has transformed traditional medical billing software to web-based technology. With AdvancedMD'', you won''t have to purchase expensive hardware, install server-based software or perform manual data back-ups again.
Allscripts is the leading provider of clinical software, connectivity and information solutions that physicians use to improve healthcare. Across the country, thousands of health organizations ranging from solo doctor's offices to large academic physician groups and hospitals embrace Allscripts for our proven ability to optimize financial and clinical outcomes.
Alme for Healthcare delivers high-touch clinical and administrative assistance.
The Cerner® electronic medical record (EMR) is an integrated database that provides a comprehensive set of capabilities.
ChartLogic, Inc. is a leader in the Health Information Technology (HIT) industry that provides Electronic Health Records (EHR) solutions to medical practices across the country.
CureMD is the leading provider of innovative health information management solutions that transform the administrative and clinical operations of healthcare organizations of all sizes.
The only solution built from the ground up for the smartphone and tablet world. With secure mobile messaging, mobile websites, reputation growth, verified patient reviews and automated patient reminders - all integrated into your EHR system for complete automation.
To increase patient safety through building a connected community of health care providers based on the industry leading Rcopia e-prescribing system.
Today, e-MDs empowers physicians with clinical and financial tools to improve patient care, maintain financial independence and rediscover the privilege and joy of practicing medicine -- making all of this available at an affordable price. We launched e-MDs to partner with physicians to make this vision a reality.
EMR & EHR
The Healthcare Scene network is a leading provider of high quality healthcare IT and EHR insights.
EMRConsultant.com is aware of over 200 different Electronic Medical Records companies and programs. We have personally analyzed a significant majority of these, and have reviewed the parameters of many of the remainder. We utilize patent-pending technology to find the closest fit between a physician's requirements and the known capabilities of the many programs of which we are aware.
Founded in a basement in 1979 with 1½ employees, Epic develops software to help people get well, help people stay well, and help future generations be healthier.
EPOWERdoc is the leading provider of EMR software solutions for the rapidly expanding Freestanding Emergency Center (FEC) market. With the fastest EDIS on the market, our EMRDoc System offers a comprehensive solution with a streamlined workflow designed to drive efficiency and maximize reimbursement in the FEC environment.
We started eVisit with a big dream – to fundamentally simplify healthcare. How are we doing this? We’re creating physician-first tools that improve healthcare delivery for providers and patients by bridging the gap between technology and healthcare.
Global Care Quest
The company's ICIS System delivers remarkably powerful and flexible tools directly into the hands of health care providers to help them make faster, more informed patient care decisions.
gMed's Electronic Medical Record System integrates medical information, cuts costs, increases revenues, improves quality and reduces risks for selected medical specialties including Gastroenterology, Cardiology and Urology.
Greenway PrimeSUITE puts comprehensive information at the fingertips of clinicians and their administrative/financial staff to improve care delivery and outcomes.
When it's your job to protect your family's health, you need every advantage. Imagine if you had a way to collect, store, and share the health information critical to your family's well-being.
Hello Health provides the Patient Management platform and the professional services that allow practitioners to build stronger patient relationships, automate their processes, increase revenue and take control of their practices.
IQMax has extended the functionality of the PDA so care givers can now capture relevant patient encounter data including dictation and charges, thereby significantly increasing efficiency, advancing patient safety and care, improving the revenue cycle, and enhancing the value and overall utilization of PDA's
ITelagen Brings Fortune 500 IT Support to Small/Medium Sized Businesses by utilizing enterprise-grade management tools to proactively manage and support all aspects of your infrastructure. We become your IT Department without the in-house staff. ITelagen provides unlimited support for all your employees for a flat monthly fee.
Manage your personal health information with state-of-the-art HIPAA compliant, SSPP technology. You can upload your medical records from doctors, hospital, clinics, pharmacies and labs. And, you can track your diet, fitness, and overall wellness goals '' then access your information online by cell, PDA or flash drive.
LiveHealthier is a global provider of innovative health management programs that are tailored to individuals and customized to corporations. We provide comprehensive employee wellness solutions to corporations that help bring healthcare costs under control while boosting employee productivity, job satisfaction and morale.
High-end EMR with advanced features. Certified, voice and handwriting enabled. User-friendly and affordable.
The Site offers a unique opportunity to bring Doctors, Hospitals, and MT Organizations on a common platform to facilitate complete workflow automation of Medical Transcription.
MedExperts is a unique solutions provider for medical facilities. Our goal at MedExperts is to provide a broad range of products and services designed to meet the specific needs of various types of medical entities.
Empowering health workers with mobile technology.
If you haven't looked at us lately, you may be interested to know about our thriving Electronic Health Record. With an EHR, a patient's record follows her electronically. From the physician's office, to the hospital, to her home-based care, and to any other place she receives health services. And, she and her doctors can access all of this information and communicate with a smartphone or computer. This is really happening!
Medusa Medical Technologies Inc. was incorporated in 1998 with a mission to develop information technology solutions that improve pre-hospital emergency data capture, improve emergency medical staff effectiveness in patient care encounters, and ultimately lead to improved pre-hospital emergency treatment protocols.
Finally, a new way to own your health care experience. With Minerva Health Manager, you'll have a powerful personal health record software solution that places your complete health history at your fingertips: medical tests, diagnoses, conditions, x-rays, medications, allergies, and much more.
Vital Data Technology develops emergency medical information systems that share accurate and timely data with the right people in an emergency.
Dragon Medical 360 | eScription from Nuance streamlines clinical documentation for the healthcare enterprise and is based on a simple premise: it is faster to edit than to type.
Internet-based Medical Practice Management Software.
NueMD offers an integrated, robust solution for medical billing professionals and physicians. Our HIPAA compliant medical billing software allows electronic claims to be filed securely and with ease online, and our practice management software and electronic medical record (EMR) streamlines workflow for medical offices of all sizes.
OptumInsight specializes in improving the performance of the health system by providing analytics, technology and consulting services that enable better decisions and results.
This highly customizable EMR has no licensing fees, and its low cost of ownership makes OSCAR one of the most efficient and affordable EMR solutions in Canada for practices of all sizes and specialties.
We build software from the physician's perspective and work backwards to integrate all of the systems a physician needs throughout the day giving physicians a single system to utilize for all their patients, across all settings.
Phreesia replaces your patient clipboard with a FREE wireless touch-screen PhreesiaPad. We provide everything you need (short of the broadband internet connection), including a wireless network.
Physician Technology Partners
When it comes to EHRs, Epic is the best of the best. And when it comes to specialized implementation, optimization, testing, training, and go-live services for Epic, Physician Technology Partners stands alone.
Picis is a global provider of innovative information solutions that enable rapid and sustained delivery of clinical, financial and operational results in the acute care areas of the hospital the emergency department (ED), operating rooms (ORs), post-anesthesia care units (PACUs) and intensive care units (ICUs).
pingmd® is a safe harbor communication platform for
care networks to 2-way message, call and videochat with their
referring networks and engage with their patient population.
We develop software that Makes Doctors Happy™. pMD lets you use your mobile device to quickly capture charges, access information and communicate securely, vastly increasing your efficiency. That means you'll spend more time being a doctor, and less time acting like an accountant with a really expensive medical degree.
Practice Fusion addresses the complexities and critical needs of today's healthcare environment by providing a free, web-based Electronic Health Record (EHR) application to physicians.
QPID Health was launched in late 2012 to bring the power of the QPID Clinical Intelligence Solution to hospitals and health systems nationwide. The software uses a scalable cloud-based architecture and leverages advanced concept-based natural language processing (NLP) to extract insights from data stored in EHR systems and other clinical repositories.
Surescripts is dedicated to giving healthcare providers secure, electronic access to prescription information that can save their patients'' lives, improve efficiency and reduce the cost of healthcare for all.
Our goal is simple – deliver outcome-focused solutions that align with the clinical needs of patients and providers and affect positive change in healthcare.
The EHR Group
The EHR Group is committed to providing consulting, education, and training to individual practices, medical groups, and community hospitals attempting to navigate through Electronic Health Records and Health Information Technology vendor selection, price negotiation, contract negotiation, and implementation.
VitalHealth Software, a joint venture by the Mayo Clinic (US) and the Noaber Foundation (NL), delivers web-based software solutions for personal health management, including solutions for managing chronic diseases such as Diabetes, COPD-Asthma, Congestive Heart Failure, Depression and HIV-Aids.
Vitalize Consulting Solutions, Inc. provides a wide variety of clinical, business and IT solutions for healthcare enterprises across the country and in Canada.
Waiting Room Solutions
Waiting Room Solutions provides a complete, affordable integrated web-based EMR and Practice Management Solution that’s designed to make life easier for you, your staff and your patients.
ZebraHealth has uniquely packaged its solution in a way that simplifies the health care process for not only the patient, but for the employer and health care provider as well.
ZebraHealth is dedicated to giving patients, employers and doctors the tools needed to enhance the patient-physician relationship and reduce the cost of high quality healthcare.