

Doctors Find Barriers to Sharing Digital Medical Records - andrewl
http://www.nytimes.com/2014/10/01/business/digital-medical-records-become-common-but-sharing-remains-challenging.html

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nospecinterests
There are no enforceable standards and no governmental body has come together
to figure out the standards for data transfer. I don't think its going to
readily happen either. Currently, each company (the Epics, GEs, etc) will
ALWAYS say that their product is the best and their standards should be the
ones used. No one wants to give so they don't play nice with each other. They
are leveraging the built in incompatibilities to make more money and there is
nothing wrong with that. Plus, there are no economic reasons (like fines and
quite frankly most patients don't need to go between large systems for care so
there is no driving force from patients) to force them to play nice.

In this case, the free market can be the solution. In this fact, Judith
Faulkner is wrong (and she is passing the buck). The government does not need
to get involved and write standards. Especially if it is anything like the way
the government has done other standards. If they did they would invite in the
manufacturers to sit on a committee and each one would push and pull until the
standard includes all of the features of their respective software systems.
Before you know it, the standard is bloated, useless, and costly to implement.
The solution is the free and open market. Some enterprising group of
healthcare providers and practitioners, along with their IT teams, need to
come together and form a group (away from the influence of the software
manufacturers) to write the spec. They then need to form an alliance
organization that calls on its members to require their systems to implement
the group's specification. That way as a group (much like health insurance
pooling) they have a large enough force to get manufacturers to listen to
their needs. Because it costs millions to implement an EHR/EMR this path would
not provide instant results for those who have already implemented a system or
are in the process of implementing one. But as healthcare practitioners and
providers upgrade to new versions they would gain the functions of their spec.

~~~
pragueexpat
As someone who works in this field, there actually are government standards
and working groups that involve all the vendors. I'm talking about in the U.S.
- Europe has a much more varied ecosystem and standards appear harder to agree
upon. In the U.S. the standard is the Consolidated Clinical Document
Architecture (C-CDA)([http://www.healthit.gov/policy-researchers-
implementers/cons...](http://www.healthit.gov/policy-researchers-
implementers/consolidated-cda-overview)). The government body involved is the
ONC (Office of the National
Coordinator)([http://www.healthit.gov/newsroom/about-
onc](http://www.healthit.gov/newsroom/about-onc)). The only problem at the
moment is the finalization of the draft proposals and the vendor-specific
interpretations of the standard. It's getting there but obviously the details
are slow to work out.

~~~
nospecinterests
Thats a good point. In the US the ONC/HIT at HHS has put out recommendations
and rules for the schemas for data storage. Which is what the documents you
reference are about they are about defining the building blocks used to store
and capture health data. But, they do not define how they are transported or
exchanged. The C-CDA even notes this, the "CDA DOES NOT specify how documents
are transported, simply how critical data elements should be encoded for
exchange and interoperability". Its the same thing for HL7 and all those great
ICD9 and ICD10 codes. They are just building blocks not rules for transport.
(I also know a thing or two about the field. We are magnetic buddies.)

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nospecinterests
Am I the only one who thought judith faulkner's quote was hillarious?

 __" Let’s say a patient is coming from U.C.L.A. and going to the University
of Chicago, an Epic-to-Epic hospital. Boom. That’s easy" __

Well no kidding! Your company wrote the software. Its like saying its easy to
mix 2 packets of Grape Jello together to make a larger serving. Of course that
will work! I would be slightly terrified if it wasn 't possible. Plus, they
wrote Epic Care Everywhere to exchange data between healthcare providers. Its
part of the selling point of their software! "Buy us, we have half of 'Merica
covered so you can exchange patient records like relz easy." (not an actual
quote).

