As a lot of other posters have noted - hospital level deployments, where good data practices and IT are arguably the most needed due to the mission critical nature and the larger volumes of data generated, is hobbled by entrenched interests, IT policy dominated by insurance revenue concerns rather than driven by patient or practitioner needs, and being swallowed up by a oligopoly (soon to be monopoly) consisting of Cerner, McKesson and Epic.
All of these companies use antiquated databases (MUMPS forms the basis of the products of these companies for the most part, a data language invented in the basement of Massachusetts General that predates FORTRAN and COBOL). The UI/UX design is nonexistent (all of them would crush any of the Daring Fireball interfaces of shame posts).
More ominously - these companies protect their business AND their data formats ferociously. Epic is famous for lock ins - once you pay the $50-100 million contract for them to take over your IT, your data will not interface with any other system again, ever. They are good at generating numbers for Medicare and insurance billing revenue that make hospital CEO's giggle with glee (ignoring user experience and good data practices for the doctors, nurses, and patients on the line - which translates into lousy care administered to patients). Judy Faulkner, the CEO of Epic, is known for having much of the Wisconsin Congressional delegation in that company's back pocket, such that she sits on some congressionally mandated committee for EHR's promoting closed, proprietary systems as a means for "patient privacy" (lolwut).
The system I work in actually has a reasonable setup. Not nearly as sexy as some of the advanced hadoop/linkedin/facebook/netflix setups - it was build on an Oracle back end running MS IIS and ASP. But at least it's on the web and the database isn't creaking along on a system that looks like this: http://thedailywtf.com/comments/A_Case_of_the_MUMPS.aspx?pg=...
Yet swayed by whatever koolaid Epic fed them, they forked over the millions in contract to go 40 years back in time.
I think this industry is so so so ripe for disruption. Focus on the doctor/nurse/patient user experience, make EHR software that does what every facebook/google+/linkedin, heck even blogger user takes for granted, get the adoption rates up, and kill these greedy as sons of bitches at their own game.
> Focus on the doctor/nurse/patient user experience, make EHR software that does what every facebook/google+/linkedin, heck even blogger user takes for granted, get the adoption rates up, and kill these greedy as sons of bitches at their own game.
I agree 100% in principle, but I think that in reality this won't work. Why? Because the people that would benefit from that approach (focusing on the user experience, etc.) are not the people that make the decisions about which system to buy. Those people could care less about what it looks like, or how usable it is.
That's the reason why so many EHRs have UIs that look like they belong up on blocks in somebody's front yard, and even worse-looking APIs- a misalignment of interests between the users of the system and the people who make the purchasing decisions.
It's like a little microcosm of everything that's wrong with the entire medical system... :-)
Not always true; for any project we do which would impact patient care there is always at least a physician involved, sometimes a nurse as well. The reason our Epic UI looks they way it does is because clinicians want it that way.
We have tried to streamline the interface, but they don't want IT telling them what is important to put on the screen. During our last upgrade we had issues because some physicians put so much on the screen that caused a problem with the program; Epic implemented a fix for us, but the physician took something we showed them and ran with it. Then they started telling others who did the same.
The end result was like the image people like to link to whenever this topic comes up; a screen full of check boxes and sliders. They like this because all of the information they want is on one screen and they can quickly go down the screen making selections. When we tried to streamline this they didn't like that there would be multiple screens to load and then they wouldn't have one way to see everything selected without a summary page which was yet another screen.
I work in IT security and user experience is one of the key things we focus on; a system that is confusing or difficult to use will be used in ways we do not expect. Making the most obvious choice the right choice reduces risk, confusion and helps ensure people do the right thing.
Epic is famous for lock ins - once you pay the $50-100 million contract for them to take over your IT, your data will not interface with any other system again, ever.
I'm not too familiar with MUMPS but is there anyway the hospital's IT Dept. could allow a 3rd Party App to integrate to the actual MUMPS database/data source to get to the data, and thus bypass trying to get access to the EPIC/Cerner API or HL7?
As a lot of other posters have noted - hospital level deployments, where good data practices and IT are arguably the most needed due to the mission critical nature and the larger volumes of data generated, is hobbled by entrenched interests, IT policy dominated by insurance revenue concerns rather than driven by patient or practitioner needs, and being swallowed up by a oligopoly (soon to be monopoly) consisting of Cerner, McKesson and Epic.
All of these companies use antiquated databases (MUMPS forms the basis of the products of these companies for the most part, a data language invented in the basement of Massachusetts General that predates FORTRAN and COBOL). The UI/UX design is nonexistent (all of them would crush any of the Daring Fireball interfaces of shame posts).
More ominously - these companies protect their business AND their data formats ferociously. Epic is famous for lock ins - once you pay the $50-100 million contract for them to take over your IT, your data will not interface with any other system again, ever. They are good at generating numbers for Medicare and insurance billing revenue that make hospital CEO's giggle with glee (ignoring user experience and good data practices for the doctors, nurses, and patients on the line - which translates into lousy care administered to patients). Judy Faulkner, the CEO of Epic, is known for having much of the Wisconsin Congressional delegation in that company's back pocket, such that she sits on some congressionally mandated committee for EHR's promoting closed, proprietary systems as a means for "patient privacy" (lolwut).
The system I work in actually has a reasonable setup. Not nearly as sexy as some of the advanced hadoop/linkedin/facebook/netflix setups - it was build on an Oracle back end running MS IIS and ASP. But at least it's on the web and the database isn't creaking along on a system that looks like this: http://thedailywtf.com/comments/A_Case_of_the_MUMPS.aspx?pg=...
Yet swayed by whatever koolaid Epic fed them, they forked over the millions in contract to go 40 years back in time.
I think this industry is so so so ripe for disruption. Focus on the doctor/nurse/patient user experience, make EHR software that does what every facebook/google+/linkedin, heck even blogger user takes for granted, get the adoption rates up, and kill these greedy as sons of bitches at their own game.