Comment by wavefunction | Hacker News Reader

Comment by wavefunction | Hacker News Reader

Having worked for an EHR company at one point, the author misses the main reasons for a lack of interoperability: government regulations regarding "meaningful use" that allow physicians and hospital systems to receive financial incentives to offset the costs of the software. The regulations have been ill-defined and incredibly slow in being released.

http://www.healthaffairs.org/healthpolicybriefs/brief.php?br...

This page gives some background to the issues but basically, the federal government has held the process up, while many companies are champing at the bit to make a lot of money regardless of interoperability which everyone agrees will be a good thing.

This is not necessarily a criticism: I wouldn't expect a nurse/iOS dev to be familiar with the regulatory background governing EHR standards. It's unfortunate that they definitively lay the blame on profit motives or technical challenge. No offense to the author but there are some very intelligent people who have been working on this problem for some time.

Having just started work at an EHR company, it is absolutely mind bogging how much more complicated the regulations make the business.

Shameless plug: said company is athenahealth and we're hiring in Austin (and also other places, but this office is the best), and we've also got a budding API program looking for startups to interact with. Email me at my HN username at athenahealth.com

- http://www.athenahealth.com/cmp/more-disruption/more-disrupt...

- http://www.forbes.com/sites/zinamoukheiber/2014/06/19/a-hand...

Excellent company! My buddy is there right now and y'all have some incredibly smart and talented folks. Congrats!

I applied for a job with athenahealth in Boston many years ago, but sadly didn't make the cut then. It sounded like a fantastic place to work, where you could make a difference in people's health as well as make good money.

Nice! I'm an athenahealth developer in the atlanta office (well... alpharetta, but soon to be atlanta). While I love it here, I can confirm that the Austin office is the best. We sometimes watch your scotch friday meetings, and Jack comes to our neck of the woods for a "scotch tuesday/wednesday" every so often.

In more relevant news, the CEO (Jonathan Bush) just wrote a book ("wrote", he joked) that's a semi-right-wing take on the problem posed in this article (lack of EHR interoperability). Solid read though regardless of politics.

Also, the MDP program (the API you're referring to) is more designed to allow third party developers to build functionality onto athenanet that we don't have the specialization or capacity to build. It's not really a means of sharing health data (to my knowledge). However! We have been making the sharing of EHR data a priority, or at least seeming to, with the formation of the CommonWell Health Alliance (members including most major EHR creators... except Epic, because they're Epic). Additionally, we're working on some stuff with athenaCommunicator to help hospitals talk to labs, and stuff with Coordinator that I think involves the Austin crew too... but I don't know what of Coordinator we're allowed to talk about yet so I'll probably shut up on that matter.

>Having worked for an EHR company at one point, the author misses the main reasons for a lack of interoperability: government regulations regarding "meaningful use" that allow physicians and hospital systems to receive financial incentives to offset the costs of the software.

Ha! "Meaningful Use" is not the reason for lack of interoperability. The lack of interoperability existed before "Meaningful Use". My pet theory: The individual companies don't really want it. Oh sure, at conferences and trade-shows everybody says the right things, but in their heart of hearts, they want to be firmly in control of data in order to make it as painful as possible for the customer (i.e. hospital) to move away from them, or even integrate a competing product.

Well, let me lay out my case:

"Meaningful Use" is tied to the regulations that also govern the glacially-developing interoperability standards, and is only achieved through certification. What "meaningful use" actually means is still not very well defined from what I know (I'm now in the financial industry so I haven't kept abreast of the current state of EHR regs.) So even if the industry settled on a standard themselves, they can't be sure adopting it or the non-existent government decreed standards would meet certification even for meaningful use. And meaningful use and interoperability are the result of HIPAA from 1996.

Doctors and hospital systems are hesitant to adopt any EHR solution because they will receive huge subsidies from the federal government in the form of tax-breaks as long as they are using a certified solution, which is the only way many smaller practices will be able to afford adopting EHR systems. There is a lot of uncertainty around committing to an EHR solution because the practitioners can't be convinced that the EHR systems will meet cert, so they're dragging their feet, which really retards the growth and revenue of the industry.

I think if there was a standard for interoperability that everyone knew would meet cert (which ties into "meaningful use"), we wouldn't be having most of this conversation.

>"Meaningful Use" is tied to the regulations that also govern the glacially-developing interoperability standards, and is only achieved through certification.

"Meaningful Use" is largely agnostic to the underlying standards. It rewards (or punishes) outcomes but its aim is to increase electronic patient record usage.

>So even if the industry settled on a standard themselves, they can't be sure adopting it or the non-existent government decreed standards would meet certification even for meaningful use.

That's not really an issue. The standards are the way they are because there are no dominant players that can push through a standard unilaterally, and as I've said, the big players just don't care enough about standards outside of marketing, and they downright hate them if it means an easier time for a competitor to supplant them on-site. The interoperability mess is not due to MU in any 'meaningful' way. It was there before MU, it's there today, and it'll be there after MU.

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