Federal electronic medical record data sharing rules have been released, many years after the $38B+ federal taxpayer backdoor subsidy, which promised “interoperability”.

David Wahlberg:

Rick Pollack, CEO of the American Hospital Association, said in a statement Monday that the final ONC rule fails to protect patient information. “The rule lacks the necessary guardrails to protect consumers from actors such as third-party apps that are not required to meet the same stringent privacy and security requirements as hospitals,” he said.



Nick Hatt, a product designer at Madison-based health care data-sharing company Redox and a former Epic employee, said Epic “didn’t really get very much in the final (ONC) rule. The content did not change substantially, so it was kind of a win for the patient-access side.”

The rule requires full exports of patient data, beginning in three years, to patients or hospitals if requested, Hatt said. “You’re being asked to develop something that helps your customers switch from your software to someone else,” he said.

Also, screen shots of electronic medical records will become more public, which Epic didn’t want, Hatt said. “They really don’t want to have screen shots of their software out on the internet, and now essentially it’s illegal for them to put those kinds of clauses in their contracts,” he said.

But the scope of data that must be shared will be limited for two years, and companies such as Epic will be able to warn patients about the dangers of sharing data with third-party apps — changes that were in Epic’s favor, Hatt said.

The rules apply to scenarios such as patients wanting to share clinical data and check lab results with Apple’s Health app, Hatt said.



Epic has said the proposed ONC rule could threaten patient privacy and intellectual property, and increase health care costs. CEO Judy Faulkner urged customers to support a letter in opposition to the rule. More than 60 health system CEOs, including those at UW Health, UnityPoint Health-Meriter and Gundersen Health System, signed the letter sent in February to HHS Secretary Alex Azar.

Related:

1. Paying – Repeatedly – for Epic’s Walled Garden

2. Airdrop trumps $40B Taxpayer Medical Record Subsidies.

3. Madison’s Property Tax Base Growth; $38B+ Federal Taxpayer EMR Subsidy.

4. $37,920,077,070 in Taxpayer Electronic Medical Record Subsidies: 2009 – January 2018

5. Epic Electronic Medical Record Implementation: $100,000,000 for Stanford Hospital in 2005.

6. Epic Systems Clearing Storm Landscape Images.

7. A failed 2007 attempt to use Wisconsin taxpayer funds for electronic medical record subsidies.

7. More notes and links on Epic Systems and its founder: Judy Faulkner

8. Federal electronic medical record data sharing rules: 474 page pdf.

Dave Chase:

I know of no industry where technology is as despised as it is in health care. It’s a statement that it took government money to incentivize healthcare providers to finally do what virtually every other industry has done — apply IT to streamline processes. “Established technology is being given a federally funded new lease on life,” athenahealth CEO Jonathan Bush said. “Traditional health software now is on Medicare, being kept alive like grandma.” Bush dubs this program as the “cash for clunkers” program for health IT leaving no doubt what his opinion is regarding the legacy vendors’ solutions.



While one might dismiss this coming from a company with a dog in the fight, the feeling is nearly universal amongst physicians who are the most important users (besides patients who are almost completely ignored). The best evidence of how abysmal legacy healthIT is, is that the market leader is having trouble getting medical practices to adopt their software even with huge subsidies from large health systems. In the course of discussions with large health systems, they share the deployment of a mega Electronic Medical Record (EMR) and how they were offering subsidies to affiliated doctors to adopt the same system. When pressed about how broadly it was being adopted by non-employee physicians (i.e., MDs who have a choice), the penetration was staggeringly low — 0.2% was the average of those who shared figures. This was despite the fact that they were subsidizing 85% of the cost (the maximum allowed by Stark Law).



When I’ve spoken with doctors who have rejected the entreaties from their affiliated health systems, it’s more than the expense (even after a massive subsidy, it’s still several thousand dollars plus monthly costs). Rather, the complexity and lack of user friendliness is the bigger driver. A common statement one hears in healthIT conversations is that doctors hate technology or are afraid of it. Hogwash. They only hate bad technology. Consider the iPad. Doctors are one of the biggest buyers and it’s not just young doctors.