Should Apple get into the Electronic Health Record industry?

[Hmac]

https://www.americaninno.com/wisconsin/madison/could-apple-buy-epic-systems/

If you've ever used Epic, you know it to be one of the most sprawling, convoluted, and non-intuitive pieces of software ever created (with the possible exception of one or two other health record software).

I can't imagine that Apple can't improve it in some way. One of the biggest issues is the fact that there are multiple EHRs around the country and they can't talk to each other. It will take a company with some degree of leadership capability to try to get the mythical Universal Health Record of fthe ground and turn such software that is intuitive enough to actually useful when it comes to time vs results.

 

[C DM]

Seems like there's something of that sort that Apple is involved with: https://www.macrumors.com/2019/01/13/apple-health-records-satisfaction-survey/

 

[maflynn]

If you've ever used Epic, you know it to be one of the most sprawling, convoluted, and non-intuitive pieces of software ever created (with the possible exception of one or two other health record software).

Its complicated due to the complex laws and regulations. With Epic it can include other features/functions, i.e., billing, so it makes for a one stop shopping. I'd say it increases the complexity if you just have one system for EHR, another for billing, or appointments, etc etc.

One of the biggest issues is the fact that there are multiple EHRs around the country and they can't talk to each other.

Sure they can, I work for a hospital, and patients in a completely different hospital can access our records (with the prior authorization). I know this first hand, as I took my daughter to one doctor's office from one organization and they were able to see her medical records from a completely different entity.
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Seems like there's something of that sort that Apple is involved with: https://www.macrumors.com/2019/01/13/apple-health-records-satisfaction-survey/

I think that's a bit different, where its giving consumers access to their medical records, where as Epic is an enterprise application that provides many functions of managing patients and the business of running the hospital.

 

[wh2402]

Seems like there's something of that sort that Apple is involved with: https://www.macrumors.com/2019/01/13/apple-health-records-satisfaction-survey/

Healthkit integration with medical records is cool — but Apple didn't really do all that much here:

Source

 

[Zwhaler]

Hint: Apple is getting into the medical records business. I know this from a source; Apple has already acquired talent & tech in this field and it will grow into a big market initiative for Apple.

 

[Tech198]

If Apple did move into health space, then they would probably do something everyone else seems to not care about : "keeping your medical stuff private"

In order to opt out of our own Australia medical sharing system, here, we had to opt out "online"

Exactly why ? Why could we just phone up ?

Sharing stuff is ok, but there should be a limit to this stuff. But as it stands now, now one really cares, and just users "encryption" in the sentence to say "we are good"

It may safe, but only till it gets out, then it is '"no longer" safe. You can't THAT life back, no matter how hard you try and convince people. Sometimes, there *should* be only 1 chance the more private it gets. And if you can't make it fool proof, then perhaps you shouldn't be making easy.

 

[robjulo]

No. Epic is a mess but Apple hasn't done software well in years. Examples: Final Cut rewrite, photos rewrite, pages rewrite, itunes, etc etc.

 

[Hmac]

Its complicated due to the complex laws and regulations. With Epic it can include other features/functions, i.e., billing, so it makes for a one stop shopping. I'd say it increases the complexity if you just have one system for EHR, another for billing, or appointments, etc etc.


Sure they can, I work for a hospital, and patients in a completely different hospital can access our records (with the prior authorization). I know this first hand, as I took my daughter to one doctor's office from one organization and they were able to see her medical records from a completely different entity.
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I think that's a bit different, where its giving consumers access to their medical records, where as Epic is an enterprise application that provides many functions of managing patients and the business of running the hospital.

I’m not talking about the various other functions of Epic, I’m talking about the single function of patient record-keeping. It’s a mess. TERRIBLE software. The only good thing you can say about it is that it’s likely better than Cerner or Meditech. And while it’s true that HIPPA adds a layer of complexity, that’s not the reason that it’s crappy software.

As to interoperability, I can usually access patient records if they’re in another Epic-based system, but I can only access other systems if my hospital has acquired, at considerable expense, the conversion software necessary to access each individual system. VERY few hospital systems spend that money.

 

[maflynn]

I’m not talking about the various other functions of Epic, I’m talking about the single function of patient record-keeping

That's my point, hospitals are not going to move to an Apple based application/service for one function and use Epic for the other functions. Epic is in a sense a one stop solution and moving away from Epic just for EMH provides no benefit, but yet will increase complexity and costs

As to interoperability, I can usually access patient records if they’re in another Epic-based system,

But you posted that you couldn't access medical records, I pointed out when using Epic, you can - at least in my experience. Of course out of the box, Epic cannot access medical records from non-epic systems.

 

[Hmac]

Hint: Apple is getting into the medical records business. I know this from a source; Apple has already acquired talent & tech in this field and it will grow into a big market initiative for Apple.

No, if Apple is trying to build a complete EHR from the ground up that includes the other important functions of hospital billing and management, they will fail miserably. Hospitals and hospital systems have spent millions, billions, on their EHR systems. They are not going to trash their current system and spends MORE millions/billions to acquire a new system. If Apple isn’t acquiring Epic or some other such system and is trying to build an EHR from scratch, now is the time to sell your Apple stock.
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That's my point, hospitals are not going to move to an Apple based application/service for one function and use Epic for the other functions. Epic is in a sense a one stop solution and moving away from Epic just for EMH provides no benefit, but yet will increase complexity and costs


But you posted that you couldn't access medical records, I pointed out when using Epic, you can - at least in my experience. Of course out of the box, Epic cannot access medical records from non-epic systems.

OK, I can’t access the vast majority of patient records. I can’t directly access even Epic systems, and what access I do have is limited. In particular, I can’t access xrays, nor do I have access to all lab data, nor do I get all outpatient notes. Access to non-Epic systems is even more limited in terms of the patient data that they share.

Yes, no hospital will buy patient management software from Apple for the reasons I stated in my post above. If Apple wants to get into the EHR business, buying Epic is their only viable option.

 

[ibphd]

Its complicated due to the complex laws and regulations. With Epic it can include other features/functions, i.e., billing, so it makes for a one stop shopping. I'd say it increases the complexity if you just have one system for EHR, another for billing, or appointments, etc etc.


Sure they can, I work for a hospital, and patients in a completely different hospital can access our records (with the prior authorization). I know this first hand, as I took my daughter to one doctor's office from one organization and they were able to see her medical records from a completely different entity.
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I think that's a bit different, where its giving consumers access to their medical records, where as Epic is an enterprise application that provides many functions of managing patients and the business of running the hospital.

The ability to share is only partial and depends on the emr/ehr used. This situation is a mess and difficult to fix. It’s akin to using different word processors and transferring between them.

 

[Hmac]

The ability to share is only partial and depends on the emr/ehr used. This situation is a mess and difficult to fix. It’s akin to using different word processors and transferring between them.

Only worse, even between different versions of the same software. I can (sort of) communicate with other Epic systems and only if I’m willing to accept markedly truncated and poorly formatted data, and dont’ need to see x-rays.

 

[jtara]

I don't know what Epic is. What I do know is that every baby step toward sharing medical records that I have encountered from within the medical industry/profession has been an abject failure.

The medical group that I have selected for my HMO has their own system for giving the patient access to medical records. I found it utterly impossible to sign-up, and I'm a software developer. I've no idea how a normal person would figure it out. And the process starts with a pre-assigned password-of-the-day (yes, you are supposed to change it) that has is be handed out in the doctor's office. Armed with that knowledge, I realize that I could have accessed any account created on the day that I signed-up. (Or attempted to.) There is a simple-minded formula for account names involving the last name and the current date. All I'd have to do is overhear the last name of the person in front of me on line, or glance at the names on the sign-in sheet.

I did manage to get signed-up, only to find that there were no significant medical records to be seen. Somebody in the office has to manually "push" lab results, for example. They never did.

I asked that the account be disabled.

When I visit a specialist, my primary care physician never gets anything useful. I have to tell him what mediations were prescribed. And vice-versa. Even within the same medical group, there is no effective sharing.

I had a trip to the emergency room (my first ever) due to an injury. My medical group is affiliated with the hospital. They have the same name ferchristsake. I had to give them a medical history. They were not able to access anything. It's been a huge pain, as well, because no provider has gotten insurance information, which I provided at check-in.

At least my doctor got a report from the hospital. But he had to ask for it.

My shots that I've gotten at CVS? I had to go in to CVS personally and ask them to send immunization records to my doctor.

I at LEAST want a portable medical history on a USB thumdrive. THAT I can get, though I suspect with big gaping holes. I would have to pay Bactus. I refuse to pay Bactus for anything, they are ripoff city.

Contrast this with the system in England, where I am told, you walk into a doctor's office, and they can access your medical history. When I walk into a doctor's office here - even if it is a specialist affiliated with my insurer and medical group - I have to attempt to recreate a medical history from memory yet again.

And then, I wait for any bills from outside providers, which show full price 100% my responsibility, and have to call them to give them the insurance information they should already have.

When I talk to my doctor or the support people in the office, they are as utterly baffled as I am. But they encourage people to sign-up. I guess they are told they have to.

YES Apple should get into the medical records business. Maybe they can do it right. I'd love to see somebody from outside of the industry try. I think there's some brain-fogging virus going on within the medical industry that prevents them from creating anything sensible in this regard.

 

[Hmac]

I
I at LEAST want a portable medical history on a USB thumdrive. THAT I can get, though I suspect with big gaping holes.

THAT is most likely the thrust of Apple’s medical records adventure...portable storage of your medical records. You’ll have to be the one to make it happen, but if you put in the effort, you can someday have all your records on your iPhone. It would be interesting, but I don’t see Apple attempting an entry into the EHR business.

The difficulties in medical records management isn’t due to “brain-fogging virus”...it’s money. EHRs are VERY expensive to buy and implement, and the current systems create massive efficiency problems, sucking up about an hour of a physician’s time for about every hour of patient care that they provide. There isn’t enough money in the system to make them work efficiently.

 

[jtara]

If you've ever used Epic, you know it to be one of the most sprawling, convoluted, and non-intuitive pieces of software ever created

I'd mentioned earlier what a s***-show the software used by my medical group is. I'd commented that I didn't know if it was Epic or not.

Yes, it's Epic. What a piece of c***! An Epic failure!

I was just now going to pay a bill. I am going to pay it by phone. No way I am going to ATTEMPT to sign-up for their system again!

If Apple bought them, I hope it would only be to gain market share, and throw the existing software in the trash, where it belongs.

 

[Zwhaler]

No, if Apple is trying to build a complete EHR from the ground up that includes the other important functions of hospital billing and management, they will fail miserably. Hospitals and hospital systems have spent millions, billions, on their EHR systems. They are not going to trash their current system and spends MORE millions/billions to acquire a new system. If Apple isn’t acquiring Epic or some other such system and is trying to build an EHR from scratch, now is the time to sell your Apple stock.

Interesting, that argument sounds a lot like what people were saying before Apple got into the smartphone business. Also, you realize you're talking about Apple right? The company with the most cash on hand in the world? Whose CEO recently stated that Health would be Apple's biggest legacy contribution to mankind? I think you know what you're talking about with Epic, but not with Apple.

From John Scully: “We’re about to move into an era where sensors … [and] algorithms are getting more powerful. Technology and health care is moving from a vertically siloed, highly inefficient industry,” he said. “The big health-care players want to move to platforms, they want it to be a horizontal model, just like we’ve seen successfully in retailing and in fintech and others.” Source

Another good article: https://www.axios.com/apple-health-tech-tim-cook-interview-fe097732-b4c6-4ac8-8f12-63f93c145595.html
And before you say that they're just talking about wearables... as Cook told CNBC, "We're just at the front end of this." Wearables are the tip of the iceberg.

 

[Hmac]

Interesting, that argument sounds a lot like what people were saying before Apple got into the smartphone business. Also, you realize you're talking about Apple right? The company with the most cash on hand in the world? Whose CEO recently stated that Health would be Apple's biggest legacy contribution to mankind? I think you know what you're talking about with Epic, but not with Apple.

From John Scully: “We’re about to move into an era where sensors … [and] algorithms are getting more powerful. Technology and health care is moving from a vertically siloed, highly inefficient industry,” he said. “The big health-care players want to move to platforms, they want it to be a horizontal model, just like we’ve seen successfully in retailing and in fintech and others.” Source

Another good article: https://www.axios.com/apple-health-tech-tim-cook-interview-fe097732-b4c6-4ac8-8f12-63f93c145595.html
And before you say that they're just talking about wearables... as Cook told CNBC, "We're just at the front end of this." Wearables are the tip of the iceberg.

No, I’m not talking about consumers buying a $500 cell phone, I’m talking about big (and small) corporations making million/billion dollar software acquisitions in order to perform the most critical, most sensitive, and most regulation-laden functions of their organization. From a company with NO experience, but more importantly NO track record in the EHR business. And where the Feds have their fingers dug deeply into that very system, and are desperately clamoring to dig even deeper. Feds vs Apple? In an area where the Feds have a MASSIVE head start, speak loudly, and carry a MASSIVE stick? Uh...no. Ain’t gonna happen. They’ll either acquire an existing company WITH a track record, or their super-secret health care project will be nothing more than yet another built-in app for many of us to disable on our iPhones.

 

[Zwhaler]

No, I’m not talking about consumers buying a $500 cell phone, I’m talking about big (and small) corporations making million/billion dollar software acquisitions in order to perform the most critical, most sensitive, and most regulation-laden functions of their organization. From a company with NO experience, but more importantly NO track record in the EHR business. Uh...no.

Ain’t gonna happen. They’ll either acquire an existing company WITH a track record, or their super-secret health care project will be nothing more than another built-in app for many of us to disable on our iPhones.

I agree that Apple would pretty much have to acquire Epic in order to realistically forge ahead with EHRs... but that doesn't contradict what I'm saying. Also the iPhone was much more than a $500 cell phone. Look at iOS, which in turn influenced Android, and created apps as we know it. How many people do you know that don't use either of those platforms? It's about more than the phone, it's about the platform behind it. There's a big opportunity in health platforms that Apple is exploring currently on a small scale, with intentions to grow much larger... that's what this is about.

 

[Hmac]

I agree that Apple would pretty much have to acquire Epic in order to realistically forge ahead with EHRs... but that doesn't contradict what I'm saying. Also the iPhone was much more than a $500 cell phone. Look at iOS, which in turn influenced Android, and created apps as we know it. How many people do you know that don't use either of those platforms? It's about more than the phone, it's about the platform behind it. There's a big opportunity in health platforms that Apple is exploring currently on a small scale, with intentions to grow much larger... that's what this is about.

I don’t care what the original iPhone cost back then. The significance of that paradigm shift is DWARFED by the sheer magnitude of the Federal government’s interest in the EHR business. There is no realistic comparison wherin one can conclude that Apples success with an item of consumer electronics implies their ability to build an EHR. Now, as I said...maybe they can BUY an EHR, manage it successfully, and maybe even improve upon it. Long odds, but maybe...OR....maybe they can make small inroads into a relatively useful integration of gadgets into healthcare software.

 

[jtara]

Ack! After a bit of searching, I now realize that Epic is generally considered the best there is.

Now I understand why our health care system is such a mess!

I will read the NYT Willy Wonka story in full when I have time.

What hospital administrator in their right mind would buy this after visiting their campus?!

I think it is funny that the article talks about developers "embedding with surgical teams" to understand how things are done. A physician (Hospitalist) friend was recently railing about how the developers of EHR systems have no clue how things work in a hospital.

He knows I'm a software developer, and was saying something like "do software developers ever try to understand how people use their software". He was writing patient notes at home, because it never all gets captured in real time. (The discussion was brief, his spouse was entertaining a group, he disappeared to write patient notes...)

I said some do. I told him the story about how I let the operators of an axle assembly line design the operation of a control panel. Because a project was started late, I had to program the system right on a factory floor. My excuse for being there was "for some final adjustments to the software". I was WRITING the software, from scratch the day I arrived, LOL. (When we arrived, somebody started yelling at us about being two days late, where have you been? Nobody told us we were two days late, grrrrr....) I had the operators of the line available, sitting there twiddling their thumbs waiting for us to be done. I figured, why not involve them in the design process? So, I picked their brains, bypassing layers of bureaucracy, and nobody was the wiser.

It hadn't been spec-ed out that fully. Oh, we had a metal panel with buttons and a display, and that had been decided. But - it's software. So, why not? I ASKED... how would you like these buttons to work?

Curious what is meant about all the government "meddling" and "fingers in" EHR. Are you talking about something more/other than HIPAA? And presumably some reporting requirements? Exactly what do you mean by the "sheer magnitude of the Federal government’s interest in the EHR business". That's all very vague, could you elaborate.

Why do you think that Apple can't deal with government requirements and "interest"?

That somebody else spent a lot of money to build - and charges an unholy bundle - for a steaming pile of c*** doesn't mean that Apple would do the same. Maybe what it takes is to think different.

And I do think it is a steaming pile of c***. When I, as a software developer, cannot figure it out (just the customer-facing part) that is bad. There is no hope for the average person. I mean, I can usually read between the lines, and guess at missing instructions, work around badly-designed UIs, etc. Usually, I said. To say that the sign-up process for the customer portal with my physician's group is convoluted would be an understatement!

Curious, are these systems run exclusively on in-house systems? I'd think this industry is ripe for hybrid cloud. Is anybody new partnering - for example - with IBM on these sorts of systems? Reason I ask is I do backend development for an app (nothing close to medical in nature - it is educational) using IBM Cloud, and I notice a lot of emphasis on HIPAA there lately. My ears perk up, because we will need to comply with COPPA (data related to children under 13) at some point (products currently only for adults, which is why I say "at some point"), and requirements are similar in many ways. I would not be surprised, then, to see IBM become a surprise partner in some new EHR initiative, with their emphasis in hybrid cloud, which not a strong suit with the other cloud providers.

 

[Hmac]

In the world of sucky EHR,s Epic is generally considered to be the least sucky, and they augment their popularity with CFO's by offering good pricing, good terms, good maintenance agreements, and all the other usual sales/marketing deals. Hospitals and hospital systems buy Epic because they have little or no choice. There isn't anything better.

When you have a component of a nation's economy that represents 18% of their GDP, you better believe that that nation's government is going to want control of that massive component. Note Medicare and CMS. Now note the recent Democrat push for "Medicare for All". Also note the Feds' "Meaningful Use" program. When you're done with that, look up MACRA. Why do you think the Fed Gov wants to encourage a viable EHR concept? Answer: it centralizes all health care data and makes it easier for them to access, thereby easier (ultimately) for them to control it, as they have already started doing via programs like MIPS and MACRA.

Apple is a big company with lots of resources and lots of money. And they do have some experience dealing with the government. But that experience is miniscule compared to what they would face if they try to insert themselves from scratch into the health care system. It's far more complex than hiring a couple of hundred engineers to build a self-driving electric car. It would be a massive effort. It might be possible and fruitful for them to buy Epic and improve it, making it more efficient, but the ROI would be likely very bad as they repeatedly get stymied by an entrenched government-run health care bureaucracy who simply doesn't give a crap about Apple's success. Apple, in its push to improve the EHR world would be fighting the Federal Government tooth and nail every step of the way as the Feds, with vastly more power and money than Apple, desperately cling to the status quo. As is typical of our Federal government. Apple would be up against that massive Fed Gov inertia all the time. Take into account Apple's demonstrated willingness to buck the government in favor of privacy and consumer protection...I can't imagine Apple creating a bigger set of headaches for themselves.

Hospitals and hospital systems buy Epic because the have to buy something. This is because they need it not only for patient care as determined by the Fed's Meaningful Use program, but they also need it to electronically submit billing claims to Medicare/Medicaid, as well as virtually all insurance companies. It would be virtually impossible to build, maintain, and update your own system-wide EHR as the Mayo Clinic ultimately and recently discovered, leading them to abandon their own long-standing proprietary in-house EHR (which was pretty good) and their recent massive switch to Epic, at a cost of $1.5 billion for the conversion, not including the cost of training, and the cost of lost productivity/revenue during the ramp-up, which was $millions in itself. Think about that. It was cheaper for them to shell out almost $2 billion and start from scratch with Epic than to modify/update and continue using their own in-house system developed and refined over decades and get progressively screwed over by the Federal Government. Nor did they deem it feasible to go to IBM or Apple for help. They just bought Epic instead.

In some cases, especially larger systems, the EHR will run natively on in-house servers, but even those large systems also run their EHR on a Citrix server so that it can be accessed remotely and on most device platforms, both mobile and desktop. Our system is Citrix-based. It's kind of a pain because I have to first log into the Citrix server, then log into Epic. I also have to log in to the Dragon voice-transciption server. Especially a pain because HIPAA dictates that both the Citrix server and the Epic server have to time out after a few minutes of non-use - meaning that I have to re-log in many, many times a day in order to do my job. Just another example of the massive inefficiency that EHR's impose. I can usually get around those inconvenient time-outs by plugging in a Mouse Jiggler. IT hates that but they've given up trying to prevent it.

As an example of the added cost to an already-expensive health care system, think about the fact that it is cheaper for the hospital to hire a Ph.D nurse-practitioner at $100,000+ per year to do my computer work for me than it is for me to decrease my own productivity by taking the time for me to do it myself. Now tell me how a single-payer system like Canada (Medicare for All) will work in the USA. Practicing medicine these days is a whole new ballgame for a variety of reasons. Marcus Welby is long, long dead.

I realize and appreciate that to a software engineer, it might not seem like writing a big enterprise-level system would be as monumental as I imply. Trust me, it's probably worse. I would be astonished to see even a big company like IBM or Apple get into the game from scratch.