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Monday Morning Update 6/26/17

June 25, 2017 News 19 Comments

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Google adds medical records to the handful of categories that users can ask the company to remove from searches. Someone whose medical records have been exposed inadvertently or otherwise can ask Google to hide their information from its search results.

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Medical records thus join the Google categories of federal ID numbers, bank account numbers, credit card numbers, scans of signatures, copyrighted materials, and revenge porn that are already covered by Google’s removal policies.

The material is still visible on whatever site posted it, but is less likely to be discovered when it’s filtered from Google searches.


Reader Comments

From Vendor Locking, Data Blocking: “Re: Cerner and the DoD/VA. You covered this a year ago and it’s even more outrageous in light of the VA’s decision. Cerner forced the DoD to host MHS Genesis because, by Cerner’s rules, only Cerner can, even though the DoD finds that it’s technically doable by others. Cerner ‘is not willing to negotiate at this time for the procurement of the data rights that would enable the government to utilize the Cerner solution in a competitive environment.’ Why? Because it ‘could adversely impact Cerner’s … competitive market advantage.’  Is this is the good faith Shulkin should expect heading into negotiations without a competitive bid?” I don’t know much about government procurement (and don’t want to), but publicly naming Cerner and presumably Leidos as the VA’s no-bid vendor for a contract whose value could exceed $10 billion seems absurd regardless of the Congressional pressure the VA is facing. The DoD messed up in failing to force Cerner (pre-contract, of course) to open up the DoD’s hosting options even though Cerner came up with a hollow-ringing excuse about population health management requirements, forcing us taxpayers to ante up a few more dozen million dollars that unfortunately constitute little more than a rounding error in the massive project.

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From Supine Position: “Re: losing an IT job when systems are replaced. It’s SOP for health systems implementing Epic.” Indeed it is. Epic forces its own employment model onto its customers, requiring experienced hospital IT employees to interview competitively for newly created Epic positions and to take Epic’s bizarre but apparently effective logical reasoning and IQ-type tests that are scored secretly by Epic, resulting in only a gladiator-like thumbs up or down passed along from Epic to the hospital’s project executives who defer to Epic’s wisdom for fear of rocking the boat of their employer’s gazillion-dollar project. It’s almost like Epic is invalidating the hospital’s own methods of choosing and keeping employees. The rank and file who get passed over for the Epic team are thanklessly turfed off keep the legacy system lights on, huddling depressed like death row inmates as they watch former teammates head off to new physical locations, Epic training, and a secure employment future. I’m surprised that hospitals are readily willing to part ways with employees who have decades of experience, but on the other hand, the Epic model of creating new jobs and then eliminating the old ones is a convenient way to clean house without feeling guilty. Make no mistake – when your health system employer chooses Epic but not you, your IT life, your social standing among peers, and perhaps your city of residence will change.

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From Interested: “Re: Quantros. The CEO is leaving, according to this announcement that identifies her new position.” A May 26 trading update from Informa PLC says that Quantros CEO Annie Callanan will join the business intelligence and publishing company this summer. She joined Quantros in July 2014.


HIStalk Announcements and Requests

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The majority of HIStalk readers don’t believe Apple will live up to the hype in making the iPhone a significant interoperability component. John Smith says Apple doesn’t understand interoperability but instead is mostly interested in selling hardware to customers of its walled garden. Nick predicts Apple will be Fitness Trackers Round Two in giving already healthy people yet another gadget to play with. JC says the company’s deep pockets and strong consumer focus could allow it to make a difference, while Mobile Man says people need ways to store and share the medical information of themselves and family members that could be accessed by providers and anything Apple can do to support that would be great.

New poll to your right or here: Have you ever lost a job due to a health IT implementation?

Jenn did a great job covering for me while I was on vacation for several days. I like that she makes me at least temporarily redundant so I can get away without worrying about HIStalk, although I’m always anxious to get back in the saddle.

My candidate to become the next MySpace – LinkedIn, which under Microsoft’s ownership has become maddeningly slow, is being bloated with questionably useful and unintuitive features, and is becoming a nagware showcase of trying to get users to buy premium services. I actually dread looking someone up on LinkedIn now, nearly as much as I hate getting unsolicited pitches from it (like never-ending recruiter spam and generic partner pitches from India-based companies).


Webinars

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


This Week in Health IT History

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One year ago:

  • Massachusetts General Hospital (MA) notifies 4,300 patients that their information was exposed in a February 2016 breach of dental practice systems vendor Patterson Dental Supply.
  • McKesson announces that it will divest its Technology Solutions business into a new joint venture company that it will co-own with Change Healthcare (the former Emdeon).
  • The VA signs up for IBM Watson to bring precision medicine to cancer treatment.
  • Teladoc announces its planned acquisition of consumer engagement platform vendor HealthiestYou for $155 million.

6-26-2012 10-31-15 PM

Five years ago:

  • ONC’s Director of Meaningful Use, Joshua Seidman, PhD resigns to take a job as managing director of quality and performance improvement with Evolent.
  • The Supreme Court rules to uphold the ACA, including the individual mandate.
  • A GAO report finds that the VA and DoD have made progress in their pilot project to integrate care at the James A. Lovell Federal Health Care Center (IL), but delays in implementing the IT component have created additional costs.
  • Practice Fusion gets $34 million in Series C funding from by Artis Venture.
  • Five senators introduce a bill that would create a national standard for notifying affected individuals about information security breaches.

Ten years ago:

  • Michael W. Carelton joins HHS as CIO.
  • The Healthcare Solutions business of JPMorgan Chase and RelayHealth offer an integrated set of claim and payment processing solutions.
  • Mediware delists itself from the NYSE Arca stock exchange.
  • Two DoD medical agencies attempt to stifle use of the Joint Patient Tracking Application so they can spend millions to build their own.
  • Cerner gets 510(k) clearance for its new transfusion and specimen collection system that will be marketed under the Cerner Bridge Medical name.

Weekly Anonymous Reader Question

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Last week’s survey: what is the best practice you’ve seen for a company to encourage gender equity?

  • Pay equality.
  • Promote the qualified women into management, upper management, and into the C-suite.
  • I have not seen this implemented anywhere, but names should be removed from resumes. Resumes should stand alone on the quality of the content, not the name of the applicant. This would also level the playing field for people who get bypassed (and there are a LOT who do) for their “ethnic” sounding name.
  • Can we please stop referring to our MAs, RNs, and receptionists as “girls,” as in “I’ll have one of my girls get that for you” or “My girls didn’t come in today, so we unable to see patients.”
  • Actually promote women to senior line roles. Most senior teams are a horde of white guys and a few token women in legal, HR, and marketing.
  • Data, data, data. Benchmark all positions against market rates and target hiring/paying everyone at the 50th percentile. Stop asking new hires what they make (now the law in Massachusetts); decide what the position is worth and pay that to all applicants.
  • Having a respected female leader.
  • Hire more men? Not always true at upper management, but at middle and down, my teams have been dominated by women for as far back as I can remember. Nurses (female-predominant career) switching to IT plays a huge role in this.
  • None that I’ve seen, but the term gender equity is a good example of an oxymoron.
  • Truly following an employee engagement strategy like those from Gallup, Press Ganey, etc.
  • It’s not really a best practice per se, but I started my career at Epic, and as a female, I did not see any limits to my career based on gender. The CEO and many senior leaders are female. I think having that as a first example helped shape what I will accept and what I have sought out culturally at future employers.
  • Several years ago while I was on active duty, the Air Force opened fields that were previously closed to women. Of all the careers positions that I have held since then, I have come to appreciate that no organization does a better job at “assimilation” than the military.
  • Promoting a feminist to CEO.

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This week’s survey: If you were offered a new job, what would be your limit on expected weekly work hours and travel requirements? I’ve never had a travel-intensive job so I don’t really know how that works, other than I’ve heard people gripe about spending their evening hotel hours catching up on work after a full day in front of clients and prospects. Maybe my next survey should address travel tips from road warriors who have learned to live out of a suitcase with little time back at the office.


Last Week’s Most Interesting News

  • Senate Republicans publish the Better Care Reconciliation Act of 2017, the GOP’s renewed effort to repeal and replace ACA.
  • Theranos reaches a tentative settlement with Walgreens that would result in the retail pharmacy getting only $30 million and losing more than $100 million of its original investment.
  • Teladoc acquires Best Doctors, a telehealth vendor focused on offering remote second opinions to support complex medical cases.
  • CMS publishes the 2018 Quality Payment Program proposed rule.
  • FDA Commissioner Scott Gottlieb, MD outlines his digital health plans for the agency, which include the development and launch of a third-party certification program for low-risk digital health products.

Announcements and Implementations

The ACOs and IPA of Orange Care Group will implement Epic’s Healthy Planet population health management system and will also offer its EHR via Memorial Healthcare System (FL) and Epic Connect.


Government and Politics

Some of the scariest words I’ve heard out of Washington, DC involve the idea that people shouldn’t be forced to buy health insurance they “don’t want or need.” Who might that be, other than psychics who can predict with certainty that they won’t have an auto accident, experience a stroke or heart attack, get hit by an exploding genetic time bomb, or find that they have cancer? Choosing not to buy insurance is a gamble in which those who bet wrong on the likelihood of circumstances beyond their control stick hospitals with their bills (and thus everybody else who was responsible enough to insure themselves), receive inadequate care, or lead their families into medical bankruptcy. There’s a reason that even good drivers are forced to buy auto insurance even though they might rather spend the money elsewhere. Healthcare is so expensive that even the relatively rich couldn’t afford the uninsured cost of a major, short-term illness or any long-term one. Personal responsibility in healthcare comes from both lifestyle decisions as well as backstopping the inevitable eventual costs with insurance.

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Meanwhile, here’s the most insightful comment I’ve seen on the US healthcare system given that everybody focuses on the cost of insurance that inevitably reflects the cost of healthcare services.


Sales

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Australia’s Northern Territory selects InterSystems for its $196 million clinical systems replacement project. Telstra Health, Epic, and Allscripts failed to make the cut from the shortlist, while Cerner, Meditech, and Orion Health didn’t advance to the final four.


Decisions

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  • Ocean Beach Hospital (WA) will replace Healthland (CPSI) with Epic in October 2017.
  • University of California Irvine Medical Center (CA) will go live on Epic in November 2017.
  • Winneshiek Medical Center (IA) will replace Meditech with Epic in September 2017.
  • Mayo Clinic Hospital – Rochester (MN) will go live on Epic in 2018.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.


Privacy and Security

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Anthem will pay $115 million to settle a class action lawsuit over the 2015 cyberattack that exposed the information of 78 million people.


Other

A hospital in India denies well-placed rumors that its patient oxygen supply went offline for 15 minutes and thus killed 11 patients, even though reporters seeking information found that the records of the victims had vanished along with the oxygen supply logbook. Administrators of the 1,400-bed hospital say there’s no need for alarm since 10-20 patients die there each day. The same hospital killed two children last year after giving them nitrogen instead of oxygen.

A professor in South Korea says hospitals interested in artificial intelligence should focus their efforts on EHRs instead of IBM Watson. He adds, “I have to question whether we can use Watsons with absolute trust. It seems that hospitals have introduced the technology mainly for publicity reasons. They are promoting Watson to win the competition, especially now that its cost is falling.”

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A depressing New York Times article covers the opioid addiction problems of Delray Beach, FL, whose paramedics responded to 748 overdose calls in 2016, 65 of them involving fatalities. Most of the victims were from elsewhere since the town has several addiction treatment centers that draw in addicts from all over the country who stick around afterward, who are then pursued by minimally supervised, often fraudulent, and insurance-paid treatment centers, labs, and group homes that profit from their relapses. Delray’s mayor notes that you can’t cut hair in Florida without a license, but you can run a substance abuse center. Also noted is that the Affordable Care Act gave young addicts insurance that made them a target for unscrupulous operators found in abundance in South Florida, to the point that they try to steal business from each other by offering addicts manicures, gym memberships, and sometimes even drugs, also rooting for their relapses that restart the insurance benefits clock. Residents complain that the rapidly proliferating sober homes create endless noise, property crime, and homelessness once a resident’s insurance runs out.

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Georgia Tech researchers are developing a touchscreen that will allow dogs to call 911 if their owners experience distress or ask them to summon help. Those in technology-powered homes who plan in advance might name their dogs Alexa or Siri to double their chances of obtaining assistance.

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Weird News Andy notes the potential rollout of “self-driving doctors,” in which a Seattle design firm proposes a rather ridiculous system of in-home monitoring and a self-driving health pods that people step into to have their health-related measurements taken at their own location. The pods would also offer telemedicine sessions and dispense medications via artificial intelligence, whatever what means. The company says it’s just a concept, but adds that “there’s a very big need for much better care experiences.” I wish the many people who propose Jetsons-like ideas for improving health would take the time to understand it first, particularly from a public health perspective, but unfortunately all the techno-gimmickry focuses on that small population of self-paying people who can theoretically fuel a company’s bottom line.


Sponsor Updates

  • QuadraMed, a Harris Healthcare company, Sagacious Consultants, The SSI Group, T-System, ZirMed will exhibit at the HFMA ANI Conference June 25-28 in Orlando.
  • Surescripts will exhibit at the AHIMA Long-Term Post-Acute Care & HIT Summit June 25-28 in Baltimore.
  • Verscend Technologies releases a new podcast, “why value-based care requires ‘strength from all sides.’”
  • ZappRx names Julia Austin (Digital Ocean) to its board.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
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Currently there are "19 comments" on this Article:

  1. Re: Cerner and the DoD – I do not find their response to the DoD to be going against the ‘policy’ they use with their non-Military customers of HealtheIntent. It is a multi-tenant SaaS application. There is significant power in all the customers’ underlying data being in the same platform. There is also significant risk but customers know that going-in.

    There are three points that I find puzzling:
    1) With all of the EHR expertise in the U.S., the Military couldn’t find one individual to review the Cerner-Leidos RFP and point-out the outrageous error. HealtheIntent is multi-tenant SaaS. It should have been quoted as such.

    2) Leidos, who is holding themselves out to be both an expert in Cerner and in all things ‘legacy’ Military Health System IT, didn’t point-out the mistake in the response to the DoD.

    3) Cerner, albeit a ‘minority’ partner in this equation, didn’t review the RFP response in enough detail to point-out the mistake.

    Given it is our tax dollars at work AGAIN, I propose that we start a campaign to name an experienced multi-disciplinary panel of individuals with real experience in implementation and optimization. They would provide the real Independent Verification & Validation (IV&V) services. Avoid the usual suspects and ask organizations who have successfully implemented on a large-scale to provide a list of names of individuals who understand the challenges and the opportunities. It can include consultants, but it should not be dominated by consultants.

  2. On another note, I am eager to see if the DoD’s information security and privacy policies make it into Cerner’s architecture for all their customers? That could be a win for the industry.

  3. I think you were too hard on the “Automated Doctor Car” conceptual idea from the design firm Artefect – which is a very respected healthcare design firm that just did this work as a fun,
    pro-bono to challenge the industry (https://www.fastcodesign.com/90130217/who-needs-a-hospital-when-this-self-driving-doctor-comes-to-you).
    Their model makes a good point: If we do have “autonomous cars” – why not fit a few up with some medical devices for telecare and send them out on the streets so people could call them to their houses; and then onec in the “car/pod”, it could do vitals, ask some questions, and decide if the medical problem could be answered via AI, or a televisit with an RN or MD. This would actually be much cheaper than going to a clinic or ER, and really support access. It might just be the “well off” who could afford the time and money for face to face visits in the future. Seems similar to the idea that only the rich could afford personal limo drivers or calling a doctor to their house; but most people can afford Car-sharing services (which will get even cheaper once they are autonomous). And as a concept- feel free to riff on this idea – maybe another answer is to just have small telehealth medical units stationed in every pharmacy (no NP needed), or have a few devices at home for under $50 that allow you to do a full tele-visit; and maybe a drone brings you the meds. It’s not like our current system is so perfect- we need new ideas percolating for sure!

  4. So, a lot of people die from safety and quality issues in Indian hospitals. One must stay focused on the positive: the universal health insurance coverage.

    • Universal Health Care sounds awesome but look under the covers before hopping on that band wagon. Countries that have socialized medicine fined that the cost is bankrupting them, levels of care we have become accustomed to experiencing here don’t exist, i.e. 5 year wait lists for a preventive colonoscopy, transporting patients between hospitals for services requiring expensive equipment, 6 month delays for an MRI or CAT Scan procedure. It is a fact, one could be deceased before adequate diagnostic services are available, limiting the care provided based upon one’s age etc. I have lived in that world, it is a great concept as long as you don’t need to use the services. Let’s not pass the legislation so we can then “see what is in it”, it won’t be a pretty picture for those who really need it.

  5. Re Govt and politics.

    Car insurance is not mandated by the federal government doh! And it’s not tax payer subsidized.

    Why should any government mandate the purchase of any product?

    Geez who writes this stuff?

    • The economic argument is still valid regardless of the agency of government. The question is answered in the post – you can improve overall outcomes by mandating coverage. You can go to Somolia if you’d like to be free of government.

    • As long as we require treatment without regard to ability to pay in the ED, the current situation is the worst of all worlds for how we pay for healthcare. Would you advocate for that? If not, then you have to have healthy people paying into the system.

  6. Art V, hardly a mistake. The RFP called for hosting in a tier 1 DOD data center. More like a bait n switch. Here here on your other points.

    • Yes, that’s correct. At least one of the other bidders (believe me, I know) struggled mightily with the Tier 1 requirement and keeping the costs competitive and within reason. It appears the Cerner-Leidos response didn’t actually meet the Tier 1 requirement, allowing them a much lower bid, and then claim an honest mistake after the fact. The DoD isn’t going to push it because they missed it as well.

      • Bob: I don’t think the DoD missed anything. They were taken for a ride, like so many others. They also signed up for an interoperable EHR, but Cerner brought them live (late) without CommonWell.

        Zane Burke gave a pretty good hint at future scope increases to investors recently. Can’t wait to see what else wasn’t included:

        Burke said that after having gone live with the first DoD pilot in February, there are three more pilot sites planned for the summer and early fall.

        “After that point in time there is the potential scope to attack all of the Department of Defense” he said.

        http://www.healthcareitnews.com/news/submarine-effect-cerner-pres-says-dod-modernization-benefits-all-customers

  7. Your bit on why insurance is not really optional is spot on. Of course, some of us have been saying the same thing for decades. We all pay in the end.

    And no, the Feds don’t require auto insurance. But I’ll bet your state does. Overall end result is the same.

  8. I had no idea Epic did that to hospitals who purchased their software. That’s as if Epic just comes in and takes over entirely. That’s really crappy

    • I think people confuse what Epic requires and what skilled management consultants implementing Epic require. Large organizations from time to time have to re-organize to bring in appropriate team members that fit the required skill set. The tests are simply a check on the continued growth of their staff. Unfortunately, past IT shortages have left many unqualified people in large organizations. This needs to be corrected for implementations to go well.

  9. In regards to the Epic staffing model and testing, our facility has gone live within the last few years and you do not have to require existing staff to take this test. We did not and have had positive results. We did not require existing IT staff to interview for new positions unless they were going into a very different role ie. they were a clinical application and now they were wanting to move to a more technical role.

    Epic is going to have to look at the staffing model it provides to new customers. It is not a one size fits all. As they have saturated the market place with the large fish and are looking at the smaller ones in the pond, they are going to have to approach it much differently than they have in the past and seem to be having some trouble adjusting.

  10. Re: Gov’t and politics. Wrong on the auto insurance example. We don’t force everyone to buy auto insurance, just those with cars. Don’t want to pay it, don’t own a car, take the bus or Uber. I have no choice to be a person, so the comparison fails. Under PPACA several million people were forced to pay $3+B in penalties for not having coverage. The problem is the out of control cost system that has been fed by our 3rd party payer system with its massive paperwork costs, and no competition, transparency or other free market factors (which would take more space than here to explain the solution) that prevents the patient from having much say in spend.

    The spend table above vs life expectancy is also misleading as it doesn’t compare apples to apples when calculating life expectancy in various countries. Agree we spend much more per capita vs outcomes and are in 15 to 38th place (depending on whose stats you use) in the world in that regard. But we are also 17th in the world for education outcomes despite spending multiples per student when compared to other countries. That’s just how we roll.

    The solution is not forcing people to buy insurance, it is to make the cost system affordable to everyone (remove claims filing, paperwork, and the attendant fraud, waste and abuse and we’d cut total spend by 30% immediately) and to subsidize those with chronic conditions, provide umbrella stop loss insurance, provide transparency and competition, and major medical for Part A admissions. As a start.

  11. Anybody ever stop to consider the only “serious” bid that the DOD got was from Cerner? Rumor has it that one sizable vendor pulled out early because of hesitation over doing business with the government in such a very public and complicated way. I don’t recall seeing any data comparing the two bids but I might have missed it. I wouldn’t be surprised to find out Epic put in a bid with an extra huge cost premiums or contract protections to make sure they had the capital and protections to make sure it worked if they won, but deep down inside were hoping the DOD didn’t take the bait. After the Coast Guard experience you would think they perhaps learned some lessons.

  12. RE: “Epic forces its own employment model onto its customers”

    I’m ex-Epic and I work at an organization that implemented Epic. I’ve never seen Epic require any such thing of their customers. What the customers on their own may require is different. Most commonly I’ve seen organizations require their employees to become certified in the Epic applications that they will support. This means going to training and taking the Epic exams and projects related to the training they just took (no Googley IQ questions involved).

    • In seeing a number of different Epic implementations, the whole Epic IQ test / hire into new positions / lay off the others paradigm is a commonly offered solution path but not mandated by Epic. Epic and the hordes of consultants suggest this path as a way to totally remodel the IT workforce and potentially reduce overhead. IMO, weak leaders go for this while they are trying to rationalise how to swallow the whole TCO of an Epic install. It would be interesting to examine outcomes stratified by whether orgs took this route or not.







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Reader Comments

  • CommentsTwoWeeksLate: I'd be really disappointed if the "de-identified" data set contained full birth dates or zip codes. That doesn't seem t...
  • Code Jockey: Mr. H - this is a response to 'Really' but I'm not sure how to respond to his post. Also, this is a note for both you an...
  • Clarence: From my experience 7 years as an Epic employee and then 4+ years integrating 3rd party clinical content/software into EH...
  • meltoots: I take issue with one thing in this. The ACR AUC system is ridiculous for specialist physicians. I am a board certified ...
  • Really: Come on Code Junkie... Would any software company on the planet let you take their code, do a minor modification and ...
  • Code Jockey: Sigh.... Code Corrections - the origin of this conversation was a statement by someone that Epic clients were creating t...
  • WhatstheretoWonder: Fairly clear that the ambitions were crushed by unchecked capitalism and Republican waffling on doing the necessary chec...
  • Woodstock Generation: Re: Mr. HIStalk's response to Post-Acute Pat - Mr. HIStalk, you couldn't have said it better about today's healthcare i...
  • It'sNotYouIt'sMe: I also at some point "consented" to give my bank and credit data to Equifax. If you asked the average person when they s...
  • Michael: Re: WSJ article - "without the patient's knowledge or approval." All of the patients consent to give their DNA for resea...

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