The U.S. government claimed that turning American medical charts into electronic records would make health care better, safer, and cheaper. Ten years and $36 billion later, the system is an unholy mess: inside a digital revolution gone wrong.
It seems to be a recurring theme all over the world that governments are absolutely terrible at doing anything related to the digital world. I’m sure insane bidding requirements set by special interests play a huge role in this problem, but that doesn’t mean politicians tend to be terrible at properly understanding the digital world.
Disclosure: I work for a combined teaching/hospital organization that has a very large Epic install– but I’m not an expert on Epic, so take whatever I say with appropriate amount of NaCl.
You don’t “buy” Epic– You buy an infrastructure, and a number of analysts, employed locally, and by Epic, and your system is a one-of-a-kind system that’s written, built and configured for your organization. Integrating with existing systems is a massive headache, as most pre-existing systems are either homegrown, written by a company that folded years ago, or written by a company that has no incentive to work with Epic. There are Epic modules that can replace lab, pharmacy, even label printing systems– but that means retraining, converting of existing systems, etc..
There are standards (HL7), but implementing it requires more home-grown code, and some form of interface engine– Our old one was essentially discontinued and the new one has difficulty keeping up with the number of transactions per second. And not every existing piece of medical software speaks HL7 natively.
There is no “standard UI”– the UI is customized based on each organizations needs, which sounds great, but the people designing the UI aren’t UI experts– they’re doctors, nurses, or technicians.
When the system works, it’s fantastic– as a patient, my records are available to myself, and whichever doctors within the organization need access. Unfortunately, my primary isn’t a part of this organization, so he has his *own* EHR system, which doesn’t talk to the Epic install at my place of work.
When I asked my doctor about his system, he said after 4-6 months of hard work, he was now at the point where he could see patients as quickly as he could before implementing the system.
All in all, EHR’s aren’t a bad idea, but the medical industry has hundreds of largely incompatible standards, and unifying them is non-trivial.