[doctoring]

As a clinician, I'd love a way to see all the past health records of any patient that walked in the door. They usually would love for me to as well.

I'm not sure how blockchain as a technology necessarily moves us forward to get there. The vendors have a stranglehold on medical record software and have no incentive to work together, share data, or agree to any standards -- I mean, it wasn't until last year that the two hospitals I work at (owned by the same umbrella hospital, using software from the same vendor, and 3 miles apart from each other) could electronically access records from each other. We had to fill out paper forms, make phone calls, and send faxes to get access.

It's not for want of a technological breakthrough that we've been struggling so much...

[kayman]

Having worked previously in the healthcare sector (both USA and AUS), I must agree. There is zero incentive for vendors to work together to share patient data.

There is a standard for medical data already called HL7, but not everyone adheres to it.

What would work better is if the medical record is a service provided by the government or some public service which takes care of security for you. Every medical record would then be added to the patient's blockchain record and vendors can read/write to it.

Of course a vendor would have to vetted for security purposes.

[mcculley]

Agreed. I carry all of my health records on a very small USB flash drive in my pocket. Every time I show it to a doctor, they are scared to plug it into their desktop for fear of malware.

[ramidarigaz]

And that seems like a totally rational fear too.

[ChoHag]

It totally is, and the computers they use should not have working USB ports on them.

[mcculley]

Amusingly, I work with a rather large organization which still buys machines with PS/2 keyboards and fills the USB ports with epoxy. This is the state of security.

[mcculley]

This was the point of my reply. There's no technological fix when clinicians can't even safely open a read-only file.

[siculars]

Something I wrote a while back about this [0]. To summarize, it's not the lack of technology, rather it's the financial disincentivization of vendors and lack of leadership by providers.

My proposed solution is government regulation in order to level the playing field by way of EMR certification and/or tax-centivization. The goal should not be to pick a standard but rather set the rules:

- if you create data you offer public docs and/or SDKs to grok that data

- if you store data you offer public docs and/or SDKs to access that data

[0] http://siculars.posthaven.com/health-data-integration-regula...

[shandor]

I hear this from all over the world, and I honestly don't understand it.

Or rather, the only way I can see this happening is that everyone, everywhere on the buying side is either actively doing harm or so incompetent those are indistinguishable.

The arguments that "butbutbut, all vendors require us to do X and never let us do anything" got to be bullshit. If you have sexy multimillion medical project that needs vendors, and some of them won't take it if they can't force you into submission, I have no doubt that the million other companies in the world would take the project more than gladly.

[BlackFly]

As a general problem, when you want to give your vendor the boot, you go to their competitors and say you want a system that does all the things the old system does plus these additional requirements that the old vendor couldn't give you. Since you probably paid for additional features year over year for the system you do have, the price tag to replace it all at once is rather steep and the timelines will be incredibly long.

As such, the project will have a rather long list of problems. The functional specification of the system to be built will have a large number of gaps because the people writing the functional specification aren't the people using all of the parts of the system (no one person will be using all the functionalities). There will be a number of unforeseen problems causing delays, if the vendor does not have proper risk management in place the delays will compound and the entire project will become delayed. Due to frustrations, the customer will relax the priority of some of the nice-to-haves from the functional specifications and focus on the critical requirements.

Even if the new feature makes it into the end product, since it wasn't a key requirement of the system in the first place (otherwise the first vendor would have provided it from the beginning) it will most likely not be used often and may not even be piloted. Future upgrades to the system will degrade the functionality in unpredictable ways and no one will notice. When someone does notice, it is easier to revert to the old manual way of solving the problem than getting the functionality fixed or learning how to use it.

This is why some people are scared of replacing multi-million dollar software. That is why banks still have a lot of systems written in COBOL, risk averse people aren't willing to hope that everything might go right.

[specialist]

I implemented a few exchanges. We had the legal requirement to record all changes. For liability. What did you know and when did you know it kinda stuff.

Tamper evident transaction logs (rolling hash) were sufficient.

I don't quite see what blockchains (proof of work, consensus protocol) would add.

Is there a use case for tracking prescriptions? Not a provider, so I'm just guessing.

[clueless123]

EMR systems are mainly constructed to solve financial needs not medical ones. (Mainly because they are the ones paying for the system) Sharing medical information from providers out of network is not of much value for this purpose, so it does not goes up on the priority list.