[datahead]

Hi Duff! Happy to see you on HN. EDIT: not Fred.

I work for a large hosp. operations company and serve as the Dir. Engineering for our clinical operations group. Hacking Healthcare is required reading for new members of my team. It serves as an excellent introduction (with a healthy amount of critique) to the dynamics in the hc technology ecosystem. Thank you for providing this perspective on the industry and its challenges with tech.

We've been successful developing using open source technology internally. In fact, I take a fairly hard stance on disallowing proprietary healthcare specific "solutions" from working their way into our stack (aside from the EHR itself, it has staying power). We're lucky in that we are positioned as somewhat of a startup within a larger org, and are able to take that approach.

To avoid some of the issues you raise, we generally are working to reduce the surface area of the EHR to become simply the transactional backend which is then mirrored to a larger ecosystem of custom apps. This has the effect of boxing in the regulated entity. We focus on data integration (by spending $$$$ on custom HL7 interfaces, unfortunately not everyone can afford) to get outside of the walled garden. This means we can use the information/data for new and interesting purposes without worrying about the EHR vendor's roadblocks/tolls. More importantly to some people, we don't disrupt the billing cycle that originates from the EHR.

Do you notice any trends where healthcare operations/providers are starting to develop internal technology that integrates with the EHR to compliment vs. replace the core transactional system?

[duffpkg]

It's Duff (David) instead of Fred but thanks. Fred is doing great too. Are you a former CHL/TXR managed or sub-owned group or facility?

Unfortunately I see the opposite trend right now, more silos, more lip service to interoperability, more tolls. I think driven by the burden of regulatory overhead. Moving forward there could be a shift to a "patient owned" record where providers and facilities feed standardized formats into a patient owned/managed "personal cloud". I hope that continues to pick up steam.

[datahead]

Hi Duff! Apologies for the mixup, should have seen that in your handle. No, I'm not part of CHL/TXR.

While not open source by any stretch, I see the personal EHR space being ushered along by companies following Apple's lead. Aside from complex patients, I think the generally healthy/mild-chronic person is uninterested in owning/managing their health data unfortunately. Apple is contributing useful tools to understand fundamental determinants of health including cardiovascular, sleep, fitness at massive scale. It just happens to come with your watch and phone, and their vision for health is starting to come into focus. This puts the patient in the position of generating the primary data (sensors, etc.) and sharing it with their care team on their terms (more or less). As telehealth becomes more prominent, I suspect the patient will be required to engage with their data more often as it will be the means of conveying a shared understanding vs. observations recorded in the clinical setting and stashed away in centralized EHRs.

Furthermore, if labs and other diagnostics are available directly to consumers it puts the individual in a position of ownership. I think the default position is whoever generates the data owns it, and determines how easy/hard it is to share with others. If the individual is empowered to generate information about themselves- this will start to swing toward "patient owned." I too look forward to more of this, but it will have to come with more direct to consumer and digital offerings.

One of the coolest examples I've seen of individuals taking ownership in open source med tech is openaps.org . I'm not one, but T1D's are some of the most resourceful and resilient folks around. Good on them for building a community to solve real problems together. Shout out to the #wearenotwaiting crew.

[hcthrowaway111]

Hey - I'm trying to get into health tech (EHR integrations, HL7, FHIR etc), do you have any additional "required reading" suggestions beyond Hacking Healthcare?

[duffpkg]

One of the reasons Hacking Healthcare happened is the huge dearth of material for just this question, unfortunately I don't have anything else on that still. One absolutely timeless work not directly about technology but that is still very relevant is "The House of God". It is "fiction" but it is probably the most realistic depiction of the actual happenings at hospitals that exists and as a result something technologists can benefit from.

[datahead]

Hacking Healthcare (HC specific) and The DevOps Handbook (general) are the books I buy for everyone joining the team.

I recommend Eric Topol's books as well, including The Creative Destruction of Medicine and Deep Medicine. Lots of food for thought.