A Patient-Centric Database

I've been thinking a lot lately about patient registries, accountable care networks, and Healthy Planet-type stuff. Personal fact: I'm prone to think up conspiracy-theories and am, at the macro-level, a glass-half-empty person. When you put the two together, it makes this blogger concerned about the future of healthcare.


"With the Patient at the Heart" is printed on the back of Epic's business cards, and emblazoned proudly on company vehicles. I've worked at different organizations that had similar slogans about patients being first and foremost and the most important thing. The underlying sentiment with these slogans is that each patient is a unique individual, and each patient deserves personalized care.

Healthy Planet (and its primary drivers, Obamacare and MU) are active obstacles to that. No longer is Joe Smith a relatively healthy male and a compliant patient with diabetes whose lab tests happen to run slightly abnormal, he's now the 37th entry on the list of patients with an A1C over 7. He's been on that list for a year now, and gets a letter every month saying he needs to come in for a checkup. Mr Smith's doctor is worried, because even though Joe is healthy and doing everything to correctly manage his diabetes, the lab tests run high enough that the doctor gets dinged on his metrics. The doctor is therefore considering dropping Mr Smith as a patient.

Enter Accountable Care Networks. Now, not only is Medicare tracking all your stats, but your employer is too. And because your employer is paying the hospitals, your employer has a vested interested in your health. The healthier you are, the cheaper it is for your CFO, and those savings can be passed directly to the stockholders. Taken to its logical conclusion, given equal experience, equal qualifications, and identical answers during the interview, it's going to be the younger/skinnier/male candidate who gets the job. Age/Gender Discrimination will morph into Health Discrimination.

Discuss below. Are my fears irrational? Is your organization re-working existing teams to meet a growing list of reporting needs that must be available in prod yesterday?

Interview-ish article with Judy Faulkner

Courtesy of Healthcare IT News: Epic CEO Judy Faulkner talks EHR Interoperability, Need for a National Patient ID, Physician Productivity

The comment "Unique patient ID has to happen" intrigued me, because that's patently untrue.


Consider:

• We already have a national ID: Social Security Number. However, that doesn't account for recent immigrants or tourists. 
• It's possible that every single person living on planet Earth may visit the United States at some point and while visiting may need health care. 
• You'd need to be able to account for >7,000,000,000 people (and counting). 
• Tourists may visit the USA multiple times and years apart, and they can't be expected to remember an MRN.
• A national ID does no good if the potential exists for one patient to have multiple IDs. Within a single hospital, Patient Merge gets used all the time. If you've ever had to deal with Patient Merge AND Care Everywhere, then you know the problems that arise when a hospital can't match the person to the chart. Multiply that by the entire nation. Or the entire planet. 
• Biometrics are unique and they can't be forgotten because they don't have to be remembered in the first place. 
• A national (international?) database of biometric information with bi-directional interfaces to every hospital system will need to be created and maintained.
• Remember Obamacare?

That seems a good place to stop. Discuss. 

Class Action Suit Filed Against Epic. Seriously.

A reader of this blog brought this to my attention: Epic hit with class-action lawsuit on overtime wages. It appears as though ex-Epic QAer, Evan Nordgren, was not properly paid time-and-a-half for overtime work during his tenure as an Epic Systems Corporation employee. Habush, Habush, and Rottier are representing the case, and they have a form on their website if you were a QAer in the last 3 years and would like to join the list of plaintiffs.

Wisconsin state law stipulates that all employees are eligible to earn time-and-a-half for overtime, unless they fall under certain exemptions. I remember looking at those exemptions years ago and deciding that Epic TS were sadly exempt from time-and-a-half. Nordgren's lawyer, William Parsons, believes otherwise about QAers.

Epic had this to say in response, according to the numerous (albeit repetitive) articles I found on the subject:

We believe the lawsuit is without merit. We provide good, professional jobs to very talented people, and we value their contribution to improving health care. State and federal law make it clear that employees in computer-related jobs who primarily test software are appropriately classified as salaried professionals. That is precisely the role our quality assurance team performs.

After doing a quick calculation based on Wisconsin law DWD 274.04(15), if you work at Epic and make less than $53,460 yearly, you may be eligible for overtime pay (calculated by $23.67 hourly pay times 2000 hour work-year). As we all know, the 40-hour work week doesn't exist at 1979 Milky Way, so the real hourly wages for QAers are probably much less.

I'm very excited to see how this turns out. I'll post updates here as I learn more.

Update 4/7/14:
A commenter posted this on a separate page, but I thought it belonged here:

Epic recently responded to this internally. All new and current employees have to sign away their rights to litigation over wage and hour questions as a term of new/continued employment. An excerpt:

"I understand and agree that arbitration is the only litigation forum for resolving covered claims, and that both Epic and I are waiving the right to a trial before a judge or jury in federal or state court in favor of arbitration."

Caveat Emptor

 I did a brief search on the benefits of arbitration vs a trial. (Source: http://www.jdsupra.com/legalnews/arbitration-vs-bench-trial-55694/) Arbitration is more expensive than a trial, offers little ability to appeal, but offers more privacy. It's that last quality that I think Epic is more interested in. Everything they do internally is shrouded in secrecy, especially anything negative (like a lawsuit alleging they don't pay their employees fairly). Caveat emptor, indeed.

Update 12/4/14
I'm behind on posting this, but Epic settled the dispute.  Epic unsurprisingly admitted no guilt or wrongdoing, but did set aside $5.4 million for the settlement. With a class of around 1000 members, that boils down to at most $5400 per person. That's a bit over a single month's pay for your average QAer at Epic.