Should Apple get into the Electronic Health Record industry?

General General Discussion
1

https://www.americaninno.com/wisconsin/madison/could-apple-buy-epic-systems/

https://www.cnbc.com/2019/01/23/cramer-if-apple-doesnt-buy-epic-systems-heres-what-it-could-do.html

Jim Cramer is hot on Apple entering the electronic health record business by buying Epic, one of the three leading EHRs commonly in use in the US. Epic is one of the most sprawling, convoluted, and non-intuitive pieces of software ever created (with the possible exception of one or two other health record software titles). I don’t know if Apple is hot on buying Epic, but it does make sense given their stated intent to make health and wellness a key part of the ecosystem.

I can’t imagine that Apple can’t improve it in some way. One of the biggest issues is the fact that there are multiple EHRs around the country and they can’t talk to each other. It will take a company with some degree of leadership capability to try to get the mythical Universal Health Record off the ground and turn such software into something that is intuitive enough to actually useful when it comes to time vs results.

2

What could go wrong with a company having access to your biometrics as your view online content?

If they are going to control health costs, they have to get the docs and nurses out of the loop- for cost reasons- but also to reduce the chance that people will figure out their healthcare is being throttled back and forth. Wear your iWatchYou, it sends the data, gets fed through the medical AI and pills show up from the drone. Take the pills in front of your iPad for confirmation. Just don’t let your social kwan score go too low, or no healthcare for you.

3

At least Apple tries to keep the Feds out of your phone. Somebody has to do it. Might as well be someone that actually knows how to write code. I’m actually thinking of switching back to Apple from Samsung.

Better someone like Apple than someone like CoreLogic which has all but captured the Real Estate industry. You think these people don’t know a thing or two about you? https://www.corelogic.com/industry/products-and-services-by-industry.aspx

When you buy a house and all that info you have to provide for a loan… consider this. They run the MLS system your Realtor uses, they run the Lender interfaces, They own the appraisal software the appraisers use, Then own the interfaces that many of these communicate with and share ordering/data, etc… they collect all that data and re-sell / re-distribute it. They are constantly buying more data platforms. They are a giant data suck machine.

So yeah, I’ll take Apple over the likes of CoreLogic. Apple has at least tried to make your data private. CoreLogic tries to make your data available to anyone that wants to buy it. You want to hear something scary. If I had not opted out of it… which I did… they were going to suck data out of the forms I fill in with my research… IN REAL TIME. But Wait!!! There’s More!! Instantly, upon having it taken off documents that I am creating… As soon as they get it… they sell it to my competition!! So I can do research, type in the data as I believe it to accurate and 60 seconds later a competitor of mine that uses the same software… or anyone that uses the software can simply type say an address and ‘bang’ they click a button and have my data in their forms. They reason this to be legit because I get the data from public records, subscriptions to software they own, and some other nonsense. The fact is I do use those sources but could also have simply got the info first hand without any of those sources. Oh… and they know beyond the shadow of a doubt that my documents are considered copyrighted and confidential by Federal regulation / law.

Apple has not to my knowledge demonstrated such a bizarre mentality with private data.

4

Someone’s gonna do it…Better Apple than, say, Google.

5

Yeah, that’s a scenario that may happen whether Apple is involved or not. My aspirations in the thread are much simpler and less nihilistic…today’s version(s) of the Electronic Health Record suck MAJORLY. They are bloated, cumbersome, non-intuitive and a MAJOR source of wasted time for every.single.health.care.provider in the US which in turn imposes increased cost and decreased efficiency for patients. Apple has a way with software that works pretty well. Them being involved could bring efficiency to the electronic record system that would otherwise not be likely to happen since the major impetus behind it is the Federal Government.

I would be vastly more inclined to trust Apple with sensitive data than the Federal Government, based on Apple’s track record of data privacy protection.

6

I know the industry and have some friends that sell into the healthcare industry from Microsoft, Oracle, Adobe. To say the problem with records is a very tough nut to crack, is an understatement. In order for it to succeed you need buy in at the general practitioner level and up. The healthcare industry is a windows world and one that is very far behind at the desktop and server level due to cost restrictions. You could make a case that the quick remedy is a web based cloud model but Apple services and cloud specifically is by no means best in class. They have a lot of business there but its due to the lock in of their devices and ecosystem. The industry has been burned several times by the next big thing.

Cramer is seeing it at a very high level and has no idea what’s needed to get a unifying solution. Apple is by no means it.

7

The platform that Epic runs on is irrelevant. In most systems it runs via a Citrix server and is therefore readily accessible from Mac, Windows, or Linux, not to mention iPads or iPhones, or any other device that has a Citrix app available. EHR software generally has nothing to do with physician preference. It’s about dollars and features and in most health care systems physician preference is irrelevant. Those decsisions are usually made in the C-suite. It is true however that the EHR market is a tough nut to crack, but mainly because of cost. Many hospital systems have at least millions invested and will not readily accept the cost that any significant change would entail.

Personally, I think Cramer’s right…Apple purchasing Epic could be a good thing for the industry, but it would be a monumental task. It’s probably far more likely that Apple’s stated emphasis on health records is going to be limited to finding ways to put a patient’s existing health records on some kind of portable storage so that a patient can carry them with them on their iPhone.

8

I agree with this. Just another lockin point to a product on the downward slide. They will be blackberry soon and all their users will be tied into services that are not best in class hanging on to iMessage like BBM before it.

9

I guess being in the industry I read and track too many security articles… You guys keep alluding to Apple’s infallible security/privacy record and I just read an article on the horrendous FaceTime privacy breach that allows anyone to activate camera and mic on a called iphone that does not answer.

And the article before that, and the one before that.

Granted, they could not do worse than most SW only companies.

I find most apple “all in” users painfully ignorant of relative risk/capabilities.

I had win 7 laptops immune from hacks that were trivial on the same generation MacBook. And vice versa.

I operate both MacBooks and hp win7 & 10 laptops. And apple & Android mobile devices.

I won’t bother trying to convince anyone one way or the other. But none are infallible, and apple’s walled garden has risk as does Android’s bazaar. Different risk models with open source vs closed. History bears that out.

10

LOL. :no::haha:

11

Apple is far from infallible and far from immune to security issues. Whether they’re more or less fallible than any given Windows platform, I don’t know, but when I boot up Windows, I get about 5 security updates for every security update I get for MacOS. Not to mention Windows’ remarkable predilection for viruses and other malware. I’ve never run any anti-virus software on any Mac I’ve ever owned. Mandatory on Windows, of course.

I use both platforms too. In fact, since it’s what I run at work, I probably spend more time on the Windows platform than on my Macs at home. Windows is still a crappy, buggy, and insecure OS in my daily experience.

12

I won’t defend Microsoft. But will say that win7 and win 10 is worse than it should be with annoying microstuff arrongance and also more solid as a platform than anyone will give it credit for. But I not just a user, I’m in an industry that manages fleets of every platform.

Likewise, you’ve made a classic “correlation ≠ causation” leap with your assumption about security patch frequency.

A company doing a really bad job at fixing security issues might only release patches quarterly. And one doing a great job may release them the instant they are identified and fixed. Daily.

Reality is in between. Microsoft was (rightly) criticised for being slow to release patches. Part of it was their service pack approach, which was changed with Windows 10. It’s now largely real time, once a critical patch is tested it’s rolled out, much to the annoyance of us. But would you rather not have it fixed? I’d rather pick and choose, but typically users do not. Or pick wrong.

Apple is vulnerable to many issues as they use the same libraries as others. Sometimes they find and fix them on their own. But in most cases, they do not. And are opaque about it, even more than Microsoft.

In other areas they may be more immune to risks as they are not targeted as often. Business largely runs on Windows around the world. What businesses run on Mac’s? There are some, for good reason. But if you are targeting ransomware, enthralling bots, stealing secrets, windows is probably 20-50 times more lucrative of a target in terms of payback. Both due to sheer numbers and the nature of the systems data content network access. The stereotypical banker/engineer is a more lucrative target than the stereotypical hipster graphic designer Mac user. Or even Dr office.

This could change if the info content does. IOS is now a rightious target due to a combination of naive/trusting users & ripe targets. (The many iCloud hacks, anyone?)

There are increasing apple platform medical usage now, but stealing someone’s colonoscopy images is not valuable BY THEMSELF.

Let’s say magically OS-X became the platform for the medical world and had significantly more medical info on it. All medical info. Now it becomes a rich target for hacking. Ransomware? The hot celeb starlet/musician has genital warts? Their plastic surgeries? Life threatening diseases?

Whatever system it is on, it will be heavily targeted and will be hacked. Just like the systems managed by the people supposed to be ensuring the nation’s security and safety were.

13

I don’t care about any of that. I don’t root for Apple like a football team. I couldn’t care less about the company except that their demise would leave me with second-rate options in personal computing. My choice of OS, when I have a choice (as I do at home) is driven solely by my needs, my goals, and my observations borne of more than three decades of using personal computers for my purposes and using several different brands and several different operating systems. I couldn’t care less whose label is on the computer, I only care about the extent to which it meets my goals for having the computer and accomplishing the tasks I need to accomplish. Right now, in their current respective iterations, Apple meets those needs and exceeds Windows by a wide margin. If and when some Windows version and some PC hardware meets or exceeds those needs, I’ll switch in a heartbeat as I did back when Apple brought out the Performa line…an exceedingly lame set of hardware running on an OS that was only slightly less lame than the contemporary version of Windows at that time.

Viruses? :rolleyes: . You’re taking the usual Windows apology route and I don’t care about any of that theoretical crap. Of course Macs can be hacked or infected, but for me the bottom line is that I’ve never had a virus on MacOS and I have had them on the Windows 10 boot partition that I run on the same machine and the Windows 7 partition that I ran before that. For those same reasons, I couldn’t care less about Mac enterprise solutions. At work, when Windows takes a dump, as it does with distressing frequency, I just call IT and walk away to find another computer to log on to in order to do my work (assuming the whole system hasn’t crashed, as it occasionally does). At home, an OS shit-the-bed issue becomes my problem. The only time I’ve ever had a problem on a Mac was recently when a Windows 10 update corrupted my Windows credentials files preventing me from logging on. For the first time ever, I had to call a computer company technical support line. After about 20 minutes on hold, I finally talked to a very nice lady in India that took control of my computer and after about one hour and two tech “escalations”, they resolved the issue. But that was Windows technical support, not Apple.

As for medical applications…doesn’t matter. As is common in the industry, the EHR that I need to do my work also runs on a Citrix server. I can log onto Epic from any OS, any location, or any device, mobile or desktop, that supports Citrix Receiver.

If you’re in that business, maybe all that stuff you wrote matters to you. It doesn’t matter to me because none of it has ever affected me, which is all I care about…a computer and OS that “just works” for me.

14

Epic is horrible. The nurse that came up with it was a good friend of people in Obama’s inner circle, I understand there was a lot of back-scratching between her and the organization that came up with the requirements for an EMR.

As for Apple, I think Apple is in a great spot to take over via acquisition or start a competitive EMR.

15

She’s a bizarre woman, although apparently pretty smart. Maybe “eccentric” is a nicer way to put it.

https://www.nytimes.com/2018/12/20/business/epic-systems-campus-verona-wisconsin.html

Epic isn’t “horrible”, but it is definitely bloated, cumbersome, and non-intuitive…and a huge time waster for health care providers. In a land of sucky EHRs, Epic probably sucks the least.

Creating a competitive EHR isn’t in the cards. That ship has sailed. Even small hospitals have millions of $$ invested in their EHRs. Mayo Clinic, for example, just switched from their own decades-old in-house EHR to Epic at a cost of almost $2 billion. I can think of NO compelling reason whatsoever that any of them would ever want to re-climb that ladder.

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16

Ever since I started using Epic I’ve said “I wish Apple would develop an EMR”.

Sent from my iPhone using Tapatalk

17

I think that Apple’s strong suit is hardware/software integration. They work best when they have control of the whole environment. I’m inclined to doubt that they’re any good at software by itself. They couldn’t get Final Cut Pro to supplant Adobe Premiere, can’t get Keynote, Numbers, or Pages to even make a small dent in any of the Microsoft Office suite apps. Trying to write an EHR from scratch and make inroads against the massive entrenchment of Epic, Meditech/Allscripts, Cerner, or eClinicalWorks, while competing against Google’s foray into health care would be a suicide mission for Apple IMHO.

Apple is going to either buy Epic some other mature EHR system, or their foray into health care is going to be nothing more than an app to store your medical records on your iPhone.

18

Having used just about every current EMR, I think Epic is very good. It’s not perfect, but it’s far, far better than all others. What I dislike is that Epic shifts the secretarial burden on the physician. A more streamlined Epic would be better.

I don’t like the idea of Apple owning Epic. There’s already enough electronic intrusion into life and I’m sure there will be iPhone health data mining. HIPAA be damned, I’m sure they’ll mine.

19

It isn’t the EHR that shifts the secretarial burden to the physician, it’s the hospital system that bought it. The result is that most doctors now spend about an hour on the computer for every hour they spend seeing patients. That’s a serious time waster and a serious revenue drain for the hospital that hired the doctor. As an example of the added cost to an already-expensive health care system, think about the fact that it is cheaper for the hospital to hire a $30,000 per year scribe, or a Ph.D nurse-practitioner at $100,000+ per year to do my computer and other non-clinical work for me than it is for me to decrease my own productivity by taking the time for me to do it myself.

I don’t care about Apple owning an EHR. They have at least made a show of bucking the government when it comes to patient privacy and security. I would rather have them in possession of my private data if the only other alternative is the Federal government. The Feds don’t mine the data, they force the doctors and hospitals to mine it for them and financially penalize them if they don’t provide the patient data that they request.

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20

Agreed mostly that an Epic competitor won’t arise, at least anytime soon. The reason Epic got so many things right so quickly was because Faulkner was given the requirements for the EMR before potential competitors got the requirements given how much money she gave Obama and the DNC.

The word around our place is that we spent 5 billion on Epic, and the reason it sucks here is because we had to put our individual stamp on it which mucked it up. If they had left it alone in its original iteration it would have been so much better, but my institution has a way of thinking it can make something better, which is often not the case.

We have had it now for 6 years maybe and in my department our doctors still have problems sending and receiving communications to patients through it.