this post was submitted on 21 Sep 2024
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Clinical information systems and healthcare patient portals are proving to be a significant waste of money. Millions of dollars are invested into developing and maintaining these platforms, often by third-party vendors, to provide patients with online access to their medical records. While the idea behind these portals is great in theory, the execution falls flat when healthcare providers continue to send massive amounts of paper copies through the mail, despite the digital system. This redundancy is both financially wasteful and environmentally harmful, especially when patients like me would prefer a paperless option.

Even more frustrating is that at my current health insurance company, I can't even opt out of receiving paper copies. Despite several attempts to request this, I'm told there's no way to stop the influx of mail. Now, I'm left with no choice but to purchase a $70 paper shredder just to deal with the overwhelming amount of unnecessary paperwork I receive. It feels like an outdated system where healthcare organizations are not fully committed to leveraging the digital tools they've invested in.

To make matters worse, the US Postal Service bears the burden of delivering all these unnecessary documents. This means taxpayers and other users of the postal system are indirectly subsidizing this inefficiency. It’s absurd that after all the time and money spent on developing patient portals, they’re not serving their purpose if the same information is just going to be mailed out anyway. It’s a huge missed opportunity for cost savings and sustainability.

For anyone curious about which platforms I'm talking about, my chart, Healow. These are the two that I have used. I'm sure there are many others, but Blue Cross is also part of the problem, they have their own custom proprietary software that you can log in and see your bill and all that stuff but they will still send you the crap in the mail. And cannot get them to stop

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[–] [email protected] 35 points 1 month ago

Blue Cross is also part of the problem

They're probably your entire problem.

They were my previous insurer, and yeah, they sent letter after letter after letter after letter after letter after letter after letter after....

My current insurance? I get exactly zero letters in the mail about anything: it's all digital through their portal and email.

[–] grudan 24 points 1 month ago (3 children)

I’m taking a stance against these platforms by always declining to ever create an account on them when the doctor’s office asks. Having medical data accessible like this is just asking for an attack, followed by a leak. And then I can only assume insurance companies buy these leaked databases and adjust rates accordingly.

[–] [email protected] 17 points 1 month ago (1 children)

I’m talking out of my ass, but your data is likely still there whether you choose to create an account or not; so you’re still susceptible to data breaches either way.

[–] grudan 4 points 1 month ago (3 children)

I like to hope that my data won’t be released to companies like mychart without my consent.

[–] [email protected] 15 points 1 month ago (1 children)

If the doctor uses mychart, thats where they store the internal data whether you have an account or not. Its their entire computer system most of the time.

[–] grudan 3 points 1 month ago (1 children)

Yeah, a couple people are saying that, but I can’t find any information on how it’s implemented for providers. Regardless, not having an account is one less avenue for my information to be leaked. I do worry more about the doctor’s security practices (2FA, password complexity, password rotation, etc…) than my own.

[–] [email protected] 6 points 1 month ago

I'm sure some places use it to share info, but usually it basically becomes their entire software stack. Its like the salesforce of the health world. It does their billing, shift management, HR, CMS, everything.

[–] [email protected] 6 points 1 month ago* (last edited 1 month ago)

You don't have a clear picture.

My Chart is just a module of Epic systems. If it's accessible to you, it means your health care provider uses epic as EMR. You data is there, that's how the hospital or health care provider office works

[–] [email protected] -2 points 1 month ago* (last edited 1 month ago) (1 children)

released to companies like mychart

What does this mean? MyChart is a software solution used by many medical providers. They don’t “release” medical information to them.

This would be like thinking someone using Office on their computer is “releasing” documents they create to Microsoft.

[–] [email protected] 2 points 1 month ago (1 children)

I mean, with o365, you technically do. Your example doesn't work as well as you think it does.

[–] [email protected] -1 points 1 month ago (1 children)

It does, your willful misinterpretation doesn’t change that.

I looked through your post history, you seem to have at least enough technical aptitude to understand that.

[–] [email protected] 2 points 1 month ago (1 children)

That's a bit aggressive towards someone with whom you are having a civil, anecdotal discussion. You're not trading in explosive pagers or nuclear materials. Could you dial it back a bit?

[–] [email protected] 0 points 1 month ago (1 children)

I wasn’t having a discussion with them or you however when you present incorrect information or are intentionally obtuse I will call it out.

If you want to engage me on the original topic I can happily explain both how the concept that a medical provider is “releasing” data to a software vendor is wrong and how equating O365 and Word is wrong.

I imagine you’re too busy finding ways to be offended on someone else’s behalf and making light of recent terrorist acts though.

[–] [email protected] 0 points 1 month ago (1 children)

Excuse me but web office apps are 95% on par with their desktop counterparts now. There are still a few power features missing but that gap is slowly closing constantly.

So I am not being willfully ignorant. I work with both daily.

[–] [email protected] 0 points 1 month ago (1 children)

So I am not being willfully ignorant. I work with both daily.

Then you’re just being ignorant.

O365, which is actually Microsoft 365 now, is a suite of productivity software as well as collaboration and cloud-based services.

Word is a word processing program. They are not the same and use of Word does not equate to O365.

You should know this. Just like you should know that a business using a piece of software, such as a medical facility using Epic’s patient data management tools, does not equate to patient data being “released” to Epic.

Since you seem to be struggling with the concept perhaps a different example would be easier for you?

Just because you get an MRI doesn’t mean the data collected for the MRI is “released” to GE.

[–] [email protected] -1 points 1 month ago* (last edited 1 month ago) (1 children)

Do you realize how much data is sent from Word to the O365/M365 service as you type if you have an internet connection? Even if you aren't saving the document online, it sends a TON. Especially now with copilot.

[–] [email protected] 1 points 1 month ago (1 children)

I am aware of telemetry, yes.

Even if we ignore your continued conflation of Word and Microsoft 365, I suspect you have nothing to support your assertion that Word transmits the content of your document files to Microsoft.

Realistically this whole exchange is moot. A medical providers use of patient data management software in no way constitutes a “release” of data to that software provider as the person I originally replied to seemed to think.

Perhaps you’ll have an opportunity to administer a tenant someday and that’ll give you a better understanding.

[–] [email protected] -1 points 1 month ago (1 children)

It is not a conflation. Word is a component of M365.

I administer a tenant today that has given me plenty of understanding. Perhaps you should brush up on yours.

[–] [email protected] 1 points 1 month ago

I administer a tenant today that has given me plenty of understanding.

You’d never be able to tell. If this is true your “understanding” doesn’t show but I’ve seen some very dysfunctional organizations so I wouldn’t be surprised.

[–] [email protected] 5 points 1 month ago (1 children)

I think you misunderstand. I have no issue with the platform, if the platform is a complete end-to-end replacement that consumers can use. But that's not the case. They want you to use the platform, and they're going to send you pounds of paper in the mail. I don't want both. It should be either or! If I sign up for my chart, put everything in there. Send me emails. Why are you going to make me sign up for my chart, and now you're going to send me a statement every single week or month? Wtf? I need both?

[–] grudan 6 points 1 month ago

No I get you. I just had a different problem with the same platforms that I wanted to voice.

[–] [email protected] 2 points 1 month ago* (last edited 1 month ago) (3 children)

Imagine a single payer world where our medical information being shared had no monetary impact.

Yeah, people can do other malicious things, but there wouldn't a financial incentive for the companies or agencies that have access to it.

[–] grudan 3 points 1 month ago

Some things can be potentially embarrassing so your information could still be used against you by cyber gangs for money, so even though it’s no monetary impact for companies, the information still has a value.

[–] [email protected] 0 points 1 month ago

Ex spouses and debt collectors will always, always find value in snooping.

[–] [email protected] 0 points 1 month ago (1 children)

So forcing everyone to use a single system, where everything about them can be known.

And we know how "secure" these systems aren't.

Dont be naive.

[–] [email protected] 2 points 1 month ago

No, single payer as in who pays the bills, not centralizing everyone's medical history.

[–] [email protected] 12 points 1 month ago (2 children)

Working in healthcare, let me tell you that it's not just on your end. There needs to be a national standard for transmitting data. Getting faxes from other facilities and then having them scanned in is a fucking pain in the ass. It does not even attempt OCR. All your diagnostics will be done again. Patients tend to not know how to navigate the release of that information to the new facility half the time. So in those moments where that information is useful, it doesn't get to the providers that need it.

[–] [email protected] 3 points 1 month ago
[–] [email protected] 1 points 1 month ago (1 children)

Such a standard has existed for decades. It's called HL7

[–] [email protected] 1 points 1 month ago (1 children)

It only works if it's implemented, I still see regular scanned in records instead of linked records.

[–] [email protected] 1 points 1 month ago

Yes but that is not due to a lack of standard for electronic communication.

Sometimes you have to deal with providers that do not have digital records, sometimes they are old medical records that were not digitized, sometimes the insurance companies do it on purpose to drag things out

[–] [email protected] 10 points 1 month ago* (last edited 1 month ago)

To make matters worse, the US Postal Service bears the burden of delivering all these unnecessary documents. This means taxpayers and other users of the postal system are indirectly subsidizing this inefficiency.

The USPS is generally supported by stamp sales, not taxation.

I suppose one could argue that it is government-subsidized on the pension issue that's been in the news in the past few years. If you feel -- and I tend to agree that this is a valid concern -- that as the USPS shrinks, it's going to come up short on covering pensions and that at some point, people who have a USPS pension are going to be pushing for taxpayers to pay for it rather than the USPS defaulting on it, I think that that's probably a valid concern. However, in that case, the financial problems are a result of the USPS shrinking, so generating artificial load probably doesn't hurt.

Like, you're paying for it, but it'd be via you paying higher fees to your healthcare provider, who then pays the USPS to send mail. It isn't taxpayers.

Now, I’m left with no choice but to purchase a $70 paper shredder just to deal with the overwhelming amount of unnecessary paperwork I receive.

I mean, I think that in general, people should own and use a paper shredder. Most people get at least some sensitive documents, and it's a good idea to make it hard to read physical documents before throwing them out. IIRC, case law is that once you throw out material, you don't have an expectation of privacy covering it any more; this has come up in the past when police departments did warrantless searches through garbage.

kagis

Yeah:

https://en.wikipedia.org/wiki/California_v._Greenwood

California v. Greenwood, 486 U.S. 35 (1988), was a case in which the Supreme Court of the United States held that the Fourth Amendment does not prohibit the warrantless search and seizure of garbage left for collection outside the curtilage of a home.[1]

Even if you don't care about police going through your garbage, anyone can go run off with your garbage and poke through it, and those people may or may not care about legalities anyway.

That being said, I agree that one should at least have the option to not receive documents that one does not want.

Blue Cross is also part of the problem

kagis

It sounds like Blue Cross isn't unified, has different regional organizations, but it looks like at least some do have some level of paperless options:

https://www.bcbsm.com/amslibs/content/dam/microsites/som/documents/statemedicare-paperless-billing.pdf

[–] [email protected] 9 points 1 month ago (1 children)

I’m a developer at the biggest one of these systems in America. It is stupid expensive. But we support full electronic patient communication. And most of our competitors do too. I’m sorry you’re stuck with one of the few who doesn’t have that option or are choosing not to use it.

Hopefully they come around in the next decade!

[–] [email protected] 1 points 1 month ago

You must work for Epic.

I work on the hospital side and the cost and human effort investment for these systems is ridiculous. No wonder were behind the rest of the developed world in healthcare.

[–] [email protected] 5 points 1 month ago

Kaiser Permanente spent years and $120 million developing an huge replacement software system, and then gave up on it completely.

[–] [email protected] 4 points 1 month ago

They'll get there in the next probably about 20 years or so.

[–] [email protected] 2 points 1 month ago (1 children)

Just part of a larger trend of trying to digitize things that should never be digital.

[–] [email protected] 1 points 1 month ago (1 children)
[–] [email protected] -2 points 1 month ago (1 children)

Industry wants to place computer "solutions" between you and the world around you to the maximum extent possible. Data is money.

[–] [email protected] 2 points 1 month ago

What a fringe position. Patients and providers alike want digital access to health information.