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Why is it so hard to get the information we want out of systems, especially the extensive hospital systems? It may just be that they’re not well designed. It often seems that even if you have analysts and informatics guys all over the place, they can’t solve these problems either. It’s okay that I say “guys” because, yes, more often than not, it’s a geeky guy in a dark room hidden away somewhere in the hospital. So not the nerdy guys in dark rooms. The systems just aren’t set up to do this kind of stuff, to get the information that everybody wants mainly financial information. Part of this may be because they’re essentially clinical systems that route and not financial systems that are being misused in some ways.
Other times, it seems like the systems are intentionally built to withhold information. Or to get information, you have to pay. You have to pay extra to get what you want out of the system. For example, Epic won’t allow you to search by a diagnosis within the EHR unless you pay extra for that. They charge you five figures. I think the price is like $80,000 for this one.
Workarounds you can rely on
There are some weird workarounds you can do. For example, you can go into the billing module, and you can run a report out of billing and reverse engineer things backward. I remember a physician telling me that this is what they did at one point because they couldn’t pull a list based on the patients’ diagnosis. So they went into the billing, found the diagnosis codes in the billing module, ran a list of all those, and then reverse engineered, took that list back to the EHR, and then looked up those patients and found that list. That’s nuts, but you may have to do that.
Those are the kinds of things you sometimes have to do. Not only is that not automated, but that’s painful. Epic charges like five figures for almost every custom report and everything they do. Most of the major systems, Cerner, Meditec, and so on, are similar.
Often, you have to set up a separate data warehouse or something, where you can interface to something that will take the information, the financial information, drop it in for reporting purposes. That’s a lot of extra costs, a lot of additional complexity. Often, you’re daisy-chaining a bunch of different systems together. There are many moving parts to break, which means that the reporting usually doesn’t function well. Or you make one minor tweak in one place, and everything breaks everywhere else.
It does seem clear, though, that somewhere in the marketing department of these big companies, Cerner, Epic, and so on, somebody had a choice to make, which is, “Are we going to price to cost or are we going to price to market when we’re looking at reporting modules or particular applications?” or “What are we going to charge?” We could charge what it costs us or charge what we think the world will pay.
Disparity between big and small hospitals billing system
The problem is, you have this massive disparity between small hospitals and big hospitals and extensive systems. If they’re going to price to market, and they’ve chosen to price to market, not to cost, that means that many community hospitals, small hospitals, and rural hospitals can’t afford this type of thing. Only the large hospitals, large systems, things like that will afford many of these types of modules or applications. $10,000 doesn’t seem like a lot of money, but once for many different things, those start to add up very quickly, and hospitals are on a tight budget.
The net effect is it doesn’t happen. Most of the time, it doesn’t happen. More often than not, I hear complaints from people in hospitals that they don’t get them. They don’t receive what they need unless it’s the most critical type of report, or it’s a particular aspect or a function within the hospital to get special treatment.
Practices that hospitals own especially don’t get these either. The cost ratio is all off for practice. I mean, even if it’s a 10-15 point million-dollar practice or something like that, that’s still way out of whack to have a bunch of these kinds of things. Worse than that, even are the hospital-affiliated practices where they have Epic or something like that because that’s what the hospital has. They’re certainly not chunking down 20 grand, 50 grand, 80 grand, or many of these things to get reporting or the modules they need. In their words, and I quote as one practice described it, “We are low man on the totem pole.” They’re essentially in a mushroom factory. They’re kept in the dark and fed shit.
Don’t you wish you could get data out of your system that you wanted so that you could answer questions with your financial data? That doesn’t seem like that big of an ask.