Well. these practices do exist, but they are vanishing into vast medical conglomerates like Sutter who CLAIM to be co-ordinating care and improving quality. It’s mostly rhetoric. . .

The reality is that stories like Matt’s happen all the time. I think we need effective, personal small scale primary practices and payment policies that enable them to continue to exist.

But you don’t need a “system” to properly care for an infant with hyperbilirubinemia. How about a well-run independent practice with three or four docs, a staff that knows why you and your child are coming in and has obtained all hospital records needed, Saturday and Sunday hours, in-house lab services? All your child’s records are kept in one place (maybe even on paper!) and you’re given hard copies of everything for your file.

Practices like that do exist.

Adorable child!

So here’s where I am lost – the ONC painstakingly created an MU framework and spent tens of billions of taxpayer money to encourage EMR adoption – and now they are struggling with how to get the systems to talk.

What we have here is full regulatory capture. Cerner and Epic have strengthened their hands due to MU – their combined revenues nearly tripled in 5 years.

The major health systems have consolidated so much that they are byzantine complexes unable to have one hand talk to the other – and they want moats to prevent patients from getting out (they call that “leakage”)

So Aero – and all of us all held hostage. ONC can keep putting out reports calling for interoperability but nothing will happen. Health systems have no incentive to make things better.

And outside of the e-patient movement (which I can count on one or two hands), no patients seem to understand or care about this problem.

The game is over for years on this front. The vendors and systems won. We all lost.

ONC should be ashamed. If that’s all 10 years of rule-making got us, then I have lost any faith I had left in the power of government (yes, I did have faith)