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Tech Giants Push Open Standards for Health Network
securitas writes "The New York Times' Steve Lohr reports that 'Eight of the nation's largest technology companies, including I.B.M., Microsoft and Oracle, have agreed to embrace open, nonproprietary technology standards as the software building blocks for a national health information network.' Microsoft, IBM, Intel, Oracle, Accenture, Cisco, Hewlett-Packard and Computer Sciences have formed the Interoperability Consortium to build a health information network proposed by the Department of Health and Human Services (HHS). The network is the first step in moving from paper to electronic patient records and sharing health data between doctors, researchers, insurers and hospitals. Mirrors at IHT and CNet News.com with additional coverage at IDG/ComputerWorld Australia."
Finally ... now maybe health care systems won't rely on dial-up as their primary method of sharing information from facility to facility.
Amazingly enough, health care is probably 5-10 years behind in IT. The optimistic note: Health Care IT can learn from the mistakes of the 90s (which they were thinking about implementing next quarter- honest) and with movements like this, perhaps they can finally adopt proven standards.
After all, an apple a day keeps the doctor away...
Somehow Microsoft got into the same sentence as non-proprietary
Please correct and resubmit
If thou see a fair woman pay court to her, for thus thou wilt obtain love
Well we like technology. We like services that make life easier for us. Now how about the privacy, and control issues raised?
Thats the sort of stuff the National Heath Service (NHS)In england would dream of. We are spending Billions of pounds coming up with a integrated health record system and now this comes out!!.
Interoperability and sharing are all kinds of nice for the interchange of information, but what happens when a third-party developer comes up with something that can also plug-in, so it gets access to the data, but has some kind of big open hole in other parts of its code, so everyone's records are available to anyone?
Without resorting to a paranoid rant about huge databases where authorized people have access to my personal data... what about the unauthorized?
For some reason, I don't see a security framework coming down the line that is *good*, consistent, and enforced by the system as a whole.
500GB of disk, 5TB of transfer, $5.95/mo
Microsoft, IBM, Intel, Oracle, Accenture, Cisco, Hewlett-Packard and Computer Sciences have formed the Interoperability Consortium
This part of the summary (lifted from the article, apparently) mentions "Computer Sciences"; the company is actually Computer Sciences Corporation.
As an aside, the printer-friendly (i.e. less cluttered) version of the CNet link is here.
I want to drag this out as long as possible. Bring me my protractor.
I for one welcome our new open, nonproprietary technology standard overlords.
+1 Insightful, -1 Troll. What can I say, I'm an Insightful Troll.
That's all great, but Microsoft seem from history to have a corporate psychological flaw whereby on the rare occasions they try to support open standards they cannot help themselves trying to manipulate and distort that standard to their own devious ends.
MS should truly be proud of themselves if they manage to avoid that this time.
They seem to have only one representative from each field.
Intel, where's AMD?
Microsoft, where's anyone else?
Cisco, where's Jupiter or anyone else?
For a database vendor they do have Oracle and IBM, but I doubt they're going to be using DB2 if they've got Oracle in the mix.
"Finally ... now maybe health care systems won't rely on dial-up as their primary method of sharing information from facility to facility. Amazingly enough, health care is probably 5-10 years behind in IT."
56K modem-----internet ["/."]----56K modem.
Yeah, behind.
The network is the first step in moving from paper to electronic patient records and sharing health data between doctors, researchers, insurers and hospitals.
This was completely mind-boggling to me, until I realized we're talking about the big ole US of A.
If a commercial enterprise that was supposed to be working in my interests got access to my medical data here in Europe, there'd be fucking hell to pay. Heads would roll.
Can't see why you keep putting up with it.
...I sure hope it comes out better than what SAIC built for the FBI.
Who's going to pay for it? Hospitals have no money at all. To get them to spend money you have to go through so many committees and red tape its crazy. And anyone that can make a decision is already in bed with a different company and gets a kick back to only use them. Even if the product is crap and doesn't actually help patient care. There will never be a standard or open way for moving data around the healthcare environment.
The hospitals don't care about providing the best tools to the doctors to provide the best care. They care more about charging higher fees and lining their individual pockets. I see in 10-15 years or so the entire US medical industry crashing under its own weight. It is being run as a big business instead of putting the patients first.
Some of those are also the ones who are propelling trusted computing...
The AACS key is NOT 0xF606EEFD628B1CA427BEA93A9CA9773F
Anyone who has worked on IT in the health field knows about HL7. It is a free protocol for sharing any and all medical information. As of version 3, it has become XML compliant to allow programmers to use XML parsing tools to read/write data. I don't understand why there is such a need to make a new protocol for sharing health data when one already exists and is in use with most EMR systems.
The previous comment is purposely vague and generalized, but all of the facts are completely true.
"After all, an apple a day keeps the doctor away..."
Apparently having no money for either one, does a good job of keeping both away.
Amazingly enough, health care is probably 5-10 years behind in IT.
It's not amazing, really: healthcare as an industry is often both very very conservative and rather frugal. The combination results in an atmosphere of sticking with what works because a) well, it works and b) the new item(s) will cost money and might not work (see a)). It's actually not a bad viewpoint much of the time because it discourages upgrading for the sake of upgrading (i.e. with no clear and necessary benefit).
I want to drag this out as long as possible. Bring me my protractor.
Medicine is behind because of the doctors. I have done computer work about 15-18 medical offices and the doctors seem to have a 'this shouldn't cost me any money' attitude towards technology. In a lot of (but not all) the offices, things were not updated/replaced until the gun of hippa was placed to their heads.
Apparently, the ability to get more accurate records, better customer satisfaction, faster data retrieval, etc, doesn't seem to matter. It's like a lot of the doctors take out as much money as they possibly can in their pockets *now*, and do very little reinvesting for the future.
technology standards for sending health data across the network and sharing information, when appropriate, among doctors, hospitals, insurers and researchers.
I seem to have missed the point of this. There's already a standard for the data/information: HL7. As long as all systems can read and write it, does there need to be "technology standards"?
There are several companies that are already working to do this, that have been doing software for years. Why do these big name companies think that they can offer something these the specialists aren't already doing/planning to do.
There are big projects in the works with large national health care providers such as Kaiser Perminente that use Epic's software to share medical record information across the country. The Kaiser/Epic project is up and running in most locations in their Enterprise already.
These big names, I think, just don't want to be left out of the game. I call this more a marketing move than anything else. If their intentions where truely to advance this "call to arms" that President Bush has called for, then you would see companies like Epic, GE Medical, Philips, Cerner, etc on the list.
Just my two cents worth...
Obscene amounts of translation paperwork are a nontrivial part of the soaring costs of medicine in the U.S.
They do not have access to the hospital data, period. I can't see why this is such a hard concept.
Hospitals are financed mostly by taxes and in part by private insurances. At no point will I allow the hospital to communicate any information directly to an insurance company, or vice versa. All such information passes through me. And I am free to lie about what I want, but I am also accountable for such lies, should I choose to change anything.
Anything other order is unthinkable.
The Veteran's Administration Health Care System has an excellent electronic record-keeping system, and can be found even as an open-source format. I'm hoping that they build off of the OpenVista project, and have some standardization across health-care organizations, so that the patient records are more easily transferrable and readable by the providers.
"What do you think?" "I think 'What, do you think?!'"
Display * where SS# is Null ...
Oh, you mean this isn't an Immigration Service project?
Never mind, then...
Noteable ommission from this list: GE.
Given the push towards Health IT GE has been responsible for, and their data management systems, it seems odd that they would not be included. GE caught onto the importance of technology to health care well ahead of the pack, and I wonder if this is setting the stage for multiple competing standards, rather than the intended streamlined, uniform approach.
Rome did not create a great empire by having meetings; they did it by killing all those who opposed them.
if I'm not mistaken, isnt CSC really DynCorp (the DOD Contractor)? Somewhat interesting to see them on the list with all the other companies.
CSC acquired DynCorp a couple years ago. They (CSC) do a lot of DoD work but are heavily involved in healthcare, too (among other things).
I want to drag this out as long as possible. Bring me my protractor.
I've been following this story for some time now. For me, the cool thing about this quasi-open-source project is that it will be built using source code that was released to the public thanks to the US FOIA (Freedom of Information Act).
This software was built years ago by the Department of Veterans Affairs for its hospitals and clinics. Similar commercial software is easily sold for over US$1 Million. I would love to see more software developed by the US government with taxpayer money released into the public so that the open source community can benefit. If you know of any government software that could be useful, file a FOIA request! (Assuming of course that it does not violate national security, yada, yada.)
For more info on this software and other open source stuff going on in the healthcare world, see these links:
So how will the work of this consortium integrate with that being done by the HL7 organization? And if there's a disagreement between standards bodies about how best to comply with HIPAA regulations, how does it get worked out?
They can "enhance" them later...
Now I won't be able to get my pain pills from 42 different doctors anymore without them finding out about the others. :(
an RFI from the Department of Health and Human Services posted November 15th:
http://edocket.access.gpo.gov/2004/04-25382.htm
80N
The network is the first step in moving from paper to electronic patient records and sharing health data between doctors, researchers, insurers and hospitals.
G*d forbid that we, the patients, should have any access to our own data.
Doesn't the establishment of this type of venture just beg for a HIPPA violation?
Presumably this system would require a way to identify individuals (beyond name/address)...has there been any discussion of how that would be accomplished? (Social security number?) I can't think of a way that this could be accomplished where it wouldn't be controversial. Presumably you'd want to carry your "Health ID" at all times so that your records could be accessed in an emergency room. -Russ
is why previous healthcare IT initiatives have failed.
Best Slashdot Co
They thought they could milk it all with v1.0 but now with this stroke, they will cement their annual health systems payola. Look at all the companies involved - software, network and consultants.
First it payola for just process thru HIPPA and a bit of software. Then they realized that this cow can be milked, they come in with a second bolt.
End to end digital transactions, open, secure, no more paper forms to fill. More info on digital cards. Swipe and fill forms. No more errors. Did we mention that this is all federally mandated.
Bottom line - Patients, expect to pay more for insurance and healthcare since someone has to pay for all these smartcards, bioidentities, 100 Ghz computers, 400 layers of software, security, 10 gb networks, switches and massive amounts of storage.
Shit the doctor had all that data stored in his age old filing cabinet.
Proprietary noninterop has been one of the nonnegotiable ways that personal medical info has remained private. Before we switch over to the vastly healthier system of unimpeded flow of medical info among medical people, we need to protect that info from unauthorized "sharing". Our copyright on our personal information must prohibit any transfer of our info outside the transaction within which it was provided by us, unless expressly authorized - which authorization is nontransferable, unless itself expressly authorized. That authorization can be per-transaction, or under a standing policy. The only exception is in an emergency, like a car collision, and even that should be checked (if feasible) against a privacy policy which might prohibit it. In any case, no transfers of personal medical info may be permitted outside the immediate transaction, unless explicitly authorized, which would be the default policy under any sensible health insurance. Otherwise our most personal info will be distributed widely among parties with no permission to invade our privacy. If you dislike your email address on spam CDs, you'll hate your genome in marketing databases.
--
make install -not war
The idea of moving things like patient from paper sounds great except for the fact that chances are high that client computers will run Windows, and therefore be CRAP. I'd just love to hear on the 11pm news that a worm broke loose on a hospital database and corrupted all of the patients' data, and subsequently caused mass chaos.
GE Healthcare (Technologies)
http://www.gehealthcare.com/worldwide.html
Insurance companies are the ones that have been primarily pushing for this - for years. This could potentially give them a very quick reason to deny you health insurance, based on something as simple as a bad checkup, or a checkup in which you admitted to smoking in the past. Previously, this kind of data was hard for the Insurance companies to "mine" - now it will be easy. They could potentially offer employers reduced group rates depending on the number of "super healthy" they employ - thus giving employers incentive to not hire people with pre-existing medical conditions. Make no mistake - if this goes into production, a bad checkup could follow you around for years and impact you in increasingly intrusive ways. The big insurance companies really, really want this.
Actually, this would also dredge up us tinfoil hat folks. Neither my health insurance company nor any of my health care providers have access to my SSN. (Because I make a stink and refuse when they ask for it.)
We'll know if the system is being abused though, if INS shows up at the offices of thirtysomething white lawyers in North Dakota and start asking questions.
Trying to use sarcasm in text-based forums does not work.
"...sharing health data between doctors, researchers, insurers and hospitals..." Hey, what about the patients?! We should all have access to our health records online, be able to add comments, correct errors, and control who has access and to what level. E.g. I don't want to give my insurer full access to all my medical records.
Let me give an example of one of our systems, a text based system, with functionality similar to telnet, when I used it for the first time I noticed that it was slow to open, so I put a ethereal on it and noticed that to connect it sends 8MB of info every time you connect. Approximately 20,000 packets, each with every permutation of two ASCII chars.
We deal with crap this daily. For another program we are forced to use a non-standard telnet client that takes 100% of the CPU regardless of the machine you are using.
Open standards that could link admitting, clinical and financial hospital systems will save billions of dollars and probably a few human lives. Additionally, this will allow small software companies and open source coders to make applications that can be widely used. Ive been working on a multi million dollar project the last few months where an aspect of it was completely screwed up because one software vendor uses a non-standard interface that they will not allow us to access directly, as a result, our users have to settle for diminished functionality.
If encryption is built into this standard it will be a step ahead for HIPPA protection and most systems just send everything, (passwords too) in plain text. I for one, look forward enthusiastically to open source hospital applications made possible by open standards.
For any and all developers and/or entrepeneurs out there, it'd be a good idea to keep a close eye on this. There is opportunity in the government's call for this infrastrucure for a new niche in the IT industry. Just look at what HIPAA has done (and will continue to do) for IT...
The biggest problem with all these ventures is that nobody has found the genius to devise a system of keeping your medical records away from prying eyes. While the mounds of paperwork are expensive and slow, at least it is difficult for a prospective employer to get his/her hands on your medical records and decide not to hire you because you have high blood pressure and may risk costing the company. Or worse, insurance companies who decide that because you took an AIDS test a few years ago, you statistically lead a high risk life style (never mind that at least you are reponsible and get tested) and jack your rates way up. By making this information easy to share, they are making it easy to share with everyone, so the first priority should be to develop protocols to secure this data.
Funny, but remember MS's theory of "embrace and extend" which they do to many, many "open" standards that they can then effectively "close" after they get established.
-Looking for a job as a materials chemist or multivariat
... in some cases, taxis are hired by the hospital (government owned, dept of health) to drive x-ray photos *across the country*; for example, from Galway to Dublin, a journey on our roads that takes about 3.5 hours.
And that's just for one set of photos. No batches or big bundles of photos, or any kind of optimization.
should read: Consulting Giants Push Open Standards for Health Network.
BTW: have fun with hungry-hungry-HIPAA!
This one gang kept wanting me to join cause I'm pretty good with a bo staff.
Check out: http://OpenHRE.org
but that's how it mostly works, yes. The hospital bills me, I am reimbursed by the insurance company, minus a small fixed amount which I don't know the U.S. term for.
There may be other systems but this is how I know it from where I live.
This only applies when seeking private care (95% not necessary) or needing a hospital bed, though. If it's an ordinary visit, I pay a small fee when entering the hospital, and the rest is paid through taxes. Many European countries don't have the entry fee, either.
The biggest obstacle to this is doctors. That's not necessarily their fault, though.
This is going to require huge amounts of infrastructure, IT and human, to accomplish. It will take huge amounts of money and time. If you've ever wondered why the medical system is so far behind the IT curve, this is why. Also, add on to that the general resistence the medical community has, especially doctors, to change and it adds up to one heck of a hard mountain to climb.
You might say, "doctors, resistant to change? What about cutting edge medical procedures, 'n' stuff like that." True, medical science is leaping forward these days, but that doesn't mean that the rank and file are open to change. Often it's quite the opposite. You generally don't get through medical school if you're a maverick, willing to take risks. (Don't believe what you see every day on TV, folks.) Doctors are generally resistent to change. Now, add to that saying, "You're going to have to buy all this equipment for your office" and "Oh, you don't have complete control over the information anymore" and you're just asking for trouble.
I work for a small company that's trying (and, sadly failing at the moment) to sell a way to pay for part of the cost of the infrastructure from the ground up: video on demand for doctor's offices. Sound odd? It sounds even more out there to the average doctor, believe me. The basic idea is that the infrastructure for medical record storage and transmission could be payed for by doctors watching a few pharmaceutical ads per month. They'd also get educational videos for staff and patients, and training videos for new procedures.
Pharmaceutical companies already plough millions into sending reps out to the doctor's offices. They could just as easily pay doctors a fraction of that cost to get them to watch advertisement videos, saving the doctor's time to boot. But, for most doctors we've talked to, the very idea of having ads piped into their office is like kryptonite. They hate it. And they'll tell you so while writing a prescription with a pen that has "Merk" printed on it and squeezing a stress toy with a Phizer logo.
OK, try and tell me it isn't related to BG's recent donation of $750m to vaccinations!
Damien
Bush created a new office in HHS called ONCHIT (Office of National Health Coordinator for Information Technology). Brailer, who has dealt with health information exchange and the private, vended side of Health IT, was appointed the first coordinator. He requested these community-based opinions.
/ ONCHITFull_document.pdf
Since health care is complex and so far behind in IT, most people believe that most of the benefits from shared electronic health records are still large (as opposed to other industries that have adopted IT to a larger exist). The barriers in medicine are greater, though - the system is fragmented with misaligned incentives, so those who invest in IT rarely reap rewards; costs rise rapidly from other technology, like advanced treatment for cancer or expensive imaging equipment; variability in care leads to appropriate treatments being delivered only about 55% of the time; a highly educated workforce is resistant to change; and, of course, the hegemony in the availability and implementation in standards. Thus, there are a lot of reasons why IT is so far behind.
It is interesting that these IT companies have only recently entered the health IT field as more than hardware or generic software vendors; likely, they are seeing health prices rise as employers, or purchasers of health care, and feel that their expertise would help stem the tide. For some of the reasons mentioned above, and the obvious one that they probably don't really understand medicine, groups like HL7 and other standards organizations should receive the vast amount of attention and funding.
Note that hundreds of other recommendations were sent in - the one most interesting for me is the one from the consortium of people who have been struggling with these issues for decades (including HL7). Available at http://www.ehealthinitiative.org/assets/documents
you can reach me at davedorr9 AT NOWHAMMY NOWHAMMY yahoo DOT com
Anybody else notice that none of the current vendors in the electronic medical record space are in the consortium?
Great! All the huge corps that couldn't put an EMR together when we NEEDED them are going to grab the business now there is a government mandate and federal dollars to spend.
This isn't Open Standards, this is a money grab.
"Our copyright on our personal information must prohibit any transfer of our info outside the transaction within which it was provided by us, unless expressly authorized - which authorization is nontransferable, unless itself expressly authorized."
I'm sorry. Didn't you get the memo. Copyright has been cancelled on account of "movies and music just want to be free" and "how dare you violate my free speech rights?". Guess you'll have to fall back on some other defense. May I recommend obscurity?
As long as Hollywood is racking up rights and riches under the copyright laws, individuals should ride their coattails and demand the same rights for the smaller, more personal info that we distribute. I want to see the EFF cite some RIAA precedent when suing the RIAA for selling a band's mailing list to a spammer.
--
make install -not war
I formerly worked in health care IT, and consulted to Microsoft last year as they were ramping up to this.
The whole time I worked with them, there were several prevailing concerns:
1) They focused completely on the technology and suffered from an understanding of the health care/health insurance domain.
2) They failed to understand the history of IT in the health care space. There were several times I was tempted to scream "its been done already."
3) Hospitals and insurance companies have invested millions in pharmacy systems, CIS systems, and other domain specific systems, yet Microsoft was convinced these companies would switch just because the technology was "better."
Health care desperately needs talented companies and people to assist with its IT needs, but software companies forcing solutions on them without understanding the domain does nothing to solve the problems.
Remember when Healtheon, Jim Clark's disaster, was going to do this with a proprietary system that put them in the middle of every health care transaction? At least this is an open standard.
If the industry comes up with a framework which will significantly reduce errors, and they *don't* use it, then will they be opening themselves up for significant liability which either increases malpractice insurance premiums or subjects to jusdgements that their insurance won't cover.
500GB of disk, 5TB of transfer, $5.95/mo
I just hope that the patient owns his/her own records. This is the way to make health care cheaper and less time consuming for the consumer.
The client aps are all written so that one implimentation can use MS sql or the db software of choice. My wife works with business process testing and function analysis on a large roll out of health care software. So far the act of going filmless has been successfull, but the time to implimentation costs are huge because of db migration and integration testing.
As far as the security of access goes, decisions about user access control have been paramount in the design. Each user and terminmal can access only the necessary info. In short the system has had to be designed from the ground up.
With the forsight to understand the asp.net and all the other access control problems caused by MS software, Cerner (the software vendor) has made some interesting decisions about going further than just being a MS centric gui vendor. They are starting to release unix versions of their healthcare software. Most people in the know would like to go back to a good old Vax style terminal and get away from the overblown MS wacky mouse button gui crap. Creating eye candy is not a big consideration in the real world. Effective training and efficient simple gui's are much more important.
"Where are your patient records today?"
"The network is the first step in moving from paper to electronic patient records and sharing health data between doctors, researchers, insurers and hospitals." See the word INSURERS? They should be totally left out, or the FIRST THING THEY WILL DO ID DROP COVERAGE on anyone they feel like. These shits have been allowed to Legally gamble for centuries, while the rest of us, for the most part, cannot. The need to start paying up for all those denied claims.
I thought [DICOM and HL7] were distinct...?
And as I'm sure you know, there are different flavors of DICOM produced by different vendors. Last time I checked, Siemens DICOM doesn't play nice with GE DICOM. Yes, there are standards, but they're GOVERNMENT standards, not customer standards. They all have loopholes big enough to drive a truck through, and the vendors exploit these loopholes to lock customers into a one-vendor package.
If you are a Siemens sales guy, which one is better for you- a Siemens patient monitor that listens to a GE pulse ox, or a Siemens monitor that only works correctly with other Siemens equipment?
All the vendors make stuff that works. It just doesn't always play nice with the other kids. Standards compliance *on paper* is worthless if the box doesn't work with your other stuff when you plug it in. Publishing another set of standards won't fix this situation unless customers have a uniform, objective test for interoperability, and obtain the contractual right to RETURN a system that fails this test to the vendor for full refund (and some $$$ penalty for the inconvenience of being a guinea pig)...
An organized national health care system would produce "reference systems" for components of the OR suite, and provide them to the vendors with the understanding that if the vendor wanted to sell anything, their products would need to successfully interoperate with the reference system. Fortunatley for the continued financial well-being of GE and Siemens, the health care system in the US is about as far from organized as you can get.
To reply to parent's parent's parent's post- the issue is not standards. The issue is ENFORCEMENT of standards BY CUSTOMERS rather than by the government. HL7 was written by the vendors so that customers can't use "standards compliance" to change the market dynamic. DICOM was written to fix/extend HL7, but didn't change the approach. You can write RFC's all day, and turn them into a standard if you want, but the real problem is that to drive change in the market for healthcare devices, you need to take power from the vendors and put it into the hands of the customers, and the only way to do that is with contracts that carry financial penalties for the vendor if they fail an objective interoperability test.
Humpty Dumpty was pushed.
Anyone find it odd that WebMD (who owns the nations largest insurance claims clearinghouse that uses about 8 differnt formats from ansi4010 to nsf+) Does want to get in and help build a standard?
Kaiser Permanente is so old and so large and so balkanized that sharing data Internally between systems is a major headache.
They have legacy systems, built in house, that are older than some of their employees.
They are currently spending Billions on an Electronic Health Record system and a recurring problem is getting the new stuff to talk to the old stuff.
And its certainly Not for lack of spending.
Obviously, this isn't a unique problem. But if a single organization has trouble managing such a complex system, how hard is it going to be to get a network of similarly sized organizations to interoprate?
I was hospitalized in an auto accident in 2003. I was mortified to see my SSN most pieces of paperwork- the doctors reports, the medical provider invoices, the insurance company records, the lawyer records. I did not give any of these my SSN, but guess the insurance company gave it out.
My benefits admin switched away from SSN to its own number two years ago, which is useful. If some medical asks for my SSN, I leave it blank or give them a fake (memorize it to be consistant). SSN are only required for taxable transactions.
Terre Haute is 20 years behind 1960...
I've read all the posts on this topic but it seems like many important questions and comments haven't been made about the implications of having national health care records.
I could go on but I won't. As you can see, this isn't just about data, like the HL7 standard. It's about a heckuva lot more.
When two dozen Bob Smiths get the wrong diagnosis, wrong medication, wrong surgery, wrong billing -- that's another matter.
-kgj
PS to parent: sorry to see you got modded Offtopic -- I scrolled quite a ways down the page, looking for anyone to address this issue.
-kgj
Ok, it's not april, but .. Microsoft???? Supporting Open Standards?????
It also means that one bad drug interaction will stay on your file - hopefuly meaning you don't get given it again. I could also identify people who are perscritpion farming - going from doctor to doctor requesting scripts for restricted drugs. I could potentially make it easier to get confirmation that you really DO need access to a particular perscription if you are travelling
The trick to any system is to allow simple access to people who need it while denying it from those who don't.
Sara
Designer, Gamer, Macgrrl in an XP World
It's spelled (acronymed?) HIPAA. And part of it is a (gasp) open standard for data exchange format. I don't think what the big boys are doing will have any effect whatsoever on the healthcare IT field. Most IT departments in healthcare related businesses blew several years worth of budgets becoming HIPAA compliant. That generally meant new or upgraded software and hardware. Now the deadline for the HIPAA Final Security Rule of April 20th 2005 is fast approaching, and any competent IT department already has all their software in place.
Nice thinking Microsoft, IBM, et. al, but you're a day late, and a dollar too much. They should be embarassed that the US Federal Government beat them to it.
And it could mean job security for me and the company I work for. We set up several doctor's offices to where most of their patient data is scanned in and stored electronically (two using Open Source software). I know that one practice we set up is totally paperless after the last set of hardware we deployed at the end of the year.
I know the system does need fixing overall because some of the billing people that I work with on a regular basis at each of the client sites are always complaining that all of their claims are being rejected by insurance companies for various reasons, and it's becoming a time-waster to sit on the phone with the insurance company to try to get the mess sorted out. As a result, sometimes it's hard to collect our consulting fees because the money that's due us is not there because insurance hasn't paid the clinic what was charged for patient care.
As for the job security in my opinion, I'll most likely be asked to learn what the standards are, what hardware needs to be deployed, and what regulations in addition to HIPPA need to be followed.
It's interesting that the "consortuim" deciding on healthare infrastructure have a relatively small portion of the marketshare. Why weren't Cerner, HBOC, Siemens a part of these discussions? Those are the real players
Many providers choose to remain on dying Practice Management systems instead of spending thousands on software and training - just for the sake of modernization.
Some prefer not to have anything to do with electronic systems at all, since their filing cabinents perform the same duty with relatively no upkeep.
The industry as a whole appears to be moving in the direction of a uniform standard but know this won't happen overnight and it certainly isn't the fault of WebMD or other clearinghouses.
Until the older docs retire and pass the biz on to someone interested in modernizing equipment somebody's going to have to interface with the legacy systems. Kudos to Webmed for stepping up to the plate.
Sorry this is so late; I don't know if you will read it or not, but I wanted to respond.
As for including the Entire H&HS budget? It's cause Medicare/Medicaid is in there (and makes up most of it) and it is what we have been talking about here. And I notice that the amount spent on Medicare/caid is still greater than the DoD budget.
No-- you specifically equated welfare with HHS. My wife works in the welfare-to-work program (she is regional director in my area), and so this is a touchy subject for me.
For a little more than half of what Americans pay in health insurance and medicare/medicaid, we could have a first-rate subsidised healthcare system. About 90% of Americans would get better care than they receive now, with less cost. Most of the rest of the 10% would receive about what they get now. A few would have to pay for their first-class doctor, but they have to pay now anyway.
Private practice would still thrive.
I *do* agree that there are problems with fraud. However, the problems are not nearly as terrible as reported. There are a few cases of jaw-dropping fraud a year, such as the ones in the links you provided; but, sensationalism aside, these are rare. This happens in many other programs, whether federally-funded or privately-funded. It's just that people get worked up because they see "welfare queens" and think that they are getting away with something. Most people who defraud the system are caught in a timely manner, and prosecuted appropriately.
There are also problems with insuarance fraud that measure in the hundreds of millions of dollars a year.
And the insurance companies do *not* have much of an incentive to make our payments lower. The cost of *our* medical expenses (that is, the patient's cost) is increasing yearly. Any amount saved by the insurance company goes into the pocket of the insurance company.
Hospitals routinely charge two rates: one rate goes to the insurance company, and the other higher rate is charged to the patient without insurance. So any lower rate negotiated by the insurance companies do not translate to cost savings for any patient.
Given the money spent on the DoD, I could employ over 4 million people at $75k/year and solve all kinds of problems. Our DoD budget is greater than all our "enemies" combined, by a long shot. Just the increase in DoD budget this year (oddly enough, just about equal to the amount we pay in individual welfare) would pay for the *entire* defense budget of the middle east.
We gave about $200B in corporate welfare last year, including direct handouts and tax breaks. Consider where that money get be spent-- say, on education (to get people the fuck off the dole-- I don't like them there, either, no matter how bleeding-heart I sound), public transportation, research (get that oil monkey off our back), or even give it back to the corporations as contracts for services.
It's a tough debate, with no clear answer. But we can't turn our backs on those who need it, just because some people are fuckers and take advantage of the handout. There are *many* people who need help.
One last thing:
Given the money spent on welfare I could employ over 1.6 Million people at $30K/year and cut the unemployment rate significantly. As is, we are paying them to not work and stay unemployed.
As it stands now, welfare recipients are required to perform work activities. This may include volunteer work, education that will lead to work opportunities, or subsidised work activities (in which the welfare office helps pay wages during on-the-job training). Also, an individual is limited to 60 months total lifetime benefits. While receiving benefits, your home is subject to inspection, as are many other aspects of your personal life, such as your finances.
The welfare system is designed to get people back on their feet during a rough time. The work requirements promote a return to work, and discourages using the welfare system as a free ride. If you have to work anyway, you might as well work in a paying position.
Microsoft is to software what Budweiser is to beer.