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Obama Proposes Digital Health Records
An anonymous reader writes "'President-elect Barack Obama, as part of the effort to revive the economy, has proposed a massive effort to modernize health care by making all health records standardized and electronic.' The plan includes having all conventional records converted to digital within 5 years. Independent studies are fixing this cost somewhere in the range of $75 to $100 Billion, with most of the money going to paying and training technical staff to work on the conversion. Early government estimates are showing 212,000 jobs could be created by this plan."
If this can save so much money why isn't the health care industry already doing it? Are they really that stupid or are all the promises of big savings not likely to pan out?
I want peace on earth and goodwill toward man.
We are the United States Government! We don't do that sort of thing.
where exactly are all these records going to be stored? on a gov't server? private server? or only at the doctors you currently go to and they can send electronic copies to other offices?
Nope, they're just stupid
Getting all of the records into a standardized format is a stepping stone to universal health care. By biting it off in pieces, he's going to be able to make the apparent cost of the transition lower because much of the expensive work will have already been done by initiatives like this.
No doubt Microsoft is already working on their own closed source Microsoft Health Information File Format, with its own special brand of DRM and licensing scheme.
Ok. There are plenty of abuses of this system but every time I go to a doctor I have to fill out the same information, often for multiple visits to the same doctor. My permanent address does not change once a month every month, thank you. It would also be nice for the hospital to have a digital record of what I'm allergic to, if I'm ever admitted unconconscious.
Having health records as a standard brings more transparency to the Health care industry, start with that and then soon people will want them standardized invoicing and billing etc. Obfustication seems to be a popular method to profit.
"Enjoy what you're doing! If it becomes drudgery, you're doing it wrong!" - Jim Butterfield
How about doing this for my 401K? My current one through my employer is impossible to manage, and the insecurity around the thing is downright scary. My rollover IRA through Fidelity is ok, though.
On that note, how about making it so that I can choose whoever I want to put my pre-tax money into vs. whatever firm my employer wants me to use?
On healthcare, stop allowing the 'insurance' companies to be in charge, for one. Let me see any doctor I want, and they cover me. Enough with the in network, out of network bullshit. Don't cover routine stuff, but do cover surgeries, long-term care, therapy, etc. I don't use my car insurance for oil changes </bad car analogy>
$100billion? There are millions of patient records, but they do not reside in millions of databases. Let's be generous and say there are thousands of databases. But most of those databases are already manned by DBAs. Some of them may not be up to the task, but most can convert their tables to the specified format if you tell them what that is.
So it seems the task is coming up with a standard format and enforcing it. Security is another question, but again it seems a matter of mandating healthcare providers adhere to a specified standard. But hospitals and insurance companies are quite used to such bureaucracy, so it's difficult to understand where they're pulling this $100billion figure from.
Saying they'd need to hire an entire new class of DBAs and techs to make it happen is silly, since they already exist.
Odds are the figure was thrown against the wall by companies hoping to win a fat contract, and counting on the knowledge that politicians have no sense of what it takes to get the job done. I hope Obama's CIO has the knowledge and grit to tell them to take a hike.
Do what you can, with what you have, where you are.
It seems as if this is a step forward and a step backward. A standard health record seems like a great idea but... I still feel that most firms are not knowledgeable regarding the security of their electronic data. This poses the question, "Who will store the data?" If it is to be the federal government, I feel this is a step, or two back. (Forward if you're excited about the beginning of realizing Gattaca). Electronic records, unfortunately, pose more threat to the safety of your data and the abuse you will receive from the government (universal healthcare or not) and private health care companies both.
Of course they're going to be stored in a government database, or more likely a giant mega-corp's database who gets paid big bucks by the government to run the database... and the govt will have unfettered access to its contents too. And it'll be a federal felony to try to keep your medical records out of it.
> Early government estimates are showing 212,000 jobs could be created by this plan."
Uhhh, what? Adding computer automation generally _decreases_ employment - that's the idea anyway.
Part time jobs maybe? If so, that seems pretty important to mention.
Maury
If it was electronic, the only excuse they could bring up if they didn't feel like doing work is that the server was down.
I like modernizing things...it's creepy that the industry which keeps us from dying from small pox still remains only partially digital.
Are we still going to be using paper records in a hundred years? I don't think so. So, if we want to avoid many, many years of format wars in the future, ending with a crappy format no one is happy with, let's pick a decent one now and go with it, albeit slowly.
Now it'll be even easier for providers to sell my information. If you read HIPPA closely you'll see that for 'academic' or 'government' use, health care providers can and will send your data to third parties.
212,000 data-entry jobs? Just what any high-tech, 21st century economy needs.
In case most of you had forgotten, Obama is basically copying John McCain who specifically mentioned doing this in the debates. Of course at the time McCain did it Slashdot thought it was an evil intrusion of privacy. But now that Obama wants to do the exact same thing it's an enlightened 21st century idea that only some Luddite old guy like McCain could ever oppose.
AntiFA: An abbreviation for Anti First Amendment.
Good point, but the other question to ask would be who saves the money?
Having these records would make it easier to switch providers. Without them, more tests might need to be done since "we don't have the records". Switching providers isn't in the providers' interest. Charging for lots of tests is.
This is very clearly useful, but the pitfall is the insurance industry slipping loopholes into the formal bill allowing them to datamine peoples' records to further exclude anyone who actually requires medical care.
"i'm sorry sir, but your records show you're prone to sinus infection" [denied]
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I'm pretty sure that health insurance companies have electronic records of all their customer's health care. Probably those records are scarily complete.
Wouldn't it be much cheaper, and faster, to just copy the data from the insurance companies, and write a few data format conversion programs? That would get 90% of the job done. THEN you can waste $100B on the other 10%.
When you steal from one person to give to another person, nothing is created, it's only destroyed. So no, jobs won't be created, wealth will simply be redistributed.
http://mises.org/story/3058
I've had enough abrasive sigs. Kittens are cute and fuzzy.
I see many problems with this. Here are the ones that seem most important:
First off, who is going to back this data up, how are they going to back it up, and how are the backups going to be tested? The public outcry that you'll have the first time a hospital administers medication that a patient is allergic to because the IT staff is still in the middle of restoring backups will (or at least should) be epic.
Secondly, quite a bit of "medical records" is high-resolution images (X-rays, ultrasounds, MRI, CAT scans, and probably a lot of stuff I haven't thought of). A typical patient may only have one or two images in their files, but we are talking hundreds (or thousands) of patients per doctor. The storage space required will be astronomical.
Third, all systems that can be abused will be; and any "safeguards" put in place to prevent abuse will only make it more difficult to uncover the abuse. I don't know what form this abuse will take, but it will happen.
I could probably come with half a dozen more if I tried, but I should be getting back to work.
Loose things are easy to lose. You're getting your hair cut. They're going there to see their aunt.
Almost a quarter of every dollar we spend on health care is used by administrative expenses. In Taiwan where they have digitalized medical records their overhead is only 2%. There is plenty of examples around the world to why electronic records are better economically. Also there is the benefit of less mistakes since cross referencing medications and such can be done electronically for drug interactions etc. Frontline had an excellent episode were they looked at the health care systems of several other modern democratic countries. A must watch for anybody who cares about the health care debate. http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
"They who can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety" Franklin
I'll hold my judgment on whether digital records are a good idea, but I'm fascinated by the attempt at sugar coating the cost of this program. 212,000 jobs? Great, that's enough to put half the people entering welfare last week alone back to work, a few years from now. And it's only going to cost $100 billion during an economic crisis? Sounds like a bargain to me!
Murphey's fighting Occam, and we're in the stands.
Medical records are, for the most part in the US, stored in standardized formats on paper. The standards are pervasive enough that colleges can teach transcription and billing classes, med and nurses courses can be consistent.
What we really need is some lawyer telling every business how to do their jobs. I really hope Obama decides to switch the "national data structures system" to the binary search tree and outlaws the link-list-based stack. Irrespective of the fact that a: it's not his business; and b: the practitioners will chose the best tool for the job.
If the president wants to mandate his government to perform a certain way...great. If he wants to do that to private business, it's just another loss of liberty. But....think of the children!
THL phish sticks
Privacy Privacy Privacy.
Basically scare hospitals to the point that sharing becomes too financially risky to even mention. Throw in the Trial Lawyers who love to look for anything to sue a local hospital over and "accidental" disclosure or such becomes much easier if the data can be freely exchanged. Throw in possible errors, one opinion versus another (in the form of Doctor diagnoses), and treatment issues, and the can of worms become nasty.
You can't even shop for insurance across state lines because of the government's regulations. Think it is any less burdensome on the businesses in that industry?
The real problem, if the records can be accessed by outside agencies how long before it becomes a data mine for lawsuit happy agencies? How long before its leverage by some bureaucrat who has a bone to pick with a local hospital over treatments?
As for the job creation, typical political bs to sell it. Mentioning a new program which eliminates jobs doesn't float. Then again if the government is doing it it will probably create more jobs and raises costs.
* Winners compare their achievements to their goals, losers compare theirs to that of others.
Before they digitize all of that data... should we not define more clearly how that data is secured and who can view it in the future? I do not feel that HIPAA is good enough for my personal information. Once digitized, it would be easy for insurance companies to obtain and abuse that data.
and it's in beta - real Google style :-)
during these "hard" times. No doubt he means everyone but himself and the rest of the political class. A gesture of good faith on his part would be to scale back his $50 Million inaugural orgy to just a live TV swearing-in in the oval office, followed by a brief televised speech. I'm guessing that the chosen one will not choose the path of least public adoration, though...
We have a similar "project" or rather it should be characterised as a "permanently stalled horror story." There are only 70 million or so people in the UK so nobody understood why the initial budget was in the billions. Now it's in the tens of billions and no end in sight. Google NHS IT if you really want to spoil your day.
"Don't belong. Never join. Think for yourself. Peace." V.Stone, Microsoft Corporation
Just casual observations as a Kaiser Permanente member...
It looks like most of their records are digital already. I suppose the biggest roadblocks are patient confidentiality and government privacy regulations. So I'm assuming Obama's plan would/should focus on security more than anything else.
There are some interesting details with how KP handles things:
* All email correspondence goes through their own secure webmail servers. They only send you notices like "You have new email on our servers, log in to our secure servers to read it" to unencrypted mail on external email accounts.
* The data appears to be tied to a particular medical centers, so when we moved from one center to another, they had to transfer our record over. So apparently things are compartmentalized, so any random doctor can't look up information on every KP patient, just ones assigned to their medical center (and maybe their department). I'm not sure if that means each center has its own database server, but I'd assume not... it'd make more sense if they had two or more data centers in different cities with some redundancy and mirroring between them.
* Accounts for my spouse and kids can be linked to mine so I can make appointment requests and stuff for them, but it seems like it's still possible for them to hide their own medical appointments and records from me if they wanted to, I think. At least until I get a bill in the mail for things not covered by insurance :P
* There are not really any useful medical records available via the online interface, other than your email trail with doctors/nurses. It would be neat to be able to log in and download the kids' growth records and ultrasound pics. But if you really want stuff like that, you still need to get it from the doctor during a visit.
* You memorize your MRN (medical record number) real fast, because just about everyone you talk to (whether in person or on the phone) asks for it. They don't seem to "cache" it so they can start talking to you by name, nor do they transfer your MRN to the next person in the chain. OK, I guess the doctor, when you finally get to one, talks to you by name.
* Doesn't seem to have sped up any part of the process... it typically takes about 3 hours to do a visit, between checking in with registration, seeing the nurse, seeing the doctor, checking into the pharmacist, and then picking up a prescription.
Overall, I'm actually pretty happy with the service, because my family mostly tries to avoid going to the doctor so it doesn't bother me that they mostly avoid seeing me. But it could stand to be a bit more efficient. Having digital records doesn't seem to have help or hurt much in either respect.
O.k. Damn, I'm mixed on this. After hearing the numbers, I think that they are willing to be leached for far too much to develop and roll this thing out. I'd like to know where all those 212,000 IT jobs are going to though. Are we talking 2,000 for development and running the back end and 210,000 data entry clerks? That's kinda of how I'd envision those numbers going.
I've not really read much in the article that would make this sound like a grand idea. I want access to my own medical records. I could see insurance, nurses, and doctors needing access. I could see schools and employers wanting access to it though. (Talk about folks that we don't want access to it.)
The thing is data entry clerks for all this crap should exist already so new jobs shouldn't be massively created. Another thing to think about is places where data entry clerks aren't there, you know who is the real data entry clerk... you. How many medical places have you been to where you've been handed a 2-3 page form and told to fill it out? We shouldn't have to do that much manual entry if we have a unified national medical management system. When you are born you'd get issued a medical record and it would stay with you for life. Everything related to you health wise would get dumped into it. School eye and hearing tests, vaccinations, every single time and place/doctor/nurse that has ever looked at you and their notes on what you had at the time, every known drug allergy, random drug tests, and general health recommendations would all be there, and your height and weight from birth to present as well. (Remember those school fat percentage tests and that plastic thingy that they put on your back to test if you had a bent spine? That would be there as well.) Heck, a part of me things PE records could be dumped into there as well. Why? They are a general health and fitness test and results.
Ideally, we just have them scan our national ID/real ID DL and presto every medical record that person has data entry rights too would show up. So if your PE teacher was testing you in 3rd grade, they'd be able to record height, weight, fat percentage, that spine test, and results from PE test scores. The person that the school has to do eye and hearing tests would only be authorized to pull up your previous results from those tests and enter your present current test results for that field only.
I just thought of a valid reason for schools and employers to demand and get access. If you claim to have had an absence do to any medical reason, then the school or employer should be able to query the medical system that you showed up at any medical place and got seen by any doctor. (They shouldn't be able to pull out actually where you went, who you saw, or what they said you had though.)
we should change to the metric system while we're at it.
I understand the potential problems with security, cost, screwups and stuff, but part of me wonders how much of this data could be used for diagnostic analysis by looking at symptoms, vital signs, treatments and outcomes over a very large population.
We don't have the technical skill to do this job in the US we need more H1B workers from 3rd world countries.
How does this make America economically viable?
I would think that faced with a massive recession and a country with essentially no material economic base, that money could be spent more profitably creating new technologies and funding new enterprises that actually create products (and therefore new jobs well into the future) than in scanning old medical records which by their very nature can't be sold or exported.
Look at it this way. By mandating the scanning of old medical records, the government is essentially creating a tax without calling it that and using the revenue to give temporary jobs which will disappear after 5 years. The medical offices aren't going to eat the cost of this, they are going to pass it on which means that everyone will pay more for healthcare and everyone who has it will pay more for insurance premiums.
If someone could name one government program that has ever saved money, I will change my mind. But either directly out of pocket, or through taxes, every government initiative ever conceived has always cost more money and never saved it only shuffled it around and usually costs more than leaving things alone.
It is a big task and requires lots of parties to interact peacefully. It NEEDS to be done and no one company wants or can afford to do it. Good to see the government stepping in spearheading this endeavor. Being the government it will be slow moving and an virtually an unmovable force with a near endless amounts of money to make it 'happen'. Hopefully in the end it will not be come to bloated and to alter by special interest groups (and self serving political agendas).
My Sig indicates the end of the comment I posted.
And, wouldn't liberal government love to have access to my private health info and use it any way they like it to further their socialist free healthcare for everyone agenda ? I am personally in charge of my health, and *I* choose to share that information with whom ever I like not what government feels I should.
Obama is not in the office yet but the projection is clearly visible and I for one, do not like it at all.
__________
The more I know people, the more I love animals
If we made all medical records the same "format" or made all Health systems capable of exporting data into a common format, the major problem is that those records are going to be missing valuable meta-data that is used by different providers to facilitate all kinds of functions such as billing, referals, preventative care pre-screening. The second problem is that even if the data is in a common format the problem is transferability; how to facilitate transfers between providers without a central database, in a timely manner, at a reasonable cost. fourth problem is that often times, I don't want records transfered from specific providers. I had a doctor make a really bone-head annotation in my records (I'm a Kaiser patient) and I still hear about it everytime I go into the office. I'd hate to go to some dollar-store urgent care facility when I am sick to get some antibiotics or some cough syrup and have them put that I have TB or something in my file and constantly have that one bad diagnosis by a glorified P.A. skew the view of all the doctors in the future.
The current process accomodates doctors that still use paper records, and allows me to control which providers get access to particilar data. When I go to a new provider, i can get my entire record printed out where I can work with my new doctor to establish which records I believe are accurate and discuss why we (my doctor and I) came to the treatment plan we did.
I have a friend who got a "Drunk in Public" charge (after having gone to a club) and the court made him to to Addicticion medicine for n hours of drug and alcohol counseling, who also has (unrelated) back problems. Having that one flag in his records makes doctors at urgent care very very skidish about giving him cough syrup with codiene that they pass out like candy to folks like me or even giving him anything more powerful than ibuprofen when his back flairs up.
The problem with any centralized datasource like an arrest record, the credit scoring system, the DMV records, etc... is that any one provider, lender, billing firm or police department can make an honest (or intentional) mistake in those records and there can be almost no recourse to getting that data ammended that would have been a local problem, but is now a national problem. Even if the data can be ammended, it is a long difficult process that might take "years" to trickle down to the agencies using the data.
Forgive my spelling from time to time. I'm often posting during short breaks.
Healthcare is really in the dark ages with respect to this. True, there are many doctors offices that use computers, but nowhere near the majority do. As a previous poster stated, those offices have to shell out money for moving to EMR systems, and it's not cheap. That means that most of those health records really are in paper form. Not in a bunch of databases manned by DBA's as someone else posted. That would be nice, but it's nowhere near the truth. Be real here - in a typical small physician's practice, they are probably using paper records. Why? Because it doesn't take a freaking IT staff to make it work and keep it working day in and day out. It costs a lot of money from that practice's perspective to initiate an EMR system and to keep it running for very little overall ROI. Once it's up and running, it may or may not be easier to deal with but the practice will probably have to change the way they do things to conform to the system's way of doing things, and that's not easy, especially for physicians. In my experience they do things a particular way for what, in their minds, is a perfectly good reason. Let's scale this up to a hospital. Another poster stated if this was such a good thing and save so much money, why haven't hospitals already done this. It's because it's not just plopping a computer down and telling someone, "here ya go". It's a complete business process re-engineering effort on a huge scale for each and every hospital. That's not easy when you are trying to treat people at the same time and not loose critical med orders or lab reports. It normally takes a hospital a year or more to make that transition, and that's *after* they've planned it all. It's not just doctors in a hospital - it's pharmacy, labs, emergency, trauma, oncology, nursing, medication administration, medical order tracking, the list goes on. Microsoft has HealthVault and Google has Google Health, but neither are under HIPAA guidelines as other posters have erroneously stated. While they have pushed themselves as interoperable Patient Health Record repositories, they haven't even scratched the surface, yet. And would you place your data in MS or Google, knowing that they are unregulated? Obviously the first thing they want is to be able to search that data - it's worth a fortune to the pharma companies and other researchers.
Kaiser and most big HMO's already have electronic medical records in use at their facilities. In fact, some independantly owned hospitals already have them too. It really is going to come down to standards and portability. Not about getting it done because it already is being done and to a very high quality degree.
"Early government estimates are showing 212,000 jobs could be created by this plan."
On a related note...
"Early hacker estimates are showing 3,217,000 identities will be stolen by this plan...
I'm sorry, but seeing damn near every single Government agency time and time again fail Security-related IT audits has somehow brought me to the rather obvious conclusion that they simply suck at e-Security on just about every level outside of encrypted Classified comms.
Digitizing and joining the last bridge between your medical history and medical insurance greed and corruption is not my idea of efficiency, but I guess that depends on which side of that greased palm you're on. Don't hold your breath for HIPAA protection either.
I believe that patents or some other IP framework protects the coding schema used in medical billing.
Will the same thing happen with whatever schema comes with Obama's proposal? And if so, does that mean I can't have copies of my medical records without violating someone's patents?
The most persuasive argument for electronic medical records is to address the tragedy of preventable deaths and disease CAUSED by visits to our medical system. Many of these errors occur due to lack of complete information about the patient, something electronic record can address.
Check out: http://www.medscape.com/viewarticle/403657_2
I have worked in Healthcare Information Technology, in the trenches and in management for several years. I dont understand how Obama can take any credit here, we (USA) have been on a slow migration towards EMR (electronic medical records) for the past 10 years at least. If you read the Code of Federal Regulations, and the medicare conditions of participation, and the comments on proposed upcoming conditions of participation, you will see that EMR is discussed carefully and that our nation is moving towards it slowly. This headline might as well have been "obama invents the wheel"
Of course this work will be awarded to the low bidder who will have to have the menial work done off shore, and the only jobs that will be gained will be the Executives running the companies.
Obama will be selling Blagojesoft's solutions for Health Care Record Digitization.
The thing most people don't realize is going digital does NOT necessarily save money or time for the local staff, but it does force conformity that lessens the chance of a misunderstanding or a lack of information when sharing a health record. It can also make tracking who has had access to your information more or less automatic. If set up correctly: The big advantage will be to large medical facilities where mutiple staff can access the same medical record from different locations doing different functions at the same time... The main advantage to small practices will be the ability to bill insurance companies faster, as procedures performed will already be in in the record in a standard form... Insurance companies will see less fraud... Of cource, this is a big "if"... The key will be defining the "mobile" medical record format... It really doesn't matter what form the data in local databases takes, as long as the local databases can import and export the yet to be defined "standard", as opposed to the mutiple, often conflicting standards already out... Until a single standard is selected and followed, most advantages just won't exist.
I work for a healthcare organization that was one of the first to switch to an EMR. You make a lot of good points, and I'd like to follow up.
In terms of privacy, we audit all access to our medical records and have a team of auditors who monitor access. I've been responsible for writing exception reports and such. It's far easier to tell who's accessing your medical records than paper copies laying around.
Data load is a big deal. We have our main EMR and multiple data repositories where we can do reporting and other non-operational work. Lots of people support all that infrastructure. On the plus side, that infrastructure lets us do things that saves money and lives.
Server outages have been pretty bad, but we have assorted downtime procedures and downtime systems. An example is a downtime database located in the various medical record office that are constantly updated with patient allergies.
Our staff has gotten quite used to working with an EMR, but there are still cultural issues. For example, what a physician writes in a medical record may be visible to the patient. They have concerns about speaking plainly (e.g. describing a patient as alcoholic). At the same time, patients have a right to know how they're being treated.
My biggest worry about the new plan to convert paper records is that there are so many EMR systems. Will they pick one of the existing vendors? Build a new one? The ideal for the patient is to have a single nation-wide EMR that they can take wherever they go. This has a huge impact on existing EMR vendors and installs, though, so I doubt people will take that approach.
Work for any big company, and suggest an idea that will save X money over the next 10 years, but that will cost X/5 money today, and you'll get shot down. It's extremely difficult to get stuff approved that doesn't have immediate benefits.
A lot of it has to do with the traditional budget process. Expenses dealing with a traditional filing system are already in the budget, so you don't have to fight to get them continued from year to year, whereas a big new expense will encounter massive resistance, especially in cases like this where the proof of savings is theoretical.
Anyone who has ever worked on a giant data digitization project can confirm that the gains in efficiency are dramatic, and the costs of storage, duplication, and extra personnel are far lower with a digital system.
But the way people seem to work these days, the long view is completely absent. They want big gains now, and not big gains 10 years from now. Future gains can't be put on a resume.
ad logicam Claiming a proposition is false because it was presented as the conclusion of a fallacious argument.
He's down with Big Brother - did anyone expect anything else? What the hell does Obama care, his family is set for life.
I want to delete my account but Slashdot doesn't allow it.
I think people are missing the point. Like most projects that need funding you need a selling point, and a true point. And rarely are they the same. In this case the selling point is that digitizing the records will help reduce costs and save money. While this may be partially true I doubt the true reason behind the project is this, and that this is simply the selling point to get approval from the public and congress.
I believe the true reason behind the digitizing of the records is for research. Think about the large scale research that can be done on these records, it is amazing just to contemplate. A perfect example would be Autism. Does the MMR shot actually give a child autism. Does autism ever develop before the shots? What is the average time after the shot? Does the shot not have anything to do with autism? You can extract such large amounts of data to target your smaller studies from, instead of taking guesses as they do today and where to start.
Just my two cents...
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Kaiser Permanente has been doing this for a couple of years- and has been consulting with the Obama transition team. Benefits: your doctor has your entire med record there when you go in for a checkup. Your doctor's diagnoses are more accurate. Patients don't *forget* something. Outcomes are better for patients; patients get better sooner; more patients are served at lower costs to all.
I work for a healthcare organization and we've had an EMR for over ten years.
In terms of backups, we have on-site backups as well as off-site backups. The off-site backups are taken to another city, two hours away. If our data center is hit by an asteroid, there's a plan to recreate it elsewhere (though it would take some time, obviously). We've discussed having a hot backup data center, but the costs are very high.
We have a similar backup strategy for imaging data. Fortunately the cost of storage and backups have kept up with the huge volumes of stuff people want to store. Having images electronic is a huge benefit to many people, as sending film around is expensive and complicated.
Abuse is a broad term. We have people who audit access to our medical system, manditory staff training on appropriate use, and lots of privacy policies in place. So far, most of our data breaches have been relatively small (e.g. an employee looking up a patient they know but are not treating). It is admittedly scary to read about huge data breaches in other organizations.
We have folks who run reports against patient data, though much of it is made anonymous or highly summarized. I don't think I've seen any evil plans for global domination coming through our project request system.
KP HealthConnect is Kaiser's electronic records system. Your doctor pulls up your entire record system on a monitor each time you go in for a checkup.
This is good for people "going forward" and for still-current medical records created in the last few years.
As for older records, digitize them "as needed."
This is one case where "close counts," spending a bazillion dollars to make sure every last record is digitized just isn't cost-effective. Far better to concentrate on the records that will actually be useful in the future, and don't worry if you miss a few here and there and include a few that will never be referenced again.
There will also be one-off cases where it may not make sense to digitize a current record in any standard form. Say, a doctor goes out on a house call to a patient he hasn't seen in 10 years, she's had a heart attack, and she dies when he gets there. In that case, fill out the death certificate and keep your paper notes for 10 years and call it a day.
Knowledge is how to play a game, intelligence is how to win, wisdom is knowing what game to play.
Orwell predicted this years, years ago. But don't worry, you will all believe it's for your own good.
I work in IT in healthcare. We are electronically recording our medical information - now. Many of those we work with are not. We have a huge and overwhelming workload just setting up and maintaining interchanges between all of the internal and external systems and databases we are using. The paper records we have need to be digitized, but they would only be images, the work and expense involved in REALLY digitizing them meaningfully would be completely overwhelming. Scanning the paper documents has not been an urgent issue - until last week! Our archive actually got flooded and we lost a good number of documents. Now that it is a disaster, management wants to retroactively listen to us that digitizing these documents is important. So, the whole issue is much more complex than simply saying 'Hey - let's digitize our medical records!' There is a whole history and environment and corporate culture that resists this. I think everyone is so overwhelmed with bandwidth overload all the time that only mandates and disasters can really produce the animus for change.
It's not jobs that create a stronger economy; it's productivity!
For years politicians have pandered to certain mythical beliefs held by the most ignorant of the voting populace, and one of the main beliefs is that "jobs" are good for the economy. Jobs, unless they produce something worth while, are a drain on the econmy and in general and the consumers in particular. Caplan's book also makes the point that the "aggregate wisdom" of the population is reduced to the sociological phenomonen of "crowd behavior" by the pervasiveness of these underlying myths.
I found a good review of Bryan Caplan's book, "The Myth of the Rational Voter," here: http://en.wikipedia.org/wiki/The_Myth_of_the_Rational_Voter
The book itself is very good reading.
I found an interesting essay on Mark Skousen's site: http://www.mskousen.com/Books/Articles/economics1.html Caplan makes the point in his book that Economists, while disagreeing in the details, actually agree on major principles. This essay summarizes those priciples pretty well.
"The mind works quicker than you think!"
If we had a digital health records system that worked, the insurers would be quick to analyze those records and use the data in consumer-unfriendly ways. Since employers pay the insurers (and ultimately incur the cost of health care), they would be among the first to "score" the health cost of new job applicants. People with certain manageable conditions (eg, diabetes) would be unemployable and therefore uninsurable.
To prevent this, we have a hodgepodge of low-tech data capture methods, supported by back-end systems from offshore outsourcers. On a good day, it works just well enough to get the bills paid.
Making this data readily accessible would be a disaster. No matter how much privacy is built into the system, insurers and employers would require "waivers" before anyone could be insured or employed. So much for privacy.
How much of Taiwan's 2% is related to the fact that socialized medicine does not have any concern about who pays (or how much)? A single payer would BY ITSELF eliminate much of the overhead. Not that this is the ideal solution (as it creates other problems). But if the goal is administrative efficiency, the low hanging fruit is the nitpicking of invoices, negotiation of prices, and determining "coverage".
In the current world, we have someone who is AT BEST a non-practicing nurse who has never met the patient deciding whether or not to approve the doctor's treatment plan for that patient. All under the guise of "managed care". I'm surprised they can keep the administrative expense down to 24%.
There are many potential solutions to the healthcare problem, but any proposal that lets the insurance and pharmaceutical industry conduct "business as usual" is not solving anything.
Thanks Barak, but no thanks.
It's been so long, and it's been rebranded and refocused, but I thought that WebMD was originally targeted to provide such a service - digital records that would replace / glue together the mess of health care services. Can anyone confirm that?
The Health Insurance Portability & Accountability Act of 1996 not only set up privacy rules, it was also supposed to require code sets and standards to allow the "Portability" of health care information. http://www.cms.hhs.gov/TransactionCodeSetsStands/ Also, there are entire companies devoted to using digital technology to offshore medical analysis; so a doctor in India can review your CAT scan or MRI, etc. The pieces are in place; we just need leadership and focus to make something happen in a way that benefits the general welfare.
In addition we have seen that it's no use to wait for private industry to come up with a common data-format: they have no motive to spend time or money on a standardization effort, and they won't agree on a standard unless they do. And that's precisely why, despite the ritual groans about The Government being inefficient and whatnot, you need a player like the Federal Government to crack the whip and impose a mandatory standard over any objections that will be raised in order to break the logjam.
So far so good.
What's less beneficial of course is that once such records make it into any sort of network-accessible database, neither the patient nor his doctor has any further say in who accesses and uses those records or where they are sent.
Such records are are going to be (a) leaked (b) abused by everyone from employers (they prefer employees with clean medical records), insurance companies (lets sift out the high-risks), the police (lets see who had detox treatment or who is on anti-depressants), newspapers (lets find out the truth about that pesky senator XYZ), and your friendly neighborhood watch (anyone who ever had psychiatric treatment is now a child-abuse suspect).
It's all a matter of balancing the pros and cons.
Now a question is, why not distribute the database rather than centralize it.
One copy of your records remains at your local doctors.
A second record, should you choose to have it placed on a sim card (printed onto something the size of a credit card).
Have it encrypted obviously, with the only people able to access it is yourself (read only),your doctor (read&modify) and the hospitals (read & modify).
This way less chance for the gov't to screw it up, and far less intrusive. They can set the standards on how the card and formatting of the actual notes. But don't let them anywhere near the IT setup.
Someone mentioned that they are required by law to keep all records for Seven years. That actually sounds like a good time-frame to set this up. This way when you start a new patient record, you will most likely have both an electronic and paper record. The problem being is transcribing the older records, as that is very private information and not something you want part-timer data entry people having access to if at all possible.
Funding is the major problem, maybe a deal can be made with the insurance companies that if you agree to switch to an electronic form for billings and anything else (with no access to the actual records) they can either reduce the malpractice costs for that practice, and arrange for a matching grant from the gov't.
Government can't create jobs, it can only re-purpose money.
Now, if he wants to hold a consortium a la IETF/W3C to create a standard format for records, I'd be all for that. Foster an open source community to create software for those formats, based on the investments of interested parties, more power to him.
These records should not be kept in a central location, rather they should be used as a means to exchange information between providers more easily.
Yes, I am a smart ass; it's better than the alternative.
Its a good idea if the *hospitals* communicate with each other, but this will just end up being yet another part of the government's datawarehouse on citizens, for the fusion centers to mine.
Its a bad thing.
---- Booth was a patriot ----
I'm not in favor universal health care, but getting standardized and electronic records should, if done right, drive a lot of costs out of the health care system. And that is needed in general. And that's a good thing.
Except for ending slavery, the Nazis, communism, & securing American independence, war has never solved anything.
So what they're saying is that this system will require 212,000 more people to operate than the current one. I have to ask then, why they're going to develop a new system that's more inefficient than the current one? Shouldn't a new system like this actually eliminate jobs?
If this can save so much money why isn't the health care industry already doing it?
They're not doing it already because control is in currently in the hands of the proprietary health records software industry, not the health care industry proper. The actual health care industry is locked in big time.
....Digital leakage?
This is nothing more than a prelude to a huge central database of your private medical info that the nanny state and feds will have access to.
Next comes employers access where you will be denied jobs with paid health insurance due to your medical history. Nothing good can come of this.
- A Frog in a pond utters an azure cry. -
I see many benefits, from personal experience. The Mayo Clinic is all digital. As a patient moves from physician to physician during the day, successive doctors can view records updated in real time and videoconference with one another on the spur of the moment if a Dx needs clarification. Patients from out of town can zip through the system in a day. It's a snap to divert a patient to a specialist for a quick consult. Nothing falls through the cracks. Everyone can read the reports for a change. Net is better faster cheaper care and more personalized attention. At least this has been our family's experience with our 88 year young mom.
Try getting two doctors to describe the same condition on the same patient on the same day anywheres near the same way. Good luck with that.
I helped install an automated, 'standardizing' ER records application in 1998-2001. It not only took that long, but as the project unfolded, it was apparent that the fundamental reason for doing any of it was to prevent ER docs from actually *writing* notes. They were expected to conform, and this meant a menu-driven approach to the records, primarily by making them choose boilerplate for the descriptions, observations, diagnosis, etc. this was 50% to avoid their indecipherable handeritten notes, and 50% avoiding inadequate, incomprehensible, or useless content. It gets hairy in the ER, and docs don't give up their free time to think it over and re-write things. Besides, they had to write something at the moment to try and tell the surgeons what to look for upstairs, in a hurry. Not that the surgeons much care for their notes, though some did. Knowing which ankle is broken is helpful. Telling the rad tech to shoot 'the swollen one' did not really improve my opinion of much of the staff, but hey, that's why they didn't put me to sleep I guess.
Eventually, just as it was ready for production, the docs prevailed on the developers to add a free-text field for, you guessed it, 'notes'.
Ok, looked to me as if they succeeded in subverting the entire project. I was not disappointed. A month after going live, free-form notes were more than 80% of total information in a patient's record, measured by content, topics, every category except bytes. Oh, they used more bytes too, but we didn't actually use that as a measure of volume. That came later.
Mind you, ER docs are a different breed. They are mostly contractors, very mobile, and operate from a subset of the GOD complex. They may not actually BE God, but in His absence, they are all ya got, so shut up and let them do their jobs, or someone will die because of your actions, not theirs. Sue them later, if you can find them.
So I have to laugh at the idea of standardizing records. Even trying to standardize the layout beyond what ANSI has will be monumental. And ANSI is ignored regularly.
ps- As the project 'wound down', I got calls all hours of the day. Turns out they had projected way too little server space for the database. Gee, I wonder if that had anything to do with the free-text field added, but no reconsideration of the storage estimates? Long story short, when they finally maxed out the array and faced replacing it with new hardware, they blamed the sever OS, NetWare, for the problem and installed a shiny new Windows 2000 server. Went very well, though the monthly reboots were annoying. The old Novell server was up for two years straight when they decommissioned it, though of course the volume remounts and dynamic expansions did make for actual downtime. But that's another story. The CIO didn't last long after he converted the whole hospital to Windows. He just ran out of payroll before he could hire enough MCSEs to keep the lights blinking.
feh. Government being smart.
I would be pretty suprised
deleting the extra space after periods so i can stay relevant, yeah.
Who will pay this 75 googolplex dollars? Health care providers? The government? Let's review some basic economics.
If you increase the cost to health care providers, then they will need to pass those costs on to their customers. Therefore, people in need of health care will need to pay higher costs, or their insurance will need to pay higher costs, which means the people will need to pay higher insurance fees. In the end, these costs fall upon the people who need health care.
If the government pays the 75 googolplex dollars, then they will need to pass those costs on to their "customers" the tax payers. Tax payers are people. And every person will require health care at some point in their life, so therefore in the end the costs fall upon the people who need health care.
I am pointing this out because there are already gigabytes worth of government regulation legaleze, much of which already makes health care costs rather high. The point is that the more the government gets involved in health care, the higher the costs become to patients. If you know an old geezer, ask him or her. Back in the day, health care was NOT impossibly expensive for average people to obtain because it operated in the free market system. The advent of two things have made the situation impossible. First, the fact that insurance companies pay one tenth of the price, so doctors must multiply their prices by ten in order to keep their clinics running. That means people without insurance pay ten times the price. Second, government regulation, much of which frankly doesn't make sense. I'm all for digitizing stuff, but if you leave things alone, digitizing will happen anyway, as it has and is happening in many industries, over time, so that you don't have an enormous cost all at once that must be covered without the means to cover it. Now is not the time to spend googolplexes of dollars.
Posted anonymously for obvious reasons. I work for a small company that writes claims management and adjudication software for health insurance. Our software actually allows the provider to write their own decision engines using a special language.
On more than one occasion, we've had client companies, or prospective clients, come to us with requests for features and functionality that would be unethical, if not illegal. You are very correct - the idealistic principle of insurance is that it is a shared risk endeavor. That has been broken down by the insurance co's to a one-sided agenda where they know they have you by the balls and can deny for any reason under the sun, including those that specifically go against the grain of insurance (i.e. if you move to a different provider who provides 'substantially materially similar' benefits, at a separate rate, there should be no waiting period - statistics and probability don't work like that).
My wife uses chiro services. Non-insurance rate? $45. With insurance? $135. There is something very wrong with that picture, when you know that you are paying $500+ a month in health insurance, it's predominantly YOU paying that. Why not go to a HSA or FSA? Save that money, pay the cheaper rate - the only reason most people don't is for catastrophic coverage - so you'd think that catastrophic coverage only plans would be reasonably cheap, etc? No. Cheap, yes. After you pay some of the highest deductibles around (I've seen $7,500 personal, $20,000 family commonly).
It's a racket, and though anecdotal, there's something awry when someone whose income is derived from the insurance industry is agitating for universal health care (not that it'd go away entirely, but nonetheless), because as it stands now it is such a fundamentally broken system.
Quoting for relevance.
VLC FOR MAC IS DYING! IF YOU DEVELOP, PLEASE SAVE IT!!
To who? Majority of them will be outsourced .. haa haa.. its only the guy who gets the contract that makes money.
it won't save money. in the UK we have wasted billions and billions we could not afford on expensive NHS IT projects that went massively over budget and in the end were literally unusable.
Money in the health care budget is WAY better spent on doctors, hospitals and drugs. Spending it on impressive sounding databases rarely achieves equivalent results.
Governments are crap at big IT projects. Nobody knows why, they just are.
DRM-free indie games for the PC and Mac: Positech Games
Digitized health records are going to help America's productivity vis-a-viv the Chinese, or reduce it's dependance on foreign oil, or re-capilalize insolvent banks ... how ? Besides employing 202,000 voters until Obama's next term, that is. God bless America, and God help America's present and future tax payers.
If a medical practice and it's customers want to participate in the government system, they can do so and pay a fee to support it. Or, they can choose not to participate and they don't have to pay.
... there was a clause in the bill that called for the cutting off of the balls/tits of the first nitwit that lost a laptop with all the data, I still wouldn't be for this idea.
what really excites me about this sort of initiative is the scientific possibilities that this data in anonymized form can provide. With aggregates of this data containing all recorded dimensions (age, location, race, family history, weight, nationality, diet, etc. etc.) instead of having to perform decade long studies scientists could potentially test out hypothesis in seconds by running queries against an existing database. IMO this could quite possibly be the most important thing we could do to accelerate scientific understanding of the causes of illness.
And, wouldn't liberal government love to have access to my private health info and use it any way they like it to further their socialist free healthcare for everyone agenda ? I am personally in charge of my health, and *I* choose to share that information with whom ever I like not what government feels I should.
Yeah, because health insurance companies are so scrupulous they aren't allowing the government to mine their data now. What a joke.
How do they need to be trained, if they already have computers in their offices (which most do now anyways) there is no extra training needed, the software does the conversion of info into digital format, and you save it to a directory, simple no? What training, in case they need to write in hexidecimal the full value of the patients blood pressure?
This is what I just received from AT&T customer service. This is what happens when you get hired for your race and not for your qualifications OR when you outsource jobs to other nations. THIS is the problem with the US:
Dear Ms.
Thank you for taking the time to e-mail the new AT&T regarding your first bill. We understand the urgency of resolving this quickly for you. My name is Marisela Kennedy and I am happy to review your account for any errors
I do apologize for the inconvinienve and any miss understandings about the porting activation of your number.Eventhough you brought your number from another carrier it is still a new activation with AT&T and the activation fee would be aplied to your first bill. Unfortanatly this is a standard fee that is applied to all of our AT&T customer and I'm not abble to wave this for you. I do apologize for any inconviniece this might have caused you.
We at AT&T appreciate your business and value you as a customer.
Sincerely,
AT&T
Online Customer Care Professional
*****
Not to mention, they turned me from a male to a female and spelled my name wrong even though I filled it in via a web form. Nice. Nice "professional" work.
...all the crumbling bridges in the country? That would put a lot more people to work and is actually needed.
We are already critically shortstaffed on IT workers and this would send more IT jobs overseas, which when the health record stuff is done, wouldn't come back. /sigh
Don't kid yourself. It's the size of the regexp AND how you use it that counts.
Seems to me that there's a standard, but it only mandates certain parts, and the rest is all done in different ways by different carriers...
breaking into a system becomes much more attractive when you can get everything in one place
It depends on where things were in the first place. It seems to me that with all the different providers/methods, you're still going to have hundreds of thousands or more important records in a given place, and without a strict set of security standards the individual companies may be less secure.
Of course, having a strict security definition and actually having people *use* it are two different things anyhow.
I do so very much like the instant crybaby tags of "bigbrother", "easierdatamining", "zomgitstehgummint", "anythinggummintdoisevil", etc that this topic drew, especially when it's in the context of remaining as much an unknown nobody as possible even at the risk of your health.
"Sir, you don't have much time left, but we need to know if you have a history of negative reactions to the procedures and medicines we could use to help you. If you had your records from your local doctor digitized, we could've-"
*weakly* "Bah! Being an anonymous nobody is the best! I'd rather die than ever have anyone know or remember me for anything! Else my entire life would've been a waste... oh, wait. *HURK*"
It's understandable to an extent about not wanting to have your personal info out there, but there's a point where it just devolves to you trying to live a l33t fantasy cypherpunk life 'cuz its so cool and u wear black trenchcoat and glasses lawl.
Umm, I would think that digitizing them would make them more efficient - yet this is supposed to create 200,000 new jobs?
I think it more likely it will destroy at least as many jobs as it will create.
Not that there's anything wrong with that, since a computer clerk handling (for example) 1000 cases is probably better than a paper clerk handling 100.
I have to question though why is the job creation aspect being highlighted (could it have anything to do with with pro-Obama bias)?
Great! But that's a useless figure if they don't say how many will be lost in productive sectors of the economy. Government only moves money about, spilling some on the way...
Your sig seems a little out of place since your advocating efficiency first. I for one, don't want my health records digitized as I'm sure many others don't. Because I went to a doctor once, is my health information now public domain? Can any company loosely connected with healthcare access my medical records? Once the whole world's medical profile is stored on one huge database (and that office gets it's laptop stolen..) we have handed over the foundation for genetic profiling & selective population control.
Us Brits been working on doing this for years and it has been a disaster. Taking far longer than expected, costing way more and we still haven't figured out how to address the privacy concerns!
So when are they going to finish the job they started with replacing the FAA's 40+ year-old IBM mainframes?
http://www.wired.com/wired/archive/4.04/es.faa.html
Comment removed based on user account deletion
"Early government estimates are showing 212,000 jobs could be created by this plan."
Or one damn good script.
There are no loopholes. It's either legal or it's not.
Having health records as a standard brings more transparency to the Health care industry, start with that and then soon people will want them standardized invoicing and billing etc. Obfustication seems to be a popular method to profit.
It also makes it easier for three letter agencies to run searches on them.
ANSI ASCX12N 835 - Remittances ANSI ASCX12N 837 - Professional Billing These are used for billing electronic claims. The current implementation to share information with another covered entity is HL7 (Health Level 7). Another standard that itself is in flux. Always a moving target and hardly robust enough to use daily IMO.
For other industries because I disagree strongly with this:
Sorry if HIPPA is making your programmer/IT-job harder, but quite frankly that isn't my problem. If anything, all our important digital information should be regulated under something like HIPPA. The whole point of HIPPA is to protect your privacy. Without HIPPA, you'd see companies calling up a hospital requesting your medical records. You'd see weird scam companies purchasing your records in bulk and then mailing you miracle cures. No HIPPA and when some celebrity gets ill, the press could call the hospital and get all the juicy details and the patient could do nothing.
HIPPA is needed. We need to HIPPA'ize our credit history, our phone bills, our whatever. Even it costs money, and even if it makes prices go up a little. Privacy and control over your life-story is a price worth paying.
Little Timmy doesn't need them at all for his cold or stomach ache. Antibiotics aren't candy and we should treat them with more respect then we give them.
And lord only knows what kind of super-bugs we are gonna get with the latest antibacterial-everything craze.
Why study Britain's EMR? The US has had a successful public sector EMR in use in major medical centers, outpatient clinics and the Indian Health Services for almost 2 decades... it's now called CPRS and the doctors and nurses I work with love it. The effort to build an EMR started in the good ol' USA in the 80's and the EMR took a graphic form in the early 90's. How do I know? I went to my local VAMC for my post-deployment physical following the Gulf War and the VA lost all of my paper records stat (hey, I had a copy). 2 years after that, the same thing could never happen again. I love my work as a Clinical Applications Coordinator and the staff really like using CPRS a lot. Study done.
Quote: "Early government estimates are showing 212,000 jobs could be created by this plan"...
All anyone cares about is the headline "job creation". I don't want to downplay the benefits one receives by staying employed, but if these are jobs created and paid for by the government, it does not directly help the GDP, nor get us out of a recession any quicker, nor does it paint a rosy picture that the economy is all good again. Why?? The simple fact is that when Government creates jobs there is no wealth creation, rather wealth recycling. How exactly? Via taxes... i.e. government pays for the wages on the backs of other wage earners (income tax). True, government salaries are taxed like everyone else but how many times can you recycle the same money back into if it were closed-loop system?? This pyramid scheme can only sustain itself for so long. For this reason it's hard to justify how government jobs are nothing more than a leech on private sector wealth. Furthermore, I can be as bold to say that for every individual not employed in the private sector, is another dis-service to the overall economic health of our nation.
To better illustrate these dynamics, all you have to do is examine a typical contracting and/or employment staffing agency. For example, inside a typical staffing company there are two types of employees; type "A" are those that earn the company money, and type "B" are those that cost the company money. The company skims a small profit off of each "A" employee it outsources to a job site, thus these employees add wealth to their company. On the other hand, there are human resources, administrative employees, and recruiters that handle the inner workings of the staffing company. These type "B"'s do not earn money for the company and instead draw on the company's internal resources. The ratio of type A to type B employees are that as to not bankrupt the company (company must remain profitable) therefore, too many B employees would tank the company into bankruptcy.
So the only real value in these types of government jobs is keeping people employed (from starving) until the private sector (real wealth building) can recover. I don't have a problem with that. I'm just saying quit "spinning" it so it sounds like government job creation carries the same economic weight as private sector job creation. I'd rather see more private sector jobs because we need more type "A" employees for this company we all own called the U.S.A.
http://www.sbis.org.br/indexframe.html We have it since last year and in a few years it will be required by every medical system on the country to implement it it's based on a central server running on the government to store all the data about people.
Your problem is that the standard doesn't have enough XML in it. Take that thing you pasted and make it more Web 2.0. Once you've upgraded it, make sure it runs on a couple cloud computers (I read in Gartner they are going to get *big* in 2009), then we'll see it take off.
The problem with health care is we aren't leveraging modern MVC techniques nor are we using Ruby. Too much planning and corporate drones, not enough Getting Real. Just write the damn code already! Paper prototypes, meetings, offices are all just getting in the way of agile programming.
In the future, everything will be in the cloud. The problem right now is hip bloggers and tech trend setters are moving to the cloud while healthcare companies are barely running at Web 1.9, let alone Web 2.0.
Really though, your question is silly. The answer is "Cloud Computing" (and XML (and AJAX (and Push Technology (and Portals)))).
They could have saved on the licensing. MySQL is a perfectly good database for healthcare records. It is fast, lightweight and open source. If MySQL lacks something, the clinic could just hire a programmer to add the functionality into the database then share the code with the world. With Oracle or IBM, that hospitals multi-million dollar support contract still means they have to wait on Oracle to add any new feature to the database.
I hope Obama considers using something like MySQL instead of something closed source. It would be a big win for everybody.
WTF ppl? I did a Find on this thread and discovered one mention of the most ubiquitous EMR of all time... CPRS. It's the most successful and completely invisible health care tools in history, apparently. It was started back in the 80's and has been a graphic record-keeping tool since the early 90's. Why would anyone want to credit the government for anything well-done, after all? CPRS is secure, is used in major hospitals, dental offices, small corner store community centers (scales easily), is free, open-source and easily configurable. The technical support for CPRS can be done by most plain vanilla tech support shops, the clinical interface is easily learned and well-loved by clinicians and it allows a tone of other products to "hook" into it. CPRS does not give access to insurers for the most part inhibits profiling. An Information Security Officer can patrol the access and use fairly effectively. The next version of CPRS will be platform-independent and built so that users can access lab and other information, request refills, etc. CPRS is going to be ported to the web soon and has been demo'd on the Apple iPhone, Linux and Apple computers (aka, it's not a Windows only solution). Yes, it's got some rough edges and problems, but it has been on the job for nearly 2 decades... So, back to the article that was referenced... the implementation of CPRS and BCMA has proved that an EMR can be launched successfully and effectively. The tech support for CPRS was drawn from the ranks of the VAMC nursing and lab staff, none of whom (to a woman and man, as far as I'm aware) had computer applications training or degrees. A lot of the developer support has been contracted and it has worked very well. There have been a few blowouts, but CPRS is largely loved by all. The corps of very experienced trainers/developers/software specialists can be easily tapped at this point... many of the original CPRS implementation staff are now retiring and are looking for private sector employment. It's been almost 20 or more years and the experience of the VA shows that the transition CAN BE DONE... enough whining and let's get going! The amount of money to be saved is a boat load and more. And the jobs created for support staff will replace all the clerical jobs lost. I've been a clinical applications coordinator since 2003 so I should know... I did not have a day of computer training prior to starting the job. I was handed a key as my only mentoring experience... I am a nurse, and if I can do it, anyone can do it. And there are LOTS of nurses and clinicians who would jump at the chance to do something this thrilling.
It depends on what you're trying to do. If you're trying to increase convenience/efficiency of something, then going "digital" may increase employment. If you're trying to cut back on redundant steps (which may or may not go with the above), it may cut jobs as well.
It seems to me that companies would need humans to interact with this system. They'll probably need people to run their own systems too. So you might gain some "expert in interfacing with gov't system X" types in favor of losing some "expert in running our system Y" types.
I've said it before and I'll say it again: REGULATION!
With the first link, the chain is forged.
The Bush Administration is already doing this and people are working on this as we type. I've been to the meetings. It's just dang difficult to get a standard format everybody can agree on and takes lots of time and money.
If we had a digital health records system that worked, the insurers would be quick to analyze those records and use the data in consumer-unfriendly ways. Since employers pay the insurers (and ultimately incur the cost of health care), they would be among the first to "score" the health cost of new job applicants. People with certain manageable conditions (eg, diabetes) would be unemployable and therefore uninsurable.
I really, really hate the way insurance and jobs are tied together. It's slightly good for the consumer some of the time, because some big companies can get a good deal on insurance; the rest of the time it's a big lose for the consumer. People should sign up for insurance on their own, and their insurance should go with them as they change jobs. The employer should not care about insurance.
I really want a Health Savings Account. My current employer just doesn't offer that.
As you noted, someone with a condition like dabetes may have great trouble switching jobs or getting a new job, because of the way insurance and jobs are tied together. That just sucks.
steveha
lf(1): it's like ls(1) but sorts filenames by extension, tersely
http://www.boston.com/news/politics/us_senate/articles/2004/08/20/no_fly_list_almost_grounded_kennedy_he_tells_hearing/
(you didn't think I was referring to the his *other* scarlett letter http://en.wikipedia.org/wiki/Mary_Jo_Kopechne/ did you :-)
Chances are these new jobs will be taken by people that are currently employed. Pick Me! Pick Me!
Creating busy work for a bunch of unskilled and under educated people to make data entry errors on all our records is not change. That's business as usual for the government.
-People are more easily denied service due to pre-existing conditions
-Hackers have embarassing or otherwise sensitve information with which to blackmail you.
-The Government can start eugenics programs or deny you access to certain programs/benefits/priviliged access to scholarships etc.
-The Government can start profiling due to heridity e.g. what is the "arab extremist gene"
I have two concerns and neither has anything to do with sympathy....The second is personal freedom, where said freedom does not significantly impact others.
As someone who suffers horribly and can't buy insurance at any price, I find it disgusting that conservatives who claim to be about common sense equate the loss of a few bucks extra in taxes or insurance premiums to the massive degradation I suffer in my quality of life.
Apparently my ability to function is worth 50 bucks.. and I thought mob hits were cheap.
VLC FOR MAC IS DYING! IF YOU DEVELOP, PLEASE SAVE IT!!
As a patient who's had to try to dig up old records, I'm 100% in favor of digitizing. It makes it reasonable for me to be sent (via e-mail) and carry around with my all my records. A current problem is not with the lifespan of the storage medium, but the patient not remembering where the procedure was done. Hard to find that 3yo X-ray, CAT scan, whatever if you can't remember even which facility it was done in. Electronic storage could fix that easily.
Also, some routine things are a real pain to find in paper records. Try looking for your vaccination records. If you're 14, no problem, its a single sheet of routine vaccinations with checkboxes. When you're 40, not so easy - you've been stuck periodically over the last 20 years with this or that depending on your exposures, nothing routine about it. Or at least that's my case (I'm ESRD, get stuck for whatever miscellenous thing the transplant clinic thinks I need, and I/we/they are always losing track of when the last Hep B vaccine, or tetnus, or whatever was). No reason, computers should be able to answer that kind of question instantly.
This is a question most /. readers are not in a position to evaluate very well. Expect lots of paranoia about the gubermint, with very little experience of trying to locate the right information, or dealing with massive quantities of records from 20y of being progressively sicker and sicker. Damn kids! but... it will happen to you someday, unless you die young from a massive sedentary-lifestyle-earned coronary.
Did I say I was against digitizing records? No.
Did I say I was against digitizing records and then disposing of the originals? HELL YES.
All three people who've responded to me so far have made that same stupid mistake. I never said I was against digitizing records, I said that any retention plan we have needs to take into account the vulnerabilities and problems of the new(er) storage medium being switched to. If a single storage medium has problems, then keep the data in multiple places - keep a digital copy AND then store the originals in case the digital copy gets destroyed.
You do know that some of the biggest problems with paper records is, don't you? Mice, mildew, and silverfish. Yum. Many hospitals want to get the hell rid of the originals because they're a health hazard. Seriously. To expect hospitals to digitize the records and then keep the originals is foolish. At best, they'll send them to an "off site archive", meaning a warehouse. And even that costs money, sometimes upwards of tens or hundreds of thousands a year. Unfortunately, I can pretty much guarantee you that as soon as those records get digitized, the originals are getting shredded as quickly as the file room staff can manage it.
... or much cheaper foreigners?
These percentage comparisons [about overhead] may be deceptive, because service costs for Medicare beneficiaries are much higher than those for FEHBP enrollees. The two programs might spend the same dollar amounts on administration, but Medicare's spending would appear lower as a percent of claims. Absolute dollar amounts for private insurance administration are difficult to obtain, but one source does produce estimates for Blue Cross Blue Shield plans. For plans operating a PPO on an administrative services-only basis - essentially the way Blue Cross operates under FEHBP - mean administrative costs per member year were $271 in 2002 (Sherlock Company, 2002). Medicare-s costs in 2002, $4.8 billion for about 36 million fee-forservice beneficiaries, were about $133 per beneficiary, or about one-half as large.
(Emphasis added)
So it sounds like the original 3% quoted might be true, but nevertheless misleading due to the higher cost-per-patient expenses of Medicare's older recipients. Regardless, Medicare's per-beneficiary costs were still lower than Blue Cross Blue Shield, which would indicate a national health care service in the style of Medicare could provide lower administrative costs than the private sector.
-Trillian
yes, by standards written before 1800, and made very hard to amend. So, to some extent, it reflects the political values of the time and the technology of the time.
Sometimes, it's clear when it's appropriate to extend to account for modern technology, sometimes it's not.
A lot of libertarian and conservative arguments seem to use that as an excuse...waah, the Constitution doesn't specifically say we can do it.
I tend to think more along the lines of "It's OK, because the Constitution doesn't specifically say we can't." Gives you a wider range of options...
http://www.law.cornell.edu/constitution/constitution.billofrights.html
Bill of Rights seems to be a clear list of "Federal gov't can't do $foo"
I listen to both RIAA and non-RIAA stuff if I like the music, tangential business/politics nonwithstanding.
The one thing left out of the picture with other nations, and this is something we should consider before moving to UHC, is R&D. In fact, an Englishman I met on a train from London to Inverness pointed this out to me-- that this is a drawback to their system in Great Britain. All the money that the taxpayer pays goes to curing known diseases-- and little (none) goes to curing new diseases like AIDS (think of how it would be over here what with the taboo of having AIDS-- hardly anybody in the US gets it from the water; it's either drug needles or gay sex) or cancer. As it is now with our system, if there were a cure for some obscure disease developed that you and 2000 other people in the US have, you and they WOULD be cured, assuming you have normal health insurance, NO MATTER the cost (within reason, IE not $10m). This is a beauty of our system-- it ensures that if some scientist finds either a cure, or can prove that a cure may be even remotely close with enough research funding, there is ALWAYS a market for him to sell too-- Phizer or somebody will foot his R&D bill in the hopes of the big $$$payout.
But back to a UHC, if you don't let the government decide how much the treatments/cures are worth, then you can almost guarantee a perfect haven for earmarks and pork-barrel and a balooning UHC tax. As if we needed more of that.
But if DO you let the government decide how much the treatments/cures are worth, then suddenly you kill a huge incentive to bring new cures to the market. You and the other 2000 people with your disease wouldn't ever have a hope of cure-- your voice is too small; pocket too slim for the government to justify spending the money on your expensive cure.
The way this plays into your example of other countries is that because we still have our healthcare system, we don't see any of these effects. The big pharmas spend R&D because of the market in the US; that they can sell the cure down the road to other countries is icing on the cake. It doesn't even have to be a cure; it can simply be better medical equipment (this is specifically what the Englishman gave as an example--) our market subsidizes the R&D cost for more efficient/better/faster/whatever healthcare equipment, to a point where the BioMed companies over here can sell it to other countries over there at a cost their government is willing to pay. If we move to a UHC system, it IS going to cost a LOT more than other country's systems if we want to keep up our current rate of innovation/invention/cure finding.
And yeah, that's not even touching on what horrid things could come of a UHC-- no more alcohol, maybe I can't smoke pipes once a weekend anymore? Or maybe they tax these things heavily. Tax "unhealthy" foods like McDonalds? Tax you if you don't follow the specific workout routine recommended by the government? There's a whole hose of problems that I don't trust our government could sort out reasonably.
"Yeah, and how many paper pushers etc.., will it put out of work? ... While it will create jobs, it will also wipe out existing jobs."
Not sure how the number of new people employed would compare to the number of old people laid off. Your implication seems to be that we might lose more jobs than
Healthcare records clearly need to exist for society in some form. If this results in fewer jobs *in managing healthcare records*, that may not be all bad. The same thing (healthcare records management) is done with a smaller amount of resources (those resources being the time and energy of employees & customers)
So, the same thing's done for lower cost, but you have some people with nothing to do or less to do. So, hopefully, they go off and do something else productive.
Thus, the end result is the same thing being accomplished (this is a simplification/abstraction, yes), plus some more [whatever else is done by the people who got laid off & customers who spend less energy on the paperwork]
So, some people win, and some people lose. But the average (mean) should improve. Of course, the people who lose are (probably) gonna make political noise.
And, this isn't like firing 50 $20,000 guys so the boss can pocket $1 million; it should be more spread out than that.
Ideally, these price pressures come form the private sector though...But there's a lot different about the textbook ideal of the "free market". ;)
I listen to both RIAA and non-RIAA stuff if I like the music, tangential business/politics nonwithstanding.
Actually, I doubt that's the case. First of all, because billing is already done in standard formats (when it comes to electronic billing, this is a government mandate under the HIPAA transactions and code sets rule), the needs to support billing are already going to be similar. Further, the kind of process used to build standardized formats (like the standard transactions mandated under HIPAA) tends to incorporate opportunities to ensure that the needs of the various participants are met.
Sure, common formats aren't enough for exchange, you need an exchange channel. But you need a language that you can speak over that channel, as well.
(First, second, fourth?) Anyhow, assuming HIPAA's privacy provisions aren't weakened, transfer of information requires a release, so that shouldn't be a problem. I haven't heard anyone advocating standardized digital records suggest weakening HIPAA privacy protections.
Sure, some of the jobs created by this program would be temporary (related to the conversion effort itself, rather than system maintenance). However, a *temporary* surge in expenditure (i.e. an investment) makes a lot of business sense if it reduces future expenditure by a commensurate amount.
And this is true in any economic environment, this kind of investment cost/benefit analysis.
However, in a recession, the surge of economic activity from the initial expenditure is especially useful.
*Expenditure doesn't jusst mean "cash payouts" here.
I listen to both RIAA and non-RIAA stuff if I like the music, tangential business/politics nonwithstanding.
As someone who suffers horribly and can't buy insurance at any price, I find it disgusting that conservatives who claim to be about common sense equate the loss of a few bucks extra in taxes or insurance premiums to the massive degradation I suffer in my quality of life.
You seem very reactionary and emotional. You also seem to have problems understanding context and with your bizarre application of labels. In context, the sentence you quoted:
I have two concerns and neither has anything to do with sympathy....The second is personal freedom, where said freedom does not significantly impact others.
...was discussing people who have medical conditions that are preventable and brought on by a lifestyle choice and may or may not increase the cost of their medical care overall.
Your calling me a conservative is rather amusing, given that in this very thread as well as in other threads in this discussion I advocated increased taxes for the wealthy, establishment of a socialized healthcare system, and the increase in other socialist programs within the US. All of these are very unconservative opinions in both the traditional and modern sense of the word.
...and I thought mob hits were cheap.
Why, what are they charging you?
Nobody takes the industry seriously. I have been employed by a company that develops an EMR for over 6 years. First HIPAA, I remember our boss came once and told us that if we didn't implement HIPAA by April 15, 2003, we would be out of the market. Guess what? Nobody did know what the heck was HIPAA. We added a few passwords here and there, restrictions, things like that, and suddenly were HIPAA compliant. Why? Because you are not forced to make them, just "try in good faith to make them". What kind of regulation is that one?
Now we have CCHIT. One certification per year, since 2006. If you approve CCHIT, you can continue in the market. If you don't... you can continue in the market. Nothing happens. They are trying to consolidate the market, but without ideas. Just throw a lot of requirements you need to follow, and once they all pass them, bring more, and then bring more.
EMR help doctors, but these regulations are aimed at shrinking the market. Will they continue shrinking it until there is a single EMR/EHR so that they don't have portability problems?
Let's see if Obama is serious or not.
I was not directly referring to your post, but a general observation regarding this "indignation" people have at losing a few "$freedoms" to allow a few people to actually function.
VLC FOR MAC IS DYING! IF YOU DEVELOP, PLEASE SAVE IT!!
$150 million on 750,000 lines of code works about to about $266 per line. If anyone hears their manager complaining about the high cost of programmers, remind them that your cost is only about $5 (or whatever).
I'll start with the simple question.... what do MY health records have to do with the government? And further more, if I were a doctor, what would my patients health records have to do with the government?? Nothing!! Why would any government body have any interest at all in "Digitizing" extremely private health information, that is understand by only two people - the patient and physicians. What is there to be had by this? So that if someone per chance arrived unconscious at an emergency room the doctors there would know their history? That's a great idea - but for the United States Goverment to REQUIRE that to happen is a violation of my right to arrive anonymously, unconscious, to the hospital of my choice and be treated as though I have a clean record. Obama and the whole party that elected him into office, to me, is full of all the right intentions.... but reality is really misplaced. $100 billion dollars on forcing me to digitize something that ought to be first and foremost on paper, and secondly, up to the discretion of my physician.
The governor of my state appeared at the local drive-in oil change shop and said he thought medical records should be like those kept on your car. Here are the problems with that...
First, records on your car are largely superficial: you got an oil change every 3K miles, you changed your filter at 20K, tires rotated etc. None of that means anything when you are hit head-on by a drunk going the wrong way on the interstate. The body shop doesn't give a hoot if the oil is fresh, or the filter new. They are going to look at the current damage and go from there...
The same is true of medical records for people that are relatively healthy, which is most of us. The ER doctors are NOT going to care one bit if you've had a recent flu shot or a broken finger in 1973. What they DO want to know is whether you have allergies to a medication they might give you and whether you are taking any medications that might conflict with the medications they are going to give you. Then they want to know if you have a dangerous medical condition like asthma or heart/blood pressure problems etc. The LEAST EXPENSIVE way to get the doctor all the information they need to treat you in an emergency is a card in your wallet with your CURRENT meds/conditions or one of those "medical alert" bracelets. For most people, the reason they are in the ER has little to nothing to do with a previous diagnosis.
Second, if you are rolled into the ER unconscious and without any ID (you got mugged or hit by a car while out jogging) then it won't matter how good your electronic (or paper) record is. They won't be able to match you to the record, unless you plan on chipping everyone with RFID. Cars are self identifying, people are not (when unconscious).
Third, if you are conscious then you should be able to recite your significant medical history/issues. If not, well...
Fourth and most important, the quickie lube shop sells your records to the highest bidder, and then they sell it again to the next highest bidder, and again until there are no bidders left. That's how CarFax and AutoCheck work. When medical records are all electronic, the risk of losing control of them goes up dramatically. I don't want to hear any garbage about protecting my electronic records with technology. Data breaches are everywhere all the time, and it isn't one record at a time either, it's millions at a time. At least my PAPER record is relatively safe at the local hospital. It cannot be stolen by a hacker from the other side of the globe if it is physical! Even if someone was stealing records from my local hospital, they couldn't steal them ALL at the same time!
You want to save money? Make all insurance claims be submitted through ONE processor (notice I did not say one provider) and standardize payment processes and procedures. Then expose all of those costs to the light of day. You want to know why prescription drugs are so expensive? Because there is a guaranteed monopoly on drugs and doctors are constantly pummeled with hard-sell techniques for the latest and greatest drugs.
We need to spend our bailout money on things that will LAST like roads, rails, buildings, hydro-electric, whatever. We should not be throwing away our children's tax dollars on a bunch of one's and zero's.
every politician and his brother has been pushing this stupid idea for years now. It's obviously an industry (read lobbyist) push. And the ruse about creating jobs with this program, how sad for us.
Hmmm...digital records...politician...things to hide...things that need altering...no artifacts of changes or forgeries...hmmm
The pieces are in place; we just need leadership and focus to make something happen in a way that benefits the general welfare.
A good start would be making the specs free. At a minimum, it appears you must pay hundreds to thousands of dollars just to read the technical details of the standard. Feel free to correct me if you know where the transaction standards are published openly. I'd really love to see how the industry has managed to remain a clusterfvck for 12 years.
For vaccinations, try book #3 :-)
http://www.globetrotterslogbook.com/
I recently bought book #1 (that has a small vaccination register) and I plan to keep it for a while.
Harald
Obama's health care information reform plan Wow ! This plan is going to make me a born again believer in the presidency. Compared to the plan to help the bankers and the automakers, this plan actually benefits patients, voters, citizens, and not to mention doctors. I would like to form a team to take a grass roots doctor proposal to Obama. I started programming a few years ago because I had major isssues with the current state of informatics that hindered my job as a radiologist. I am interested in spreading awareness and educating doctors, students, patients, everyone about the importance of programming. I believe scripting patient related information is going to be an important part of writing a pre (script) ion. I would like to assemble a team of 100-1000 programmers to help Obama implement his plan. By default, we will be volunteers. Let me know if you want to be part of it. I will announce progress on the project in this thread: http://www.autohotkey.com/forum/viewtopic.php?t=39902