Slashdot Mirror
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."
The idea is sound, but very difficult to properly implement. You'd think with all the benefits, healthcare providors would be clamoring to make the switch (some already have), but there are a lot of hidden problems associated with digital records.
I'm a healthcare technician in the USAF, where the DoD has already implemented a system called AHLTA. When a patient presents for a doctor's visit, all the screening, labs, tests, orders, prescriptions, and physician's notes are entered into the system, where they can be referred to easily for future visits. No need to store thousands of paper records, or train records techs to pull them and locate the appropriate exams.
Problems we experience: Privacy. It's difficult to ascertain just what records which type of doctor should be seeing, so right now we basically have a system where any variety of doctor or technician can see any variety of a particular patient's records (except Mental Health and STD visits, which are accessible only by password by default). This situation makes some patients rather uncomfortable.
Data load. That's a lot of records. And it requires a lot of trained technicians to keep track of it. And it requires frequent audits to ensure the information is current, and has not been illegally accessed. And the system has to communicate and exchange information with several other (often outdated) systems.
Server outages. When we have one, the clinic is virtually paralyzed. We can't refer to the patient's paper record for reliable case history, because the system was implemented five years ago. There won't be any recent records to refer to.
Good Old Boys. The transition has been difficult chiefly because, let's face it: doctors just don't wanna have to go to all the trouble of learning a whole new computer system. It's easier for them to scribble some notes on a sheet of paper, and stick it away in a paper record and be done with it.
There are clear advantages, but it just seems like we're not quite far enough along to handle such a system for just DoD personnel, let alone every single man, woman, and child in the US. A five-year plan is just not feasible from where I'm standing.
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
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
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.
- Originals of a lot of records (x-rays for one example) do not transfer well to digital. Heck, transferring any analog recording, visual or auditory, to digital inevitably means a loss of fidelity at some point or another. You either save a far-too-small file that someone looks at and misses detail (or dismisses an important detail as compression artifacting) later, or your file is completely freaking huge.
Having worked in Radiology IT, I'd point out that the human eye is actually a limiting factor in our ability to see things. So, yes, you are correct in that an analog X-Ray had more diagnostic information encoded into it than a digital one. However, the human eye can only see so much data. The human eye isn't a microscope. So you don't need to scan an image to microscopic precision. You only need to scan it to a level of precision that the human eye can't detect a difference. And it turns out that to do a scan of an X-Ray at that level of details results in a file that's approximately 10.5MB in size. It's a very well known metric, actually.
And if you have a 600 bed hospital which sees 150,000 patients per year in the Department of Radiology, and 50% of those are X-Rays images, with 2 images (PA, Lateral) per exam, that results in, oh... about 75,000 x 0.5 x 2 x 10.5MB = 787 GB of data per year. Add some extra space for buffering, swap space, and so forth, and you're talking about a Terrabyte of data per year for the X-Rays at a large community hospital. MRI, CT, Ultrasound, Angiography, and all the rest will add more, of course.
The hospital I used to work at stored about 2.5 terabytes of images per year.