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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."
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.
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
$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.
"why isn't the health care industry already doing it"
... While it will create jobs, it will also wipe out existing jobs. Political drones just want it to sound like its creating jobs. Plus even if its adding more jobs overall, then surely its going to end up costing more money in total to keep funding the system?
Because it'll cost a fortune, and be a nightmare to implement. (Look at the mess the UK is making of their health computer system, with loads of interest groups, all pulling in different directions, pushing up the costs).
"Early government estimates are showing 212,000 jobs could be created by this plan."
Yeah, and how many paper pushers etc.., will it put out of work?
There are 10 kinds of people in the world... those who understand binary and those who don't.
Note the part where this will "create 212,000 jobs". It's not supposed to save money, it's supposed to spend it -- and the sugar daddy footing the bill is you.
Regulatory boondoggles. Girls singing to ABBA albums. It's like 1979 all over again.
Liberty you never use is liberty you lose.
While your post is intended to be a dig at Microsoft, HIPAA may actually require a form of DRM.
There is no "-1 offended" or "-1 you don't agree with me" mod options for a reason.
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.
There is that possibility, but I'd be more inclined to believe inertia in record keeping is more to blame for them having different formats.
You know that all providers are going to need to pay out cash to get new software that obeys the rules and there will also have to be a data migration effort. And you also know who that cost will be passed on to. Hint: not the providers.
The question is: is it worth having health care customers pay for this? Will the investment be worth it? I think it might be, if it does help with the need to dispense with tests, retests, and other administrivia.
If this can save so much money why isn't the health care industry already doing it?
Because in the short term it would divert money away from the really important things, like executive bonuses.
Most hospitals and health care systems have electronic medical records.
"Only about 8% of the nation's 5,000 hospitals and 17% of its 800,000 physicians currently use the kind of common computerized record-keeping systems that Obama envisions for the whole nation."
This is the key. Most health information systems are not linked to any kind of national network. So for example, your hometown hospital has a detailed electronic medical record created on you from the last time you visited the ER with a bad case of the flu (ie your allergies, your RX history...). Then you go on vacation in Alabama and get into a bungee jumping accident which leaves you unconscious. The ER doesn't have quick access to your local hospital's electronic medical record so they either have to have the info faxed (if they can even determine who your primary care provider is) or redo all those tests for things like allergies and medications.
Getting all the big players in health information systems to play nice and share their patient data repositories is going to be interesting.
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.
It's called pump priming, and it's how you end recessions. You have to spend money to make money. Create 200k jobs and the economy improves. See the Hoover Dam. I think this is a great idea. I mean, the idea to digitalize and standardize health records is painfully obvious and should have been done years ago, but there is going to be an unbelievable amount of work created by it. I read the first half of the article and my first thought was how the hell are they going to do this? Reading on, I found out they are going to do it by creating thousands of jobs. This is just about the best idea I've ever heard from a politician.
Whale
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.
Maybe the open source community should get off their butts and help to create client software and server software that will implement this standard, and provide it free to the medical community thus lowering the cost of entry into standardized medical records and systems.
This could be the best achievement of open source collaboration, and usher in a new era of open source projects that benefit mankind at the very basic level of existence.
I notice it doesn't mention how many jobs will be destroyed by this movement. I know that my entire company would go under, which represents a paltry 30 employees, but I would guess that there are at least a couple of million people employed in the art of getting the current paper based medical information into patient accounting systems. Granted many of them are doing it as only part of their job as a receptionist or office manager in a clinic, but large hospitals employ whole departments of these people.
If you are not allowed to question your government then the government has answered your question.
Interoperability is where the government steps in, for better or worse -- only the most ideological libertarian would deny that such a role exists.
I'm not a libertarian and I've never denied that Government has some roles. I'm just really skeptical about UHC. Here are just some of my concerns (off the top my head):
1) What evidence do we have that it will actually make health care more affordable? When has Government ever been able to do anything cheaply or efficiently?
2) Will Government in health care be used as yet another excuse to expand the nanny state? Will alcohol be taxed higher because it's bad for me? McDonalds? Doritos? Will all of this enforced by my employer similar to the way the so-called War on Drugs is enforced? Stop smoking or lose your job? Lose weight or lose your job?
3) What reason do we have to believe that our new Government overlords will be anymore benevolent than our existing insurance company overlords? I don't see how arguing with a Government bureaucrat over treatment is any preferable to arguing with a private sector bureaucrat. Who would you rather deal with: DMV or your auto-insurance company?
4) Will there be a way for me to opt-out if I don't see the benefits in having my health record instantly accessible from anywhere in the United States?
5) Will Government involvement in health care be used as an excuse to further erode the doctor-patient privilege? Go read the laws around credit reporting sometime -- the Government wrote in nice little exceptions for itself for all of the privacy laws related to credit reports. Will it do the same thing for medical records?
Just are just off the top of my head. I'd have to say that #2 is probably my biggest concern. I'm sick of the nanny state and the war on vice. And I see no signs that it's going to get any better. In fact I see the exact opposite......
I want peace on earth and goodwill toward man.
We are the United States Government! We don't do that sort of thing.
I don't think that the reason for reduced overhead should be entirely attributed to digitalized medical records. You also have to remember that one of the main problems that medical companies don't do this already is liability problems created by HIPPA. Likewise, insurance is a nightmare to work with. These will both continue to be true whether or not records are digitalized.
One problem few people think about with regards to health care is that the U.S. is such a diverse society, you have a lot of different types of needs. In countries with a monoculture, it is much easier to have low overhead and have a one-size-fits-all way of doing things. Also, in other countries, privacy is not so much of an issue. Here, for some reason beyond my understanding, medical records have become almost the equivalent of classified documents in terms of how they are protected. This has probably cost us much more money than whether or not the records are digital.
I think it is _possible_ we could save money with digitization, but not the amount suggested by this post. On the other hand, based on previous experience with medical IT, I think it's possible it could actually lose money in the long run, especially if "being digital" becomes more important than actually solving the communication problem.
Engineering and the Ultimate
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.
A standard isn't software; it's how to exchange information. That includes data formats, but also includes protocols and an awful lot of context. The standards work is a big job, and people have been working on it for years (see HL7). As eln points out below, it's boring as hell, but that doesn't make it unimportant. The industry has been in the process of moving from HL7 v.2 to v.3 for about a decade now.
If you want to get into the software part of the solution, have a look at the OHF Project. There are others, but that's a starting place.
I agree with tnk on the benign reason; the system as a whole will save money, but which individual players will save how much? Hospitals already spend very little on IT compared with other businesses, so spending a big whack that may end saving money for some insurance company isn't going to happen.
You want one big reason for doing this? If it can free up nurses from doing secretarial work chasing down documents in the mail and phoning around, it just might keep enough staff at the hospitals to serve the public. The U.S. department of health and human services prepared this report on the subject. It's worth reading.
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?
Actually, so far such costs are indeed passed on to the providers. Charges for services isn't something providers generally get to choose themselves -- simplistically, a specific diagnosis or complexity of a patient encounter is billed at a fixed cost determined by medicare, and by discounted contracts between provider groups and insurers (eg, "in this market we agree to get reimbursed 70% of the usual rate to have access to your patients"). So far, such costs for retooling with technology have been passed on to the providers.
Providers have been very reluctant to put money and effort into large scale technologies because so far this has been essentially out of pocket, requires several years to implement, and is not subject to a standard. Our physicians group over the past few years has migrated to a fully electronic record and prescription system. It cost 10s of millions of dollars out of our practice. It slows us down compared to the old system so we can see fewer patients a day. It's limited in the sense that it forces you into certain "boxes" in terms of documentation that make the old flexibility of dictated charts go away. The upside is much more consistent access to data, simpler provision of records to other providers, etc. It still costs us several million dollars yearly to maintain, and still can't interact with other medical record or data systems, because there isn't a clear standard.
In a nutshell, we paid for it, it's made us more efficient in some areas, less so in others, and it's not clear on balance if it was worth it for us.
In another example, CMS (medicare) has implemented a "pay for performance" system, where providers identify several measure they'll get graded on and reimbursed higher if they meet those targets. Think grocery store shoppers club. So far providers are at best lukewarm -- after making substantial up-front investments (which again, we can't directly pass on to patients ourselves, but the system overall does in one way or another) we now have a byzantine system of reporting that nobody seems quite clear on how it works, and very limited reimbursement for our efforts that are making people think it would be cheaper overall just to take a loss on medicare reimbursement. So, standards and better information systems are an absolute must in many people's minds as doctors really do hate the tremendous inefficiency we currently have, but it's vastly more complicated and expensive than it seems...
Do you also think that your car insurance company should have zero access to your driving/accident record? How can you bear risk if you have no idea what that risk is?
You DO have an idea of what risk is, as a set of proportions or probability. You can compensate for that by determining your rates according to those general models rather than excluding people from first world status.
By the way, this is people's health, not their car.
How'd they create it? By insulating the general public from the costs? Doesn't the general public share some blame too if that's the case?
no, they don't. They are never told the costs, are compelled to take care of themselves, and have no bargaining or lobbying power against centralized corporate power.
The insurance industry, however, was exposed to the costs and could easily have engaged in bargaining and lobbying to put the abuses in check.
They still can now, but refuse to do so.
I'd like to add to this that driving involves choices, medical conditions don't. Many chronic conditions are genetic, and completely unrelated to lifestyle.
Kennedy, for instance, had adison's
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And we already have a nanny state
And that's an argument for further expanding it?
You can't do most drugs, you already get taxed highly on cigarettes
And I disagree with both of those policies. So again I'll ask you, why should I be in favor of UHC if the logical outcome of UHC is even more governmental intrusion into my private life?
you clearly have no idea the hell insurance companies put people through
Actually I used to work for an independent agent so I do have a decent idea of the hell that insurance companies can put people through. I guess I view them differently than I do DMV for two reasons:
1) I know how to handle an insurance company bureaucrat. When they tried to dick over my girlfriend on paying her collision deductible after she was rear-ended I asked them which hospital she should visit for her neck pains. Had a check for the collision deductible the next day. Amazing how the prospect of a four digit no-fault claim puts a $500 collision deductible into perspective.....
2) I have a choice of which insurance company I deal with. If mine fucks me over I can go and find another one. I don't have this choice when it comes to DMV.
I want peace on earth and goodwill toward man.
We are the United States Government! We don't do that sort of thing.
Poor diet and the ensuing health issues are not something that deserves sympathy. If you choose to smoke and get lung cancer, no one should feel sorry for you. If you pig out on Doritos and Big Macs and end up a diabetic because of your poor choices, why the hell should anyone else have to pay for your lifestyle?
Do you think hospital fees are so high because of the rent? you already pay for their lifestyle, except they live in greater pain and you actually pay more because you don't provide preventive care to them.
Wellness programs should be a part of every insurance policy, obviously. Why should we insure ANYONE regardless of health since mcdonalds is obvously the most successful restaurant chain in the US. EVERYONE east there.
By the way, way to go stereotyping. It's almost racist. I suffer in horrible pain and semi-disability and can't buy insurance at any price, and I have never been obese, never smoked, and can count the number of times i've been drunk on my hands. The disease I was diagnosed with has no scientifically determined cause yet, and i've had healthy eating habits from a young age.
(ironically, because nutrition uptake is now impaired, I have to eat fast food, which I find disgusting, to get the calories I need)
Additionally, I worked my ass off and have been severely hindered both in school and post-graduate because of this condition. I could be providing a lot of taxable income, but i'm in a catch-22. Group plans are the only way i will ever be insured, but my condition is impairing me to the point i'll probably never angle something which will provide one.
It's really nice of people like you to punish me for the actions of others.
"Better 1000 innocent people go to prison than 1 guilty man go free"
Why does this sound a bit wrong.. oh wait.
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