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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.
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.
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.
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?
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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