Slashdot Mirror

← Back to Stories (view on slashdot.org)

Obama Proposes Digital Health Records

Posted by CmdrTaco on from the cuts-both-ways dept.

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."

14 of 563 comments (clear)

  1. stupid question but..... by Shakrai · · Score: 5, Interesting

    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.
    1. Re:stupid question but..... by jamie · · Score: 5, Interesting

      Standardization is one of those things that's good for everyone, but that would not be cost-effective for one player to attempt. When a bigger player (which in this case has to be the government) moves in and lays out standards for everyone to follow, everyone benefits.

      You should be asking not why the industry isn't doing it, but why the government didn't step in a long time ago, to do this and a lot more. Many doctors -- people who have invested more time in training and education than almost any other group in our society -- are spending half of their work hours on paperwork and arguing with insurance companies. The level of inefficiency and waste in American medicine borders on criminal, and it translates not just to massive deficits for taxpayers, but second-rate health care for citizens.

    2. Re:stupid question but..... by Shakrai · · Score: 5, Interesting

      Having these records would make it easier to switch providers

      I don't know if I buy that. It's pretty easy to get your records now. You request them, sign a disclosure and receive them in a few days. Some providers will even copy them right there for you. Perhaps going electronic will eliminate the wait time to have your chart pulled and copied but perhaps it won't. Will there be legislation in place that requires them to give you copies faster? Or will the excuse just change from "we need to photocopy your chart" to "we need to get IT to open up your records for the new provider"?

      There's also privacy issues that need to be addressed. I know people will scream 'HIPAA' at the top of their lungs but have you actually read your insurance contract lately? Yeah, law enforcement/civil parties can't generally subpoena your Doctor to get at your medical records -- but they can and do subpoena insurance companies for billing records, which tell them much the same things. Why that's allowed is beyond me but it is.

      --
      I want peace on earth and goodwill toward man.
      We are the United States Government! We don't do that sort of thing.
    3. Re:stupid question but..... by Shakrai · · Score: 3, Interesting

      Many doctors -- people who have invested more time in training and education than almost any other group in our society -- are spending half of their work hours on paperwork and arguing with insurance companies

      I'm aware. But simply going electronic is not going to fix this. All it will change is the data entry method from pen and paper to stylus and tablet. If you want to fix the arguing with insurance companies you are going to need to regulate how they can conduct their business -- which (while long overdue) is probably going to increase costs even further. Should the insurance company have a veto over the form of treatment or medication that your Doctor can proscribe? Probably not. But if you remove that veto costs will go up. It seems criminal to me that nobody is even bothering to acknowledge this.

      There's also a number of other things that need to be fixed. As a random example, one of the tricks that drug companies use to extend patents is to "invent" an extended release version of the same drug they've been selling for years. Tort reform might also be in order. Have any friends in the medical field? Ask them what they pay for malpractice insurance and if there would be better ways they could spend that money.

      The level of inefficiency and waste in American medicine borders on criminal

      I agree. I've just never heard of Government as a solution for inefficiency and waste.......

      --
      I want peace on earth and goodwill toward man.
      We are the United States Government! We don't do that sort of thing.
    4. Re:stupid question but..... by Sun.Jedi · · Score: 3, Interesting

      They are not already doing it because of the cost for the hospitals to get off the big iron they paid a ridiculous amount of money for in the 1970's. The proprietary, custom, and non-standard recording formats have always been determined to be too expensive to change, although they may be quite inconvenient.

      Besides... who wants to pay for a gazillion lines of COBOL to be re-written. I'd theorize that the estimates of $75-100b and 212k jobs are woefully low. 5 years seems a bit light to me as well. I'm sure there is some potential for efficiency, but the accuracy requirement alone means lots of time and lots of bodies. It's not just hospitals either; add in insurance companies, and 3rd party billing. Then figure in the oversight/regulation for HIPPA compliance.

    5. Re:stupid question but..... by arth1 · · Score: 4, Interesting

      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.

      There is that possibility, but with nearly a decade behind me in the health care industry, I'd be more inclined to believe it's the Not-Invented-Here syndrome.

      Also, I'm very worried about a system like this from the user's point of view. If it breaks, the impact could be enormous. And breaking into a system becomes much more attractive when you can get everything in one place.
      And who is to say that a future government won't use the data for nefarious purposes? If the data is there, the temptation might be high. Would you trust all the possible future governments to know who has had abortions in the past, was brought to the ER for drug pumping when 12 years old, who is lactose intolerant due to distant negroid ancestors, or who has and haven't had a bris?

      There's also the problem that if a doctor enters something incorrect, imprecise or a red herring, it's going to stick there forever, and unless you demand to see your records, you may not even know about it. Speaking from experience, doctors are humans who will focus on the first interesting thing they see, and often have made up their mind based on your journal before even seeing you. Often they're right, but sometimes they're not, and when they're not, it tends to be the same patients who suffer over and over again, because the journals don't change -- they just get added to. (It could be that some doctor at one time entered 'fibromyalgia?' in a journal, and from that point on, every doctor who reads the journal will consciously or unconsciously think that any pain you report might be related to fibromyalgia. Whether or not you ever had it.)

      I'm just surprised that privacy advocates aren't all up in arms about this dangerous proposal.

    6. Re:stupid question but..... by 99BottlesOfBeerInMyF · · Score: 4, Interesting

      Should the insurance company have a veto over the form of treatment or medication that your Doctor can proscribe? Probably not. But if you remove that veto costs will go up. It seems criminal to me that nobody is even bothering to acknowledge this.

      I think you're looking at this as though the industry where an effectively functioning, competitive free market. Do you really think costs of insurance are determined by how much it costs the insurance company plus a small profit? That would be stupid of insurance company executives when most purchasers have no choice of plans and have to go with what they are provided by their employer. It makes a lot more sense for them to provide kickbacks and large client discounts to lock in people, then use their bureaucracies to minimize payoff to people too sick and desperate to fight too hard.

      Tort reform might also be in order. Have any friends in the medical field? Ask them what they pay for malpractice insurance and if there would be better ways they could spend that money.

      Actually, this is symptom of a society with ineffective or too low of levels of socialist healthcare and disability insurance. Juries rule all the time that doctors should pay large sums to people who are sick and disabled because despite the facts of the case, they feel there is nothing else that is going to provide for the ill and disabled and they feel sorry for those people. They feel doctors can afford it and on a case by case basis, most people are in favor of society providing for the sick and disabled.

      I agree. I've just never heard of Government as a solution for inefficiency and waste.......

      This is, quite simply, the main argument I have against socialized healthcare programs, in general. On paper it saves money and benefits society in many, many ways most people never even consider. In practice, in most places around the world, it works better. The only real question is our government one of the worst and least efficient at performing tasks like these and is that likely to continue? Our government has already managed some of the worst implementations of social constructs around the world. Currently our healthcare system is one of them, but there are may more. Heck, look at how well we managed to implement broadband internet access. We paid triple in taxes (per person) more than the Swedes, who have almost the same population density and who had a huge amount of that money embezzled in the middle of the project. They still pay significantly less every month for significantly faster connections that reach an enormously larger percentage of their population. Our current healthcare is analogous (both times we tried the capitalist route, but lobbyists undermined the decision making). On solution that has worked for other countries is eating one's own dogfood. That is, whether it is healthcare or internet access, force everyone to rely on the same system. This means the lobbyists and government officials and decision makers all have to live with whatever solution results, affecting their quality of life. I have a lot more faith in congress critters voting in my best interests when they have to use the same medical system and can't bypass it an go to a private hospital they pay for with their wealth.

      One final point I'd like to address. Many times here you mention costs, but costs are not the most important factor for economic recovery and societal benefit. Whether 10% of the money is wasted or 20% is wasted makes a lot less difference to society than you'd think. What matters more is who is paying what percentage. In our current system taxes pay some portion of healthcare for some people, but over the last 8 years the burden of the taxes have shifted more and more to people on the low end of the spectrum. As a result, wealth has been consolidating more and more at the top in fewer and fewer hands. This and no other factor, is the important one for our economy. Wasted money is mostly

  2. stepping stones to universal health care by viridari · · Score: 5, Interesting

    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.

  3. A Better Idea... by SCHecklerX · · Score: 4, Interesting

    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>

  4. Hasn't this already been done? by kiick · · Score: 4, Interesting

    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%.

  5. Re:That estimate seems really high by radtea · · Score: 3, Interesting

    So it seems the task is coming up with a standard format and enforcing it.

    Which will cost FAR more than $100 billion, and be done so badly as to render the system nearly useless.

    Ever parse a MAGE-ML doc that turns out to have the actual gene expression values in an "other" or "comments" field? Most "standard formats" are so arcane, complex and counter-intuitive that most people using them can't figure out the appropriate place to put the information.

    Furthermore, medical terms change with time as new procedures are introduced and old procedures modified. The proposed format is going to either have to handle that or become the kind of straight-jacket that 501(k) process has been in medical devices.

    Anyone contemplating touching any aspect of this project simply MUST read Stephen Flowers' "Software Failure: Management Failure", which is a collection of case studies of failed major software initiatives of just this kind. The book is in fact worth reading for anyone with an interest in why software systems fail, which should be everyone involved in software development.

    --
    Blasphemy is a human right. Blasphemophobia kills.
  6. Re:There is a pitfall though. by Anonymous Coward · · Score: 5, Interesting
    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.

  7. Re:24% by mattwarden · · Score: 3, Interesting

    Do you realize that 24% overhead beats the crap out of any government program I've ever heard of? 24% might sound ridiculous to you, but when you have welfare programs fighting just to get the majority of their money to welfare recipients (ie, less than 50% overhead), 24% looks pretty damn good.

    Also, I can't help but wonder what the number would look like if Medicaid filing requirements weren't incredibly convoluted. To attribute 22 percentage points of the 24% simply to the fact that we don't have standardized EHR -- which is what you implied -- is a little off. Take a look at government regulation of the health care industry and correlate it to the increase in costs. It's not going to be 1.0, but it's sure as hell not going to be 0.0 either.

  8. Re:exactly by coyote_oww · · Score: 3, Interesting

    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.