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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.
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.
> 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
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.
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%.
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
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.
Their search ability could be limited much like the limited credit searches of those who are wanting to provide you credit, ie they can't see the whole picture unless they are actually your provider or you have approved them to.
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.
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.
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.
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.
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...
My Web Site - www.ocean-liners.com
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.
The point of an insurance company is to bear risk, not avoid it.
Medical insurance providers should have zero access, and in all reality should not be able to ask any health questions period.
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?
The presence of ubiquitous medical benefits has insulated the general public from the costs of medical care and prescriptions for a long time, allowing equipment, malpractice, and pharmaceutical providers to jack up their rates beyond all reason.
The medical insurance industry has produced this market imbalance, and they should be forced to take responsibility for it
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?
I want peace on earth and goodwill toward man.
We are the United States Government! We don't do that sort of thing.
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?
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.
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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Freedom is destroyed. As for taxation not being stealing, doesn't that depend on what authority is being used to justify it? I mean, if I grab your wallet and say "Tax!" that doesn't make it okay; nor does a democratic vote just because it's democratic. That's why we have so much sympathy for Robin Hood, whose victims were English feudal noblemen -- basically a protection racket.
Revive the Constitution.
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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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.
Pardon me for asking, but what statistics are you using to cite your first "fact"? I find that claim quite hard to believe.
Actually there have been quite a few such studies recently, mostly as eaurpean countries attempt to figure out what laws make sense with their healthcare systems. The first one to show up in Google for me was:
van Baal PHM, Polder JJ, de Wit GA, Hoogenveen RT, Feenstra TL, et al. (2008) Lifetime medical costs of obesity: Prevention no cure for increasing health expenditure. PLoS Med 5(2): e29. doi:10.1371/journal.pmed.0050029
On the second point, optimizing system means reducing unnecessary demands on the system also.
I never argued that, only that laws and regulations tend to ignore what actually reduces demand on the system in favor of punishing what people dislike (obesity) while ignoring any evidence. Regardless of if smoking or obesity reduces the cost on the system for everyone, most people will favor rules banning it and claim justification using the healthcare systems because the desire to punish is stronger than the desire to make the system cheaper.
Wow, that's the first time I've heard that study applied to socializing medicine. I've always heard of it being used to illustrate the immense hate of "rich" people and justify confiscatory taxes on said "rich".
Don't understand the logic of such an application. How does one argue such a study justifies progressive taxes? How does hate justify taxes?
I think the real argument has nothing to do with that, though. If everyone is expected to share the costs of something, everyone should share the responsibility of keeping the costs down. Poor diet and the ensuing health issues are not something that deserves sympathy.
Sympathy? I have two concerns and neither has anything to do with sympathy. The first is reducing the amount of taxes that need to be spent on the socialized portion of the healthcare system. The second is personal freedom, where said freedom does not significantly impact others. My problem is others are inclined to remove freedom and increase costs because they want to punish people they feel are doing something wrong (overeating or smoking in their home). Personally, I'm medically underweight and don't smoke, but I'm a strong advocate for personal freedoms and I don't like my taxes wasted on regulations that just increase costs to me while reducing the freedoms of others. If people want to overeat or smoke, you'd better have some really convincing evidence that it is costing healthcare a lot more than it is saving before you will get my support on restricting their freedom to choose.
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?
If you exercise all the time and eat really well and as a result live twenty years longer why should anyone else have to pay for your lifestyle? Oh yeah, because paying for everyone's lifestyle saves money overall as well as bring numerous other societal benefits like reduced crime and a more stable economy.
They end up having to wait in line (especially when you start seeing the inevitable rationing that comes from socialized medicine) for the bums that chose to live poorly and have health issues because of it.
Sorry, these scare tactics don't work on me. I spent years waiting in lines in the good ole USofA when I developed a serious medical condition. I came within months of marrying a friend and moving to Canada just for the healthcare. Objective reviews of healthcare systems around the world don't exactly paint the US's system as the top of the heap, especially considering how much more we pay. Investing the same amount in a socialized healthcare system would not inevitably lead to any longer wait times for the average person than we have now. They would pro
It destroys a larger amount of wealth than it creates, necessarily. The people who the money was stolen from would have spent said money on things that were more valuable to them than the infrastructure was.
The only time wealth can be created is when two people mutually agree to exchange consideration. Unilateral economic actions always lead to reduced wealth.
I've had enough abrasive sigs. Kittens are cute and fuzzy.
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.
Because while CPRS is a wonderful organizational success story, Britain's EMR is a national success story. And national scale is what we are looking at right now.
In US, EMRs came early and were great in academic centers and federally funded facilities. They did not work out so well for smaller practices.
For one, CPRS does not have billing and made adoption difficult in the past. Not to mention the fact that they kept rewriting it several times. The clinicians love it because it close fit they way they worked in VA. Not surprising since a ton of money was spent perfecting it in that way. But the problem is with moving it to a non-VA setting.
BTW, there are already efforts to make CPRS more generally applicable (http://worldvista.org/). They are not a major player yet however.
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.