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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.
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.
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%.
Almost a quarter of every dollar we spend on health care is used by administrative expenses. In Taiwan where they have digitalized medical records their overhead is only 2%. There is plenty of examples around the world to why electronic records are better economically. Also there is the benefit of less mistakes since cross referencing medications and such can be done electronically for drug interactions etc. Frontline had an excellent episode were they looked at the health care systems of several other modern democratic countries. A must watch for anybody who cares about the health care debate. http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
"They who can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety" Franklin
We have a similar "project" or rather it should be characterised as a "permanently stalled horror story." There are only 70 million or so people in the UK so nobody understood why the initial budget was in the billions. Now it's in the tens of billions and no end in sight. Google NHS IT if you really want to spoil your day.
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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 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.
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.
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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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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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
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.