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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."

18 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?

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    1. Re:stupid question but..... by Phantom+of+the+Opera · · Score: 5, Insightful

      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.

    2. 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.

    3. Re:stupid question but..... by MindKata · · Score: 5, Insightful

      "why isn't the health care industry already doing it"
      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? ... 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?

      --
      There are 10 kinds of people in the world... those who understand binary and those who don't.
    4. Re:stupid question but..... by tnk1 · · Score: 5, Insightful

      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.

    5. 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.
    6. Re:stupid question but..... by protodevilin · · Score: 5, Informative

      The idea is sound, but very difficult to properly implement. You'd think with all the benefits, healthcare providors would be clamoring to make the switch (some already have), but there are a lot of hidden problems associated with digital records.

      I'm a healthcare technician in the USAF, where the DoD has already implemented a system called AHLTA. When a patient presents for a doctor's visit, all the screening, labs, tests, orders, prescriptions, and physician's notes are entered into the system, where they can be referred to easily for future visits. No need to store thousands of paper records, or train records techs to pull them and locate the appropriate exams.

      Problems we experience: Privacy. It's difficult to ascertain just what records which type of doctor should be seeing, so right now we basically have a system where any variety of doctor or technician can see any variety of a particular patient's records (except Mental Health and STD visits, which are accessible only by password by default). This situation makes some patients rather uncomfortable.

      Data load. That's a lot of records. And it requires a lot of trained technicians to keep track of it. And it requires frequent audits to ensure the information is current, and has not been illegally accessed. And the system has to communicate and exchange information with several other (often outdated) systems.

      Server outages. When we have one, the clinic is virtually paralyzed. We can't refer to the patient's paper record for reliable case history, because the system was implemented five years ago. There won't be any recent records to refer to.

      Good Old Boys. The transition has been difficult chiefly because, let's face it: doctors just don't wanna have to go to all the trouble of learning a whole new computer system. It's easier for them to scribble some notes on a sheet of paper, and stick it away in a paper record and be done with it.

      There are clear advantages, but it just seems like we're not quite far enough along to handle such a system for just DoD personnel, let alone every single man, woman, and child in the US. A five-year plan is just not feasible from where I'm standing.

    7. Re:stupid question but..... by Anonymous Coward · · Score: 5, Insightful

      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.

    8. Re:stupid question but..... by Shakrai · · Score: 5, Insightful

      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.
    9. Re:stupid question but..... by Another,+completely · · Score: 5, Insightful

      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.

  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. exatly by JoeCommodore · · Score: 5, Insightful

    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.

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    "Enjoy what you're doing! If it becomes drudgery, you're doing it wrong!" - Jim Butterfield
    1. Re:exatly by Moryath · · Score: 5, Insightful

      Even with "standardized" documentation, you have to fight the ridiculous rules of the noninsurance companies / death management organizations (HMO's).

      True story: a friend of mine went in for a routine breast exam. Doctor told her she needed to have test X run. The way they would do this is, first they would do Test A (which required a biopsy about the size of a pencil eraser nub). Test A always comes back inconclusive. As in, they've been sending this test off for 10 years, and every fucking time it comes back "inconclusive." BUT, and here's the stupid part, once they've done Test A then the insurance companies/HMO's will approve Test X because Test A is "inconclusive." For Test X, they'll need to take a biopsy about the size of a nickel, same depth.

      There is no way to jump straight past Test A and go to Test X; the insurance companies will disallow it on the grounds that "preliminary" work hasn't been done. So not only does her money get wasted (one copay for each procedure, plus copay for FOLLOWUP visit to get results of each procedure and approve next one, rather than just copay for one test) but a completely redundant and useless test is done, wasting the money of everyone else who's been paying into the insurance/HMO networks. Oh, and as an added bonus, she has to go through all the pain and healing process of a biopsy, not once but twice.

      I don't think "digital documentation" will help for that.

      Other things that get in the way of digital documentation, of course:
      - Originals of a lot of records (x-rays for one example) do not transfer well to digital. Heck, transferring any analog recording, visual or auditory, to digital inevitably means a loss of fidelity at some point or another. You either save a far-too-small file that someone looks at and misses detail (or dismisses an important detail as compression artifacting) later, or your file is completely freaking huge.

      - Digital copies are unusable if you lose power. The risk of data corruption is also present. Magnetic storage media has a certain lifespan before it demagnetizes. Optical media tends to die due to oxidization, either of the ink or the metal or the plastic layer (ever seen a 10-year-old CDR? Kinda frightening when the plastic is that cloudy). Physical shock can destroy both quite easily (woe to us when people need their records following a magnitude-8 shock out in Cali).

      Now, I'm not 100% against digital records, or even the idea of all (or just mostly) typed records so that we don't have to deal with my doctor's crappy handwriting (how the pharmacist ever figures out what he prescribed and in what quantity, I have no idea). But we have to deal with the realities here, and weigh the benefits of going "all-digital", and there's a definite case for keeping originals of paper records and testing results (when possible) available.

  4. That estimate seems really high by Phoenix666 · · Score: 5, Insightful

    $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.
  5. Doublespeak time! by CajunArson · · Score: 5, Insightful

    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.
  6. 24% by MazzThePianoman · · Score: 5, Informative

    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
  7. Good luck, didn't work in UK by badzilla · · Score: 5, Informative

    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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  8. 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.