Stimulus Avoids Serious Solutions For Health IT

ivaldes3 writes in to note his post up on Linux Medical News, pointing out the severe shortcomings of the Health IT provisions of the just-passed stimulus bill. "The government has authorized enough money to purchase EMR freedom for the nation. Instead the government appears set to double down on proprietary lock-down. The government currently appears poised to purchase serfdom instead of freedom and performance for patients, practitioners and the nation. An intellectual and financial servitude to proprietary EMR companies for little or no gain. A truly bad bargain."

Comments

Opinionated much?

[religious freak]

A little too opinionated in TFS. What news is this post actually trying to tell us?

Re:Opinionated much?

[Nethead]

What news is this post actually trying to tell us?

They didn't get the money sent to them so they are calling the others bad names and getting all pissy about it.

Re:Opinionated much?

[sleigher]

I think what they are trying to say is that United States Health Information Technology is exactly that. United S.H.I.T.

Maybe that depends on who you ask. I am sure many companies will love this.

Re:Opinionated much?

[glueball]

I use the proprietary systems and had attempts at open systems (there are always "shoot outs" at the medical conferences) and I can say that the proprietary systems suck much less.

It's all about workflow. The open systems fail to understand this concept.

Re:Opinionated much?

[tverbeek]

This article is a poorly written, useless rant. It contains little information about what pisses the writer off, and even less about what should be done instead. I'd love to read a thoughtful, informative article about the subject, since I've recently started an IT job in the health care field, but this isn't it. Any suggestions?

Re:Opinionated much?

[Anonymous Coward]

I must say, I've never been one of the kdawson haters, but some of the "news" items in the last couple of days are starting to make me reconsider...

Re:Opinionated much?

[Anonymous Coward]

He has the same rant about proprietary applications without interchangeable data formats in the medical field that people have with MS Office. Health Systems are just as bad if not worse than the other closed proprietary systems that people here constantly rail about. It's very likely that you'll have to buy a special program to read the medical information that you get from your doctor. It's a closed silo system that won't get any better based on the new funding.

Re:Opinionated much?

[Anonymous Coward]

Wow. Moderated insightful for:

1. Not reading the article.
2. Asking what the article is about.
3. Apparently unjustified comment on the summary. (I mean, he didn't read the article, right?)

Is this really insightful, guys?

Re:Opinionated much?

[Ironica]

If you find one, send me the link, too. We're using OpenMRS as a cross-agency TB registry, but it's sooooo not a full-featured EMR compared to the proprietary solutions. The stuff that our agency is willing to look at isn't even web-based, so you're locked into Windows (or maybe emulation; no idea if that works) for your desktop machines too. One of the systems runs only on Windows servers with MSSQL. Gack.

Re:Opinionated much?

[Anonymous Coward]

"Posted by kdawson..."

'nuff said.

Re:Opinionated much?

[cayenne8]

Yeah, but is any of this really surprising?

I mean, the whole fiasco of a spending bill was ram-rodded through congress, no one really read it....etc.

YOu have to guess nothing in it was well thought out...and it is a shame, especially with items concerning a very important topic, our private health records.

Re:Opinionated much?

[conureman]

With some extra cash, maybe the proprietary system vendors could widen that gap. Or at least hire some lobbyists to explain why they'll need more money next year. Failure seems to be our new economic engine.

Re:Opinionated much?

[TapeCutter]

I see the humour in your post but who says these campanies are failing? Just because car makers are getting a free ride so that auto-workers do not become angry pennyless voters doesn't mean that government infrastructure investment falls into the "rewarding failure" category.

Re:Opinionated much?

[Anonymous Coward]

My employer isn't tied down by a proprietary solution: they write their own software for EMR... using VB.NET. {sigh}

Re:Opinionated much?

[rtb61]

Let's just think about that. A patient EHR electronic health record system, so no one is capable of creating a open free system with 17 billion dollars. The government is not capable of putting to tender the creation of an open source system where the vendor or vendors have to surrender copyright as part of a lump sum payment for that system. So instead they are committing to a closed source, data locked up, per seat, perpetual licence fee upgrade cost.

All with no public review of patient confidentiality and security requirements, no review of data ownership, no review of abuse of data and no review of data longevity and accessibility. So the new administration comes up with a sound investment for the future which is immediately squandered away by existing crony government managers from the previous administration feeding their corporate sponsors profit margins.

The current administration will really have to sharpen up and focus on the fact, the existing cronies from the previous administration know they are on borrowed time and will cheat at every opportunity to pick up those 'purchasing' commissions and future cushy job placements. GE is already bragging about getting most of the money and they are a suck PR=B$ firm, so locked up in bullshit that they own even mass media companies, news at a profit fro GE and bugger the public interest.

They like a bunch of other corporations are all pushing for don't save the mortgagees, if they can't pay kick them out. The reason why, they want you and your family out of your house and on the street, so they can buy your ex-home at 20 cents and the dollar and then rent it back to you based upon it's original value and then ultimately sell it back to you at 10 times what they paid for it. Greed at it's finest. The corporate sponsors of the, oh my, Rush Limbaugh party, basically want to buy up America at fire sale prices, the more of you they can evict the more money they make.

Re:Opinionated much?

[Ironica]

Wow. To put all that effort into coding your own solution but to choose that platform... ugh.

Re:Opinionated much?

[Anonymous Coward]

NO, because in open systems, you can make your own program to interface and create whatever workflow you want. A propritary company can even come out and produce that interface, but they have to be careful that it does so in a non-derivative, non-extending way. Propritary systems are made for extreme lock-in where the company owns your data, not you.

Re:Opinionated much?

[Anonymous Coward]

Greed at it's finest.

"its".

Re:first stimulus

[Anonymous Coward]

I'll show you MY stimulus package!

Avoids serious solutions?

[iminplaya]

Sounds to me like all objectives were met.
As Richard Nixon said, "Solutions are not the answer."

Why Is Health Care even in the Stimulus

[Anonymous Coward]

On top of all the other crap that certainly won't really stimulat the economy.

Here's the bottom line. The problem with the economic crisis today lies with the financial and banking system. Health care wasn't the reason for the collapse, and fixing health care isn't the core issue here.

Its funny how liberals were complaining that invading Iraq had nothing to do the GWOT. This is the liberals version of 9/11, using the crisis as a pretext to remake the US economy and set their agenda.

Re:Why Is Health Care even in the Stimulus

[Captain Splendid]

This is the liberals version of 9/11, using the crisis as a pretext to remake the US economy and set their agenda.

It's tempting to think that, but the truth is McCain would've done pretty much the same thing. Except he would have cried more.

Re:Why Is Health Care even in the Stimulus

[iminplaya]

Health care is big business. Moves(washes) lots of money. Government and big business always help each other. The insurance companies are the democrats' "Halliburton".

All seriousness aside, the truth is that health care is as much part of our infrastructure as the the lights and roads are. Perfectly within the government's interests to see that everybody has access. Handing it over to private interests has proven disastrous for everybody not involved the business. Most of all the patients. But, like everything else...

Re:Why Is Health Care even in the Stimulus

[tthomas48]

This also goes to show that Republicans aren't really the party of small business. One of the biggest ways that small business struggles to compete with big business is in the realm of health care costs. Big businesses have better bargaining power and pay less per employee. Small business can't simply compete with salaries, they have to compete on benefits, and they have to pay more for them than largeer businesses.

The best way to create a boom in all sectors is to nationalize health care premiums. Companies and employees would have more in their pocket. Employers could hire more, and could pay their current employees more, which would be great for the economy.

Re:Why Is Health Care even in the Stimulus

[Em Emalb]

This also goes to show that Republicans aren't really the party of small business.

Neither party is the party of small business. They're the party of the party, for the party, by the party.

It's not a democrats versus republican thing, it's an US versus Politicians thing.

Re:Why Is Health Care even in the Stimulus

[Anonymous Coward]

On top of all the other crap that certainly won't really stimulat the economy.

In the short term, paying people to hop up and down on one foot would stimulate the economy - as long as the people were going to spend the money rather than stuff it in their mattress.

Here's the bottom line. The problem with the economic crisis today lies with the financial and banking system. Health care wasn't the reason for the collapse, and fixing health care isn't the core issue here.

Ah, but why do we care about the financial crisis at all? Because some CEO might not be able to afford to buy his second mistress a third vacation home? Not so much.

Rather, because ordinary people end up out of work and can't afford basic necessities like health care. Fixing health might not help people this time around (just like the GWOT didn't go back in time and prevent 9/11) but it might help next time around.

Its funny how liberals were complaining that invading Iraq had nothing to do the GWOT. This is the liberals version of 9/11, using the crisis as a pretext to remake the US economy and set their agenda.

The only reason that makes sense as to why Bush invaded Iraq is that he was doing a favor for his associates in the war, oil, and religion industries (plus his friends in Saudi Arabia).

On the other hand, I get the sense that Obama really does care about helping poor people. I may turn out to be wrong about Obama's motives and, even if I'm not, Obama's only guy (up against a sea of simple-minded people like yourself).

But, at the end of the day, I feel better about helping poor people than Bush's associates (plus, Obama's methods don't involve killing so many people).

Re:Why Is Health Care even in the Stimulus

[tthomas48]

It's people. Politicans are PEEEEOPPPLEEEE!!! They're using people to make decisions. Next thing you know they'll create a democracy and make us vote!

Re:Why Is Health Care even in the Stimulus

[ravenshrike]

Of course, McCain also joined in McCain-Feingold, so clearly he's not a conservative barometer.

Re:Why Is Health Care even in the Stimulus

[cgenman]

Our economy is broken in more ways than just the financial system. Our Car companies have been mismanaged for years, our healthcare system is derided worldwide for being incredibly expensive and backwater, our education system is a joke.

What we need to get out of any economic downturn is higher per-capita productivity. Health Care has been a big drain on our economy for years, and a distributed automated health records system is long overdue. My Mechanic has better records of the work done on my car than My Doctor. I've seen doctors prescribe to my grandmother treatments that had serious interactions with drugs she was already taking, and treatments that she was simply allergic to.

We need growth and efficiencies, and this is one area where a little expenditure would save a lot of lives. And I hate to sound this crass, but saving lives cheaply is good for the economy.

Re:Why Is Health Care even in the Stimulus

[DragonWriter]

The problem with the economic crisis today lies with the financial and banking system.

No, the problem lies with the lack of availability of credit and the lack of consumer demand. The primary direct cause of that may have been actions in and affecting the financial services industry including the banks, but that doesn't mean that the most effective way of dealing with it is exclusively with policies directed at that industry, in the same way that bad diet and inadequate exercise may be the principal cause of a heart attack, but the best response to a heart attack may not be limited to diet and exercise changes.

Its funny how liberals were complaining that invading Iraq had nothing to do the GWOT.

Liberals, in fact, were not generally complaining about that. Liberals were complaining that Iraq (not "invading Iraq") had nothing to do with 9/11 (not "the war on terror") and that invading Iraq was directly counterproductive in (not "had nothing to do with") the war against the people who had actually attacked the United States on 9/11, and that contributed to producing more people who would be more easily recruitable by groups wanting to attack the United States through terrorism.

The first half relates to the justification, the second to utility. Confusing different parts of two distinct-though-related criticisms of the invasion of Iraq misses the point of both criticisms rather completely.

This is the liberals version of 9/11, using the crisis as a pretext to remake the US economy and set their agenda.

That doesn't make sense. The economy is broken. Liberals are proposing a particular way of fixing it that, they argue, apply both to the immediate problem and the longer-term structural problems that make problems like the immediate one both more likely to occur and more damaging to individual citizens when they occur. As you note, what they are doing is directed at the economy, which is where you admit the problem is, not at some unrelated thing. Now, you might argue that the proposals are not directed well to fix the problems in the economy, which would be a legitimate point to debate, but you fail to make that argument, instead making an argument by analogy (though, as noted, a poorly-crafted analogy that reveals poor understanding both of the immediate situation and the one to which an analogy is drawn) that seems to rely on the idea that it is not directed at principal immediate cause of the problem, rather than arguing that it is ineffective at solving the problem. But being effective at addressing a set of undesirable conditions is logically orthogonal to being directed at the events and conditions which contributed to the development of those conditions.

Re:Why Is Health Care even in the Stimulus

[Anonymous Coward]

My Mechanic has better records of the work done on my car than My Doctor.

Well of course he does. Why would your doctor care about your car?

Re:Why Is Health Care even in the Stimulus

[damn_registrars]

Of course, McCain also joined in McCain-Feingold, so clearly he's not a conservative barometer.

As I recall McCain helped with that in 2002, before opposing it while running for president in 2008. So a more accurate statement might be:

McCain joined in McCain-Feingold in 2002, before making himself a conservative barometer and opposing it in 2008

Re:Why Is Health Care even in the Stimulus

[Garrett Fox]

It was never "handed over to private interests" in the US, because it was always in private hands and hasn't been forcibly taken away. Yet. Partially.

There's no legal authority for the US federal government to be providing, funding, or controlling medical care, so any debate about expanding its role ought to focus on whether to amend the Constitution to allow it.

Re:Why Is Health Care even in the Stimulus

[Anonymous Coward]

Now, you might argue that the proposals are not directed well to fix the problems in the economy, which would be a legitimate point to debate, but you fail to make that argument, instead making an argument by analogy (though, as noted, a poorly-crafted analogy that reveals poor understanding both of the immediate situation and the one to which an analogy is drawn) that seems to rely on the idea that it is not directed at principal immediate cause of the problem, rather than arguing that it is ineffective at solving the problem.

OMFGWTFBBQ?!

  Worst. Sentence. Evar. C-, please rewrite.

Re:Why Is Health Care even in the Stimulus

[Anonymous Coward]

You totally misread that. I'm still confused about why his mechanic is working on a doctor, but... hey.

Re:Why Is Health Care even in the Stimulus

[MrHyd3]

That's the dumbest idea ever besides using hydrogen in the Hindenburg. I own a small business, nationalising healthcare would do nothing but raise our taxes for ALL, thats bad.

Re:Why Is Health Care even in the Stimulus

[Attila Dimedici]

"You never want a serious crisis to go to waste"--Rahm Emmanuel, Feb 9, 2009

Re:Why Is Health Care even in the Stimulus

[MBGMorden]

our healthcare system is derided worldwide for being incredibly expensive and backwater

Not really. Our healthcare IS expensive, and that's annoying mostly to people who live here, but the QUALITY of US healthcare is pretty much the best in the world. Certainly not "backwater" at all. You pay through your nose for that quality (and many of the ricer people of the world will visit the US just for healthcare - ironically some of our poorer people are starting to visit places like India though simply due to the cost), but it IS quality.

Whether or not that's viable long term, or best for the people is the issue. Calling our system "backwater" is giving an entirely false impression though.

Re:Why Is Health Care even in the Stimulus

[Lord Ender]

What nitwit modded that comment insightful?

And now, the top two reasons why healthcare spending is economic stimulus...

drumroll

• A healthy population is more productive than a sick population
• Economic resources wasted on inefficiencies in the health system hurt the economy. That waste is not economically productive.

cymbal splash

Re:Why Is Health Care even in the Stimulus

[sumdumass]

Perhpas McCain doesn't support it because some of the provisions were struck down in court as unconstitutional and it's ineffective and doesn't make sense now. Then he not even pretending to be a conservative barometer. BTW, that is what Palin was supposed to have been.

Re:Why Is Health Care even in the Stimulus

[sumdumass]

This also goes to show that Republicans aren't really the party of small business. One of the biggest ways that small business struggles to compete with big business is in the realm of health care costs. Big businesses have better bargaining power and pay less per employee. Small business can't simply compete with salaries, they have to compete on benefits, and they have to pay more for them than largeer businesses.

Small businesses who become members of the chamber of commerce or other quasi politico entities are able to pool their resources for insurance and get more of a discount or better pricing then many large companies. And yes, there were a few laws passed allowing this to happen.

For instance, when I had my shop open, I received a 35% discount on my automobile insurance just for being a member of the chamber of commerce. I also received a 25% discount on liability insurance for the business, almost 50% off of the unintentional loss insurance (the business version of comprehensive home owners insurance). And get this, during the last election, both parties claimed that the average insurance plan costs 6 grand a person and 12 grand a family per year, I had no family coverage but the 10 employees (including myself) costs an average of $3,800 a year for bluecross/blueshield insurance. That came out to around $75-80 a week and I covered half of that. Of course this was in 2003 so in 5 years the costs could have went up a little but other business owners I know don't complain about the costs.

The best way to create a boom in all sectors is to nationalize health care premiums. Companies and employees would have more in their pocket. Employers could hire more, and could pay their current employees more, which would be great for the economy.

You say this without acknowledging that it will have to be paid for. I'm not sure why people like you do this but your not the first one to do it. I know plenty of self employed people who claim the government should cover insurance costs because it would be cheaper for them, Usually it's when taking their boat to the lake for some water skiing or when riding 4wheelers. If it already averages $12,000 a year for family coverage and every family is all the sudden getting covered, then every family will have to pay $12,000 a year in taxes to get the nationalized coverage. The extremely poor are already covered and most people with children are covered in some way, I don't expect the costs would be spread over to them so the only option left would be to tax the people being included in some sort of coverage.

The effect is that you don't save anything, the companies don't save anything, but instead of you having a choice to spend that money on a computer instead or to buy a nicer car or to buy a boat or put your kids in a better school or whatever, it will now be forced out of you in the terms of taxes.

Just like your wild assertion on small businesses, I don't think you have thought this through enough or even considered all the facts of the situation. The money won't magically appear from nothing, it won't just be there, it will come from taxes and it will be your increased taxes paying for it. And this time, you won't have the choices you have now.

Re:Why Is Health Care even in the Stimulus

[iminplaya]

BTW, that is what Palin was supposed to have been.

Poor conservatives. They really know how to pick 'em. They would've gained more ground by propping up Buckley's corpse.

Re:Why Is Health Care even in the Stimulus

[damn_registrars]

They would've gained more ground by propping up Buckley's corpse.

They've done frighteningly well with puppet presidents in recent memory (Reagan, Bush II, in particular). One would have expected that after turning John Sidney McCain III into a marionette that they would have done quite well there as well. Really, what could have possibly gone wrong with that iron-clad plan?

Re:Why Is Health Care even in the Stimulus

[tthomas48]

My health insurance (family, employer pays half of my premium) through blue cross blue shield is closer to $3,800/month. Single person is well over $1000. So yeah, your figures are wildly out of date. But yes I realize there are ways for a small business to pay fees in order to pool their resources to get better rates. You can call it the chamber of commerce, but you're still describing an ad hoc form of government.

I do acknowledge where this money is coming from. Higher taxes. Our taxes are ridiculously low. We haven't even been paying for what we've been spending. Once we get out of this recession we're obviously going to have higher taxes. Trickle-down doesn't work in any substantial way. Otherwise we would have had surpluses during the most recent boom years. I think the American taxpayer is beginning to realize that health care is something like roads or electricity. We're not willing to compromise on it. We think it's a basic right, and we're willing to pay for it. The federal government already is insuring an enormous number of Americans. Our taxes are already paying for the uninsured when they hit hospitals and cost a ridiculous amount more than preventative care. Let's finish the deal and ensure a right to health as a fundamental American right.

"The effect is that you don't save anything, the companies don't save anything, but instead of you having a choice to spend that money on a computer instead or to buy a nicer car or to buy a boat or put your kids in a better school or whatever, it will now be forced out of you in the terms of taxes."

You are correct. I question anyone who thinks that a new computer, nice car, boat, or private school is a priority over having health coverage. I know there are lots of these people. You're making the assumption that it would be cheaper for the tax payer to foot the bill of paying for those people's emergency room bills rather than their preventative care. Considering how much an emergency room costs, I find that hard to believe.

I think you haven't considered that there are rational Americans who are willing to pay taxes to the Federal Government to get what they need. They may chafe at Alaskan bridges to nowhere, but when you propose something sensible, like educating children or making sure no one dies of preventable diseases, they're willing to pay for it.

Just because I don't agree with you doesn't mean I haven't considered the facts.

Re:Why Is Health Care even in the Stimulus

[lazy genes]

A healthy population will make better political choices than a sick population. What you see in the financial sector is a sector infested with parasitic type people. It was caused by a misinformed population. Our newly elected seems to recognize this and is moving in the right direction. The main problem is that people do not have the time to exercise and eat properly. So are we DOOMED to live in a ignorant society?

Re:Why Is Health Care even in the Stimulus

[Ironica]

That's the dumbest idea ever besides using hydrogen in the Hindenburg. I own a small business, nationalising healthcare would do nothing but raise our taxes for ALL, thats bad.

Um.

Children dying from asthma attacks is bad, too.

As a small business owner, national health care would free you from any expectation of providing health benefits to your employees. You may not have employees, but you probably hope to be that big someday if you don't. You may currently use some sort of workaround (such as hiring people "on contract" or "part time") to avoid providing benefits, but that makes your listing less competitive, so you have to pay higher salaries. Also, if we had a government insurance-style system, the profit margin would be removed, which will lower the costs of operation.

Yes, you might pay more in taxes than you pay in health premiums... but you'll also *get* more. Go visit the ER of County General some night if you don't think we've got a healthcare crisis.

If you don't feel any sort of responsibility to the other members of society, there I can't help you. Evolution should have taken care of that a long time ago. Humans are social creatures; we survive better when our entire group is healthier.

Re:Why Is Health Care even in the Stimulus

[Ironica]

What nitwit modded that comment insightful?

And now, the top two reasons why healthcare spending is economic stimulus...

Both true, and very valid.

But there's also the way in which *most* spending is economic stimulus. Yesterday, our organization (a non-profit healthcare provider with Section 330 funding, so we're a Federally Qualified Health Center (FQHC)) learned that we'll be eligible to apply for a skosh over $400k in ARRA funding in the next couple of weeks. These funds are to be disbursed in two payments, the first of them by the end of the month. This is LIGHTNING speed for government funding; the typical RFP comes out about three months before the application deadline, and the awards are made about five months later. Then the payments are pro-rated over the course of the year.

The major requirement for this funding opportunity is that it will be used to either keep jobs that you'd otherwise have to cut, or to add new positions. We'll be using it for new hires; we already had a project that required over $200k in new positions we've been scrambling to find funding for.

But why are they in such a hurry to give us the money? Because we can't spend it *that* fast... but we'll put it in the bank. You know, banks? Failing? Needing cash infusions? Two birds, one stone.

More than two birds, though, because this will temporarily increase our reserves, which betters our chances for qualifying for other funding sources too, such as private foundations.

And what comes out in the end is better healthcare for people who can't just pick up and go to another doctor. The clinic that's going to get the bulk of our ARRA funding serves about 8,000 patients a year, most of whom are homeless. We're moving to a new larger facility, and will have additional services available on-site (such as dental and mental health), in a big cooperative deal with the County (who is paying the lease, and providing some of the mental health personnel). Turns out, it's *cheaper* to provide good access to quality routine and preventive care, than to wait until these folks show up in the ER and have to be admitted to the hospital.

In the end, we're talking about using money more efficiently. It galls some folks to think that people who "don't deserve it" will be benefiting from the spending, but the truth is, we'll spend the money on them now or later. It also isn't a good idea to let them die on the street; that causes HUGE public health concerns for everyone.

Re:Why Is Health Care even in the Stimulus

[sumdumass]

I don't know why you said "poor conservatives" for. I thought we just established the McCain wan't one and HE PICKED Paling in order to appease them. Any logical following of that would be that someone who isn't a conservative didn't exactly know about conservatives. Perhaps we are talking about you too.

Re:Why Is Health Care even in the Stimulus

[sumdumass]

My health insurance (family, employer pays half of my premium) through blue cross blue shield is closer to $3,800/month. Single person is well over $1000. So yeah, your figures are wildly out of date. But yes I realize there are ways for a small business to pay fees in order to pool their resources to get better rates. You can call it the chamber of commerce, but you're still describing an ad hoc form of government.

I think you got something wrong on that there. Perhaps your employer is only claiming to pay half but according to those numbers, it would be over 45K a year. This provides(PDF warning) some more current information on costs but they are averages and 3 years old. However, it puts your claimed cost to around 6 times the national average for the most high costing age group (50-54 at $6,751 average anal family coverage). Of course it says that premiums vary from state to state and even breaks down those for us. It says that your numbers would be 2.5 times the average in Massachusetts which seems to have the highest rates. In fact, if you look at the states, the more liberal states seem to have the highest costs for some reason and pretty much set the national average. My state seems to be right in the middle of the state list and for single coverage, the average is actually lower then what I was paying but I also had indemnity instead of a HMO plan.

The types of plans will effect price but then again, if you going after the most expensive plan, your not complaining about coverage costs, your complaining about costs of certain coverage which is quite different.

I do acknowledge where this money is coming from. Higher taxes. Our taxes are ridiculously low. We haven't even been paying for what we've been spending. Once we get out of this recession we're obviously going to have higher taxes. Trickle-down doesn't work in any substantial way. Otherwise we would have had surpluses during the most recent boom years. I think the American taxpayer is beginning to realize that health care is something like roads or electricity. We're not willing to compromise on it. We think it's a basic right, and we're willing to pay for it. The federal government already is insuring an enormous number of Americans. Our taxes are already paying for the uninsured when they hit hospitals and cost a ridiculous amount more than preventative care. Let's finish the deal and ensure a right to health as a fundamental American right.

Most people I speak with don't think we should be spending that much in the first place. But that wasn't the point. The point is that you are still spending the same amount of money regardless of if it comes out of your pocket at your will or if it is taxed and comes out at the will of some politician who seems more interested in kickbacks or greasing some fatcat's pockets in order to secure campaign donations and retain power. If for some reason you believe it would be cheaper with the government controlling it, you really aren't paying attention.

As for trickle down, the federal budget has increased every year in recent years, so have the tax revenues, you can't claim something doesn't work when you're simply not playing by the rules. To say we should have had a surplus and blame an economic principle without acknowledging the increases in spending is like blaming your boss for you bouncing a checks you wrote. The problem with surpluses is that the money isn't allowed to just sit there. If the government is taking too much, it has to give the money back or it has to spend it. Those are the rules set up. Recently, they have chosen to spend it which has the side effect of reoccurring costs, and when the funding doesn't come in, you have a deficit. That shouldn't be new to anyone, the only difference is that when the US government spends like that, it's business as usual. When companies or even you spend lik

Re:Why Is Health Care even in the Stimulus

[Anonymous Coward]

Ideas like yours -- the notion that all parties are the same, which as I recall was a pretty popular viewpoint in the 2000 election -- brought us the presidency of George W. Bush. Do you honestly believe Al Gore could have fucked it up as severely?

Neither party is perfect, but let's not pretend that one of them hasn't been worse in recent decades.

Re:Why Is Health Care even in the Stimulus

[bobwoodard]

Exactly right regarding the supposed failure of trickle down. You can't call it a failure, if it was never tried.

While tax side was implemented, the spending side was never kept in check. With the increase in tax revenues, Congress only saw the chance to write bigger checks and expand the reach of government.

Criticisms and a Better plan

[tjstork]

I read the article.

The guy's central point is that corporate systems are bad, and open, federally funded systems are good, with the further implication that government is good, and corporations are bad.

Now, the reason, though, that he gives for this is that a private corporation owns his data in the present system, but if the government owned, then, somehow, he'd own it more.

That's the crazy thing. There's no such thing as "public ownership". You own as much of something that is public as you do a car by walking past a Ford factory. Ownership at its most practical is, who controls it, and you really don't have any control over the daily disposition of property managed by the government. In effect, when you argue for publicly owned health care, or publicly owned anything, what you are really arguing for is to pay your own taxes to buy something for some administrator either elected or appointed or a lifelong civil servant. In any case, its not you.

There's a lot of good reasons to adopt open source in health care. For one, the creation of a single standard document for representing a medical history would go a long way towards enabling applications across the medical spectrum to coexist.

This will be easier said than done.

A good example is that there were some efforts to do this in insuring property for catastrophic losses - a build is remarkably complex for insurance purposes, but that specification has essentially died by its own complexity. The industry largely and thankfully essentially resorted to using SQL Server copies of the leading vendor of property and casualty software for CAT. Is it proprietary? Yes. But, it allows all the insurers to exchange books in a way that is relatively practical and easy to use.

The moral here is that its not good enough to say that a standard is open for data interoperability. Ease of use and ease of transportability becomes paramount and if open source wants to drive health insurance, it stands to reason that there needs to be a pervasive application that goes along with it.

Re:Criticisms and a Better plan

[Em Emalb]

Wow, you got all that out of the article?

Good for you.

All I got was that the guy is pissed off and wants people to play in his particular sandbox and not "some big companies".

Re:Criticisms and a Better plan

[Nethead]

I think it was Heinlein that said something like: You only truly own that which you can carry in both arms at a dead run.

Re:Criticisms and a Better plan

[be0wulfe]

You're only half right. The problem is that HIT vendors are generally well behind the times, slow to innovate and closed and proprietary as all get out. You think MS is bad? You haven't seen highyway robbery until you've seen the shit in a box most HIT vendors push. The technical implementation is lacking and the SOLE focus, the SOLE focus of every sale is simply to further ensare the particular customer still deeper into more from the same proprietary stack. Integration is a joke, made challenging by intention rather than accident.

This is a HIGHLY lucrative market. Any given vendor has ZERO interest in open systems and will push to make sure you buy their entire stack.

Thankfully, there are exceptions to the rule and there are many CIOs and CEOs that are wising up to their antics.

This stimulus plan, unfortunately, only makes things WORSE backing proprietary vendors and closed systems over open standards - real standards, not the recommendations AKA HL7.

Re:Criticisms and a Better plan

[tverbeek]

When it comes to what's done by the government, I have only one vote. But that's one more vote than I have when it comes to what's done by private businesses, and it guarantees me a right to participate in the process.

Re:Criticisms and a Better plan

[ColdWetDog]

There's a lot of good reasons to adopt open source in health care. For one, the creation of a single standard document for representing a medical history would go a long way towards enabling applications across the medical spectrum to coexist.

This is exactly right, and a bit wrong. We don't need open SOURCE code, we need STANDARDS and DATA STRUCTURES. I don't care if GE writes the database and front end using FORTRAN or Visual Basic. But we do need commonality in the record so that the GE system can talk to Epicare and, more importantly, you can switch systems without trying to key in all the data.

TFA really has the right idea, but a screaming rant isn't going to impress anybody.

Re:Criticisms and a Better plan

[Asic Eng]

I think a stimulus bill should be an investment bill. Initially there is extra spending which causes economic activity of some kind, and that helps in the short-term. However the spending needs to be directed, so that long-term public costs are reduced. If that doesn't happen your debt may get out of control. One way of investing in that way, could be to pay for software to be written so you own it, rather than owning a license to use it.

If you buy e.g. an installation of MS Office, then you own merely the right to use it on one computer. Maybe you want to buy it at many sites because it has feature X which OpenOffice doesn't have. Rather than spending the money to buy many installations you could spend it to have it added to OpenOffice. This could have similar short-term cost, but in the long-term you could access this new feature wherever you needed it, without extra cost.

Similar for medical software - you could direct the spending so that you'll get extra features in the short-term and keep paying for them in the long-term. Alternatively you could pay to have it created under GPL license, and in the future you could always get competing bids when it comes to add features to the software, and you could add additional installations without further licensing costs.

Re:Criticisms and a Better plan

[Anonymous Coward]

Now, the reason, though, that he gives for this is that a private corporation owns his data in the present system, but if the government owned, then, somehow, he'd own it more.

That's the crazy thing. There's no such thing as "public ownership".

I took my kid to a public park the other day. We showed up, played on the play structures for while and left.

Would that have been possible if the land had been owned by a private corporation? Sort of. It's possible the corporation would have set up some kind of pay-to-play situation. Some of the cost would probably go to maintaining the play structures but some of the cost would also go the owners (or management) of the corporation as "profits".

The essence of capitalism is that some people get paid for doing work and other people get paid for owning "capital" - that's right, some people get paid for doing nothing other than being rich. So, who gets paid for owning the land the park is on? If the land is owned privately, then whoever owns the land gets paid for doing nothing other than owning the land. If the land is owned publicly then no one really gets paid, per se, but people who use the park don't have to pay some rich person for doing nothing other than owing the land.

In effect, when you argue for publicly owned health care, or publicly owned anything, what you are really arguing for is to pay your own taxes to buy something for some administrator either elected or appointed or a lifelong civil servant.

That depends on whether you think government officials can be compelled to act in the public interest.

The recent business with Bush invading Iraq for the benefit of his friends in the oil (and war) industries does suggest that there is a strong tendency for government leaders to spend tax dollars for their own benefit.

On the other hand, getting back to the public park example, the land the park was on was very clearly not being used exclusively for the benefit of a government official (for example, as a private residence).

Bottom line. It's not quite as black and white as you claim.

Re:Criticisms and a Better plan

[jerdenn]

For one, the creation of a single standard document for representing a medical history would go a long way towards enabling applications across the medical spectrum to coexist.

This document type does exist. Please review the emerging HL7 v3 documentation. Pay particular attention to CDA/CCD.

The bottom line is that once there is convergence around interoperability, which proprietary EMR solution a Healthcare Organization utilizes matter much less less. Prior to CCHIT and changes in STARK, vendors had little incentive to develop interoperable solutions - vendor lock-in is part of the HIT business model.

For once, the government is actually driving positive change into an industry. Through provider-based incentives (carrot vs. the stick), HCOs (Healthcare Organizations) will have positive incentive to implement interoperable solutions.

It's a facinating time in HIT, and I'm frankly enjoying being on the vendor side of right. I expect fundamental change over the next 5-7 years in HIT, unlike anything we've seen in the last 15. Great stuff, really.

-jd

Re:Criticisms and a Better plan

[falsified]

You mean HL7?

Re:Criticisms and a Better plan

[Ironica]

Similar for medical software - you could direct the spending so that you'll get extra features in the short-term and keep paying for them in the long-term. Alternatively you could pay to have it created under GPL license, and in the future you could always get competing bids when it comes to add features to the software, and you could add additional installations without further licensing costs.

Exactly. For our non-profit organization, which operates six clinics and two mobile units, EMR/PM bids are coming in at half a million for the first year and $200k and up each year after. The costs scale with our size, too; if we start seeing more patients or hire more doctors, we pay more for our EMR. This means we can't even *think* about switching to electronic records until we've secured funding for at least a few years, while we build that into the budget and our indirect cost agreements.

If instead, the government actually purchased one or two well-developed EMR systems and open-sourced them, then let all their Federally-Qualified Health Centers (FQHCs) and look-alikes use them for free, it'd cost more like $100k per grantee organization to implement... including hardware, which the costs above don't count... and the continuing costs would be negligible, probably one more person on your IT staff, or a low-cost helpdesk contract.

Instead, there's an RFP out right now that will spend $4.5 million on *six* FQHCs to implement EMRs. Only clinic systems with at least 30 sites, or consortiums of three or more clinics are eligible, so I'm guessing their target is to get 200-250 sites onto EMR systems with $4.5 million dollars. Not exactly cost-effective.

Re:Criticisms and a Better plan

[StopKoolaidPoliticsT]

I took my kid to a public park the other day. We showed up, played on the play structures for while and left.

Would that have been possible if the land had been owned by a private corporation? Sort of. It's possible the corporation would have set up some kind of pay-to-play situation. Some of the cost would probably go to maintaining the play structures but some of the cost would also go the owners (or management) of the corporation as "profits".

The essence of capitalism is that some people get paid for doing work and other people get paid for owning "capital" - that's right, some people get paid for doing nothing other than being rich. So, who gets paid for owning the land the park is on? If the land is owned privately, then whoever owns the land gets paid for doing nothing other than owning the land. If the land is owned publicly then no one really gets paid, per se, but people who use the park don't have to pay some rich person for doing nothing other than owing the land.

I stopped at McDonalds with my niece a couple weeks ago... if you haven't heard of them, they're a huge multi-national corporation (and I happen to own no stock in them, so I have no ownership claim). Get this, they had a play area complete with slides, video games, etc and I didn't have to pay a thing for my neice to use it. There wasn't even an evil overlord there demanding that I buy some food to use it.

Private ownership doesn't mean you have to pay some evil capitalist to use their property. Some of those evil bastards may allow free usage to garner some good will or simply out of charity. The key is, they do it of their own free will without forcing anyone else to pay for it.

Contrast that to the government... Back about a decade ago, my town wanted to buy "the last undeveloped piece of land" on our lake. It went up for a referendum and the people of the town voted it down. The town board turned around and bought it anyway, at an even higher price, against the will of the people, and then promptly developed it, killing that whole notion of it being the only undeveloped piece of property on the lake and also contradicting the will of the people. Thousands of people that said no were forced to pay for something they didn't want and yet it only benefits a handful of people (they turned it into a half assed flower garden right next to another park four times its size and virtually nobody goes over there unless they're using it for a wedding). Oh, and the town board put in memorials dedicated to their friends and family (might not be a private residence, but I'd say the memorials are an exclusive benefit of the politicians).

You most certainly do have to pay for that park even if they don't charge an entrance fee. One way or another, depending on where you live, you pay a tax to finance that park. In my case, I paid $422 for my portion of that park that nobody wanted just to buy it... and then another $100 or so to develop it. And then there's another amount I pay every year to maintain it (I don't know the budget line on that off the top of my head, but we'll call it another $20 a year). How exactly is that free?

So which is the more equitable system for the little guy, being forced to pay for something they clearly didn't want (in conjunction with a majority of their neighbors) through government monopolization or being allowed to use something for free because of the generosity of a capitalist? Not all capitalists are so generous, but just because the government owns something doesn't mean you aren't paying for it... and you have virtually no choice in the matter, so I'd say the government isn't all that generous either. But at least with the capitalist, I have an actual choice in the matter.

Re:Criticisms and a Better plan

[tyrr]

The problem with your response is that you have no knowledge of the economic and legal concept called public goods. Look it up. Public ownership and public property in fact exists in order to provide benefits that are non-rivaled and non-excludable.

Health services should be just that non-rivaled and non-excludable. If you turn health care, or heath insurance for that matter, into a profit-seeking growth industry you get just what you have in the United States - expensive and tremendously inefficient system. It may be a novel concept to you, but in many cases government can actually create a more efficient enterprise then the private industry.

Re:Criticisms and a Better plan

[imamac]

That's great for a data/transmission standard, but another big problem is proprietary databases. Every application has it's own "under-the-hood" storage structure. Imagine if there was a standardized database structure, don't you think that would go a long way towards better interoperability and communication?

Re:Criticisms and a Better plan

[californication]

HL7 isn't a standardized format to store medical information, but rather to transfer medical information from one system to the next. Private companies and medical centers still have to configure their systems to spit out the HL7 from their proprietary data structures and databases so it can be transferred to/from their systems. It's also a very loosely defined standard, purposely so that it allows the people developing the applications as much flexibility as possible.

Re:Criticisms and a Better plan

[ColdWetDog]

Have you ever seen a medical record from one vendor successfully brought into to another vendor's EHR? I'd like to believe that it's really being done at this point in time, but I've never actually seen this behavior in the wild....

Re:Criticisms and a Better plan

[Anonymous Coward]

Get this, they had a play area complete with slides, video games, etc and I didn't have to pay a thing for my neice to use it. There wasn't even an evil overlord there demanding that I buy some food to use it.

My understanding was that the play areas at fast food restaurants were only for paying customers: if you didn't buy food, technically you were trespassing on private property. But maybe I'm misinformed; do you have a link to the McDonalds website where they indicate that their play areas are available to the general public (who don't buy food)?

You most certainly do have to pay for that park even if they don't charge an entrance fee. One way or another, depending on where you live, you pay a tax to finance that park.

You're kind of missing the point - which was that "capital" (in this case, the land itself) produces value.

But let's look at your point that the actual play structures cost money. OK, fair enough, in a public park these play structures are paid for by tax payers.

But who pays for these structures at McDonalds? The play structures didn't just spring into existence out of thin air. The CEO of McDonalds didn't even build them as a hobby in his spare time. Oh, that's right, they are paid for as increased cost of the food at McDonalds.

People who bought food at McDonalds paid for the play area that your niece was playing in "for free". Did the people who bought food have a choice? Did McDonalds say "How would you like to pay extra for your burger so we can build a play area for some random guy's niece?" Hardly.

So which is the more equitable system for the little guy, being forced to pay for something they clearly didn't want (in conjunction with a majority of their neighbors) through government monopolization or being allowed to use something for free because of the generosity of a capitalist?

When it comes to the Iraq war, I'd agree with you. If Bush's friends in the oil industry wanted the USA to invade Iraq they should have paid for it themselves. In fact, I'd like to see a law that, in the future, the US military will be funded exclusively with private donations.

Re:Criticisms and a Better plan

[falsified]

Meh. That's why people should just go enterprise. =)

Re:Criticisms and a Better plan

[StopKoolaidPoliticsT]

My understanding was that the play areas at fast food restaurants were only for paying customers: if you didn't buy food, technically you were trespassing on private property. But maybe I'm misinformed; do you have a link to the McDonalds website where they indicate that their play areas are available to the general public (who don't buy food)?

We had breakfast, so I did pay... but there wasn't anyone there demanding to see proof of payment to use them. In fact, in the hour that she spent playing on there, no staff came in to check to see if anyone had bought anything. In fact, there were people in there that didn't buy anything.

In McDonald's case, at least this one, the policy is to generate good will and hope that good will translates into increased sales... kinda like advertising, though without going out of their way to annoy you. Other big companies do similar things, like when you're walking through a Sam's Club, BJs, your supermarket, or whatever and they give you a free sample. It's a form of advertising to get you to buy their product. I've gotten the free samples without buying a thing. Yes, when I do buy something, a portion of that goes into providing those freebies, be it a piece of pizza or an hour of play time... but it happens because I choose to buy that item, not because the money was forcibly extracted from my wallet regardless of my willingness to pay.

You're kind of missing the point - which was that "capital" (in this case, the land itself) produces value.

Only so long as that capital is in demand. Raise property taxes too high and the value of the land is diminished. Further, property taxes actually mean that you no longer own the property, you are renting it from the state/county/town. Fail to pay your taxes and they will confiscate your property.

But let's look at your point that the actual play structures cost money. OK, fair enough, in a public park these play structures are paid for by tax payers.

But who pays for these structures at McDonalds? The play structures didn't just spring into existence out of thin air. The CEO of McDonalds didn't even build them as a hobby in his spare time. Oh, that's right, they are paid for as increased cost of the food at McDonalds.

People who bought food at McDonalds paid for the play area that your niece was playing in "for free". Did the people who bought food have a choice? Did McDonalds say "How would you like to pay extra for your burger so we can build a play area for some random guy's niece?" Hardly.

You do have the choice... you can opt to buy food at McDonalds, go across the street to Burger King, stop at the local family owned diner or cook your meal at home. Government removes that choice and forces you to pay against your will for things you absolutely would not support. Your only choices are to move to another government or to accept the repercussions (confiscation of property, jail time for tax evasion, etc).

The town citizenship voted against buying the land, developing it and building a park. The town board did it anyway at an even higher cost than what the taxpayers turned down. Our option to go somewhere else if we didn't want to pay for it (by voting it down and using the existing facillities or our own yards) was outright ignored.

When it comes to the Iraq war, I'd agree with you. If Bush's friends in the oil industry wanted the USA to invade Iraq they should have paid for it themselves. In fact, I'd like to see a law that, in the future, the US military will be funded exclusively with private donations.

So when the government does something YOU don't like, we should have the option. When the government does something I don't like, I have to accept it and say good job?

That's part of why we're supposed to have a weak federal government... because it is too broad of a brush and it is too easy to punish people via government

Re:Criticisms and a Better plan

[jerdenn]

I've seen PHR to EMR interoperability, but very little EMR to EMR. The Social Security Administration is also doing an enormous amount of work to leverage the NHIN to pass CDA content for disability eligibility, but that's a payor/eligibility type relationship, kinda sorta.

RHIOs were supposed to be the "grass roots" mechanism to get this going, but while there have been some marginally successful RHIOs, most of them are funded by grant money. Without a mechanism to monetize this data exchange, there's little incentive (and action) in EMR to EMR interop.

Again, CCHIT and changes to STARK will inject incentives into adoption of this technology, and you'll see a lot of gears turning in this space.

-jd

Re:Criticisms and a Better plan

[jerdenn]

You're only half right. The problem is that HIT vendors are generally well behind the times, slow to innovate and closed and proprietary as all get out. You think MS is bad? You haven't seen highyway robbery until you've seen the shit in a box most HIT vendors push.

While there is certainly long history behind this statement (and some truth), it's not so black and white. Innovation works great when you are landing new client deals - flashy and shiny sells.

However, many clinicians (and dare I say physicians in particular) while normally highly intelligent, are actually very "challenged" users of technology. Changes that are straightforward in the business world are a complete no-go in HIT. Many large healthcare entities will actually draw into contractual language the amount of technical and GUI changes that may occur in a software release or update.

For the most part, it is not vendor resistance to change, but an entire vertical that is very conservative. If it was otherwise, conservative vendors would die very quickly in a Darwinian manner as more responsive companies stepped up to bat.

In short, it's a symbiotic client/vendor relationship that inhibits change.

-jd

Re:Criticisms and a Better plan

[jerdenn]

That's great for a data/transmission standard, but another big problem is proprietary databases. Every application has it's own "under-the-hood" storage structure. Imagine if there was a standardized database structure, don't you think that would go a long way towards better interoperability and communication?

No, I don't think a common data storage schema would promote better interoperability. I think a correct data exchange standard will promote this, and vendors will implement data storage and business logic independently.

The problem is that HL7 v 2.x is too "loose" of a standard. It's not particularly descriptive, and both vendors and healthcare organizations have had to stretch the HL7 protocol in order to make it useful.

HL7 3.0 and the RIM have gone a long way towards fixing many of the problems with 2.x. However, 3.0 is not ratified, and there is not straightforward mapping between 2.x and 3.0. This makes it a challenge for vendors and healthcare organizations to leverage 3.0.

HIT is a conservative, slow moving vertical. We'll see gradual movement towards better interop on the wire, and we'll go from there. The RDBMS (or, in some cases OODBMS) is not the place to tackle this issue.

-jd

Re:Criticisms and a Better plan

[be0wulfe]

Very observant and well put. I completely agree WRT physicians. Let us perhaps try to be fair and say they just want something that a) works without them having to think about it so it b) doesn't distract them from patient care.

The good news is that there are some very nimble new vendors out there that are aggressively solving the integration problem while staying above the fray.

Personally, I think there's room for innovation, it requires at the very least a rethink of the vendor/customer relationship.

Re:Criticisms and a Better plan

[ninjagin]

I agree. You've made a great point. The same could be said for transportation, imho.

Re:Criticisms and a Better plan

[ninjagin]

Can you tie that experience and thought to Healthcare IT for me? Thank you.

Re:Criticisms and a Better plan

[ninjagin]

The BPEL standard languished, there have been a host of other standards that have languished... firewire, USB,XML? It's too long a time to spend on arguing over common ground at the structure level, I think.

I heard the idea of a seperate internet proposed, especially for healthcare traffic, optimized for images and wild DB queries for genes and records and disease information content and pharmacy data... a whole new cloud.

Fantasy? Maybe, but I think bigger companies have a better sense of what's working NOW and an ability to act, over what these smaller companies (and states, maybe) can assess and work on.

The businesses will shift faster than the government will.

Re:Criticisms and a Better plan

[StopKoolaidPoliticsT]

Sure... there's no such thing as free health care and IT isn't going to provide it either. You can bemoan the rich capitalists in the health care industry for making a profit by owning something, but that doesn't mean government would do any better nor that government is the only means which can provide the service.

Under the current state of things, I have the freedom to decide what type of coverage I want, who my doctor will be, etc. Under a government run system, there is a monopoly and that freedom is taken away for everyone but the most wealthy who can afford to buy a better system outside of the one mandated upon the little people. If government wants to take more than I'm willing to pay, I have no choice in the matter. It's nothing short of an abrogation of your freedoms.

Now, where does healthcare IT come into play? Government controlled ownership of the healthcare database infrastructure is a step toward government acquisition of the sector, and is a violation of my Fourth Amendment rights to be secure in my person and papers from an unreasonable search by the government. Government wants to set a standard for intercommunication between health care providers? I'm fine with that, though I think a better measure would be an independent standards body... Government wants to be the standard? That I have a problem with.

There's no such thing as a free park... somewhere, someone is paying for it even if they don't realize it. There's also no such thing as a free health care database, even if the government is running it, and there are huge implications that come along with that. Corporations may be uncaring, but the government, especially the federal government, is no different... and they have a long history of using the information they do control against people they don't like. At least with a private system, I can opt out or create my own insurance (through a HSA) of I'm not satisfied with the other options available to me... not so easy with Uncle Sam or I wouldn't be paying into Social Security right now even though I know it'll be bankrupt before I see a dime from it. Ditto for this "stimulus" package that our grandkids will be paying for because we're too greedy to take responsibility for our own actions. The idea that government spending money creates more jobs and more GDP is just the economic version of perpetual motion.

Re:Criticisms and a Better plan

[Anonymous Coward]

In fact, in the hour that she spent playing on there, no staff came in to check to see if anyone had bought anything. In fact, there were people in there that didn't buy anything.

You do realize that in certain (urban) areas, the vast majority of people can't afford houses with yards? Are you seriously proposing a society where the only places children have to play are (sneaking into) McDonald's play areas?

You're kind of missing the point - which was that "capital" (in this case, the land itself) produces value.

Only so long as that capital is in demand. Raise property taxes too high and the value of the land is diminished.

No, absolutely wrong! In the standard model of capitalism, capital has inherent value. The land produces value whether it is in demand or not. Some land has more value than other land but the value absolutely does not result from the demand. It's actually (supposed to be - in the absence of a real estate bubble) the other way around: the land is in demand because it has inherent value.

The essence of capitalism is that the owners of capital (that is, the rich) get paid just for owning the capital (being rich).

Why work for something when we can have the government get someone else to pay for it for us?

Currently the US government is around 10 trillion in debt. But what if the US government could save up 30 trillion and what if the government could get a 10% real return on investment? That would be 3 trillion per year which would be enough to fund the entire federal government - no more federal income taxes.

Would that be so bad? Not having to pay federal income taxes? What you have to do here is to understand enough about capitalism to recognize not all production is the sole result of labor - in fact, these days labor is a small component of production: most production is the result of capital (e.g. machines and technology)

Re:Criticisms and a Better plan

[Anonymous Coward]

I'm glad I'm strong enough to carry my wife in my arms while running.

Re:Criticisms and a Better plan

[korbin_dallas]

You forgot the BEST part.

YES, Your LIFE does depend on it !!

Millions of lives depend the crap software(as you say) that is being pushed. They are far too many articles describing the multitudes of failures with EMR, and hospital software. Yet the majority of dumbasses really believe this will work. Try this at home. Try to get a copy of your credit report. Is it wrong...super. Now try to FIX it!. Think a credit report applies only to getting a loan? Think again, try to get a new job.

Now think of the same thing, only now your life depends on the errors in your electronic medical records.

 

Re:Criticisms and a Better plan

[Anonymous Coward]

I completely agree, I'm a EDI specialist for a EHR vendor, hence the anonymous post. HL7 v 2.x is a complete joke. "I know Lets create a phone book sized standard that very few people will actually read, but then let's not have anyway to enforce that anyone is actually conforming to the standard." So pretty much any text delimited with a '|' is hl7 in HIT world. Oh and HL7 v3, "hey lets completely abandon everything we have done before, and lets now redo everything, but lets use XML this time. Why XML? I don't know everybody else is using XML for everything so we should too, right." Their drive is to fix the problems with previous HL7 versions with version 3. Which I agree with what they are doing, but not how they are doing it. The real problem is the lack of control of over the standards. I know they are suppose to be open standards, but that doesn't mean lack of control. HL7 needs a certification program, and should have control over the HIT vendors who say there are HL7 compliant. This is not just about HL7 standards, this applies to all of the other standards that HIT systems use for interoperability.

To put the problem in perspective for non HIT terms. This is like a kindergarten class room full of children who all want to play together, but there is no teacher to supervise how they play. So the children just do what they want, where some know how to play correctly, and other bigger kids just run around try to bully the other kids into doing it there way.

Just because something is open, doesn't mean there shouldn't be control on who gets to use it.

What I'm calling for is a HIT standards Police, so we all can play ball together.

Re:Criticisms and a Better plan

[StopKoolaidPoliticsT]

You do realize that in certain (urban) areas, the vast majority of people can't afford houses with yards? Are you seriously proposing a society where the only places children have to play are (sneaking into) McDonald's play areas?

The premise of your original post was that only the government can provide "free" parks. I pointed out that there are privately owned parks which are also free, and that you're forced to pay for those "free" government parks whether or not you want them and regardless if you intend to use them.

The key difference is, we're all forced to pay for your park. Nobody is forced to pay for the park run by the generosity of another individiual. That's something the big government types like you don't grasp unless you're complaining about the government spending money on something YOU don't like, and only in that case, is the government being abusive. Any time you force people to pay for something they don't want against their will, you're being tyrannical. Government is a tool to protect our rights, not to force your beliefs and priorities onto someone else.

The essence of capitalism is that the owners of capital (that is, the rich) get paid just for owning the capital (being rich).

The rich don't make money for simply owning something, they make money for investing their asset. Land left undeveloped doens't make the owner money. In fact, if there are property taxes, undeveloped land COSTS them money, possibly even faster than the land appreciates.

Currently the US government is around 10 trillion in debt. But what if the US government could save up 30 trillion and what if the government could get a 10% real return on investment? That would be 3 trillion per year which would be enough to fund the entire federal government - no more federal income taxes.

The government's debt problem isn't in how much they tax, it's in how much they spend. We've been living beyond our means for decades, spending like drunken sailors in the best of times and doubling down with borrowed money like a gambler chasing lost money in the worst of times. Proposing even more spending and the government taking on more functions will only further drive us into the hole.

Re:Criticisms and a Better plan

[Anonymous Coward]

I read the article.

This is /. what were you thinking...
RTFA, you must be new here.

Re:Criticisms and a Better plan

[Ironica]

And yet, EMRs also *save* lives, by reducing medical errors.

As with nearly all technology implementations, there are multiple dimensions in which things change. When examining security issues with EMRs, people get frightened about the fact that if someone just broke into the system at ONE point, they could get access to EVERYONE's records... which is true. However, that's no different from now, where someone could slip into the chart room (which is usually locked, but doors have to open sometime) and have the same access. The difference is, it's a lot harder to take the data with you, because paper is inherently more burdensome to access and copy than digital records... which is also why electronic charts provide advantages over paper ones.

However, with an electronic chart, you have *greater* security in another way, because you can grant access to only the part of the chart that a particular person needs in order to do their job. Now, there are relatively low-paid employees whose entire job consists of pulling charts, running them to whatever department needs them, duplicating whatever needs to be sent elsewhere, and then re-filing them. Those individuals have NO reason to EVER actually read what's in your chart... but there's no way to prevent them from doing it, either. They can even try not to, and sometimes, they'll accidentally see something. Electronic charts are not nearly as weak on that.

Similarly, while errors can happen in electronic charting that are more difficult in paper charting (such as having the wrong patient record open and not realizing it), there are also errors that can happen in paper charting that are far more difficult in electronic charting, such as misreading someone's notes, losing pages, or losing the entire chart. EMRs often provide what's called "decision support," where the computer system prompts the doctor to ask certain questions or recommend certain lab tests based on what they've included in the symptom summary or physical examination. While it would be catastrophic for a doctor to completely *rely* on the computer system to make all these decisions, human beings are more limited at processing information, and might miss a connection that a computer can check for in less than a second. With a competent and conscientious doctor using the system for support, people can get faster and more accurate diagnoses for their ailments in many cases, especially when they have an unusual problem.

Re:Criticisms and a Better plan

[Ironica]

Meh. That's why people should just go enterprise. =)

"Just going enterprise" doesn't cut it. Sure, you can buy your PM and EMR from the same vendor, and in most cases, that's your best option (even though the PM from one vendor and the EMR from another may meet your needs better, neither company is going to play very nicely, so you'll end up wasting the increased efficiency in mediating the tussle over your data). But your pharmacy is going to be using a different system, and the hospital you have privileges at will be on another system, and your labs have to be able to talk to your system.

If you're using public funding in any way (FQHC, Medicaid, etc.), you're going to have other reporting requirements, such as the LINCS system in California for immunizations. If it's a Federal or State requirement, then chances are you'll find an EMR vendor who has already built support for it or who is willing to, but you'll still pay extra for the interface.

And then, there's the special case where you really, really have good reasons to want to share data across similar care providers. We're in that situation now, with three major clinics on Skid Row operated by three different organizations. Yes, our clients do shop from one to the other... "What's the wait time today? Ok, I'll go around the corner." Yes, they do duplicate services... "My broken leg is *really* hurting today, can I get a refill on my Percocet?" Multiply that x3 and you've made a nice profit on your broken bone. And yes, they do just forget where they're going and what their diagnosis is.

So, we've started a cross-agency registry that our patients can join, so that we can record when they have an encounter at each location (including several non-medical social service agencies). The HIPAA issues have been onerous, but the single biggest obstacle is how much it COSTS to connect our existing electronic systems to this system, which happens to be Open Source. We really had to pick an open system for the registry, because there was no way to fund the licenses for such a huge number of providers. We also didn't *need* the infrastructure of a full EMR for this purpose, so it would have been wasted money even if we could find a way to get it.

But we've got PM systems (and in one case, an EMR) already in place, and the idea of entering every patient a second time into a second system is daunting. so it cost $9,100 to connect our agency's PM system to the registry, and will cost about $10,000 to connect another agency's (our PM vendor did their end for free... the charges were all on the registry end... but for the other agency's, it's about $5000 each side).

"Going enterprise" just isn't feasible for a project like this. We have to have a way to specifically add patients to the registry *after* they've signed consent, so we can't use the same system for general records, since patients need to be able to withhold consent to be added to the cross-agency registry. We're looking at having to set up conduits for any agency that we want adding data on a regular basis, and it's going to be pricey.

Re:Criticisms and a Better plan

[Ironica]

I agree. You've made a great point. The same could be said for transportation, imho.

Which is why we have an interstate system, and large urban areas operate public transit systems, which people can ride for free or at very low cost if they're indigent and/or disabled.

If we had the ability to *buy* medicaid coverage, with premiums that slide based on income, it'd be better coverage, because there would be a financial incentive for it to be better. As it is, I've heard from many folks who have been on medicaid and private insurance that, in many ways, medicaid offers better service.

Re:Criticisms and a Better plan

[Kazoo the Clown]

One question you might ask, is does competition have any role in increasing the effectiveness of the products here? The problem with government mandated open source is there will likely end up being only one to choose from.

Right now the proprietary vendors know their own products well, and have to keep on top of them as regulatory changes are happening all the time that require updates of the software-- much of the money they make in the process is in maintaining their customers with these sorts of things. Now sure, they could do that with open source software, but that would relegate them to support-only organizations rather than support and development organizations unless the developers at the companies work to enhance the open source offering. But if it is mandated not just that open source should be used, but a particular open source package (in a quest for standardization), then in order to make it better by adding features they want, they'd have to get the new features vetted by a monolithic open source and regulatory community, and couldn't opt to fork the source tree for their own enhanced or custom version wanting to provide new features for their customers. All of a sudden, the "freedom" of open source isn't really so "free," the purpose of it becomes "transparency," not "freedom."

On the other hand, if there is a collection of open source offerings to choose from, is an environment that restricts options to these somehow better than one that also allows for proprietary solutions? Not in the "freedom" department, I'd say, possibly only in the "transparency" department.

So the real issue here is transparency-- what we have now is no less free than it would be if open source was mandated in some way, in fact it's more free, I'd say. Then I'd have to ask, just what are the transparency issues we're talking about-- what the vendors *do* with the data? That has little to do with whether or not it's open source or proprietary software, that has to do with how they manage the resultant data. Seems to me that there may be some apples & oranges going on here, but it's not clear-- just what is the transparency problem? We need to identify that clearly first, before we can judge what effect the use of open source or proprietary software has on it, which may in fact turn out to be irrelevant to the issue.

Re:Criticisms and a Better plan

[GargamelSpaceman]

I dunno about the government, but yes, open systems are good while closed ones are bad. That's because closed systems lead to monopolies which bring innovation to a standstill while extracting more money than their software is worth. ( in other words, for less than the money they extract a better alternative could be made available, but nobody will use it because it can't be interoperable with the existing infrastructure since the owners of the monopoly won't open their closed data formats. )

Rather than the government having to break up a health care software monopoly some years down the road due to antitrust, the more enlightened approach is to try and influence the development of that industry in ways that will keep it open. Openness breeds competition, which in the long run is good for everyone. Sure, there may be some great products on the market now which are closed, but once they get a stranglehold on the potential users of such software, the software will cease improving in any way that benefits users, and the price will go up.

Re:Criticisms and a Better plan

[bittmann]

I feel your pain. We are a closely-held corporation (it's for-profit, but the docs own the place so they set the priorities), and we're now looking at commercial EMR software costs in the neighborhood of $12,000/physician to license a system, $2400/physician annual maintenance, plus all of the necessary hardware, etc. The hardware cost is a gimme (obviously), as is the implementation effort, but paying a couple million for software plus 400k/year maintenance stings a bit. Especially when you consider that our current home-brewed EMR is working well enough for us to want to limp along for another 5-7 years while letting the commercial EMR scene shake out a bit, but since our EMR misses a few CCHIT checkboxes, it won't qualify for any federal funding (or avoid the upcoming penalties) that HITECH offers. So, after planning for and funding a 10-year commitment to our current EMR, we're looking at being forced to drop it 4-5 years in just to avoid penalties that didn't exist 3 months ago. Bah.

Re:Criticisms and a Better plan

[Anonymous Coward]

I'm glad I'm strong enough to carry my wife in my arms while running.

That implies you own your wife... I would prefer a wife who stays with me of her own free will, at the very our joint property would be greater than what either of us could carry alone.

Re:Criticisms and a Better plan

[gbjbaanb]

I don't think anyone wants open source applications here - what they really wanted was open systems. Standards, or publically open, defined protocols.

Once you have that, then you *can* have open source as much as anyone wants to create it, but without the open standard, you have no choice in the matter at all.

Just imagine if http protocol was proprietary to Netscape - we'd still be paying to use navigator 4. But, because it was open we can have Firefox and IE, and rubbish browsers like the old NS ones die away pretty rapidly.

So, yes transparency is good, but the word to describe that is usually referred to as 'open standards'

Re:Criticisms and a Better plan

[scientus]

learn something from biology:

"form fallows function"

In any moderately complex system function and form are at least initially tied together. Yes, a standard is really god, but without a reference implementation or a scattered landscape, propritary systems will extend the "standard" until its incompatible so they can easily make it incompatible when they want to. This is the big lesson from the Microsoft world. (Netscape vs Microsoft extensions for example.) Without a open implementation the standards cannot be open.

Not as big of a deal as you might think

[Dr Reducto]

The people building health information sharing networks have taken this into consideration and have designed "translators" for all the health record formats.

I'm peripherally attached to the team working on the first state-wide health information network (in Maryland), so I can tell you a lot of these problems have already been solved long ago

Re:Not as big of a deal as you might think

[DamnStupidElf]

Quick, what's the proper race code to send in PID-10? What about PID-17 (that was a fun one to standardize)? Not to mention the mess with PID-18, PID-2 and PID-3 across disparate systems, and every mind-boggling combination of ways that different systems treat persons, encounters, orders, results, reports, and images.

Basically, the government will have to throw out or severely limit the use of most medical software, and enforce its replacement with something standard if they want to make health information electronically available to any provider. Otherwise the "solution" will be sending PNGs of medical records back and forth.

Re:Not as big of a deal as you might think

[bugs2squash]

wouldn't the government then do better to define a "Lingua Franca" for all medical records. ie, one central standard to which all insurance companies' individual crap should be translatable by, say 2011. And mandate that the insurance companies must handle the translation themselves.

Re:Not as big of a deal as you might think

[VP]

PID-2 has been deprecated for ages.

Re:Not as big of a deal as you might think

[Ironica]

ie, one central standard to which all insurance companies' individual crap should be translatable by, say 2011.

And mandate that the insurance companies must handle the translation themselves.

Why do people keep talking about insurance companies? Their stuff has been computerized forever. TFA and most of the discussion is about medical records in the clinic or hospital setting.

It has to do with insurance only peripherally, in that one of the driving forces behind digitization of medical records is to ease the billing process through better coding of medical procedures and reducing after-the-fact data entry, but being able to do billing from your system in an integrated fashion is a standard feature of all commercial EMR/PM solutions.

Re:Not as big of a deal as you might think

[DragonWriter]

Basically, the government will have to throw out or severely limit the use of most medical software, and enforce its replacement with something standard if they want to make health information electronically available to any provider.

Which is what the government has done (more than once) with existing billing software, by specifying (and then updating) standards for electronic health care claims and related transactions under the HIPAA Transactions and Code Sets rule. (These standards aren't open, but they were for quite some time free-as-in-beer for interested parties to get electronic copies of and use, until the government stopped subsidizing them.)

It makes more sense to do that with medical records, since the benefits of interchangeability are much higher than with billing-related transactions, but it definitely needs to have a suitable lead time and support for transition costs, because you don't want to drive providers out of business with the mandate.

Re:Not as big of a deal as you might think

[Qzukk]

So in other words, it's required in every system older than 5 years, and an error in any system newer?

While reading the blogpost...

[NeutronCowboy]

... I thought for a second that Slashdot had again updated its interface. Then I realized that this is a random internet rant. Really, not much different from a NYT or WSJ rant, but those at least pretend to have outside expert sources.

Yes, I would like Medical institutions to use GPL'ed software. Yes, I'm disappointed that the government still doesn't think that software freedom and dumb pipes are the keys to a networked future. But am I surprised? No, not really.

Re:While reading the blogpost...

[QuantumRiff]

I really don't care who makes/manages the software, as long as the file format, and method's of talking to it are standardized, public, and open.

*blink*

[Anonymous Coward]

Say what? Can someone tell me what language that summary is written in so I can work on getting it translated.

From the poorly written article it sounds like the healthcare industry is sticking with proprietary hardware/software/whatever. Is this really big news in a highly specialized and highly accountable field? (If my code explodes a few records in a database may be lost. If healthcare code/hardware explodes someone literally dies.) Personally, I wouldn't want to take on that kind of responsibility as an open source developer.

Healthcare is full of closed apps

[joeflies]

Healthcare is dominated by application vendors who each make their own megaplatform for healthcare records. Cerner, Meditech, Siemens, et al. are all trying to keep as much of their system closed as possible, and aren't particularly interested in opening it up to third party systems. They don't particularly want open interfaces, their goal is to keep their customer locked in as much as possible.

So the healthcare IT companies get what they want, i.e. a bigger push for electronic records, selling the software they already have.

The stimulas package isn't going to add an open spec for EMR because nobody in the healthcare industry is bringing it up that they want one.

Re:Healthcare is full of closed apps

[californication]

I work for an EMR company and we have been working towards giving customers more freedom of choice, at the customer's request. For example, previously the customer had to purchase software AND hardware from us, now they can purchase the software standalone and bring their own hardware to use. Also, a lot of medical information is available for transfer or synchronization from one system to the next using HL7 interfaces. You can use a third party system to schedule exams and use our system to perform the exams, all the information is synchronized via HL7 interfaces.

You are right on the money that there is currently no demand for an open EMR spec. If customers were asking for it, believe me they would get it, but that's honestly the last thing on their minds. They want more features to reduce the amount of resources (people, time, materials) that they need, thereby saving them money.

Not to mention the fact that forcing all EMR software companies to support a completely new spec in addition to their existing one would cost these companies a lot of money. That's time that could be spent improving the functionality of the existing software.

Re:Healthcare is full of closed apps

[Yvanhoe]

The government does not need to pay money for this. It just need to mandate openess (of standards, for a start). It will save money in the long run.

Re:Healthcare is full of closed apps

[bittmann]

Healthcare is dominated by application vendors who each make their own megaplatform for healthcare records. Cerner, Meditech, Siemens, et al. are all trying to keep as much of their system closed as possible, and aren't particularly interested in opening it up to third party systems. They don't particularly want open interfaces, their goal is to keep their customer locked in as much as possible.

So the healthcare IT companies get what they want, i.e. a bigger push for electronic records, selling the software they already have.

In my experience, you are right on-target with your assertions. In fact, it seems that the "Health Information Technology for Economic and Clinical Health" or HITECH Act (PDF warning) leaves as many questions unanswered as it answers. What we do know: We involved in healthcare have the opportunity to qualify for incentive pay based on "meaningful use" of a "qualified" electronic healtcare record. Unfortunately, what "meaningful use" is, or what "qualifies" an EHR system is conveniently not addressed by the bill. We ASSUME that "qualification" means "certification under specs provided by the Certification Commission for Healthcare Information Technology (CCHIT)"...and that SEEMS to be a fair assumption.

So, what does "certification" under CCHIT consist of? Basically, it seems to be likened to a laundry-list of requirements that are best described as "what the megaplatforms already do". Funny how that works out, until you start looking at the CCHIT decision-makers, e.g. Siemens and NextGen have members on the CCHIT Commission. Allscripts has a member who is a Trustee. And guess what? The Siemens, NextGen and Allscripts products all passed the CCHIT certification without requiring major rework. And other large vendors (e.g. GE, Epic) have representation and input to the CCHIT decision making process. And to add to the pain of trying to avoid one of the "big systems", the CCHIT certification requirements can be punitive for small or one-off vendors...certification costs are start at $35,000 (PDF warning), retesting requires additional payment, and 2-year recertification is mandatory. Not a big problem for a megacorp, but crushing to a small outfit that has written a non-commercial EMR.

What is truly galling, though, is a myopic refusal to realize that yes, there is life outside of a monolithic EMR. Example: In the CCHIT requirements for clinical testing, there are requirements that lay out in annoying detail how e.g. Lab tests must be ordered, tracked, commented upon, and displayed directly in the EMR itself. There is no recognition that there is any other way to accomplish this outside of the EMR. However, for decades -- long before we moved our health records to electronic format -- we used our Practice Management (scheduling, billing, etc.) system to order Lab, to check for duplicate orders, to ensure that referrals exist when required, to enforce insurance eligibility requirements, etc. NONE of which qualifies for ANYTHING under the CCHIT rules -- under those rules, your EMR must do the order, the tracking, the duplicate checking, etc. So - in order to make our EMR comply with these CCHIT requirements, we would have to pull these activities out of our Scheduling system, and force them into an EMR system which does not, and can not, handle all of the insurance- and billing-driven requirements that our Practice Management system easily fulfills. Patient satisfaction, and ultimately Quality, will be negatively impacted by such a move. But we have little choice but to do so under these CCHIT "requirements" if we are to qualify for any of the HITECH incentives (or more to the point -- avoid the penalties that kick in later in the project).

Another thing that gripes me is the way that this inc

Re:Healthcare is full of closed apps

[scottv67]

> For example, previously the customer had to purchase software AND hardware from us, now they can purchase the software standalone and bring their own hardware to use.

Medical software vendors sold packaged hardware and software systems because the profit margin on the hardware was very healthy. I've dealt with scumbags like this in the past. The vendor claimed that their software would be supported *only* on hardware that they've certified. Bullshit.

The days of buying hardware from the software vendor are gone (thank God!).

In days gone by, I used to do a lot of work with VAX and Alpha systems running VMS in healthcare environments. We'd get quotes from the software vendor for new hardware, laugh heartily and then buy the VAX or Alpha hardware (and storage!) from somewhere else at a greatly reduced price.

Re:Healthcare is full of closed apps

[kullnd]

You know, the one thing that cracks me up is the number of times that the "big players", GE mentioned a few times, are brought up as having all this input into CCHIT, when GE themselves has not certified with CCHIT since the 2006 standards. Not sure about the other ones, nor do I have the time to look them up... However, there are plenty of smaller vendors on the CCHIT 2008 certified list...

Re:Healthcare is full of closed apps

[kullnd]

I stand corrected, it does look like they did get around to 2007, around the time that others were working on 2008...

Re:first stimulus

[Anonymous Coward]

You package isn't large enough to stimulate a single female, let alone the economy of a nation of 300+ million people.

OK, help me out here...

[Em Emalb]

Here's the last line of the rant/article:

This time it is no different: 'All Electronic Medical Record software purchased with federal funds must be licensed under the Affero General Public License version 3.' This guarantees the requisite transparency. This needs to be written into the law yesterday to ensure our nations Health IT future is a bright one.

So then, not knowing what the Affero GPL is, I go to wikipedia (yeah, I know, whatever, most of the time Wikipedia is good) to see what the heck this version of the GPL is. Apparently it closes an ASP loophole in the GPL. Anyway, while I'm reading that, I see that one of the authors of the Affero GPL is RMS, the other is Henry Poole. Henry Poole created a company called Affero which apparently "is a service which enables personal ratings and donations to causes on behalf of individuals who freely share with others."

Ok. So the author is upset that the government isn't using Open Source software (I am assuming the Affero.com webpage is free, didn't look) and wants them to...because of security concerns?

Is that it? Because the blog/rant/article reads like an angry rambling rant to me. Not trying to troll, just saying if this guy wants to be taken serious, stop with the "people have been telling me to tone it down" rhetoric. Post the facts, not emotion.

Re:first stimulus

[weirdcrashingnoises]

but chuck norris can.

Try A Different Pot Of Money

[damn_registrars]

The National Institutes of Health just announced the NIH Challenge Grants that is used for doling out stimulus money to small projects. In it they identified several high-priority topics, which if you look through, you will find includes Information Technology for Processing Health Care Data.

So there certainly is money available for this type of work. And for those not familiar with grant funding by the US government, the NIH is the single largest grant provider for the life science in the US.

Before and after:

[Anonymous Coward]

Before: ZOMG a Stimulus bill shouldn't have any healthcare provisions in it, what the hell are you thinking?

After: ZOMG this stimulus bill didn't have any healthcare provisions in it, what the hell were you thinking?

Seriously, make up your damned minds.

Not entirely true

[Dishwasha]

At least down here in Texas, any grant money funded through DSHS as well as HRSA at the federal level have specific sections that state that any system proposed that makes use of the VistA system will receive higher consideration to getting funded above any proprietary solution. Unfortunately the available solutions are still very high risk and many hospitals and other healthcare entities really don't like the look and feel when compared against proprietary browser-based systems.

What, are you nuts

[bugs2squash]

Unemployment would quadruple overnight if 90% of the "Medical" staff at a hospital were no longer needed to do paperwork for the insurance companies.

Hell no, make more paperwork not less, the country needs jobs.

Re:What, are you nuts

[An Onerous Coward]

:)

I know you're only half serious. But in the short term, the number of people employed by the changeover to the new records systems is going to dramatically outweigh the number of people that the new systems make unnecessary. It's only once the systems start coming online that the carnage begins.

Re:What, are you nuts

[Anonymous Coward]

Stop saying that. People don't think you're just being facetious.

Re:What, are you nuts

[Ironica]

Unemployment would quadruple overnight if 90% of the "Medical" staff at a hospital were no longer needed to do paperwork for the insurance companies.

Hell no, make more paperwork not less, the country needs jobs.

EMR solutions don't touch the medical billing side of things; that's been computerized forever (and is still hugely overburdensome).

However, once paper charts go out of style (a practice typically continues to pull and use paper charts for at least a year after switching on an EMR), the people whose job it is to pull, file, and fetch charts will be out of those jobs.

OTOH, the total amount of money spent on things is unchanged (or higher), because now you're paying for people to update and maintain the computerized system. You can't retrain the same people for those jobs, though, and probably there aren't as many of them... but each one is higher paid.

deja vu!

[Anonymous Coward]

It sounds like we struggle with the same issues up here in Canada that you do. The main obstacle is rarely technology, and commonly politics.

Please, get the government OUT of healthcare

[Anonymous Coward]

Do you really think government bureaucrats making decisions about your LIFE is an improvement?

Health care is NOT and CAN NOT be free since it is so resource intensive. SOMEONE MUST PAY FOR IT! And since someone must pay for it and health care resources aren't infinite, ACCESS TO HEALTH CARE MUST BE CONTROLLED IN SOME WAY!!!!

So, why is GOVERNMENT BUREAUCRACY BETTER THAN FREE MARKETS?

I don't see too many USians going to Canada for health care, but there sure are a lot of Canadians fleeing their FREE GOVERNMENT HEALTH CARE for the "evils" of the US system.

Re:Please, get the government OUT of healthcare

[Tanktalus]

As a Canuckian who realises that we already have two- or three-tiered health care already, despite all the politicians who deny it (a base level, like the US's medicare, but a bit more pervasive; another level for those who can afford extra health insurance above that; and yet another level for those who get health insurance from their employer, none of which are unlimited health care options), and can't imagine a purely government-run system working pretty much at all, I'll just point out the difference for you: it's a matter of who is making the calls on whether the procedure you want/need is covered. In the case of publicly-funded health care, it's the bureaucracy who calls the shots: people who are beholden only to their next level of management, and the overall budget they've been assigned by the government. An arbitrary line is drawn that weighs cost and perceived lifespan should the procedure be done, and if you fall on the bad side of the line, you're denied with basically no recourse.

In the case of private, for-profit health care, there is an obvious bias toward profitability. It's a delicate line to toe, because if you make an obviously bad decision, you'll end up in court and lose all the profit and then some from that customer, and you'll also get bad PR, which hurts profitability. The former is easier to deal with (bury the plaintiff with your corporate lawyers), but the latter can be a bit more difficult with plaintiffs that show a backbone. Of course, there's the obvious way around both: deny every claim to start with, and pay out all claims that appeal. As long as that doesn't get out, you'll probably pay out next to nothing, with few lawsuits and little in the way of negative PR.

Re:Please, get the government OUT of healthcare

[Dr_Barnowl]

Isn't it the other way round? Don't Americans by the thousand drive across the border to get their drugs from Canadian pharmacies?

The bureaucracy of the American system is much, much higher than that of the UK NHS (which is no model of streamlined elegance). Just looking at the messaging protocols for the IT systems will tell you that. We don't have to implement half the messages because they relate to billing.

On top of that, the US system is treated as a for-profit endeavour. I'm told that a 15% profit margin is considered to be at the low end.

In the UK we spend only 40% per head what the US does, yet we have universal coverage, flat-rate prescription costs, and no co-pay. Access to treament is based on what is cost effective within the NHS budget, not which loophole your policy manager can use to yank the rug out from under you.

I'd much rather be ill here in the UK, especially if I was poor, than in the USA.

Re:Please, get the government OUT of healthcare

[HornWumpus]

Frugal Americans buy their meds from Canada. The Canadian system got very good prices by threatening to steal the drugs (ignore the patents) unless they got them at cost. Same as your national health system did. 'It's good to be a sovereign nation.'

Rich Canadians get health care in the US as they avoid the wait and/or denial that comes from government funded care. (You have that too, Your super rich come to the USA as well.)

One question: Where would you like to be if you were a 60+ year old that needed a kidney transplant?

Re:Please, get the government OUT of healthcare

[smoker2]

One question: Where would you like to be if you were a 60+ year old that needed a kidney transplant?

Rich, anywhere. If you are not rich then the UK is better than the US.

Re:Please, get the government OUT of healthcare

[HornWumpus]

Unless you fall into one of the categories that the English national health has decided is not worth treating. (like over 60 needing a kidney)

If you are employed and/or insured then the US is better then the UK.

Granting it can be hard to get treatment from the insurance company, it is impossible to get from the government once they decide the answer is no.

If insurance companies went too far everybody would take their business elsewhere.

What did you do when the nation health went too far?

Re:Please, get the government OUT of healthcare

[Ironica]

One question: Where would you like to be if you were a 60+ year old that needed a kidney transplant?

At the top of the transplant list. But at 60 years old, I'm going to get deferred for younger, healthier people better able to tolerate surgery and with more years of life left. I may luck out, though, and a kidney may come along that matches me better than those younger, healthier people above me.

If I'm in the US, I may be able to bribe my way up the list or to buy a kidney from Asia, *if* I have the money. Of course, if I have that kind of money, it doesn't matter where I am, I can go where there's a kidney for me.

Re:Please, get the government OUT of healthcare

[hawkfish]

If insurance companies went too far everybody would take their business elsewhere.

And where exactly would that be? I ask because they have already done that, yet no magical solution seems to have appeared. But maybe we should all just go back to Linus' pumpkin patch and keep waiting...

What did you do when the nation health went too far?

Um, the ballot box?

Health care reform and payment is the real issue.

[Samschnooks]

He brought up some interesting points. But the real problem with health care in this country has to do with the payment system. Here's an example on how to do it well: I don't know about your dentist, but mine informs me about costs upfront. I know how much something will cost and I can make the decision, based on his or another dentist's advice, on what to do and how to spend my money - which includes what my dental insurance eventually pays because I am the one paying the premiums after all and I am the one paying the co-pay.

Medical care, on the other hand, has an obfuscated price structure. Do you want to know how much something will cost? You can't find out. There's a price for the insurance company which is a trade secret, a cost for cash paying customers, and another cost for government. What really pisses me off is that there's a price to pay in cash, assuming the doctor won't cut you a discount, is MORE than the insurance price! The insurer will take their sweet ass time to pay the doc (I've seen over a year!) and yet, if I pay NOW, it costs more! I tell you doctors are pretty stupid when it comes to business!

Do you know who the true customer is? The one who pays. That's right! The insurance company is the REAL customer! They're the ones that the docs answer to: not us. That's why health care is so over the top! And the other thing is keeping folks alive for another month or so. My wife had an 89 year old patient who had a heart valve replaced. The doc who did it said that the patient will be gone in a couple of months because he was too old to handle the surgery - at a cost of tens of thousands of dollars to the tax payer. Why are we spending so much money keeping people who should be dead alive for a couple of more months? I'm not suggesting a Soylent Green scenario, but we have to face the facts of life that we can't live forever. Sure the doc could be wrong and that old guy could live to 100, but the odds are, he'll be gone and our health care costs continue to spiral out of control. I'm sorry for being callous, but I have a real problem with spending thousands and thousands of dollars on people who should be dead: they're too old, they lived hard (smoked, drank, fucked everything in sight, etc...)

Nope, IT is not going to help anything. We, as a society really need to reevaluate our priorities and and how we pay for our care.

Re:first stimulus

[Tanktalus]

Chuck Norris doesn't need to stimulate the economy of a nation of 300+ million people. He just stands there and the economy stimulates ... er, nevermind.

Health IT making right steps

[wally40]

Being someone that works in health IT, things are going in the right direction, much to what this article says. There are certifications for the software that state to be certified, compatibility must be included in the software including HL7 (Standards for electronic interchange of clinical, financial, and administrative information among health care oriented computer systems) www.hl7.org. The main certification for the software is CCHIT www.cchit.org. Our clinic has been on an EHR (which is CCHIT certified) for over 4 years. It began as proprietary software, but now with a little help from the software vendor, works very well. I will agree most started out not wanting to share data, but that was only because sharing the data was not a thought back when EHR's were started. PS - Just my opinion, most are now called EHR, Electronic Health Records. :)

Re:Given that nobody read the bill...

[Tanktalus]

Not that I'm particularly a fan of Democrats, and in fact prefer the Repubs on almost (not quite) every issue, but I suspect that if you just scratch "Democrat" from both occurrences in your post, you'd probably still be right.

Re:Health care reform and payment is the real issu

[be0wulfe]

I agree and disagree with you! :)

You are SO right that the whole BUSINESS of healthcare is rotten because of exactly the picture you drew - well drawn.

However, I also disagree that IT is not going to help anything! Quite the contrary, IT, BETTER IT, will definitely help Healthcare out of the stoneage that it's at. When you can integrate better you can complete better. Offerings like carol.com are the tip of the coming iceberg unless the Obama Stimulus melts them. IT can certainly help bring transparency, cost-savings and competitiveness, but not alone no.

Privacy protections are lagging

[Anonymous Coward]

The privacy laws aren't anywhere close to where they need to be before this step is taken. Your data is going to be stolen/lost and resold. It is only a matter of time until it ends up in the hands of off-shore brokers who are beyond the reach of US "regulators".

With all of this information sharing, where is the protection for pre-existing conditions? People who have paid insurance their entire lives, then change jobs or move out of state and are denied coverage. Maybe because they simply forgot to disclose some conversation or question they asked their doctor. Humana applications go back FIVE years and they want to know everything you've ever discussed or asked your doctor about.

It is too easy for insurers to deny coverage in order to pump up quarterly profits.

Those issues need to be solved... along with the issue of who owns "my" personal information.

Re:Privacy protections are lagging

[Logic Worshiper]

The protection for pre-existing conditions was gone long ago. We have to fix the medical system, not the medical information system.

Re:Privacy protections are lagging

[Ironica]

The privacy laws aren't anywhere close to where they need to be before this step is taken. Your data is going to be stolen/lost and resold.

That *is* illegal... extremely so. What laws do you propose that would somehow make it impossible?

It is only a matter of time until it ends up in the hands of off-shore brokers who are beyond the reach of US "regulators".

The only way in which electronic health records are less secure than paper records is that they are easier to duplicate and carry. Paper records are more difficult to secure, because by necessity you have to give complete access to low-rung clerical staff, who pull, file, and run charts from one place to another. There is no effective way to log their activities, either; if something turns up where it shouldn't be, you have no way of knowing who did it.

Meaningless rant

[zuperduperman]

I read all the way through this looking for a single line of content and found none. The author seems to be demanding that it be legislated that all health IT software be licensed under some obscure variant of the GPL that he personally favors. Regardless of what you think about Free software this point of view is completely bananas and makes no sense whatsoever.

IMHO, the only action the government actually needs to take is to mandate consumer access to health records in a standard format. It matters not which format or how good or bad it is. The minute universal access to health records is guaranteed in a fixed format there will be a health IT boom like never seen before as every existing and thousands of new companies spring up to support it, not to mention hundreds of open source offerings. The only thing the government should fund is an open source reference implementation that will kick things off and set a baseline for others to follow.

Re:Meaningless rant

[Boomerang Fish]

And a minute later, some software company is "extending" the format because it doesn't let them include data from Blah in the format of BlahBlah usable by their blahblahblah equipment...

Standards are great, but a federally mandated standard is sure way to stifle innovation because it makes it difficult if not illegal to exceed the standard.

I've yet to go to a hospital and have them tell me the information sent to them from my previous doctor is unusable and they have to redo all my tests and throw out my previous medical history... otoh I'll admit I haven't had to go in often, so I can't comment on how big of a problem this might be... but I'll bet that for most of us, it isn't.

Standards evolve because they help the industry... if they haven't evolved, isn't it possible that the industry won't benefit from them? I mean I like a good industrial conspiracy as much as the next guy... but sometimes they're just a good bed time story...

--
I drank what?

Re:Meaningless rant

[Logic Worshiper]

The standard should be changeable to fit the circumstances, but any change to the standard should have to made on GPL, so others can read and modify the new standard.

Thomas Jefferson disagrees with you

[jeko]

Now, the reason, though, that he gives for this is that a private corporation owns his data in the present system, but if the government owned, then, somehow, he'd own it more.

That's the crazy thing. There's no such thing as "public ownership".

I visited Washington DC a while back. I stood on the Mall. I stood on the Lincoln Memorial. I own a piece of it. So do you. I ran my fingers down the names on the black Wall, and I knew that my family had bought a piece of it at the cost of blood. I looked up at the top of that giant obelisk and knew that Washington had given me a piece of it. I walked through Arlington. I for damn sure own a piece of that.

Yes, if the government owns it, you absolutely own it more. You own it more because there's a huge difference between being a citizen and being a customer. I own it more because generations of my kin have stood in uniform and fought and bled for it.

If there's truly no such thing as "public ownership," then why is my family pulling on uniforms and strapping on guns to fight for it?

Re:Thomas Jefferson disagrees with you

[HornWumpus]

You don't own any of it.

If you own something then you can sell it.

Try and sell 'your share' of the Washington memorial.

You family protected the nation. The nation government used to mind its own business (courts, national defense, some infrastructure...nothing else) and mostly leave us alone.

You can say you have a stake in the commons, but that is nothing like ownership.

With businesses you can choose which company you deal with. Government pretty much always grants itself a monopoly.

Re:Thomas Jefferson disagrees with you

[Logic and Reason]

I visited Washington DC a while back. I stood on the Mall. I stood on the Lincoln Memorial. I own a piece of it.

Do you? Really? Can you sell your piece of it, or give it away? Can you take your piece somewhere else, or destroy it if you feel like it? If not, you sure have a funny definition of "own".

Re:Thomas Jefferson disagrees with you

[Anonymous Coward]

or give it away?

Yes, you can renounce your citizenship.

More seriously, what do you think happens to the money from selling your radio waves, your oil, and so on? Ideally, that money would be spent by the government as money it would not have to take from you, though in the past few decades of "spend and spend" governments, it would just be extra pocket change on top of the money its extracting from you.

The law may prevent you from selling your citizenship (legally, ask any of the immigrants with your ID how much they paid for your citizenship) but that doesn't make you not an owner.

Re:Thomas Jefferson disagrees with you

[vyrus128]

If you own something then you can sell it.

This right here, ladies and gentlemen. This is the cancer that's killing /b/^H^H^H America.

Re:Thomas Jefferson disagrees with you

[Anonymous Coward]

Flamebait? The guy is telling the truth. Defining human concepts in terms of capitalist commerce is one of the ways in which America has been reduced to a simplistic producer/consumer system with no values other than the economic.

Re:Thomas Jefferson disagrees with you

[perrin]

"If you own something then you can sell it."

There are lots of things you can own, but not sell. Some things you can only sell under certain very limited circumstances, other things not at all. There is an infinite variety of property arrangements, and trying to define property to be just one, simple (ideologically loaded I guess) concept is meaningless. Try reading a book about the philosophy of law and property one day. You might learn something.

LOL, right he's simple minded.

[HornWumpus]

But you believe Obama really cares about helping poor people.

Simpleton.

Re:LOL, right he's simple minded.

[Anonymous Coward]

Since when is trolling considered Informative?

Re:LOL, right he's simple minded.

[HornWumpus]

It's only a troll to you because you are in denial.

Re:LOL, right he's simple minded.

[An Onerous Coward]

Would you like to lay out your alternative theory in detail?

Re:LOL, right he's simple minded.

[HornWumpus]

Obama likes power.

He knows which side his bread is buttered on and will serve his masters (none are poor) in order to be re-elected.

Same as all politicians.

Solutions, bit by bite

[josefrederick]

Ever thought of capturing data already generated by most of us who exercise? Why? To create a health platform with already existing technologies and allow those in better shape to pay lower insurance premiums, if any. This implies sharing information which yes, can be sensitive, but with proper regulation from Congress should not go astray. I am actually doing this experiment in (not the USA) but Spain, and of course I get NO support from insurance companies so far because as you all agree they have no interest in innovating given they have hoarded cash for decades without any questioning from the general public. But, slowly bite after bite I am creating a database that will be open and available to all insurance coÂs that will then have to lower premiums to thos e who are healthy or otherwise they loose the client. No need to invent anything today. Just apply what we have, which is far too much in terms of IT and R&D in this HIT world. ;-)

Dr. Valdes, ...

[ninjagin]

It sounds like you're being ignored because you're coming off as bombastic and shrill.

I have no doubt that you feel passionately about patient care, open source software, open standards, EMR and the range of other issues that come into play, but I also get the sense that you're unlikely to change your position or find a middle path, given that large healthcare companies already occupy a lot of the thought-space. As I listen to you, I get the sense that you see the pool as having already been peed in, and made unfit for you at the outset.

First: Open source software is great for some things, but when it doesn't work, you have nobody to sue.

As for the assertion that healthcare IT companies get their certifications because they have "purchasing power", I fear you are misled. Getting your software to meet the certification requirements, and doing that safely, securely, and in such a way that privacy is assured, is a very long and complex process that takes hundreds of thousands of engineering hours over the course of YEARS. It doesn't come by writing some check. There's a lot of hard work, and a lot of testing and evaluation that takes place. Only the big players have the resources to do that, and do it quickly, admittedly.

The notion that performance can only be judged by having non-proprietary EMR is also a red herring. Clinicians and administrators are able to gather and assess their own metrics to ascertain the quality of adoption and performance. Granted, open (and secure!) EMR standards are desirable and we're not there yet, but the lack of open standards at this time is no direct impediment to assessing performance of Healthcare IT at the hospitals, clinics and offices where it is being used.

I hope that you continue to shake things up, and I have a feeling that you will.

The point of the system: Ammo against your enemies

[Anonymous Coward]

The point of digitizing your health records is not to "lower costs" the point is to maintain a record of your political enemy's health issues.

Take a look at the "leaks" of the taxes, etc. of Joe the Plumber once he became a political liability.
Or take a look at how often political candidates "sealed" divorce papers are leaked to the press.
I believe there is an instance of the ex-husband of 7 of 9's divorce records becoming "oops, unsealed". Allowing a certain candidate to run unopposed.

What this will mean is that when you (or someone else) runs for office, your medical history will be leaked to the press.
"Oh, Candidate X, I see you took anti-depression medicine after your divorce."
"Oh, Candidate Y, I see you got treated for an STD in college."

  The purpose of the digitized medical records is to provide an automated muck-racking system for people who run against the favored party.

The TFA doesn't seem to have noticed...

[Ironica]

Page 488 of the ARRA:

(b) STUDY AND REPORT ON AVAILABILITY OF OPEN SOURCE HEALTH INFORMATION TECHNOLOGY SYSTEMS.
(1) STUDY.
(A) IN GENERAL. - The Secretary of Health and Human Services shall, in consultation with the Under Secretary for Health of the Veterans Health Administration, the Director of the Indian Health Service, the Secretary of Defense, the Director of the Agency for Healthcare Research and Quality, the Administrator of the Health Resources and Services Administration, and the Chairman of the Federal Communications Commission, conduct a study on -
(i) the current availability of open source health information technology systems to Federal safety net providers (including small, rural providers);
(ii) the total cost of ownership of such systems in comparison to the cost of proprietary commercial products available;
(iii) the ability of such systems to respond to the needs of, and be applied to, various populations (including children and disabled individuals); and
(iv) the capacity of such systems to facilitate interoperability.
(B) CONSIDERATIONS. - In conducting the study under subparagraph (A), the Secretary of Health and Human Services shall take into account the circumstances of smaller health care providers, health care providers located in rural or other medically underserved areas, and safety net providers that deliver a significant level of health care to uninsured individuals, Medicaid beneficiaries, SCHIP beneficiaries, and other vulnerable individuals.
(2) REPORT. - Not later than October 1, 2010, the Secretary of Health and Human Services shall submit to Congress a report on the findings and the conclusions of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.

I'm planning on using this to justify why we're applying for ARHQ research funding for implementation of a non-CCHIT certified product... we're just trying to help them research open source options. ;-)

$30 billion

[Anonymous Coward]

"...the nation will spend $30 billion on Health IT..."

Couldn't people just make medical reports with vi and latex? That would be cheaper I think.

Re:$30 billion

[Ironica]

"...the nation will spend $30 billion on Health IT..."

Couldn't people just make medical reports with vi and latex? That would be cheaper I think.

Do you have any idea how much it would cost to teach all the doctors to type, though? ;-)

Even the "free text" EHR solutions I've seen have a prompt system that saves folks from doing most of the typing. Which is good, because our Chief Medical Officer still prefers plotting out his schedule on blank paper with a ruler and pencil.

Republicans always talk up the small business.

[FatSean]

See: Joe the Plumber. Republicans often campaign on small business issues.

Democrats? Not so much.

Re:Republicans always talk up the small business.

[Anonymous Coward]

They waved Joe the Plumber around so they could claim to be for the little guy, but did they actually suggest anything that would be in his benefit?

Re:Republicans always talk up the small business.

[Anonymous Coward]

Let's see: Not taxing him out the wazoo....Not destroying the currency with $3T worth of pork spending...Not taking away his choice of health care...Not forcing him to unionize...Letting him be free to do what he feels best for his business, not "we're from the govt and we're here to help....

That enough?

Re:Republicans always talk up the small business.

[Anonymous Coward]

That enough?

That's nice and all, but none of that does jack for Joe until they're for letting the guy practice without a license.

Re:Republicans always talk up the small business.

[Ironica]

Not taking away his choice of health care...

I've never once seen anyone suggest we should take away health care choices... just that we should better fund health care, so that those who have no choices now actually can get some.

I have trouble believing you could prohibit the system of private health care that currently exists. However, if we devise some sort of national insurance program, and the government therefore stops compelling employers to provide benefits to their employees, people will have the choice of the government plan or paying out of pocket for a private health plan (or just to see the doctor of their choice). Funny thing is, when people have to pay for it themselves, they suddenly find it's not nearly so important to them.

Finally... if there's a national health plan, rather than all these siloed practice groups and coverage networks, I'll bet people will have a LOT more doctors to choose from. No more of this "Oh, well, we took your old insurance, but we don't take your new insurance, so you'll have to pay out of pocket or find a different doctor."

Accessed much?

[Anonymous Coward]

"It's all about workflow. The open systems fail to understand this concept."

It's easy to have a failure to understand of something that most don't have access to.

Translation Please?

[thethibs]

This article is not in any dialect of english that I know of. Can anyone out there translate this for us?

HL7? Anyone?

[Anonymous Coward]

Apparently, despite writing for a site dealing with medical technology, and ranting on about the lack of openness in EMR, the author of the article has never heard of HL7. That is, an open ANSI-standard EMR platform that has been around since 2003. Oh, but I'm sure that doesn't relate to the article.

Or would the fact that most medical records HAVE to be in a non-proprietary format since they must be passed between so many systems that are operating in a Hospital. Do you think one single proprietary software application handles all of the different departments, plus billing, plus insurance, plus pharmacy, plus the lab tests and results, etc? Most hospitals use different software to cover each phase and shift data between each application's database, or use HL7 to pass them as messages.
Even the large software applications which handle everything pass data through HL7. I know.. I've worked with many of the top ones.

Re:HL7? Anyone?

[falsified]

We handle everything we make without HL7. But we don't make everything. So we use HL7 to talk to the stuff we don't make. So yeah. There's a standard, everyone who feels like staying in business uses it, and it's not even hard to use. What's the author of the article whining about, anyway?

Re:HL7? Anyone?

[be0wulfe]

Careful there good sir you almost come off as a HIT Vendor sales critter.

HL7 is a best a recommendation. It's entirely inconsistent in implementation.

All hail the extremely abused Z-segment.

Just because everyone in HIT uses HL7 doesn't mean it's either good or a standard.

With all due respect.

If it's made with public money it should be GPL

[Logic Worshiper]

even if making the program was contracted out. The public deserves that kind of accountability, and other corporations deserve the ability to compete they'll only have when it's not a proprietary system.

Open Source medical software in Canada

[kbahey]

I recently got delayed in an airport, and sat next to a Canadian doctor.

The discussion led to what I work with and hence Open Source. He said that doctors in Canada use open source software. So I looked it up and found OSCAR which is indeed open source.

No proprietary lock-in for formats, no vendor lock in, and minimal costs.

Re:Open Source medical software in Canada

[Anonymous Coward]

a Canadian doctor.

The discussion led to what I work with and hence Open Source. He said that doctors in Canada use open source software

Clearly this must be a result of their single-payer healthcare system, which of course is evil, evil, evil socialism in action. We all know that all Canadians are miserable over their system, and they all strive to come across our border for our awesome, awesome, awesome for-profit healthcare system that the rest of the world envies so much.

So obviously, we don't want to become evil, evil, evil socialists like them. Therefore we must make sure that we avoid their evil, evil, evil open source software as well!

Re:Open Source medical software in Canada

[be0wulfe]

Isn't http://www.va.gov/VISTA_MONOGRAPH/ on sourceforge now ... ?

Re:Open Source medical software in Canada

[Ironica]

Fascinating. Great link. I need to send that demo page to a few people in my organization. ;-)

Re:Health care reform and payment is the real issu

[rattaroaz]

>and yet, if I pay NOW, it costs more! I tell you doctors are pretty stupid when it comes to business!

I do not think anyone would disagree with you on this one, but think about why it does cost more to pay cash. I'll give you a hint: many insurances still pay a percentage of billed charges, and any drop in billed charges = a drop in collected charges.

>I'm not suggesting a Soylent Green scenario ...

I think the problem is that, as a society, we have not decided who gets to live and who does not. Life is about probability, and medicine is no different. The real issue is value for the risk. In other words, if my probability of living 3 more days is one out of a million, but it costs me $0, them why not risk everything? Not my money! But what if living another 6 months, cost me $10 million? Is it worth putting several generations of my descendants out on the streets? Maybe, maybe not. Now the next question would be, what is the magic number where value and probability intersect? Once we decide that, as a society, I think we have our answer. No, we will never get the answer, and that is why we are in the mess we are in.

Re:Rewarding Failure

[conureman]

Spasmodic cynicism. I'm sure none of the IT providers benefitting from this are having any trouble at all. And I doubt this will buy us a standardised, open, or interoperable system. I reckon we should just be glad they hustled this through so fast only a scant 8 billion extra went to buy local votes. The failure of which I speak is the overall system inefficiency, which seems to be designed around cash-extraction rather than service. I, for one, would like to move away from systems that have already demonstrated their inability to provide solutions.

Re:Rewarding Failure

[TapeCutter]

I'm not from the US but I understand what the US euphemisticaly calls a health "system" is farked. Your sig seems to describe the overall situation very succinctly.

Meanwhile, WalMart plans to sell MS-based EMR

[Anonymous Coward]

I thought TFA was a bit rabid, like a lot of you.

Then I saw this NYTimes article about how WalMart will be feeding at the stimulus trough by selling a Microsoft-based EMR system.

That's both scary and ironic. The ironic part is how WalMart will continue to not provide health insurance coverage for the poor minions it pays minimum wage to install this stuff.

NEMSIS

[taliesinangelus]

Forget EMR - data is already collected in detail on most EMS runs in the nation. Reference http://www.nemsis.org/

Re:Health care reform and payment is the real issu

[MBGMorden]

What really pisses me off is that there's a price to pay in cash, assuming the doctor won't cut you a discount, is MORE than the insurance price! The insurer will take their sweet ass time to pay the doc (I've seen over a year!) and yet, if I pay NOW, it costs more! I tell you doctors are pretty stupid when it comes to business!

While I have no idea if the practice is universal, my mother works as an insurance coder for a doctor's office and I know for a fact that in all the practices she's ever worked in (3 over the last 15 years), the exact opposite of this has been true. If you have insurance, they'll bill at a higher rate because they know that the insurance will pay up (and sometimes they'll even bill the insurance company for what they can get and so long as they get back a reasonable amount they drop the remaining unpaid portion of the bill rather than charging the patient anymore). If you're paying out of pocket, they'll drop the charges down considerably because they know that an individual has more budget constraints and they're more likely to get paid at all if they keep the cost lower.

Eh, my two cents

[DullJokerman]

I work in the HIT industry, but I don't particularly care for it, so hopefully I'm a mix of informed and unbiased on this one. There are two types of things to consider as "open source" for HIT. The first, which is what most of this is discussing, is the core software package. This being open source wouldn't really work. For one thing, that would _eliminate_ jobs, which is a rather backwards way to write a stimulus package, and a more important issue, the complication level would be such a hindrance. That being said, we're still in the fledgling years of EMR. It would in no way shock me if, say, ten years down the line, some hospital IT worker sits down with some friends and starts an open-source project. It's fairly rare for open-source to precede commercial, as open source projects _tend_ to copy commercial ideas. Even after that, I would doubt that hospitals would go clamoring for the open source. Professionals still tend to use commercial projects over open-source ones. I alluded to two types of open source possible. The second form of open source you could refer to is with EMRs themselves, that being the ability to pass information from one system of proprietary software to a different system, so that that patient care isn't hindered by a patient going to a different hospital for some reason (usually emergency). I can't speak for other companies, but I know mine, which is one of the larger ones, is working on this fairly actively. So, yes, I understand the "open source good company bad" thought, I just don't think it can be universally applied.

Re:The point of the system: Ammo against your enem

[Ironica]

What this will mean is that when you (or someone else) runs for office, your medical history will be leaked to the press.
"Oh, Candidate X, I see you took anti-depression medicine after your divorce."
"Oh, Candidate Y, I see you got treated for an STD in college."

  The purpose of the digitized medical records is to provide an automated muck-racking system for people who run against the favored party.

Yes, I'm so glad this can't happen now. So is Britney Spears.

Paper charts are just as vulnerable as digital records, and moreso in some ways. Get yourself the right kind of lab coat and an ID badge that will pass casual inspection, and you can probably slip into the chart room at most major hospitals. From there, if you have the patient's medical record number (that you saw over the shoulder of the doctor as they walked out of the patient's room), you just pull their chart and use your camera phone to take pictures of all the juicy pages.

The only way in which paper charts are more difficult to access than electronic ones is that they're bulkier and harder to copy. This is a detriment to treatment as well as a "security feature."

Have you ever requested a copy of your medical records? They can charge you a "reasonable fee" for duplication, which can be as much as a couple bucks a page. If your entire chart is 50 pages (and for a condition with a long treatment history, that's totally in gamut), that adds up fast. When records are digital, many clinics routinely hand the patient a copy of the doctor's notes and findings on their way out.