Slashdot Mirror
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."
A little too opinionated in TFS. What news is this post actually trying to tell us?
If you can read this... 01110101 01110010 00100000 01100001 00100000 01100111 01100101 01100101 01101011
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.
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.
This is my sig.
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.
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.
Damn_registrars has no butt-hole. Damn_registrars has no use for a butt-hole.
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.
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.
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.
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.
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?
He put his boots up on the table and made a face. "The sig," he smirked. "You can waste your life in search of the sig."
Would you like to lay out your alternative theory in detail?
You want the truthiness? You can't handle the truthiness!
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. ;-)
Don't you wish your girlfriend was a geek like me?
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.
John McAfee 'It was like that time I hired that Bangkok prostitute; to do my taxes, while I fucked my accountant'
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.
See: Joe the Plumber. Republicans often campaign on small business issues.
Democrats? Not so much.
Blar.
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.
2bits.com, Inc: Drupal, WordPress, and LAMP performance tuning.
Rich, anywhere. If you are not rich then the UK is better than the US.