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Federal Deadline Hobbling eHealth IT Rollout

Posted by Soulskill on from the you-can't-hold-servers-together-with-red-tape dept.

Lucas123 writes "A federal deadline that begins next year and requires hospitals to prove they're meaningfully using electronic health records will lead to technical problems and data errors affecting patient care, say politicians and top IT professionals responsible for the deployments. Physicians and hospitals have until the end of 2011 to receive the maximum federal incentive monies to deploy the technology. If not deployed by 2015, they face penalties through cuts in Medicare reimbursements. 'I think we have nontechnology people making decisions about technology,' said Gregg Veltri, CIO at Denver Health. 'I wonder if anybody understands the reality of IT systems and how complex they are, especially when they're integrated together. You're going to sacrifice quality if you increase the speed [of the rollout].'"

99 comments

  1. Fast, Good, Cheap, pick 2... by RingDev · · Score: 3, Insightful

    Slow, Bad, Expensive, pick 1...

    -Rick

    --
    "Most people in the U.S. wouldn't know they live in a tyrannical state if it walked up and grabbed their junk." - MyFirs
    1. Re:Fast, Good, Cheap, pick 2... by Anonymous Coward · · Score: 0

      Obviously this is just a stall tactic to make it cheap and something else, rather than Fast and Good :-)

    2. Re:Fast, Good, Cheap, pick 2... by ColdWetDog · · Score: 3, Insightful

      Slow, Bad, Expensive, pick 1...

      We're talking about the US Federal Government here. In particular, the CMMS (Center for Medicare and Medicaid Security)

      You get all three.

      --
      Faster! Faster! Faster would be better!
    3. Re:Fast, Good, Cheap, pick 2... by Da_Biz · · Score: 4, Insightful

      We're talking about the US Federal Government here. In particular, the CMMS (Center for Medicare and Medicaid Security). You get all three.

      "Ggovernment is bad" sock puppet, we're talking about private-sector insurance here. CMMS has a fraction of the administrative costs of the private sector. I've worked at private insurance companies: the business processes and technology is frequently appalling.

      Stop chanting the "privatization is good" mantra--some of those who grew up in the Reagan era (such as myself) and were diehard conservatives (such as myself) understand that sometimes, private industry is NOT the answer.

    4. Re:Fast, Good, Cheap, pick 2... by HungryHobo · · Score: 1

      In my experience the private sector can be just as awful as any government department.
      There is a certain amount of selection bias since companies which are really really really bad choke on their own incompetence and fail.(unless they have political connections /and are "too big to fail")
      Government departments are just less inclined to die when they're insanely inefficient and unproductive due to a money supply not based on productivity.

      When it comes to government contracts there's little difference since a company which keels over and dies takes with it all the money it's been paid by the government to do it's job and so we see good money thrown after bad to try to keep the company afloat and from that point on the company is as safe from keeling over due to incompetence as any government department.

      So ya.
      The private sector when working for the government can be every bit as bad if not worse than the government doing it in house.

    5. Re:Fast, Good, Cheap, pick 2... by Attila+Dimedici · · Score: 1

      Slow, Bad, Expensive, pick 1...

      -Rick

      Why? I know lots of companies that do all three very well.

      --
      The truth is that all men having power ought to be mistrusted. James Madison
    6. Re:Fast, Good, Cheap, pick 2... by Da_Biz · · Score: 1

      The private sector when working for the government can be every bit as bad if not worse than the government doing it in house.

      I'm completely in agreement with you here (*cough* KBR *cough*). However, my point was specifically toward comparing and contrasting the performance of CMMS vs. private insurance (i.e., Blue Cross, United Healthcare, etc.).

    7. Re:Fast, Good, Cheap, pick 2... by ColdWetDog · · Score: 2, Interesting

      CMMS may have a fraction of the costs of the private sector, but that isn't even close to the point here. CMMS controls more of the health care dollar than any group in the country - more than most countries combined. They have enormous clout and control and they Make The Rules.

      Fine and well, somebody has to do it and, as you point out, per patient administration costs are lower than most (but not all) private companies.

      But if you have ever worked with anyone from the CMMS or their minions, the Third Party Administrators (contractors that actually do most of the heavy lifting trying to get a bill through the system) you will understand instantly and completely what my original snarky reply was all about.

      Rules that are are logically inconsistent, randomly applied and so voluminous that changing one thing requires ten committees, 4 years and numerous sacrifices of goats, virgins and cases of Diet Coke. This is what IT departments and vendors have to deal with when creating and maintaining EMS / EHR systems. All in an environment of red ink (for most of the smaller hospitals - that's another story for a day when I've doubled up on my blood pressure pills). So no, most hospitals won't make congressionally mandated guidelines for implementation. For one thing, no one will have any idea what the actual guidelines are until six weeks before the deadline. Then they'll change it again.

      And then, your friends, the private insurance sector, has to come on board as well. Right. Hell, Slow, Bad and Expensive would be a best case scenario.

      --
      Faster! Faster! Faster would be better!
    8. Re:Fast, Good, Cheap, pick 2... by bittmann · · Score: 1

      We're talking about the US Federal Government here. In particular, the CMMS (Center for Medicare and Medicaid Security). You get all three.

      "Ggovernment is bad" sock puppet, we're talking about private-sector insurance here.

      "A federal deadline that begins next year and requires hospitals to prove they're meaningfully using electronic health records will lead to technical problems and data errors affecting patient care, say politicians and top IT professionals responsible for the deployments. Physicians and hospitals have until the end of 2011 to receive the maximum federal incentive monies to deploy the technology. If not deployed by 2015, they face penalties through cuts in Medicare reimbursements. 'I think we have nontechnology people making decisions about technology,' said Gregg Veltri, CIO at Denver Health. 'I wonder if anybody understands the reality of IT systems and how complex they are, especially when they're integrated together. You're going to sacrifice quality if you increase the speed [of the rollout].'"

      "Private-sector" applies to this discussion ... exactly how?

    9. Re:Fast, Good, Cheap, pick 2... by Da_Biz · · Score: 1

      Rules that are are logically inconsistent, randomly applied and so voluminous that changing one thing requires ten committees, 4 years and numerous sacrifices of goats, virgins and cases of Diet Coke.

      This is no different than private sector, with their "clinical edits" and other tactics to hope that someone simply doesn't resubmit the claim.

      That said, it's only fair to mention that to try to reduce the claims process to a flowchart would be folly: this would assume that there's one right treatment path for a specific pathology. Human judgement will still need to be involved--and at the very least, CMMS isn't motivated by shareholders to generate profit at the expense of reasonable patient care.

    10. Re:Fast, Good, Cheap, pick 2... by Anonymous Coward · · Score: 0

      I really did not know there were other people like me that thought this way.

      Are you also almost 40, and disillusioned that the current 'republicans' are not fiscally conservative?

    11. Re:Fast, Good, Cheap, pick 2... by NecroPuppy · · Score: 4, Insightful

      Because it's the private sector receiving that money to build an infrastructure that meets the government requirements.

      Or to put it more simply:

      * Government give money to hospital.
      * Hospital supposed to use money to build computing infrastruture that makes medical records / insurance easier to process.
      * Hospital say "five year deadline too fast; we too stupid/bureaucratic to build infrastructure. We need more time so that money can be hidden / wasted / embezzled."

      --
      I like you, Stuart. You're not like everyone else, here, at Slashdot.
    12. Re:Fast, Good, Cheap, pick 2... by jimbolauski · · Score: 1

      It's not that the private sector is good it's just that the public sector is much worse. At least with private sector you get a choice of who bends you over.

      --
      Knowledge = Power
      P= W/t
      t=Money
      Money = Work/Knowledge so the less you know the more you make
    13. Re:Fast, Good, Cheap, pick 2... by Danse · · Score: 2, Insightful

      Republicans haven't been fiscally conservative for decades now. In fact they've actually been worse than Democrats most of the time. Just look at government growth figures. Don't take that as some kind of endorsement of Democrats though, they're usually not fiscally responsible either. The problem is that most of the issues that the government deals with are a lot more complex than can be explained easily to the public. So you can't tell who's lying about any given subject unless you have a pretty intimate knowledge of it.

      While one representative may be telling the truth about how some program is wasting money, he'll also turn around and funnel that money to different interests that support him and tell us how it's such a good thing to do, regardless of the reality of the situation. So we end up with wars of soundbites that one side or the other will win, and ultimately we just end up with a somewhat different mix of irresponsible assholes wasting our money.

      --
      It's not enough to bash in heads, you've got to bash in minds. - Captain Hammer
    14. Re:Fast, Good, Cheap, pick 2... by Hurricane78 · · Score: 1

      Fast, Good, Cheap, pick 2...

      We’re the government. We don’t need any of those. ;)

      --
      Any sufficiently advanced intelligence is indistinguishable from stupidity.
    15. Re:Fast, Good, Cheap, pick 2... by phlamingo · · Score: 1

      Except that, because of our arcane and byzantine tax laws, we really don't have private-sector insurance or health care. It's all tied in to the guvmint one way or another, by regulations and requirements written by bureaucrats and lawyers.

      --
      I had forgotten how much cooler teenagers look when they are smoking. Oh, wait ...
    16. Re:Fast, Good, Cheap, pick 2... by shentino · · Score: 2, Insightful

      The problem with privatization is that it puts corporate profits ahead of the mission.

      And unfortunately people have proven that if they can get away with cheating, they will do it. Look at all the money swallowed by the telecom industry.

      That's one thing I like about government. It might be bureaucracy, but it's about as close to "interest in the common good" as we're ever going to get, seeing as the bureaucrats, at least in theory, still have to answer to the voters that put them in office. With corporations, the "voters" are shareholders who probably don't give two shits about anything except dividends and stock value.

    17. Re:Fast, Good, Cheap, pick 2... by Bourdain · · Score: 1

      Stop chanting the "privatization is good" mantra--some of those who grew up in the Reagan era (such as myself) and were diehard conservatives (such as myself) understand that sometimes, private industry is NOT the answer.

      While on the face your statement makes sense, are these organizations truly private in a classic sense? --> No, these organizations have exceptions from anti-trust law and are also highly regulated. Further, the barriers to entry in this market are huge.

      Contrary to the propaganda spewed by republicans, other first world countries with "socialized" medicine are considerably more "privatized" than our backwards country.

      After all, why is it that in many of these countries, individuals have more choices for insurance than people in the US?

    18. Re:Fast, Good, Cheap, pick 2... by Qzukk · · Score: 1

      Actually, hospitals don't get the money until AFTER they show that they're using electronic records.

      --
      If I have been able to see further than others, it is because I bought a pair of binoculars.
    19. Re:Fast, Good, Cheap, pick 2... by skgstyle · · Score: 1

      A choice? Last time I looked around there was only 1 choice for cable in my town.

    20. Re:Fast, Good, Cheap, pick 2... by coredog64 · · Score: 1

      Medicare has lower administrative costs than private insurers when you compare percentages.
      However, Medicare spends an awful lot per each insured. When you compare the amount of money spent per insured person,
      Medicare doesn't look so great. If you really want to compare, you'd have to break down administrative costs into
      buckets based on whether the costs scale with the number of insured and then compare those.

      I'd also note that many of the costs that a private entity would incur show up on another department's books.
      The IRS estimates their cost of revenue @ .5%. That's covered under admin/general for a private entity, but it's not
      accounted for @ all when Medicare publishes their results. Then there's OPM and GSA.

      My guess is that once you do a true apples to apples comparison, you'd find that there's probably only a difference of
      one or two percentage points between large private insurers and the government.

    21. Re:Fast, Good, Cheap, pick 2... by Thuktun · · Score: 1

      It's "CMS". Somehow the Ms overlap or something.

      http://www.cms.hhs.gov/

    22. Re:Fast, Good, Cheap, pick 2... by Attila+Dimedici · · Score: 1

      That's because the local government gave them a monopoly years ago that no one else was allowed to offer cable service. Now that that monopoly is no longer valid there are only a few cable companies left (the big guys bought up most of the little guys) and none of them offer service near you, so it isn't worth the cost to try and compete in your area.

      --
      The truth is that all men having power ought to be mistrusted. James Madison
    23. Re:Fast, Good, Cheap, pick 2... by rev_sanchez · · Score: 2, Insightful

      From what I've seen with these kinds of projects we tend to start off with a very complicated yet somehow vague mandate. Hospitals spin their wheels trying to become compliant and generally do a poor rush job at the last minute. When this becomes painfully obvious the deadline is extended and everyone eventually does a somewhat adequate job at becoming more or less compliant most of the time.

      In sort it works like every other giant IT project and we're still in phase 1.

      --
      If you didn't come to party don't bother knocking on my door. Prince '1999'
    24. Re:Fast, Good, Cheap, pick 2... by Anonymous Coward · · Score: 0

      Public contract employees are largely lazy overpaid people. When they do something it's over budget and frequently not done properly. Give me any example and time and time again I will prove this to you. Even with profits public works are more wasteful. Some easy examples include US postal service, AMtrack, US Military and so on. Aside from making noise they're pretty useless. Oh yeah the military is in their because of cost/performance ratio.
      They aren’t even more focused as you suggest either.

    25. Re:Fast, Good, Cheap, pick 2... by Da_Biz · · Score: 1

      Medicare has lower administrative costs than private insurers when you compare percentages.
      However, Medicare spends an awful lot per each insured. When you compare the amount of money spent per insured person,
      Medicare doesn't look so great. If you really want to compare, you'd have to break down administrative costs into
      buckets based on whether the costs scale with the number of insured and then compare those.

      Of note: when assessments of per-person costs are performed, it's critical to ensure that similar demographic groups are being comapred.

      I'm not completley sure, but I would bet that the majority of people on Medicare or Medicaid fall into two classes:
      1) Geriatric
      2) Low socioeconomic status/disabled

      These two groups are known for having the highest healthcare resource utilization rates amongst many demographics. Compare this to a 25 y/o IT professional that works out and is well-versed in nutrition.

      Then again, maybe a bad comparison :-)

    26. Re:Fast, Good, Cheap, pick 2... by minion · · Score: 1

      Stop chanting the "privatization is good" mantra--some of those who grew up in the Reagan era (such as myself) and were diehard conservatives (such as myself) understand that sometimes, private industry is NOT the answer.

      Then obviously you are NOT a diehard conservative. In fact, you're like most Republicans that get elected these days - you tell everyone you're a diehard conservative, but your vote betrays your words.

      --

      -- If we don't stand up for our rights, now, there will be no right to stand up for them later.
    27. Re:Fast, Good, Cheap, pick 2... by jon3k · · Score: 1

      Just FYI - It's abbreviated as CMS not CMMS. But I couldn't agree with you more.

  2. Who? by Anonymous Coward · · Score: 0

    ....say politicians and top IT professionals responsible for the deployments.

    I really don't care what a politician's opinion is because:

    1. They're not qualified
    2. They're liars
    3. or they were paid, usually with soft money, to say what they say.

    A prime example of soft money used to bri...lobby Congressmen is rides on corporate jets. It also explains why the airlines and TSA get away with their moronic bullshit.

  3. Does hospital IT work pay well enough? by cryfreedomlove · · Score: 1

    Great software developers entering the field today aspire to work on pop culture technology like Facebook, Google, and CG animated film production. Who does that leave to work on hospital IT? Does hospital IT pay well enough to compete with the sexy IT jobs?

    1. Re:Does hospital IT work pay well enough? by epdp14 · · Score: 1

      As a healthcare IT administrator, I can say that I am paid about the same in healthcare as when I worked for a Fortune 500 manufacturer. As far as developer (which is what the OP was implying by saying Facebook, Google, etc... I don't think the OP meant the companies' sysadmins.) pay goes, I have no idea.

    2. Re:Does hospital IT work pay well enough? by Anonymous Coward · · Score: 0

      well the sexy ones are ultra competitive and can be a gamble when starting out.
      pick your poison

    3. Re:Does hospital IT work pay well enough? by Kjella · · Score: 1

      For some uses yes it's choke full of niche medical equipment and other lucrative business. But if you start talking about standardization and using common tools, then you have to start herding cats. If you ask a doctor to draw the organization chart they are often the senior medical expertize on this area with them on top and the management hierarchy is just the overhead coordinating the medical units. Even with the exchange of skills they aren't working on any true collaboration, most of the time it's one doctor, one patient. It becomes their patients, their way of doing it, their medical records. So along comes this electronic patient journal and everything has to be in this format. You will meet resistance and they have a trump card in pushing medical reasons like poorer data quality and health care in front of their own unwillingness to change. The result is a very fractured health system, we are working on a regional project now and each local hospital have their own system with wildly different versions and access methods and whatnot. Luckily we're not the ones dealing with that mess, but someone is...

      --
      Live today, because you never know what tomorrow brings
    4. Re:Does hospital IT work pay well enough? by cryfreedomlove · · Score: 2, Insightful

      You are making my point for me. Dr's are running everything and programmers are 'overhead'. I think that will keep really great programmers away and that increases the pain associated with healthcare IT development.

    5. Re:Does hospital IT work pay well enough? by ircmaxell · · Score: 1

      When I was looking for a new job a few years ago, I applied to the hospital I worked at for a help desk position. In that company, the help desk was more like a lower level sys admin (You were admin over all non-server computers on site). I was offered the position, but turned it down when I learned the pay. $8 per hour. Considering I was making $19 an hour at the time (at the very same company) doing security, I laughed. From the people I talked to who worked that job, they said it was actually a very good job. The turnover rate was about 9 months, but instead of people quitting, they were usually promoted rather quickly (to full blown sys-admin or other IT positions) with an accompanying salary boost. All IT employees regardless of credentials (except upper management) started in this "help desk" position. While it was an insult to some (or most) of whom applied, there was a big upside. Everyone in IT knew the base system very well, and knew not only the hospital layout, but where all the systems were and how the systems interacted. Is it worth the $8 per hour? Not to me it wasn't...

      --
      If a man isn't willing to take some risk for his opinions, either his opinions are no good or he's no good
    6. Re:Does hospital IT work pay well enough? by RKThoadan · · Score: 1

      Keep in mind that the developers are not generally working for the hospitals, they are working for the software vendors. The vendors are where the real time and resources crunch is. It takes months (sometimes years) to convert a hospital over to a completely new system, and they are likely limited by staff and other resources as to how many hospitals they can bring up at one time. Any individual hospital has plenty of time, but from the vendors perspective it's dozens, possibly hundreds of hospitals they need to get up in a limited timeframe. I have a feeling they'll be hiring lots of developers, implementation managers and others, but it takes time to really get them trained up. Do you want to have the junior implementation manager in charge of your hospitals migration when you're facing a looming federal deadline?

    7. Re:Does hospital IT work pay well enough? by Anonymous Coward · · Score: 0

      not everyone wants to work on pop culture garbage

  4. Politicians playing the King! by Anonymous Coward · · Score: 1, Insightful

    This is the same as the political push for the CFL light bulbs. Non technology people dictating the technology sector. Obama does not have an ounce of knowledge about health care systems, yet thinks he knows everything that should be done. It's a farce.
     
    Side note: Jesus told the people they absolutly did not want a King, yet the people wanted to blindly follow and appointed a King anyway. So, here is your King Obama, shortly to dictate Intel manfucaturing numbers because it effects "the environment".

    1. Re:Politicians playing the King! by hyades1 · · Score: 1

      One of those know-nothing politicians challenged the US to get to the moon in 10 years. The job got done. Of course, insisting that a hospital somehow manage to make the necessary change to electronic record-keeping in 5 years (when anybody with an ounce of sense has known the change was coming for at least that long already) is impossible.

      Give me a break!

      --
      I've calculated my velocity with such exquisite precision that I have no idea where I am.
    2. Re:Politicians playing the King! by Anonymous Coward · · Score: 0

      This is the same as the political push for the CFL light bulbs. Non technology people dictating the technology sector. Obama does not have an ounce of knowledge about health care systems, yet thinks he knows everything that should be done. It's a farce. Side note: Jesus told the people they absolutly did not want a King, yet the people wanted to blindly follow and appointed a King anyway. So, here is your King Obama, shortly to dictate Intel manfucaturing numbers because it effects "the environment".

      Not even a competent troll. Please try harder to amuse us.

    3. Re:Politicians playing the King! by QuantumRiff · · Score: 1

      You are right! The president of the united states actually writes all these rules and bills. Unlike every president before him, that relied on advisers and people with intimate knowledge of subjects, this president does everything himself. Hell, this president even goes one step further, and skips the whole legislative branch of government, and writes, votes, and enacts legislation and policies on his own!

      Seriously, your a trolling idiot.

      Take a basic civics class. Please. I beg you! Or at least do everyone a favor, and stop voting.. (but don't worry, you can keep tea-bagging)

      --

      What are we going to do tonight Brain?
    4. Re:Politicians playing the King! by wintercolby · · Score: 1

      shortly to dictate Intel manfucaturing numbers because it effects "the environment".

      I'm waiting with baited breath. Mr. AC do you know nothing about business, politics, organizations or societies? Ideas guide work, rarely do the people who come up with the ideas, or even the ones that push them get work done. Even more rare is when they do the work themselves. The only idea-men in our economy that actually know how to get work done and come up with the work that needs to be done are the entrepreneurs. The financial incentives (did I forget to mention economics) mentioned in TFA provide more than enough for the market to take care of this. In fact, what we have here is an opportunity for private companies to make a product that does what needs to be done, reliably. Is it not the capitolism espousing party that is typically against Obama's policies that encourages market competition? No small family physician will be able to afford quality one off software, but they'll be able to afford a really well developed commercial solution that's made to address this need. All I want to know is which software firms are out there working to fill this niche and profit?

      STFU unless you have some insight to add to the topic.

      --
      Most ignorance is vincible ignorance. We don't know because we don't want to know. --Aldous Huxley
    5. Re:Politicians playing the King! by wintercolby · · Score: 1

      Mod parent down: Flamebait/Overrated/Troll

      --
      Most ignorance is vincible ignorance. We don't know because we don't want to know. --Aldous Huxley
    6. Re:Politicians playing the King! by cartzworth · · Score: 2, Funny

      I've never understood why people use the "teabagging/teabagger" phrase in a negative context politically. You're insisting I keep teabagging. I will indeed continue to be the one putting my balls on your face. Now go back to the DailyKos.

    7. Re:Politicians playing the King! by jimbolauski · · Score: 1

      Obama does have some sense of health care systems, Michael Obama worked at the University of Chicago Medical Center and pushed the Urban Health Initiative, a patient dumping scheme where "low income" patients were redirected to clinics so beds could be saved for people with insurance. The firm that was hired to sell the Urban Health Initiative is owned by David Axelrod so the Obama administration does have experience.
      Urban Health Initiative

      --
      Knowledge = Power
      P= W/t
      t=Money
      Money = Work/Knowledge so the less you know the more you make
    8. Re:Politicians playing the King! by oatworm · · Score: 1

      Playing devil's advocate here, I'll point out that there's a bit of a difference between a clear goal that's technologically difficult (send people to the moon) and an unclear goal. Electronic record-keeping, at least at first glance, sounds really easy - you create a database, populate it with some tables and some columns, and you go home. Trouble is, practically applying electronic record-keeping isn't anywhere near as cut and dry, especially in a hospital setting. What information do you keep? Heck, what information are you even allowed to keep (HIPAA and so on)? How do you keep the information from walking out the door? How do you guarantee that the right information is getting into the system?

      Technologically, none of this is cutting new ground - it's all just databases with various front-ends. The problem here is that you have a bunch of hospitals and doctors with wildly divergent business methodologies and wildly divergent goals that recently received a mandate and some money from the federal government to become less divergent and nobody is entirely sure how to do that. It's more like a standards debate than a technological issue, and standards debates take a while. To put this into perspective, C++0x will probably take 13 years between initial conception and planning to actual ISO publication, assuming they hold to their "late 2010-early 2011" deadline, and they had to put a feature freeze in place in 2006 in order for that deadline to look even remotely reasonable. Medical IT regulations, meanwhile, are still changing, and nobody can even agree on what goals this initiative is supposed to achieve, much less how anybody is supposed to achieve them. This is why a lot of medical groups are freaking out about the deadline - since nobody's clearly defined what it means to actually meet the deadline, much less how anybody goes about doing that, it's going to be virtually impossible to do so.

      Of course, the flip side here is that the entire reason everybody took federal money on this is because it was such an ill-defined project in the first place - as long as you're doing something that looks vaguely connected, you could say that you're working on becoming "compliant", whatever that might mean at a given point in time, and collect free money for it. That's now looking like a less-wise decision than it did a few years ago.

    9. Re:Politicians playing the King! by Civil_Disobedient · · Score: 1

      Side note: Jesus told the people they absolutly did not want a King, yet the people wanted to blindly follow and appointed a King anyway.

      Side note: Nobody on Slashdot cares about your invisible friends.

    10. Re:Politicians playing the King! by hyades1 · · Score: 1

      Good analysis. I hope you don't mind if I make a couple of observations. First, it should be pretty easy to come up with a basic list of things that need to be tracked at EVERY hospital, then gradually extend the list over time. There's some Palm software for nurses that has the concept on a very simple level.

      For the sake of argument, put blood work first. There's a pretty standard set of tests that are run everywhere when somebody presents with certain symptoms. A second possibility would be standard drug interactions, so that an electronic chart would throw up a flag when one drug was prescribed in combination with another. The data already exist, they just aren't widely available electronically.

      As far as accuracy is concerned, I strongly suspect that things couldn't get much worse. Estimates as high as 180,000 deaths per year due to medical error have been reported, and even conservative figures range from 45,000 - 100,000 deaths per year and about a million injuries. The cost is (again conservatively) estimated at around $5 billion.

      I certainly take your point about unexpected complexity, but I'd ask you to consider that laziness, stupidity, pig-headed obstinacy and inertia go a long way toward explaining why a lot of the data aren't already available for standardization and potential inclusion in a database. As it is, I strongly suspect the biggest bottleneck in the whole process will be keyboarding the dusty, yellowing contents of hundreds of thousands of filing cabinets.

      --
      I've calculated my velocity with such exquisite precision that I have no idea where I am.
  5. Bah... by Wrexs0ul · · Score: 3, Funny

    It's not like anything bad's ever happened when critical systems are rolled-out untested, unprepared, or irresposibly.

    I mean it's not like someone's life is ever put in jeaopardy by minor software glitches, especially in hospitals. ...on a side note, Googling "IT disasters" leads to some very interesting results.

    -Matt

    --
    --- Need web hosting?
    1. Re:Bah... by Anonymous Coward · · Score: 0

      Warning: gzuncompress() [function.gzuncompress]: data error in /home1/firmanco/public_html/itdisasters/wp-includes/http.php on line 1824

      on itdisasters.com sidebar.

  6. On the flip side by Dynedain · · Score: 4, Insightful

    On the other hand, look at the digital TV transition debacle.

    If you don't set a deadline and enforce it, difficult technology implementations tend to drag on forever.

    --
    I'm out of my mind right now, but feel free to leave a message.....
    1. Re:On the flip side by Lucas123 · · Score: 1

      Yeah, but it's not like people were going by pushing out digital television faster. There are already a substantial number of reports indicating drugs are being incorrectly dosed due to system errors related to EHRs.

    2. Re:On the flip side by Danse · · Score: 1

      Yeah, but it's not like people were going by pushing out digital television faster. There are already a substantial number of reports indicating drugs are being incorrectly dosed due to system errors related to EHRs.

      It's not like we don't have tons of human error and problems with lost or incorrect paperwork anyway. Maybe we replace one set of problems with another, but the new tech has the ability to be improved upon constantly, which is how very complex systems tend to be done anyway.

      That said, from what I've read about these EMR systems, they range from pretty horrible to decently good. They take years of work to get the most serious bugs out. How much they actually do to improve patient care varies dramatically from system to system though. I tend to believe the opinions that this stuff isn't going to be ready as soon as they'd like. That's par for the course with these types of systems. That doesn't mean we should have goals though. Without both carrots and sticks being used, the development could drag on forever. If we get to the point where the sticks come into play, they'll have to evaluate the situation again to determine whether the goals were realistic or not, of course.

      --
      It's not enough to bash in heads, you've got to bash in minds. - Captain Hammer
  7. The clear solution... by SOdhner · · Score: 3, Insightful

    The clear solution is to just not put a deadline on it at all. Surely that will result in quality systems, right? I mean, it's not like they can put this off indefinitely... can they? Oh.

    1. Re:The clear solution... by Anonymous Coward · · Score: 0

      If this follows the precedent set by the HIPAA transaction mandate set out, it will be delayed until everyone's pretty much ready. If everyone is not yet ready in 2013 then they'll move the deadline out. I think the 835/837 processing mandate got pushed back at least a couple of years.

  8. Stop Whining by Fantom42 · · Score: 0, Flamebait

    'I think we have nontechnology people making decisions about technology,' said Gregg Veltri, CIO at Denver Health. 'I wonder if anybody understands the reality of IT systems and how complex they are, especially when they're integrated together. You're going to sacrifice quality if you increase the speed [of the rollout].'

    You know what, Gregg? Suck it up. Man up and get your system production ready. I am so tired of excuses from the IT department.

    Maybe I'm being unfair here, but my experience with IT managers is that their development plans look something like this:

    1. Promise the impossible
    2. Get buy-in to develop an expensive system based on (1)
    3. Essentially let people play with themselves until the time is up.
    4. Realize what you have is not even close to (1)
    5. Try to rebaseline the schedule, and GOTO 1.

    Instead of telling us what you can't do, how about telling us what you can do. Meaning what functionality you can deliver (production-ready) by the deadline. Otherwise, you are just whining.

    1. Re:Stop Whining by Attila+Dimedici · · Score: 1

      Or maybe the government should just let healthcare professionals decide how much IT can improve the care they give. Why do we need this government mandated health database?

      --
      The truth is that all men having power ought to be mistrusted. James Madison
    2. Re:Stop Whining by Fantom42 · · Score: 1

      Or maybe the government should just let healthcare professionals decide how much IT can improve the care they give. Why do we need this government mandated health database?

      This is really a nonsequitur to my original point. The fact is the mandate has been given. It doesnt matter if it came from the Government or the CEO. The CIO here is still responsible for making it happen. His claim that it won't be ready may be true, but why not? what fall-back functionality CAN be provided?

      Maybe the CIO should just accept that he's not going to get the MAXIMUM incentive payment the Government is willing to hand out in order to get this done.

    3. Re:Stop Whining by OldeTimeGeek · · Score: 1

      Why do we need this government mandated health database?

      Because if I have a medical problem in New York at night there's almost zero chance of a doctor there knowing that I'm allergic to penicillin-based drugs because that information is only on paper files in my doctor in California's office and he is only available 9-4:30 PST. No, I don't have a Medic-Alert bracelet - I shouldn't need one. That information should be available to emergency personnel anywhere I am at any time and a goverment-mandated database is the only way this is likely to happen.

    4. Re:Stop Whining by Anonymous Coward · · Score: 0

      Maybe I'm being unfair here, but my experience with IT managers is that their development plans look something like this:

      1. Promise the impossible 2. Get buy-in to develop an expensive system based on (1) 3. Essentially let people play with themselves until the time is up. 4. Realize what you have is not even close to (1) 5. Try to rebaseline the schedule, and GOTO 1.

      Instead of telling us what you can't do, how about telling us what you can do. Meaning what functionality you can deliver (production-ready) by the deadline. Otherwise, you are just whining.

      In my experience it's usually management that demands the impossible (with often very vague ideas about what the final product should be), and IT that tells them it won't happen, but are forced to do it anyway. So they have to build the infrastructure to support the vaguely-defined and moving target that they are supposed to deliver, the specifics of which will be determined by management and their proxies once they get to see the initial system. At that point they tell you you got it all wrong and that it doesn't do half the things they wanted but never thought to ask for.

    5. Re:Stop Whining by Anonymous Coward · · Score: 0

      Or maybe the government should just let healthcare professionals decide how much IT can improve the care they give. Why do we need this government mandated health database?

      They are. Medical professionals are driving the development of these systems. Doctors are hardly of one mind on these things though. They tend to have their own working styles and comfort zones. That doesn't mean that that's best for their patients' care though. Especially when those records need to be shared or moved to another doctor or hospital.

    6. Re:Stop Whining by Fantom42 · · Score: 1

      In my experience it's usually management that demands the impossible (with often very vague ideas about what the final product should be), and IT that tells them it won't happen, but are forced to do it anyway.

      This guy is the CIO. He is management.

    7. Re:Stop Whining by Attila+Dimedici · · Score: 1

      That information should be available to emergency personnel anywhere I am at any time and a goverment-mandated database is the only way this is likely to happen.

      So, we should all give up our medical privacy so that you don't have to be inconvenienced by wearing a Medic-Alert bracelet?

      --
      The truth is that all men having power ought to be mistrusted. James Madison
    8. Re:Stop Whining by Anonymous Coward · · Score: 0

      In my experience it's usually management that demands the impossible (with often very vague ideas about what the final product should be), and IT that tells them it won't happen, but are forced to do it anyway.

      This guy is the CIO. He is management.

      Is he the management driving the requirements though, or just the one tasked with carrying out those requirements? I'm thinking it's the latter.

  9. A lot of hospitals already have e-records by alen · · Score: 3, Insightful

    i know people that work in the medical field and a lot of hospitals already have electronic charts. people i know have worked with them for years. going back to 2005 or earlier as far as i can remember.

    I bet this is another case of the leftovers crying about investing money in infrastructure that will save them money in the long run but they see it as an expense and fight it. just like the genius MBA's at Dell and HP who concentrated on volume and tight margins while Apple went the opposite direction. Now Mac sales are growing by double digits, profits are rolling in from boring things like computer sales, the prices compared to higher end Dell/HP computers are comparable on the same specs most of the time, and Apple has a much better brand name. And they don't have Asus and Acer taking away their market share

    1. Re:A lot of hospitals already have e-records by frank_adrian314159 · · Score: 1

      It might also be some of these organizations that have part of their records done electronically, but not all that the government requires or that don't have proper linkages between their clinical and billing systems. There are often separate (and, in merged organizations, several) vendors for scheduling, EMR, lab, prescribing, and billing all working "together" with different amounts of integration.

      --
      That is all.
    2. Re:A lot of hospitals already have e-records by Anonymous Coward · · Score: 0

      The problem is not that they have to have e-records. They have to DOCUMENT that they are used according to standards. Many of the programs do not track use enough to document the flow of data, so even though they are used meaningfully they can't PROVE they are used meaningfully. And that's what makes it sticky.

      I have worked in healthcare IT and am looking at returning to the field, and some of the best-equipped hospitals are still sweating about meeting the standards, because they're not just "have electronic records." They require dozens of programs, working together properly, with a data flow that meets (arbitrary?) standards, and has appropriate logging to demonstrate it in an audit. "Meaningful use" is a higher standard than "have and use." The rules were set so that a large amount of hospitals and practices can't meet the standard, so the reimbursement rates for Medicare drop, helping to balance the budget.

    3. Re:A lot of hospitals already have e-records by Tekfactory · · Score: 1

      Intermountain Healthcare had electronic medical records in the 1980s, used the data gathered from the system to improve their medical practices, improve patient outcomes and reduce costs.

      http://www.longwoods.com/product.php?productid=20146&cat=571&page=1

      Their system was chosen as one of 5 to be studied by a Canadian Quality by Design process improvement team, and one of the 'few small exceptions' in the Congressional Budget Office report that eHealth records don't reduce healthcare costs. The others were the Cleveland Clinic and Mayo clinic.

      What the report should have said is eHealth records by themselves don't reduce healthcare costs. If your system is a mess, taking it digital gives you a digital mess.

      Intermountain was lucky that Dr. Brent James was also a computer geek, now he's pretty much the guru of healthcare improvement. The NYTimes did a couple of stories, one on him, others referencing his work.

      In the Times article, Intermountain mentions they hurt themselves financially by improving their cardiac (or pulmonary?) practice to the tune of about $300k because the patients had fewer complications, they were leaving the hospital earlier costing them x number of days income per patient for the extra recovery time. They made the conscious decision that patient outcomes were more important.

      I have no connection with these folks, just read a lot about them, and care enough to post about them even in an article that's about to fall off the front page.

  10. The Flip Side by 99BottlesOfBeerInMyF · · Score: 4, Interesting

    Clearly there are a lot of people here posting about how the government should not be getting involved and that seems to be the bias of both the article and summary. Allow me to go into some personal experience here though. As someone who has been very ill, lack of standardized medical records and the inability of various hospitals to transfer digital copies of video and images resulted in my spending another month or so of my life in a state I would not wish upon anyone. Right now a very good friend of mine works in healthcare and they have been (I shit you not) writing down patient information on recipe cards as the one and only method of storing drug prescription info. This resulted in, by her count, several hundred patients not getting needed insulin, antipsychotics, and other drugs as a result of numerous ordering errors that were never caught and were impossible to search for. So when people say digitizing medical records in a standard fashion is going to result in problems for patients... well not doing it is resulting in the very same.

    I'm not big on government interference with many parts of our lives, but they are addressing a very real problem and they're doing it with kid gloves. They did not pass regulations requiring hospitals to comply, they just tied federal funding to that compliance and gave the hospitals many years in which to get their shit together. If medical providers have not done so and are rushing about now, that is absolutely not the fault of the feds.

    1. Re:The Flip Side by DucksUnderwater · · Score: 1

      Congress doesn't have the Constitutional authority to directly require this of local hospitals and physicians, so they have to use the end-around of tying it to federal funding. In most cases, this limitation on Congress is probably a good thing.

    2. Re:The Flip Side by 99BottlesOfBeerInMyF · · Score: 1

      Congress doesn't have the Constitutional authority to directly require this of local hospitals and physicians...

      How is it any different that HIPA from constitutional standpoint?

    3. Re:The Flip Side by DucksUnderwater · · Score: 1

      It's probably not much different. From cursory research, it looks like HIPAA has been challenged before and upheld under the Commerce Clause. This may survive a challenge as well, but tying it to federal funding avoids the inevitable litigation over constitutionality.

    4. Re:The Flip Side by caudron · · Score: 1

      I work in healthcare and my opinion here doesn't necessarily reflect my employer's. That disclaimer aside, I feel for you. I sincerely hope your situation has improved. I will offer one counterpoint, though. If your friend's practice couldn't get it together well enough to store prescriptions in Word, Excel, Access, or even Notepad, should we have any hope that they will be able to participate meaningfully in a fully transactionalized data transfer system without error or confusion?

      I don't advocate doing nothing, mind you. I'm very much behind the idea of seeing physicians moving into the 21st century. I just worry that our current method for doing that may be flawed and create more problems than it solved. I could be wrong, though. It's been known to happen. :)

      In any case, sorry to hear you had a bad time of things and I hope we all see general improvements soon.

      --
      -Tom
    5. Re:The Flip Side by 99BottlesOfBeerInMyF · · Score: 1

      If your friend's practice couldn't get it together well enough to store prescriptions in Word, Excel, Access, or even Notepad, should we have any hope that they will be able to participate meaningfully in a fully transactionalized data transfer system without error or confusion?

      Yes, because while the employees will never change without being motivated, the corporate headquarters will mandate change and hire some experts to implement a system if they see both a chunk of change from the feds to more than pay for it and they see a threat to their medicare payment revenue if they don't make the change in the long term. A bunch of aged secretarial types will never upgrade anything on their own. They will, in fact, resist change. When management tells them a new system is being put in, sends them to training, and tells them to use it or they're fired (because money is on the line instead of just people's health) those same secretarial types will grumble but do it.

      I don't advocate doing nothing, mind you. I'm very much behind the idea of seeing physicians moving into the 21st century. I just worry that our current method for doing that may be flawed and create more problems than it solved. I could be wrong, though. It's been known to happen. :)

      The real question is, what do you advocate. Its easy to say a solution is not perfect (none ever is). Do you have a better idea for getting this problem solved?

      In any case, sorry to hear you had a bad time of things and I hope we all see general improvements soon.

      I appreciate the concern. I lived through several years of medical hell that pretty much ruined most of my life. I still have not recovered financially and as a person who had some of the "best" commercial health insurance and hospitals out there, I'm a strong advocate for real reform.

    6. Re:The Flip Side by bittmann · · Score: 1

      I'm not big on government interference with many parts of our lives, but they are addressing a very real problem and they're doing it with kid gloves. They did not pass regulations requiring hospitals to comply, they just tied federal funding to that compliance and gave the hospitals many years in which to get their shit together. If medical providers have not done so and are rushing about now, that is absolutely not the fault of the feds.

      Actually...one of the dirty little secrets here is that the final rule for meeting "meaningful use" still isn't actually final. The "interim final rule" wasn't even available to view until Jan, 2010 (link), comments are accepted through March 15th, and we should have a final rule that we can (hopefully) comply with by the end of this month.

      And: We don't have "many years" to do the install. We have a few years...very few, if we want to actually participate in the government incentives. Have to be installed and in production by late 2011 to qualify for the full incentive. Any delay, and the incentives go down drastically.

      In our case, this whole thing really bites. We have an EMR, fully deployed, and we haven't maintained a paper chart in years. But, because of the definition of "Certified EMR" (which at this point basically means "Must be certified by CCHIT"), we can't qualify for "Meaningful Use" under these proposed rules. So, we have an EMR, we produce escripts, we do online order entry, we can even exchange imaging information (something that this round of certification doesn't require), but because we can't fill in all of the check-boxes in a CCHIT audit, we have to scrap our homegrown EMR and pay millions to replace it with a "certified" alternative. And the government will give us some of that money back if we cram it in fast enough *and* if we are able to show that we meet whatever standards the final rule eventually mandates...all within the next 18-30 months.

      Nice.

      It may not be the fault of the Feds that some providers haven't transitioned to digital records, but the Feds certainly aren't making things very easy, either.

    7. Re:The Flip Side by Anonymous Coward · · Score: 0

      I also have some personal observations as an MD who has been involved in the design and implementation of EMRs (Electronic Medical Records). They definitely CAN be time saving for the clinicians (MDs, NPs, and PAs) but not necessarily. They definitely can reduce medical errors and improve patient care. The problem is misaligned incentives...

      There is no bottom-line incentive to implement an EMR if the cost savings do not (1) Accrue to the hospital or medical practice, and (2) do not pay for the cost of the EMR. Many administrators at hospitals and medical groups see cost savings coming from fewer clerical staff to transcribe clinician notes or transmit test orders to their respective destinations. Instead, the clinician writes (read: types) their note at the time of the visit and also enters all of the orders into the computer. I can tell you that most of us do not like using our time with patients to do this, so we do it later. Leading to an extra hour or two a day in time completing our notes - this leads to a lot of resistance from the clinicians. The administrators do not reduce your appointment load to compensate, as then they would lose their cost-savings as a result of reduced productivity... Speech recognition sometimes is an acceptable alternative, but a missed inaccurate transcription can lead to significant mis-information that is actually counter-productive (and can lead to legal liability problems...)

      Another unintended result (ah yes...) are notes that are overly brief (to avoid too much typing) or "standardized" thru the use of templates, thereby losing a lot of detail and accuracy. Aside from reduced clerical staff, where are the cost savings coming from? If there are shorter hospital stays or fewer redundant tests, this may be to a hospital's favor if the patient is on Medicare, since Medicare pays by diagnosis and not by cost to hospital. But if it is a privately insured patient, the savings accrue to the insurer thru a lower bill... And these large systems cost in the many millions of dollars. No wonder there is not a rush to buy them.... Yes, my patients probably would have better care, but who pays for that and how?

      The other problem is the Babel one - unless we all use the same system (in the office and hospital), it is rare to be able to meaningfully exchange data. Yes, there is an HL7 (Health Level 7) standard for data interchange, but it has tons of problems related to free text fields and fuzzy definitions. I am in the San Francisco Bay area - several hospitals have implemented EPIC (Kaiser, Sutter Health, etc.) - yet the customizations each has made to accommodate their institutional needs has lead to a lack of data exchangability even using the same system!

      Lastly, if you do not make your operations efficient before implementing a computer system, you have just taken an inefficient manual system and substituted an inefficient computer system - yet many practices never look at how things are done prior to implementing a computer system.

      Whew ... my 2 cents... back to my patients.

  11. Upgrading in the middle of a recession by PIPBoy3000 · · Score: 1

    I work in the healthcare industry, though admittedly just on the web side of things. There's been a lot of talk getting our current EMR to the place where we're getting the maximum amount of healthcare dollars. Our healthcare organization is at a pretty good place, far ahead of most organizations. At the same time, we're being asked to do so much with reduced staff due to minimal hiring. I'm not sure we'll really be able to manage it all. There are also a number of non-technical issues, such as getting all the doctors ready for electronic order entry. Cultural issues often drive technology decisions.

    That being said, I think it's a good idea to move people towards using EMRs in healthcare. They're expensive, difficult to maintain, but can produce much improved healthcare. As we often say, the main challenge facing healthcare these days is getting the right information to the right people at the right time. Doing that electronically is the only approach that makes sense.

  12. It's the Fed's money, they don't have to take it. by WilliamBaughman · · Score: 2, Insightful

    Is there something I'm missing? It seems like the deadline is for applying to receive "federal incentive monies" to roll out the new technology. If they're not rolling out the new technology, then they shouldn't be applying for the money. If they are rolling out the technology, then send in the application for free money.

  13. The whole thing is ridiculous. by Anonymous Coward · · Score: 1, Insightful

    First off, only in the health care industry - which is insulated from almost any market pressure - would you have to have the government fund such a basic infrastructural system. All these companies/doctors have to do is sit back, rake in the profits, and wait for the government to improve their basic tools of business for them. It's bullshit - why should I have to pay for this as a taxpayer? Banks seem to have figured out how to do monetary transactions just fine on their own, why couldn't there be a visa of medical records come around? Take a few cents/dollars for a transfer of medical info, get it so ubiquitous that doctors/hospitals are FORCED into using them - Oh, wait, there's no incentive for the doctors/companies to make it easy for individuals to do this - because individuals aren't their customers, Insurance companies are. And why should they care about your medical records being easy to access and transfer?

    Either make them pay for their own systems, or nationalize health care and give me my monies worth. The government owns half the equipment they use through tax breaks/incentives etc. anyways. I shouldn't have to subsidize their extortion and medicine should never have been a 'For Profit' business.

  14. Re:It's the Fed's money, they don't have to take i by ColdWetDog · · Score: 1

    Is there something I'm missing? It seems like the deadline is for applying to receive "federal incentive monies" to roll out the new technology. If they're not rolling out the new technology, then they shouldn't be applying for the money. If they are rolling out the technology, then send in the application for free money.

    Of course your missing something - you're posting on Slashdot...

    The issues within the issue is something like this:

    - Systemic EHR's (ones that do something potentially useful) are very expensive. Very expensive.

    - Most hospital systems, especially smaller ones or public hospitals are doing very poorly financially.

    - Along comes Uncle Sugar dangling a carrot. A nice sweet carrot. But Uncle has lots of sticks, thorns, belts and various other nasty gizmos hidden under the blanket. And he moves the toys randomly. Your job is to get the carrot without getting the various shafts. That's hard because of many reasons. For one, they are pushing a very aggressive timeline. For another it's not really clear what the carrot actually consists of or how strong the string is.

    - So, if you are a small hospital with a limited budget (the people that arguably need the most help), how do you exactly go about doing all this?

    *** Nobody really knows. Makes it hard.

    --
    Faster! Faster! Faster would be better!
  15. Interoperability by Theodore · · Score: 2, Informative

    That's the biggest problem I've seen.
    There's no real e-standard for e-medical records.
    This is mainly from friends with knowledge of Meditech and Epic, some of them from HIMSS level 6 institutions (it only goes to 7).
    The systems might be able to talk to others of the same type (maybe, sometimes they don't), but so far, there's no real "medical record standard" that everyone can read.

    Another added problem is actually DOING the e-record...
    History, documentation, orders, verifying meds,,,
    I've heard of widely varying times for these activities, anywhere from 20 to 60 min. on a new patient, all usually done by the RN on duty, typing away instead of actually attending to the patient directly.
    Speed of completion is usually in relation of the RN's language skills relative to the patient (native english speaking RNs are usually the fastest, bi-lingual eng/spanish are almost always the exact same speed).

    1. Re:Interoperability by Anonymous Coward · · Score: 1, Informative

      In my experience as a healthcare interface (hl7) guy at a small hospital, there are. According to a link in TFA that points to a summary on healthit.hhs.gov :

      The adopted standards rely heavily on existing standards for the interoperability of health information technologies, including those established and/or promoted by Health Level 7, Inc. (HL7), the National Institute of Standards and Technology (NIST), and Integrating the Healthcare Enterprise (IHE). The standards also rely on existing classification and nomenclature systems including SNOMED CT, ICD-9 and 10, X12, LOINC, NCPDP, and RxNorm. These standards were chosen in an attempt to provide a minimum set of transport, content, and vocabulary standards required to drive or enhance the predictability of data exchange when used in EHR technologies, thus driving adoption.

      The Mirth Project is an open source project that has a wonderful product for this already in "Mirth Connect" and is extending it to "Mirth Exchange" to speak externally.

    2. Re:Interoperability by Theodore · · Score: 1

      Mod this guy up, VERY informative.
      The systems named are indeed standards, it's usually the implementation that leaves much to be desired (vendor's fault most of the time).

    3. Re:Interoperability by Anonymous Coward · · Score: 0

      My experience as a developer for billing software for small clinics is that by choosing to standardize on a shitton of proprietary databases for vocabulary, everyone is getting shot in the foot. My doctors refuse to buy new books for ICD/CPT codes, figuring they'll just search the web when a code stops working to see what the AMA shuffled it around to (the process is VERY much like college textbooks: changes for the hell of it just to make everything inconvenient). Or they expect me to pay the AMA's per user fees for the data files and load the whole list into their system for them. For free, of course.

      LOINC appears to be royalty-free as long as nothing is changed, unfortunately nobody actually uses it and because they just number tests incrementally, it is completely unorganized. I'm still trying to figure out SNOMED's licensing but SNOMED is distributed as a piece of a larger database (UMLS) that includes ICD and CPT and a bunch of other proprietary databases again. Looking at the cryptic megalicense for UMLS I THINK I could take the SNOMED part out and load it into a computer system without the others as long as the computer system is in a "member" country of the organization who created it, but I'm not positive. It's also not clear that use of UMLS (or its databases) in non-research commercial products is permitted. NCPDP refers to too many things at once, they publish a standard for pharmacies to bill for dispensing drugs (helpfully called NCPDP) as well as a pharmacy identifier (also helpfully called NCPDP). RxNorm is just fucking expensive, but then again it's the only comprehensive list of medication data around since none of the Big Pharma felt like working together to make databases available so that doctors actually know shit about the medications they're prescribing, so even without the government declaring it to be The Holy Database, everyone pretty much had to pay for it anyway.

    4. Re:Interoperability by zuperduperman · · Score: 1

      These standards sound good as acronyms, but in practice, they are relatively unuseful for conveying clinical information. We basically have a situation where it has been in the vendor's interests for 30 years to build IT systems that are walled gardens. The parts that are standardized are all the low value parts that they know they can lose without reducing lock-in. Even simple things like code sets are mostly licensed with huge fees attached so that there are huge barriers to entry to small players. In reality, getting a full patient record out of one system and into another without data loss is near impossible.

      I wish the feds had funded and mandated an entirely separate medical record format (something like CCR, but released under liberal licensing) that would force everyone to sing the same tune. Instead they've just come out with rather generic "meaningful use" requirements and said the formats are up to the vendors.

    5. Re:Interoperability by gmhowell · · Score: 1

      This is mainly from friends with knowledge of Meditech and Epic, some of them from HIMSS level 6 institutions (it only goes to 7).

      There's your problem. Make it go to 11, and it'll kick ass.

      --
      Jesus was all right but his disciples were thick and ordinary. -John Lennon
  16. Re:It's the Fed's money, they don't have to take i by bigpaperbag · · Score: 1

    It's more than a carrot, there is also quite a large stick attached to this.

    All ER/EDs treat any patient that comes in, regardless of insurance. They report to and receive money from Medicare based on treatment of these uninsured patients. If you do not meet the new standards set forth, the money you receive from Medicare will be drastically cut. For large city hospitals this is simply not an option.

  17. EMR Integration and Developer Pay by ChronoFish · · Score: 3, Informative

    After reading the posts here I felt compelled to respond to several points raised:

    1. "Great software developers entering the field today aspire to work on pop culture technology like Facebook, Google, and CG animated film production. Who does that leave to work on hospital IT? Does hospital IT pay well enough to compete with the sexy IT jobs?"

    Yes. It pays quite well and with federal dollars flowing there is a HUGE push to implement and integrate EMR technology. There are development gigs that pay more, but not a lot more (in either number of open positions or dollars).

    2. "Non technology people dictating the technology sector. Obama does not have an ounce of knowledge about health care systems, yet thinks he knows everything that should be done. It's a farce."
    True - Obama doesn't know about health care systems - Nor does he need to. "He" is not dictating the "how" just the "what". That seems appropriate for the Federal Government. In terms of actual Federal input - it's pretty minimal - maybe even more minimal than desired. They are certainly driving the industry in a good way (towards integrated health records) - but have not even specified format or protocol - much less the "single repository" that so many are afraid of. The private sector - rightly or wrongly - has standardized on HL7 (v2 mostly from what I've seen - too bad really - v3 is XML while v2 is a bit arcane - pipe ("|") and carat ("^") delimited).

    3. Deadline : Plain and simple, without a deadline the industry would easily take another 20 years to get fully automated.

    4. "I bet this is another case of the leftovers crying about investing money in infrastructure that will save them money in the long run but they see it as an expense and fight it."
    Because of the stimulus package no one is fighting it. On the contrary - any given EMR is now reporting a six month backlog to integrate.

    1. Re:EMR Integration and Developer Pay by bigpaperbag · · Score: 3, Informative

      Working in Healthcare IT and actually on an EMR project for a fairly prominent hospital I'd like to comment on a few of your points:

      1) There is HUGE need for developers but budget concerns are a real problem, the stimulus money is years away but the cost of implementation is immediate. This creates a real problem, the need is there but the budget isn't and the timeframe for implementation doesn't leave much room to adjust the budget to open new positions without cutting into development time.

      2) I'm going to stay out of the pro/anti-Obama sentiment but I will agree that the government is being way too minimal. If they want to set the rules, they need to set the rules. Currently the vague nature of "meaningful use" is a major problem when trying to tie together multiple legacy systems in time. Obviously it would be nice to eventually merge everything into one flow, we simply don't have time for that, and no one can afford to miss the deadlines. Also, Google and MS are both making extreme pushes for their "single repository" systems. The very concept disturbs me even as I implement it.

      3) Yes deadlines are good for driving the industry forward, but there are realistic problems with the deadlines that have been set. If you told every person in america that they had to switch to a hybrid car or half their pay would be garnished you would end up with a lot of people walking to work. Which ties directly into 4) the third party companies are backed up, the hospitals are trying to pick up the slack but are backed up by point 1 and everyone is just sort of holding their breath.

  18. Re:It's the Fed's money, they don't have to take i by Danse · · Score: 1
    Ow... that gave me a tortured analogy headache.

    Along comes Uncle Sugar dangling a carrot. A nice sweet carrot. But Uncle has lots of sticks, thorns, belts and various other nasty gizmos hidden under the blanket. And he moves the toys randomly. Your job is to get the carrot without getting the various shafts. That's hard because of many reasons. For one, they are pushing a very aggressive timeline. For another it's not really clear what the carrot actually consists of or how strong the string is.

    That's an impressive way of not saying anything meaningful. Why is the timeline considered so aggressive? WTF does any of the rest of that even mean in reality? If some hospital systems are making it and others aren't, why is that? Why aren't smaller hospitals and hospital groups working together on this or working with bigger hospitals? This stuff has been coming for a long time now. What exactly is unclear about the incentives or penalties or the requirements for them? Who says nobody knows about this stuff?

    --
    It's not enough to bash in heads, you've got to bash in minds. - Captain Hammer
  19. 1 Billion Dollars by spamking · · Score: 1

    WASHINGTON, DC - Health and Human Services Secretary Kathleen Sebelius and Labor Secretary Hilda Solis today announced a total of nearly $1 billion in Recovery Act awards to help health care providers advance the adoption and meaningful use of health information technology (IT) and train workers for the health care jobs of the future. The awards will help make health IT available to over 100,000 hospitals and primary care physicians by 2014 and train thousands of people for careers in health care and information technology. This Recovery Act investment will help grow the emerging health IT industry which is expected to support tens of thousands of jobs ranging from nurses and pharmacy techs to IT technicians and trainers.

    http://www.hhs.gov/news/press/2010pres/02/20100212a.html

    Seems to me that regardless of any deadline, the Feds are making every effort to provide the financial assistance necessary to all types of health care providers so that Health Information Exchanges can be stood up and make electronic health records more available and their use more efficient.

  20. "No duh!" moment by Chris+Mattern · · Score: 1

    'I think we have nontechnology people making decisions about technology,' said Gregg Veltri, CIO at Denver Health.

    Yes. Yes, we do. Frequently.

  21. Re:It's the Fed's money, they don't have to take i by ColdWetDog · · Score: 1

    Ow... that gave me a tortured analogy headache.

    Sorry, take two Pintos and call me in the morning.

    That's an impressive way of not saying anything meaningful.

    Thank you. I'm running for office in November. I consider this a compliment.

    Why is the timeline considered so aggressive?

    The government is in a bit of a bind. You can't let these things go on forever or nothing will happen. In the current political climate, rationale thinking and long range planning just don't seem feasible. We can't even set payments to physicians on a yearly basis, much less anything more complex or politically charged. Any range you set is going to be arbitrary. But from a health care facility's standpoint, the combination of an essentially unfunded mandate (the money isn't nearly enough and it's not guarenteed), the complexity of the rules and having to change from ICD-9 to ICD-10 (the language that classifies diseases and treatments - this is way overdue in the US) just makes it a mess.

    Why aren't smaller hospitals and hospital groups working together on this or working with bigger hospitals?

    Many are, but there are numerous small hospitals that for one reason or another are left out. Perhaps 30-50% (number made up on the spot, likely to be fairly close). Why they can't work amongst themselves is another question, but it hasn't happened.

    What exactly is unclear about the incentives or penalties or the requirements for them?

    Actually if you RTFA you get a pretty good idea of the big picture. I understand your reluctance in this issue, but trust me. The CIO of Denver Health is pretty sharp and actually Denver Health is one of the more functional entities in this game.

    --
    Faster! Faster! Faster would be better!
  22. qip-pro-quo Re:Fast, Good, Cheap, pick 2... by OldHawk777 · · Score: 0

    Slow, Bad, Expensive, pick 1..., You get all three.

    WooWoo, qip-pro-quo and more zombie-land dogma for US.

    Excuses are all bullshit for US. "Slow, Bad, Expensive" and no insurance company wants to do the job for US without far more "Slow, Bad, Expensive" bullshit.
    "It is all to complicated," "It is all wrong," "It is too expensive," "It is bad," .... How many more bullshit excuses for doing nothing, before we save US "The People" from more bullshit excuses.

    If bullshit excuses were around 65 years ago, German would be the USA national language. If bullshit excuses were around 41 years ago, the USA would have invested more in bomb-shelters, than education, science, space research.... Where in the hell has all the wimpy-ass-mommy-puke US citizens come from, they can't be US born. Sounds like a bunch of web-foreigners, politicians, or C*Os supporting the failure, exploitation, and collapse of a great nation and people.

    Zombie-land dogma (politics, religion, economic...) bullshit excuses are good for totalitarian plutocrats seeking to oppress free people with the help of witless qip-pro-quo fools/traitors.

    "Dogma Knowledge" is individual or cultural idiom with no actual applied value, other then providing an agreeable reassuring explanation of reality.

    This is not flaming/trolling. I have a colorful way of stating fact about bullshit excuses that hurt US as a nation and people.

    ===

    "Authoritative Knowledge" is Implicit (factually required) and explicit (expressly required). Source is the origin of the implicit (Science / Engineering) or explicit (Law / Regulation). So, implicit a/o explicit implies authority.
    "Prescient Knowledge" is personal heuristic (germane experience) perceptiveness into real and actual affect, or cause and effect, that adds unpredicted desirable value for the person, situation, community....
    "Tacit Knowledge" appropriately applied is useful and valuable, individual or group, private/secret skills, methods, detail, experience, information....
    "Unknown Knowledge" does not implicitly, explicitly, tacitly... exist, but as prescient/suspect (Hypothetical Imagination) can be investigated (Theoretical Science) for eventual use (Applied Science).
    "Omitted Knowledge" is individual or group withheld (implicit, explicit, prescient, or tacit) to prevent applied value utilization and provide the individual or group an advantage (Secret, Personal, Private...).
    "Open Knowledge" is free of any legal, economic, religious, or other encumbrances within acceptable limits of personal, family, social, community... species.
    "Dogma Knowledge" is individual or cultural idiom with no actual applied value, other then providing an agreeable reassuring explanation of reality.

    --
    Unaccountable leaders are masters, and unrepresented people are slaves. How do US and EU fare?
    1. Re:qip-pro-quo Re:Fast, Good, Cheap, pick 2... by wintercolby · · Score: 1

      Tired of Bad/Expensive/Slow all rolled into one? Perhaps it's time to get all these Nerds and Geeks on /. and start a software firm that writes a vertical software package soley for the Health Care industry. We could make something that scales from a two server (modified desktops) solution up to a 50 server solution, so that the hospitals and the doctors offices could all afford it. This wouldn't be that hard to do. We just need to focus on a simple pricepoint: under $44k/physician, that's what they're paying for early adopters. It would be much better to do this under $25k/physician so that we can accomodate for budget creep. It needs to be IN USE by the end of 2011? Lets set a goal to have our SCRUMs completed by November on the prototype, and find some early adopters willing to get a bargain rate in exchange for helping with our maketing message. We'll need some venture capital, but that shouldn't be too hard to get with the obvious government mandate which makes our business model viable.

      See how easy it is to make this a positive message instead? It's clear that there are plenty of IT managers that are used to bloat that don't think it can be done. I say I could write a php/mysql (or postgresql) app that could work in conjuction with netbooks to make this practical. I'm doubting there's actually much of a market for it, every hospital and doctors office I've seen in the last 4 years (quite a lot, don't ask) has had PC's or laptops for every physician.

      --
      Most ignorance is vincible ignorance. We don't know because we don't want to know. --Aldous Huxley
  23. Re:It's the Fed's money, they don't have to take i by Danse · · Score: 1

    Many are, but there are numerous small hospitals that for one reason or another are left out. Perhaps 30-50% (number made up on the spot, likely to be fairly close). Why they can't work amongst themselves is another question, but it hasn't happened.

    I'd like to know why that is. Seems like they should be working together at the very least to ensure that data could be exchanged in some openly defined formats.

    Actually if you RTFA you get a pretty good idea of the big picture. I understand your reluctance in this issue, but trust me. The CIO of Denver Health is pretty sharp and actually Denver Health is one of the more functional entities in this game.

    Yeah, I read it. Seems to me that a lot of the hospitals and doctors that got started on this ahead of others will have the best shot at the earlier, larger amounts of money for compliance. I don't see a problem with that. The others have several years still to get their systems in place. I don't think we can expect the government to pick up the tab for all the work, and the ones that are implementing solutions later still benefit from the experience and work of the early movers. I think they would be wise to work together too.

    --
    It's not enough to bash in heads, you've got to bash in minds. - Captain Hammer
  24. Re:It's the Fed's money, they don't have to take i by Lucas123 · · Score: 1

    If you don't roll them out by 2015 and show meaningful use of electronic health records, you then get penalized through Medicare reimbursement cuts.

  25. Re:It's the Fed's money, they don't have to take i by ColdWetDog · · Score: 1

    I'd like to know why that is. Seems like they should be working together at the very least to ensure that data could be exchanged in some openly defined formats.

    That doesn't really seem to be the problem. The data set is there for small hospitals as much as it is for the big boys. The big problem for little places is that apparently there isn't any money in it. There are few vendors that deal in the small hospital space and the ones that do are pretty anemic. Since there are so many smaller institutions, it would seem a natural for some up and coming company, but it hasn't happened.

    Likely reasons are 1) just not enough ROI, 2) It is really a complex problem and given that each little hospital has it's own 'way of doing things' and extent equipment (and no real money to replace much of the infrastructure) you are talking about custom programming AND custom support. Obviously hard to do.

    We really need a model for a 'drop box' hospital, complete with a hardware and software package that is common around the country and easily configurable. It's certainly doable, but again, the business case isn't there. Of all the stupid policies and structures that American Medicine has created (and that list is a long one), the idea that MOST of a hospital's revenue comes from specialty surgery (ortho, cardiac, etc), cancer treatment and radiology has to be one of the bigger ones. Guess which hospital's DON'T do those things - the little ones. That's fine since you really need volume to keep up skill sets and make a decent business case for the infrastructure, but for smaller hospitals it doesn't leave much to pay the bills.

    As one Catholic Sister who ran a large hospital in Denver used to say "No money, no mission".

    --
    Faster! Faster! Faster would be better!