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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].'"

19 of 99 comments (clear)

  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 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!
    2. 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.

    3. 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!
    4. 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.
    5. 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
    6. 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.

    7. 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'
  2. 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?
  3. 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.....
  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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).

  10. 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.

  11. 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.