Man Charged £2,000 For Medical Records Stored On Obsolete System

An anonymous reader writes "In Britain, where it is custom and practice to charge around £10 for a copy of your medical results, a patient has discovered that his copy will cost him £2,000 because the records are stored on an obsolete system that the current IT systems cannot access. Can this be good for patient care if no-one can access records dating back from a previous filing system? Perhaps we need to require all current systems to store data in a way that is vendor independent, and DRM-free, too?"

Comments

Just store it in the cloud

[Anonymous Coward]

That'll fix all the issues. London has fog, too, so the clouds are even easier to access.

Re:Just store it in the cloud

[h4rr4r]

Will the fish that live in the fog eat this data?

Re:Just store it in the cloud

[sconeu]

Only the sharks.

Re:Just store it in the cloud

[ArcadeMan]

Still less dangerous than dinosaurs on a spaceship.

Oh crap, where did I leave my towel?

Re:Just store it in the cloud

[FatdogHaiku]

And in fog the sharks are easy to pick off because of the laser indicating your aim point... shoot where the laser originates and you got 'em.

Re:Just store it in the cloud

[t1oracle]

Enough is enough! I've had it with the m**** dinosaurs on this m**** spaceship!

What a fuckup

[nighthawk243]

Who the hell decided to not do the format conversion when they phased out the old system?

Re:What a fuckup

[geekoid]

Accountants.
At least, if it's like any other large conversion I have been through.

Re:What a fuckup

[Kingkaid]

It is amazingly common to have this kind of thing happen. Healthcare is always strapped for cash and they probabily look at the cost of conversion and someone freaked out. To them it made more sense to keep the old equipment with its old data around in case it needed to be accessed. Over time, everyone forgets how it works and then someone actually needs to access it. And ta-da. Money is a very powerful motivator and to be blunt, the healthcare system in nearly ALL places is so technologically behind, it isn't funny.

Re:What a fuckup

[CanHasDIY]

Healthcare is always strapped for cash...

Huh, must be a British thing.

Re:What a fuckup

[Anonymous Coward]

An unfortunate sideaffect of the publicly funded NHS.

The NHS gets stuck in the middle with the public wanting free healthcare but without paying higher taxes, and with the costs of healthcare increasing due to larger aging population and the higher costs of newer diagnosis/treatments (MRI machines etc). So politicians can never set their budget as high as they want, because to do so they need to put taxes up.

But we at least are all guaranteed free healthcare even if circumstances mean we can't afford to pay for it (eg because we're too ill to work).

Re:What a fuckup

[garcia]

In a past life I worked as a manager of a college's records department. We were putting all records onto a document imaging system beginning with more current records (paper -> scanner -> DIS) which kept all files current.

There was a legacy storage system (microfiche) which, when someone requested records or when we had spare staff/time, was converted adhoc to the new system. We didn't charge previous students for this service even though it was a huge fucking hassle.

This should be the same thing. The onus is on the organization to do this, not the person requesting their records.

Re:What a fuckup

[Anonymous Coward]

But we at least are all guaranteed free healthcare even if circumstances mean we can't afford to pay for it (eg because we're too ill to work).

Unless you're too old, or too fat, or smoke, or you die in the two years you're waiting for treatment.

Re:What a fuckup

[Beorytis]

Healthcare is always strapped for cash...

Huh, must be a British thing.

That's what I was thinking. Around here, healthcare spends as much as possible to keep their "non-profit" status.

Re:What a fuckup

[Anonymous Coward]

Or too young. My dad died because he wasn't allowed to go on the waiting list for a heart bypass until he was 50.

Re:What a fuckup

[Synerg1y]

They're also arrogant enough to try and pass the costs on to the customer...

Re:What a fuckup

[CanHasDIY]

Healthcare is always strapped for cash...

Huh, must be a British thing.

That's what I was thinking. Around here, healthcare spends as much as possible to keep their "non-profit" status.

Not to mention the insane price gouging that is standard in American healthcare.

For those who don't know and are too lazy to RTFA, in American healthcare a hospital may charge uninsured patients upwards of 500x more than they would charge an insured patient for the exact same procedure.

Re:What a fuckup

[tompaulco]

I'd take Britain's system over here in the US where paramedics check to see if you have a valid insurance card before they check your pulse
Saying a thing doesn't make it true.

Re:What a fuckup

[tompaulco]

Healthcare is always strapped for cash
Maybe in the U.K., but here in the sates, the healthcare industry is extremely wealthy. They also are extremely cheap. They pay crap wages for IT and will not invest in IT unless absolutely forced to (maybe this is the same in UK). But meanwhile, they are constantly expanding their billion dollar hospitals which all have much nicer furniture, flooring and trim then my house, and of course, they all have to have the absolute latest fad equipment to use on the patients for top dollar. But yeah, their backend software and behind the scenes hardware is usually ten year old equipment living on life support.

Re:What a fuckup

[tompaulco]

They're also arrogant enough to try and pass the costs on to the customer.
What other industry could ever have the balls to charge a customer more based on a bad decision that the company made? Well, other than the Cell Phone industry, and ISPs, and Banks, and Insurance Companies.

Re:What a fuckup

[Synerg1y]

And that's why the media's involved at this point, want to stand up to the big guys? Involve a larger audience and apply PR pressure.

Re:What a fuckup

[Anonymous Coward]

That's not true. I was in that position a couple years ago, and they most certainly did not check to see if I had insurance. The reason is that they don't care. If I can't afford to pay, the hospital has to write it off as a loss, assuming that they can't work out a payment plan. In which case everybody else has to pay for it. As a result, the only concern is health, not getting paid.

The ambulance service isn't that expensive unless you live in the middle of nowhere. It's expensive, but it's not really that expensive.

Re:What a fuckup

[ChumpusRex2003]

The old system may not have been phased out completely - only phased out for new data. In fact, this is typically what happened with the older systems. Data was stored on MO discs, and stored on yards and yards of shelves. Although the data on the discs is in an open and standard format, the discs are an obscure and obsolete format.

When a new system was installed (which after about 2000 would have been networked with data stored on a large server, rather than individual discs/tapes) it would have been too labour intensive to convert the format - and indeed, the existing equipment may not have supported it, or if it did, it may have required expensive configuration on both the image acquisition device and on the server side (to set up a connection from e.g. a CT scanner to an image server is an expensive process - typically configuring the server's IP address in the "image destination" config on the scanner is a manufacturer service call out - $4k+; and there must be a matching entry on the server with the scanner's IP address - again, software vendor only setup + new image source IP address licence - $5k+).

So, even though the old system has been decommissioned for new use; the discs may still be available, and the workstation still functional, so that the discs can be read and the study examined by a doctor that needs it. However, there may be no way to transfer the data to a new format. E.g. the workstations may not have been fitted with a CD Writer; just the MO drive.

This means that there is no way for the hospital to get the data off an MO disc and onto a contemporary format (like CD or DVD). The only way to do it, would be to acquire an old external SCSI CD-writer compatible with the old workstation (which may be something obscure like a sparcstation or an SGI indigo II) from a specialist IT supplier - or acquire an MO drive which can be connected to a modern workstation with a CD-Writer, or network access (in fact, even that isn't the end of the story, the old equipment may have been unix/linux based, which means the MO discs might be formatted in ext2 - an MO drive on a Windows workstation won't help with that). It is entirely plausible that this is the first request they have had for the data to be migrated to a new format, and that the equipment and configuration needed would have been expensive.

Re:What a fuckup

[Draknor]

You exaggerate the amount, but are correct in the idea.

Most hospitals (that I've worked with the billing offices for), charge the same price to insured vs non-insured patients. But insurance companies negotiate substantial discounts, so the hospital only gets paid a portion (sometimes as low as 40-50%) of what they actually charged. Uninsured individuals have no such bargaining power, and so end up with a bill for the full 100% of charges.

To partially rectify this, many hospitals now offer a "self-pay discount", where if you don't have any insurance, the total bill may be discounted 10-20% (note this is typically NOT applied to your coinsurance or copay, as your insurance company already negotiated a discount).

Re:What a fuckup

[Anonymous Coward]

Still better than not getting healthcare because you're too poor, or you have some obscure heath condition that's not life threatening but determined by insurance companies as a "pre-existing condition" that can bar you from getting any insurance through anyone except for medicare/medicaid.

In our system, an otherwise perfectly healthy person could die from an illness that he/she didn't know they had that would have been treatable if they had just gone to a doctor (something like pnemonia)... and didn't go to the doctor because they didn't have health insurance to cover the visit... and didn't have insurance because an insurance company deemed the person un-insurable by pre-existing condition (a pineal cyst or enlarged pineal gland can create this bar while at the same time not be serious enough to be considered a disabling condition by the government to be able to get on the government's care system).

Re:What a fuckup

[ColdWetDog]

Healthcare is always strapped for cash

Maybe in the U.K., but here in the sates, the healthcare industry is extremely wealthy. They also are extremely cheap. They pay crap wages for IT and will not invest in IT unless absolutely forced to (maybe this is the same in UK). But meanwhile, they are constantly expanding their billion dollar hospitals which all have much nicer furniture, flooring and trim then my house, and of course, they all have to have the absolute latest fad equipment to use on the patients for top dollar. But yeah, their backend software and behind the scenes hardware is usually ten year old equipment living on life support.

Nice overgeneralization there, chucko. Yes, some hospitals think they have to bling up because they're competing with the other blinged up facility down the street. Others are trying to just keep afloat. Depends on your location, payor mix and the kind of things you do.

The bigger systems actually pay pretty well for IT folks - at least that's what they tell me. I'm sure there are exceptions - it isn't a very flat playing field like the UK.

A couple of things that make me a little confused about the TFA: I can't imagine any ultrasound system that cannot print to a CD or at absolute worst, a VHS tape. It might be a SCSI CD burner (which should still be attached to the unit) but that is the technology that anything running the past THREE DECADES would be using. So duplicating a CD or VHS really shouldn't be beyond the NHS.

But the bigger issue is the apparent fact that this guy is a bozo.

He already has the 'result' - the interpretation on a piece of paper. The next level of information would be the static pictures. They are basically there for the convenience of the radiologist. A patient or referring physician would hardly ever use that data. That might be given out on a CD. The original full data scan is never given to a patient. They have no use for it. They are basically held until the statute of limitations expires as they are occasionally useful in malpractice actions, but it's not something a patient would ever need to see.

The only thing he really needs to compare different scans is the interpretation. Anything else is really being anal retentive and they likely should charge him a bunch.

Re:What a fuckup

[Darinbob]

It's an American thing too! People see a huge healthcare bill and assume that the healthcare industry is just rolling in cash, but it's not true. Hospitals in the US are always having to cut corners, technology is out date, etc. Ie, they have to keep the ten year old capital purchases because they cost so much initially and it needs to be amortized, unlike rich corporations which routinely give out new computers every 3 years.

Re:What a fuckup

[Sir_Sri]

This.

health records are probably under the purview of the NHS one way or another. Someone looked at the numbers and figured that it wasn't an effective use of taxpayer money.

Or this guy was sent 1000 notices for 15 years saying to pick up his records for 10 pounds, didn't, and is now on the hook for a specialist.

Re:What a fuckup

[Sir_Sri]

, assuming that they can't work out a payment plan.

bankruptcy being a more and more common 'payment plan'.

If I can't afford to pay, the hospital has to write it off as a loss

You mean what you said

In which case everybody else has to pay for it.

Hospitals don't have some magic source of money. They are, ultimately, insured by the government against losses incurred treating people who go to the emergency room. Now the trick here is that they aren't owned by the government (as in the NHS system) so their incentive is to get as much money from you, or from the government as possible. In the NHS system their objective is to do find the optimal balance between spending and demonstrable health outcomes.

Hospitals in the US are first and foremost interested in their bottom line. Health is a means to make money like any other business, you want to do it just well enough you can get paid, and you do the minimum required for regulatory compliance. The UK system is fundamentally different, because the owners of the hospital (the public) are also their customers, and politicians like an issue they can get behind in the UK as much as in the US, so if you don't have demonstrable benefit for the cost in the UK you're in trouble. In the US as long as you can get paid for a cost, whether it provides any benefit or not is all that matters.

Re:What a fuckup

[Sir_Sri]

Unless you're too old, or too fat, or smoke, or you die in the two years you're waiting for treatment.

Which is still a better reason than you happen to be poor and couldn't get treatment until you had to go to the emergency room and by then it was too late.

If the system is rationed based purely on money (and much as we rail on it from the outside, that isn't quite the case with the US system) a rich guy who has a private doctor is, in effect, denying 1999 other people access to that doctor*.

In the UK system when someone dies waiting for treatment that is a problem to be fixed, and if it happens enough in one hospital or under similar circumstances the government looks to do something about it. In the US system if someone dies before receiving treatment that is a cost savings to insurance companies, or a lost sales opportunity to hospitals. The system is adversarial but not in a good way.

Believe it or not, for people who are very sick especially, sometimes the best treatment is to let them die peacefully and without a lot of risky surgeries or medications, and just manage their pain. The US doesn't like to talk about end of life, but I'd rather live on average 2 weeks less - and not spend them being propped up by a dozen very expensive machines that ultimately aren't going to do me any good anyway. The people in that situation are usually fat, old, smoked, or all of the above. Sure, 20 and 30 year olds get cancer, and if that happens to you you'd be much better off in europe or canada than the US, but if you're 70 and have an aggressive cancer, or you've suffered a crippling heart attack/stroke from your weight or smoking, well, you may get much more machines that go 'bing!' in the US, but most of the time they won't actually do you much good.

*only partially made up statistic, I believe GP's see an average of 2000-3000 patients a year, but the 'Doctors per capita' is about 2-4/1000 (http://www.nationmaster.com/graph/hea_phy_per_1000_peo-physicians-per-1-000-people), working out to somewhere between 250 and 500 patients per year. Except in san marino, but well, they don't count (city state).

Re:What a fuckup

[filthpickle]

their backend software and behind the scenes hardware is usually ten year old equipment living on life support.

I work on the other side of them moving off of that ten year old equipment, and it probably isn't worth it. The difference between the charges getting to the payer in a Ferrari or a Ford mean absolutely nothing to them whatsoever. I also hear the quotes hospitals/providers get from companies for their new software/server package and am just astounded that anyone would pay for it.

You should move out of the IT side and learn as much as you can about billing. It is almost easier than working in IT and you will make more money if you are good at it.

Re:What a fuckup

[Sulphur]

Accountants.
At least, if it's like any other large conversion I have been through.

Relax we only want a few simple changes.

Re:What a fuckup

[Anonymous Coward]

The ambulance service isn't that expensive unless you live in the middle of nowhere. It's expensive, but it's not really that expensive.

In Boise, Idaho I had a grand mal seizure a few years ago in my home. My then-wife called for an ambulance because she was scared and I was incoherent. My brain was scrambled for a while after the seizure, you see. I kept yelling, "I don't have a wife! I'm not married!" when the fire fighter guys were talking to us.

Anyway, to my point: the hospital I went to was literally a mile and a half from where I lived and the ambulance bill for the transport was a little over $800. This confuses me when you say things like "...it's not really that expensive." I didn't live in the middle of nowhere but along two major roadways in a city of about 250,000 people and Boise has an extremely low cost of living. I find 800 bucks in this case to be much more than not really expensive.

Re:What a fuckup

[sg_oneill]

Well, in the UK when conservatives are in anyway.

We see a similar thing with our healthcare in australia. When labor is in theres a fair bit of cash flowing around healthcare, then the conservatives come back in, decide its in everyones interest to stop paying nurses and everthing goes to hell.

Re:What a fuckup

[davester666]

You got the $700 "Annoying Customer" surcharge.

Re:What a fuckup

[AxeTheMax]

But insurance companies negotiate substantial discounts, so the hospital only gets paid a portion (sometimes as low as 40-50%) of what they actually charged. Uninsured individuals have no such bargaining power, and so end up with a bill for the full 100% of charges.

>

Presumably the hospital still manages to make a profit otherwise it would close, so they can still function with the the 40 or 50% discount. Does that not mean that the uninsured individual is effectively overcharged?

Re:What a fuckup

[tengu1sd]

A patient or referring physician would hardly ever use that data. That might be given out on a CD. The original full data scan is never given to a patient.

I don't know what cut rate medical care you have, but's it's common to source the original images for review by when seeking a second opinion, at least in California. Images are generally burned to DVD, some services provide shared encrypted access to image servers. Archive graphics can be reloaded to the server by phone. Legally, there's a 7 year retention for adult records, copies must be made available to patients on request.

Re:What a fuckup

[robot5x]

Of course, british healthcare is not 'free' at all. It is free at point of usage, but all salaries have 'national insurance' deducted to pay for it - so it is effectively a government mandated health insurance scheme).

It is also important to point out that there is quite a bit of research now showing that age is not a valid independent predictor of healthcare utilisation and costs - the biggest costs are a product of end-of-life events/hospitalisations and illness. An Australian study found that 'older decedents were not more likely to be hospitalised than younger decedents... [and] once hospitalised, their in-patient costs were lower'. Another study found that 'the relationship between age and health expenditure was weak and possibly inverse once proximity to death was allowed for'.

So it's rather facile to buy in to the notion that an 'older' population inevitably means much higher health costs. In fact here in urban NZ, with a young population facing rapidly increasing rates of obesity and diabetes, it is more likely to be younger people developing poorly-controlled chronic conditions that will place the biggest strain on the health system in 10 years time. Factor in also their loss of productivity in the economy, and it all looks pretty bleak, unless some pretty serious measures are taken now to stem the rise.

Refs for the curious:
Segal & Bolton (2009), 'Issues facing the future health care workforce: the importance of demand modelling', Australia and New Zealand Health Policy, 6:12.
Breyer & Felder (2006), 'life expectancy and health care expenditures: a new calculation for Germany using the costs of dying', Health Policy, 75.

Re:What a fuckup

[BeanThere]

Who the hell decided to not do the format conversion when they phased out the old system?

So everyone's crying out about how expensive healthcare is, but at the same time we're all crying out about every decision to try save money? Can't have it both ways.

Re:What a fuckup

[BeanThere]

a hospital may charge uninsured patients upwards of 500x more than they would charge an insured patient

It strikes me there is some sick downward-spiral type thing going on there .. the reason they charge so much more is that the majority of these patients end up refusing to pay and the hospital has to pass the cost on to the remaining patients. But I am certain the majority refuse to pay because the cost is so high .. most people probably can't. So you end up with a small percentage of suckers with money footing the bill for all those who can't/won't pay. But if it wasn't so overpriced, more people would pay.

Re:What a fuckup

[Pieroxy]

I'd take Britain's system over here in the US where paramedics check to see if you have a valid insurance card before they check your pulse

Saying a thing doesn't make it true.

I've been in the Stanford Hospital ER when my wife delivered.

I say a mother and her son walk in, the boy was literally covered in blood and dripping blood rapidly. They were promptly taken to the secretary where the boy had to wait patiently for the mother to validate health insurance with the nice lady on the other side of the desk.

Then, the hospital lady looked somewhere behind her and made a sign. The paramedics rushed in with a stretcher, got the boy and took care of him. Some cleaning dude came in almost instantly after to mop the blood.

I'm still wondering to this day what would have happened if the mother would have forgotten her insurance papers or anything else. Would they have let the boy die in there? Probably not, but I suspect that it would have been because of the bad PR this could have generated, nothing else.

Re:What a fuckup

[Xenx]

In the US, virtually all hospitals are required to treat actual emergency cases. Those costs are absorbed by the hospital if/when they are unable to recover costs from the patient.

Re:What a fuckup

[poolecl]

He is looking for a copy of an ultrasound that was done in 2004. It doesn't seem unreasonable to expect that records that are only 8 years old remain accessible.

Re:What a fuckup

[Cederic]

It's free for far too fucking many people.

I do support having a NHS, but I also support people contributing. Right now too many don't.

Re:What a fuckup

[Cederic]

Why pay for a format conversion for data unlikely to be ever needed? On this one occasion it has, but many organisations have a ton of data that they can't immediately access, but that they can't just delete (for various reasons, usually regulatory).

£2000 is bloody cheap for accessing an obsolete data store. Given the conversion could have cost anywhere from £50,000 to £500,000 or more, an occasional £2000 is fuck all.

Charging someone making a subject access request £2000 is the problem, not the organisation saving a lot of money by avoiding premature data conversion.

Re:What a fuckup

[Gonoff]

Gotta love them death panels.

An interesting idea from a very small and (apparently) unrepresentative number of US politicians.

Re:What a fuckup

[tompaulco]

Well, if she had just said "I don't have insurance", that would have gotten the bureaucracy out of the way and they could have got the boy back there, then, once he was being taken care of she could start working on the insurance.

Re:What a fuckup

[tompaulco]

You should move out of the IT side and learn as much as you can about billing.
I don't actually WORK for a hospital, but I have interviewed for jobs with hospitals, back when I was a Unix admin. At one "state of the art" facility, the IT department was in a trailer out in the back parking lot. They offered me $40k for an experienced administrator at a time when engineers fresh out of college were making about $50k.
I HAVE worked for the insurance industry, for several different companies, including Zurich and CNA. The insurance companies have money almost literally falling out of the ceiling tiles. They had a team of about 20 of us there from Sybase professional Services essentially doing daily administrative tasks at a cost of probably $40,000 a day, and this went on for years. There were whole buildings full of people doing nothing but jacking their jaws and collecting a paycheck. The insurance industry in the U.S. has more money than any other industry I can think of, and yet Obama still felt the need to "Bail them out" with the Obamacare plan, which guarantees that everyone will be forced to buy the industry's overpriced product.

Re:What a fuckup

[Custard Horse]

Of course, british healthcare is not 'free' at all. It is free at point of usage, but all salaries have 'national insurance' deducted to pay for it - so it is effectively a government mandated health insurance scheme)

It’s worth noting that National insurance is paid by all people who have earnings subject a lower earning threshold of between $9.5k-$13k depending upon self-employment and full employment. You generally pay around 12-14% of your earnings. If you are an employee national insurance is deducted at source so you never have it to spend which is probably just as well.

So, it is fair to say that national insurance is a tax that is used to fund the NHS (amongst other benefits), it is not discriminatory in its application. If you had cancer you aren’t barred from being treated for cancer again.

In fact, with illnesses that are known to reoccur you would be placed on a regular check up schedule which would become less frequent over time e.g. every 3 months for a years, every 6 months for 4 years then every year thereafter.

The NHS has its problems but there is nothing fundamentally flawed about the system and buying medical supplies in bulk does afford some serious bargaining power to the NHS which is just as well as various expensive projects have been canned before completion.

Re:What a fuckup

[uglyduckling]

What he's requesting is unnecessary. He wants copies of the images/videos from his cardiac echo from years ago. It's pretty common not to store that kind of data for very long, only the written report (which he already has). I would think these archive copies have been kept (unfortunately) to avoid litigation in case anyone ever makes a complaint. They're unlikely to be of any relevance to his ongoing healthcare, which is why the hospital trust has asked for this money - it's because they would have to buy the old equipment back again to make the format conversion for information which would likely be of no medical use. That's why they didn't do the format conversion at the time.

Re:What a fuckup

[uglyduckling]

It is unreasonable - there's no medical use to seeing the images from an 8 year-old scan, only the written report will be actually helpful for his ongoing medical care. Unless, of course, he want to challenge decisions/conclusions made at that time which would be an issue of litigation, not of medical care.

Re:What a fuckup

[Big Hairy Ian]

Hell man this in the NHS (National Health Service) they still use plenty of systems that have technically been phased out :|

Re:What a fuckup

[uglyduckling]

It's not the scan that matters, it's the written report of the person who did the scan, which is why it's not customary not to keep copies of ultrasound scan videos/stills up to date. Ultrasound is a dynamic examination where what you see at the time matters most - the still images only provide a legal backup in case someone challenges the sonographer's conclusion. Video is being used more extensively now, but often video images are not kept long-term as they're large files that are expensive to store.

Re:What a fuckup

[nbauman]

I went to a lecture on Medicare, by a guy who now works for a union and used to work in all sides of the insurance business.

I just looked up my notes.

He said hospitals have a list price which is 12 times Medicaid. Medicaid is the cheapest, and some doctors and hospitals claim to lose money on Medicaid.

The highest prices are for foreigners who come to the US for medical treatment. Usually they can afford it. If they couldn't afford it they would go to Costa Rica.

Insurance companies get discounts.

Individuals also get discounts if they ask for it. Sometimes, they can also get a large portion of the bill, or all of it, written off if they don't have the money. Some hospitals are greedy, though, and will send unpaid bills to collection agencies who are known for being tight-ass.

If you're really poor, you can be eligible for Medicaid, but the income level is so low -- $6,000 a year -- most people wouldn't qualify.

Re:What a fuckup

[uglyduckling]

That's correct - the result is the report, not the images. Chances are, the images would be of no practical use 8 years later, unless the guy wants to engage in litigation in which case he could probably obtain copies of the raw data but perhaps not format converted.

I suspect the data is stored in a 'raw' imaging format which is unique to that scanner - it may well be on CD - but probably not usable in any modern machine or computer, just as would be the case if you had a CD full of Canon or Nikon raw DSLR images and no plugin.

Re:What a fuckup

[uglyduckling]

Not for ultrasound, unless you want a really silly opinion. You can really only assess what you're seeing when the probe is in your hand.

Re:What a fuckup

[uglyduckling]

The 'customer' being someone who has received free healthcare, and is now demanding clinically irrelevant data that would cost a huge amount of money to provide.

Re:What a fuckup

[Pieroxy]

Yes, but how would she know about that?

I'm not saying it's right or wrong, I'm not pointing fingers. I'm just relating something I saw first hand.

Re:What a fuckup

[Pieroxy]

As I said, I'm just relating something I saw firsthand. I didn't even heard what they were talking about.

Re:What a fuckup

[loadedmind]

Sounds a little like Microsoft's decision to go "x" on their office suite suffix instead of "odf"...

Re:What a fuckup

[loadedmind]

How many people die on the streets every day because ambulances can't verify insurance and literally leave them there to die? Happens in LA all the time...

Re:What a fuckup

[Sir_Sri]

If it was 2004 it was probably on equipment designed before 2001. How much software do you know that works properly without modification from pre-windows XP days?

I agree, it's a nuisance, but this is an archival question. Someone bought a system, ran it for 4 years, and realized it was a disaster for whatever reason and tossed it, ( my money is on a requirement for windows 2000 or windows 98 or the like, or that it relied on SPARC or some niche architecture that you just can't get anymore) , at the time they made the assessment that the written records and description of the results was good enough. This guy is, in-specific asking for some of the data analysis to be essentially re-done. That means it's probably a custom job, and the NHS doesn't have the hardware or software to run whatever is needed.

And that nonsense might be exactly why after 4 years they turfed the system out. It seemed like a good idea at the time, but if you can't migrate it to x86 windows 7, time to find an alternative. There is data they've taken from this that the guy does have too, it doesn't have the full scan to be reproduced, so someone did the maths and figured the medical benefit of running that system for an extra 4 years (until today) or porting so they could get the full records, was outweighed by how much it would cost, since they do have partial records anyway.

Re:What a fuckup

[tehcyder]

Accountants. At least, if it's like any other large conversion I have been through.

Whereas you being the expert would, of course, spend an unlimited amount of money because all data is so precious?

Re:What a fuckup

[tehcyder]

Of course, british healthcare is not 'free' at all. It is free at point of usage, but all salaries have 'national insurance' deducted to pay for it - so it is effectively a government mandated health insurance scheme).

Gosh, thanks for pointing that out, everyone here in the UK thought the NHS was funded by unicorns sprinkling fairy dust over ponies.

Re:What a fuckup

[tehcyder]

It's free for far too fucking many people.

I do support having a NHS, but I also support people contributing. Right now too many don't.

Yes, that will be because they don't have jobs and/or aren't earning enough from their fifteen hours a week at McDonald's to pay National Insurance.

That's sort of one of the problems when the economy isn't doing too well. Other tax receipts tend to go down too.

Re:What a fuckup

[david_thornley]

It wasn't going to be cheap anyway. What probably happened is that an expensive vehicle came out with two highly trained professionals, stayed a bit while they determined approximately what was wrong and what to do about it, drove you to the hospital, and then re-sterilized and partially re-stocked the ambulance. Moreover, this isn't like a cab, which can keep busy most of the day. I would hope that the ambulance and paramedics are doing this occasionally, and they might have to pay for additional ambulances and paramedics to cover simultaneous emergencies. (If there's too much demand for a cab, people wait longer and are inconvenienced. If there had been too much demand for ambulances at one particular place and time, I would have had little pieces of my heart dying off as I waited in serious pain.)

The other part of that is that the health care system in the US is screwed up, and to a large extent has the worst of free enterprise and the worst of government control. Most people who get such health care are largely insulated from the costs, and both the hospital and insurance companies are trying to make money. This really sucks when you're poor, lack health insurance, and need health care. I have great insurance, and was able to look over all the fees without personal shock, but things really did look awfully expensive.

Re:What a fuckup

[Cederic]

It's also the tax rebates and other payouts. Child benefit? Fuck that. Maternity pay? Fuck that. If you want kids, fucking pay for them.

If you don't earn enough, the answer is to make housing more affordable, reduce taxes on transport, make it easier for people to earn a living. It's not to give them more actual cash than they contribute.

I don't want people living in absolute poverty, but I do resent paying for people to maintain a lifestyle that I can't - I earn well above the average wage and have at best the average disposable income. I do resent that.

Re:What a fuckup

[robot5x]

well the AC I replied to above seemed to think so, based on the comment

But we at least are all guaranteed free healthcare even if circumstances mean we can't afford to pay for it (eg because we're too ill to work).

and indeed, many british migrants who come here talk endlessly about their wonderful 'free' healthcare system. So - yes, it actually is worth pointing out I think.

Re:What a fuckup

[mcgrew]

True, but when your kid is covered in blood, your brain isn't at its peak.

Re:What a fuckup

[mcgrew]

a little over $800. This confuses me when you say things like "...it's not really that expensive."

Er, I think the GP is Mitt Romney or Bill Gates. Hell, for some of those folks, $800 is lunch money.

Re:What a fuckup

[rhalstead]

ER is supposed to take care of everyone whether they have insurance or not. How they handle service varies widely from location to location. Just wait until we have 2 or 3 times as many to serve with half the doctors. People without insurance go to the ER for even minor things because it's difficult to find a new doctor. Mine retired (wanted to get out before Obamacare) and it took over 6 months to get in to see a new doctor. Typically I walk in for an appointment, sign in, and am taken back to the examination room within 5 minutes. Usually the doc is there in less than 5 minutes.

Re:What a fuckup

[rhalstead]

Having been a sys admin, then programmer, and finally a project manager with computer systems for a large multinational corporation, they definitely did not buy all new computers every three years. Last I knew they were still using XP Pro. They did have to keep the latest versions of many programs (particularly word processors and spreadsheets) to interface with the rest of the world and those corporations that had to have the latest and greatest.

Re:What a fuckup

[mcgrew]

People see a huge healthcare bill and assume that the healthcare industry is just rolling in cash, but it's not true.

The biggest costs in health care is insurance. As long as there is health insurance and malpractice insurance, your costs will be sky high. You're not just paying the doctor, nurse, landowner, and janitor, you're paying the insurance companies' billionaire chief officers and boards of directors insanely high salaries.

Why is a health insurance CEO's pay higher than a doctor's? Why is health care treated as a business? IMO it's batshit insane.

Re:What a fuckup

[jwhitener]

They are, ultimately, insured by the government against losses incurred treating people who go to the emergency room.

I worked for a hospital years ago. That is the first I'm hearing about insured against losses in the ER. I also wrote their budgeting app.

This seems to contradict you: http://articles.latimes.com/2012/jun/18/nation/la-na-emergency-care-20120619

That hospital was also eventually bought out because it couldn't make ends meet, I lost my job, and the main problem was uninsured ER visits by mostly very sick poor people. In that community the largest type of uninsured were migrant farm workers.

Re:What a fuckup

[bhiestand]

What probably happened is that an expensive vehicle came out with two highly trained professionals

I really wish that were the case, but... Ambulance workers are not paid well. I've known a few, and they weren't exceptionally well trained either. They were doing it while doing other training, etc. (I forget all the details, but it seems a lot of firefighters work as EMTs/ambulance workers early on).

The other part of that is that the health care system in the US is screwed up, and to a large extent has the worst of free enterprise and the worst of government control. Most people who get such health care are largely insulated from the costs, and both the hospital and insurance companies are trying to make money. This really sucks when you're poor, lack health insurance, and need health care. I have great insurance, and was able to look over all the fees without personal shock, but things really did look awfully expensive.

I agree with you entirely. However, I think it's worth noting that "free enterprise" doesn't adapt to ambulances all that well. Prices aren't even discussed or negotiated ahead of time (unless you have insurance, and even then there are often big surprises). Imagine the free market solution: "Your husband is having a heart attack? We have one ambulance 5 minutes away and that will be $1500. There is another ambulance 15 minutes out and we can give you a discount to $750."

Re:What a fuckup

[Sir_Sri]

Which means they either exceeded their mandate, to provide only the minimum care necessary for regulatory compliance, or they needed better accountants.

I've helped on a number of US hospital billing systems now, basically, if someone comes in and can't pay there are layer and layers of begging for money from them first, then it becomes a medicare problem. But no, the government doesn't cover everything that could be done, and without providing emergency medical care hospitals don't qualify for medicare funding at all I believe (as per the article you linked). That's a form of insurance - a monstrously bad one, but 'monstrously bad' describes pretty much the entire US healthcare system. They have guaranteed access to funds, and it's chosen to be enough for the minimum of regulatory compliance. If they aren't managing the resources well enough the free market will force them out and find someone who can. Because fuck sick people, that's why.

Hospitals also retain a somewhat privileged monopoly on healthcare. So people who can pay have to go to you. That is, again, a form of insurance (for both patient and hospital, the Hospital is guaranteed a revenue stream and patients are guaranteed to not have to deal with quacks).

Those costs have prompted financially strapped hospitals to rely on a complex system of shifting costs. Most of the burden falls on taxpayers, with the government providing tens of billions of dollars annually to help hospitals care for the uninsured.

From page 2 of the article you listed. Yes yes, hospitals are claiming hundreds of millions in losses but they're collecting billions. The basic problem is that hospitals are incredibly inefficient in the US. If I give you 10k to solve a problem that should cost 9k (1k profit), but you're costing 12k because you're paying too many lawyers, billing staff, greeting staff, administrators for the administrators etc. well sure, you're not going to get enough cash to cover things. I didn't say this was a smart system.

Re:What a fuckup

[jwhitener]

I know a VP of a hospital, I emailed them what you said, because I was curious if things had changed, or I missed something. This is the response:

"I disagree with him. Hospitals are mandated by the federal government to provide a medical screening exam for all patients coming to the hospital seeking emergency care. The law is EMTALA or the emergency medical treatment and active labor act. The medical screening exam must comprise all the services available the patient needs. So it might be lab work, CT scans, X-rays etc.
If the patient is uninsured (private pay) we offer them a 60% discount off the top of their bill just coming in the door (all hospitals in WA state handle this the same way) If there is a way to seek funding through the state (Medicaid) we will do so.
Most generally there are no funds available so the patient ends up being private pay and owes us 40% of their ED bill. Obviously most private pay patients don't have the resources to pay so we try to collect but generally end up w/o the bill as bad debt.

The government funding, both federal and state, has decreased dramatically in the last several years for hospitals."

Re:What a fuckup

[Sir_Sri]

The government funding, both federal and state, has decreased dramatically in the last several years for hospitals."

This is where you really run into problems. Cutting funding itself isn't the issue. But when a law mandates something from a government, and the government says 'sorry, we don't have money to pay it' it's not really obvious who wins, and you can't wait 15 years for courts to fight it out while there's someone needing healthcare right now.

Governments usually also narrowly construct laws. As I say, to qualify for medicare funding you have to follow the various emergency room rules, so you are, in effect, expected to find the revenue for your legal mandate from your medicare funding or from something else. It's a stupid system. Some hospitals partition off their budgets, so if you come in and are uninsured you get charged even more money (I know of at least one in New York that does this), because they pool all uninsured patients into the same funding pot, so a rich uninsured guy is supposedly paying for the poor uninsured guy sort of thing, but they spend a lot of money on lawyers trying to chase after people for money they don't have.

I can't imagine anyone actually thinks the US healthcare system is even remotely good. If you believe 'let them die' then you believe the emergency care laws are government overreach, and if you believe that hospitals should be government owned and operated then the whole thing is stupid. And there's not a little of middle ground that isn't going to make both sides angry about the same things.

Re:What a fuckup

[RockDoctor]

It is unreasonable - there's no medical use to seeing the images from an 8 year-old scan

Bollocks.

If something has been noticed in a recent check-up, then examining a record from 8 years ago to see if the problem was there (but not noticed) back then, can be a powerful tool to determining how fast an issue is changing. In my case, because I routinely get exposed to TB, I've had to go back to examine 10-year old records regularly when I've had another exposure event. This case ... echo cardiograms ... I can think of several reasons where I might want to look back at data from that time period (if I'd had any cardiograms done).

What the fuck the machine manufacturers are doing not having access to their own image formats after a mere 8 years is another question. It's on CD, so hardware to read it shouldn't be an issue. The format of data on the CD ... well, that's mainly the domain of the hardware-software writers. But the commissioners of buying the equipment should have insisted on getting the specifications of the data formats before signing contracts. (People we develop stuff for insist on getting that from us. So we put the important stuff into the program code, not into the data files.)

Re:What a fuckup

[uglyduckling]

Bollocks to you too. If it hadn't been noticed at the time, then it's highly unlikely to be on the recorded image. The recorded image only shows where the sonographer pointed the probe and therefore what they noticed. You've very unlikely to see something new 8 years later that has any clinical relevance. Ultrasound is a dynamic imaging modality that is very much operator dependent.

Re:What a fuckup

[AF_Cheddar_Head]

Seems to work with the myth of death panels.

He should seek legal advice.

[Anonymous Coward]

That's more than the statutory maximums in both the Access to Health Records Act 1990 and Data Protection Act 1998 (as amended), which is £50 (if the records are a combination of computer and paper) or £10 (computer only).

This is not legal advice, but it is a recommendation that he should seek legal advice.

Re:He should seek legal advice.

[Sporkinum]

What is the length of time requirement to keep records? In the US, for most medical studies, it's 7 years. He would be outside that here.

Re:He should seek legal advice.

[Shrike Valeo]

Had no idea that it became £50, but I am curious on the reaction with such a request and threat of legal action if it's not complied with.

Legal advice is sound advice, It's no more a standard request than requesting a copy of records from any data controller.. their fault for preventing their own access.. time for them (well, the taxpayer in the end, as always) to pay up

Re:He should seek legal advice.

[h4rr4r]

So you have no medical history older than 7 years?
Hope you never need to prove you had some required shots.

Re:He should seek legal advice.

[Anonymous Coward]

So you have no medical history older than 7 years?

Yes and no. Records about former patients are kept for at least 7 years then can be destroyed, if the patient was not seen during that time.

During that those 7 years with no patient care, hopefully copies of the records will be transferred to the patient's current healthcare provider (or the patient).

Records about current patients (even if very old) are to be kept indefinitely.

Re:He should seek legal advice.

[Anonymous Coward]

There is no statutory limit, but the Department for Health has guidelines on minimums in the absence of any local policy.

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4131747

In practice, they are usually kept until some time after the patient dies.

Re:He should seek legal advice.

[Dahamma]

Not sure why you are being sarcastic to him, since he's right, it's pretty easy to look up.

It somewhat varies due to different state laws, and the *recommendations* are generally 10 years, but 5-7 is a pretty common *requirement*. Of course that's the minimum, if your doctor/group/HMO doesn't suck I would think they would probably keep more, especially now that things are mostly digital.

Though as far as I can tell none require them to provide the data in any raw format (besides basic imaging/x-rays). An interpreted summary/result (which they already gave the guy in the article) is sufficient (by law at least).

Re:He should seek legal advice.

[Sporkinum]

I work in medical imaging. When we migrated images to our new system, we went back between 7-8 years for most. We still have the old system running for as requested comparisons, but it is being decommissioned at the end of this month. There are exceptions, and the retention periods vary by state. http://www.xrayfilmsrecycling.com/state-law/
We migrated based on retention rules.

Re:He should seek legal advice.

[Malenx]

That's up to the patient to track, not the medical provider.

Re:He should seek legal advice.

[Malenx]

There is no reason to keep it longer than 7 years. It's worthless information that doesn't matter to the provider, why wouldn't they delete it?

Re:He should seek legal advice.

[fast turtle]

In the United States, it's until Death. That's right, they have to keep your records until you die even if you only see that doc once in your life.

Re:He should seek legal advice.

[war4peace]

There are quite a few illnesses that develop over 10+ years. Syphilis, Uterus cancer, certain heart diseases and I'm sure there's plenty others.

Re:He should seek legal advice.

[ChumpusRex2003]

Those are the statutory maximums. However, there is a get out clause. The data holder only needs to provide a copy of the data which can be accessed without "disproportionate effort".

In other words, your name might have been mentioned a couple of times in an e-mail conversation, and those mail spools have now been purged under retention policies. However, there might be a great-great-grandfather backup tape with a snapshot of the exchange server on it, and that might contain e-mails referring to you. However, the effort involved in creating a new exchange environment, restoring the snapshot to it, and running a search is not reasonable for a generic information request (but retrieval might have been appropriate in the context of court-ordered discovery).

If the data holder advises that the costs of data copying are disproportionately large, they can refuse to provide you with a copy. If you insist, then they are entitled to charge you their legitimate costs in making the copy.

Re:He should seek legal advice.

[Onco_Rx]

There is no reason to keep it longer than 7 years. It's worthless information that doesn't matter to the provider, why wouldn't they delete it?

Try telling this to someone that was diagnosed with cancer further back than the retention period. Many diseases come back 10, 15 or more years not the future. This information could be invaluable...

Re:He should seek legal advice.

[Dahamma]

Ok, here's an example: OHSA requires any work health related records to be kept for 30 years. There are plenty of exposures to toxic chemicals, etc, that only show up as cancer many years later, but knowledge of that exposure would dramatically help a diagnosis.

Even many booster vaccinations are recommended every 10 years.

Re:He should seek legal advice.

[ColdWetDog]

No, that's up to the medical provider to track. The patient isn't automatically given those records and much of the information in those records is written only for the doctor. That's gotten doctors in trouble over the years having to explain what the various abbreviations are.

Part of what you pay for when you go to the doctor's office is for them to keep records. Few patients are in the position to be able to store the documents, let alone understand what they mean. I'd never go to a doctor who was destroying records after only 7 years.

Then you should stay out of pretty much any clinic in the US. Medical data retention laws are in the book of most, if not all, states. Very, very few clinics keep records longer than necessary. This may change with EHRs since we are finally getting to the point of near universal formats and it's much easier to copy and store digital data as opposed to paper and film, but don't count on it.

Re:He should seek legal advice.

[ColdWetDog]

No, it's not. Look in the threads above. It's proscribed by statute. How the hell could that possibly work? If you saw a provider in California and kicked the bucket in New York, who's going to tell the clinic that your dead?

Re:He should seek legal advice.

[ChumpusRex2003]

In the UK, 7 years from last modification date is generally regarded as the minimum retention period. Up till now, paper records would be destroyed after this point, due to the cost and space constraints of maintaining them. However, some hospitals would have microfilmed them, or scanned them into a document management system prior to destruction, with retention of the microfilm or digital data for a longer period.

However, although 7 years is the "normal" retention time, there are lots and lots of exceptions; cancer cases , clinical trials, legal cases - 25 years after death; children - at least till age 25 or 7 years after death; the list goes on and on...

One of the things with digital data storage, especially server based storage is that it is now so cheap that there is much less pressure to destroy data. I was recently involved in purchasing a PACS system (digital X-ray/CT/MRI storage/viewing solution). One of the things that I asked the vendors was do they offer a method to destroy old data to free up space on the discs. (the previous system was subject to an insane markup on the cost of the SAN, and not only that, the system didn't support tiered storage, so the only storage upgrade option that the solution vendor would support was another EMC box of 15k drives with a 200% markup on top). Out of 8 vendors, 7 stated that they do not support automated data destruction; the answers basically came back "we sell this software in 53 countries. We have never had this request outside of the UK. Bearing in mind that we are only charging you $500/TB for archive storage on SATA arrays, realistically, why would you ever want to delete anything when the cost is that low, and only set to drop further if you purchase an upgrade at a later date?".

While current guidelines do recommend data destruction when the data is sufficiently old, and with the cost of storage continuing to drop, have decided that it is better to hoard it just-in-case.

Re:He should seek legal advice.

[Sporkinum]

That's the case with us now. We will just keep expanding. We migrated about 900,000 studies and we accumulate about 110,000 a year.

Re:He should seek legal advice.

[filthpickle]

Those are just the ones you have? ;)

Re:He should seek legal advice.

[BeanThere]

So you can't just keep a file labelled "My important medical records"? Really? That's just overwhelmingly too complex for you?

Re:He should seek legal advice.

[Cederic]

The minimum retention time is completely irrelevant. They have an obligation to provide all records for an individual, on request.

Whether they should have those records is irrelevant. Indeed, one use of a Subject Access Request is to find records that should not exist, that are inaccurate (and/or expired), or that contain data that the organisation does not have permission to hold/process.

As the existence of that data has been admitted (through the quote of a price to retrieve it) the statutory maximums should come into play.

There are a number of exemptions, including the ability to withhold data that may damage someone's physical or mental health. As the data has been offered (at a ludicrous price) I'd assume those exemptions do not apply.

Re:He should seek legal advice.

[jimicus]

IIRC there's a get-out explicitly written into the data protection act that states organisations can refuse to supply data if to do so would be disproportionately expensive.

Sounds like what's happened here is the hospital's said "Sorry, disproportionately expensive" and our chap has said "Exactly how disproportionately expensive are we talking here?"

Re:He should seek legal advice.

[war4peace]

No, I only have a (so far minor) heart disorder and a busted lumbar vertebra. At 33, it's pretty sad that I already suffer from those, but I kind of asked for it, with my work schedule and hectic life style.

Re:He should seek legal advice.

[uglyduckling]

Yes... and reviewing 8 year old ultrasound results won't help with those.

Re:He should seek legal advice.

[nbauman]

Friend of mine got an X-ray.

The pulmonologist told him he had a spot that "could be cancer," and he had to get a lung biopsy "to be sure."

He had an x-ray several years ago. If he could have gotten it, the radiologist could have compared the 2 x-rays to see whether the spot was there years ago. If it was, and it wasn't growing over several years, then it wasn't cancer.

BTW, lung x-rays always have spots. It sounds to me like the pulmonologist was running a scam, giving a lot of unnecessary and dangerous biopsies.

In general, it's often important to know whether something is new or whether you've always had it.

It amazes me that doctors aren't required to keep medical records for basically the life of the patient. A medical history is the most important part of an examination. Hopefully, with electronic records, it will be cheap enough to keep them forever.

Re:He should seek legal advice.

[nbauman]

First you'd have to get your records from your doctor -- and keep them up to date, every visit.

My doctor's office charged me $1 a page. They charged $15 for a CD of my x-ray.

If you have a chronic disease, your medical records can get very detailed.

Things get lost. Homes get burned down or flooded.

The doctor is a professional, and one of his required skills is to keep records. He hires consultants to make sure his records are kept properly.

I'm an amateur. If I wind up in the hospital unconscious, how can I tell anybody where my records are?

If you give people the responsibility of keeping their own medical records, those records are going to get lost.

That's why it's the doctor's responsibility to keep records.

Re:He should seek legal advice.

[nbauman]

Not true. I called the New York State Department of Health about that.

I don't have my notes handy but as I recall, doctors are required to keep a patient's records 7 years after they stop treating him, and hospitals are required to keep their records longer, I think 30 years.

It's a ridiculously short period of time. I think the 7 years comes from the statute of limitations for malpractice. The 7 years is to protect the doctor, not the patient.

Re:He should seek legal advice.

[war4peace]

Furthermore, even if old medical records are almost always useless, the one-off case where they could be useful might save someone's life. The theoretical benefits exceed the record-keeping costs because, frankly, life is more valuable than space saved by destroying a bunch of papers.

Re:He should seek legal advice.

[war4peace]

I haven't specifically mentioned ultrasound.
Here's a real-life case. A friend of mine has an eye problem, squint eyes. When she was 4, her mother took her to an optician and asked whether surgery should be performed. The optician said "no, this is going to correct itself in a few years". 7 years pass by, the issue is still there, and appears to get worse. The second optician looks at the girl, says "too late for surgery". Sadly, previous medical records were not kept and thus the mother couldn't sue the first optician who basically fucked a little girl's life.
My friend wears glasses (she's 29 now) and although medical advancements could now correct the physical issue (and it could have been corrected back then as well), the underlying problem is not the physical deviation of the eye, but the fact that the brain got used to interpreting images and compensating for the squint itself, and surgery would make the whole matter a lot worse, because the brain would never re-adapt (the true reason for the "too late" prognosis).

Re:He should seek legal advice.

[nbauman]

Furthermore, even if old medical records are almost always useless, the one-off case where they could be useful might save someone's life. The theoretical benefits exceed the record-keeping costs because, frankly, life is more valuable than space saved by destroying a bunch of papers.

Those were the words I was looking for.

Re:He should seek legal advice.

[Dahamma]

What's absurd when doctors are ordering expensive tests like MRIs and CT scans on speculation or trivial injury just to make people feel better. Not to mention all of the neurotic parents saving their childrens' umbilical cords at the cost of thousands of dollars in the microscopically minute chance it may come in handy in some as of yet unknown way in the future.

But saving a few more medical records is wasteful...

Re:He should seek legal advice.

[uglyduckling]

Sad story. But THIS story is about ultrasound (echocardiogram) so my point stands.

Re:He should seek legal advice.

[war4peace]

It doesn't matter what THIS story is about. You can't simply say "these medical records are useful, those are useless". That's what was considered of blood stains from crimes before DNA analysis existed: "destroy them after X years". there's a story about a guy who's convicted of a crime and his sister becomes a lawyer just to review his file, and finally finds case evidence which miraculously was NOT destroyed although law allowed it to be destroyed after some years.
Or better yet, when you produce medical records, give a copy to the patient, who signs a document agreeing that they will only be kept for n years by the medical facility. Problem solved, legally speaking, and patient is responsible for his copies.

Single Payer Cost Board Says "No"

[xxxJonBoyxxx]

>> A statement from the trust (Britain's single payer health care system) said: "The trust does have the visual data on file but the cost of generating an image from what is now obsolete technology is not a cost effective use of public money.

Good thing there's no chance of the US going to a single-payer system...er...am I right?

Re:Single Payer Cost Board Says "No"

[h4rr4r]

So 1 person has some trouble getting some old files vs our current system where we let folks with cancer die.

Yeah, what a terrible tradeoff.

Re:Single Payer Cost Board Says "No"

[Daas]

A private insurance company would have for sure spared no expense to recover this man's files...

Re:Single Payer Cost Board Says "No"

[sjames]

Yes, then instead of someone being forced to actually make a decision and admit that they are actually refusing, he could have had a fun game of "go ask your mother - Go ask your father" where nobody actually acknowledges that they have made a decision in any form.

Re:Single Payer Cost Board Says "No"

[Microlith]

I'm trying to understand your point, but it's so unbelievably stupid I can't believe it's true.

Are you suggesting that in a system like what we have today, someone would actually spend the $3000+ they're asking to retrieve the records?

Re:Single Payer Cost Board Says "No"

[TheSpoom]

First paragraph of TFA (emphasis added):

Andrew Brown, 49, requested a copy of a cardiac ultrasound he had in 2004 at the Worcestershire Royal Hospital.

2004 means nobody can reasonably claim that it's obsolete to the tune of £2000. Dude needs to sue the hospital and the government. This isn't a failing of single payer, it's corruption through and through.

Re:Single Payer Cost Board Says "No"

[maxwell demon]

So 1 person has some trouble getting some old files vs our current system where we let folks with cancer die.

Yeah, what a terrible tradeoff.

You know, after they died they certainly will not ask for old pictures. Problem solved.

Re:Single Payer Cost Board Says "No"

[Anonymous Coward]

In Britain they don't just let them die, they send them up the Liverpool Care Pathway.

Re:Single Payer Cost Board Says "No"

[h4rr4r]

Clearly he would have forced to pay even more and the GP would have suggested the guy select a better hospital next time. He would also also stated that you have no right to question what the job creators want to charge for access to your own records.

Re:Single Payer Cost Board Says "No"

[Anonymous Coward]

You've failed to mention that both systems will let folks with cancer die. Socialist medicine has proven to fail (Canada), and the steps we've taken towards it in USA have failed (Obamacare is causing all small and medium sized hospitals to go bankrupt - mine only survived because it is the largest one within a few hundred miles). People will die no matter what - it's just a matter of how much free stuff we give to people who don't work for it before they die. Somebody has to pay for it (before you say "government", where does gov't get its money? That's right, it's your money and my money).

Re:Single Payer Cost Board Says "No"

[h4rr4r]

I disagree with your claim that it has failed in Canada.
It appears to be working fine, for an good example check out life expectancies.

People always die, selecting who lives based on who has the most money is immoral.

I pay my taxes happily, in the knowledge that they buy me the civilization I expect. That is the entire point.

Re:Single Payer Cost Board Says "No"

[LordLimecat]

I am thrilled to hear that we have a cure for cancer.

If you look carefully, I think you will find that all healthcare systems let people with cancer die.

Re:Single Payer Cost Board Says "No"

[h4rr4r]

With no care at all?
That claim does not reflect reality.

There are many cancers that are treatable or curable. In most of the first world this care is available to all citizens. In the USA if you lack a method of paying for said care you will be given pain killers by an ER doctor and sent home.

Re:Single Payer Cost Board Says "No"

[cdrguru]

Not sure you can say the Canadian system has "failed". They have had their problems and when there isn't enough government money to go around, their system is terrible. But conversely, when the government is rolling in dough the system works fine.

I suspect the US will have the same experience shortly. But post-Vietnam when has the government had enough money? For a little while during the dot-com boom, I suppose, but not really any other time. So I would expect that if you look at Canada in the 1980s when people were waiting months for any sort of health service and the answer to a lot of health care questions was that they used up the budget for that operation already - you have to wait until next year - this will reflect the US experience soon to come.

Oh, and don't forget that the government tax load in Canada is more like 70% of your income. That is what it is going to take here as well, if not more. With the local taxes and state taxes added in you may find yourself getting 10% of your gross pay as take-home.

Re:Single Payer Cost Board Says "No"

[h4rr4r]

We could easily come up with the cash. I imagine canceling a war or two might pay for it? Or maybe we could limit ourselves to only 2x as many aircraft carriers as the rest of the world combined.

Tax load is not 70% in Canada.

Re:Single Payer Cost Board Says "No"

[Capt.DrumkenBum]

don't forget that the government tax load in Canada is more like 70% of your income./blockquote> Bullshit! I am Canadian and my tax load is no where near 70% of my income.

Re:Single Payer Cost Board Says "No"

[Dahamma]

In the US it would have been both beyond any legal requirement to keep records (which is usually 5-7 years) and allowed to charge a fee based on the actual cost of making the copy. So doubly screwed by that amazing private health care system.

Re:Single Payer Cost Board Says "No"

[Em Adespoton]

So 1 person has some trouble getting some old files vs our current system where we let folks with cancer die.

Yeah, what a terrible tradeoff.

You know, after they died they certainly will not ask for old pictures. Problem solved.

Further than the "solution by death" system -- if the system is that old, why do they still have the records?

The problem I usually have is that all records older than about 5 years are destroyed, meaning that unless I specifically request the records and store them myself, all my long-term medical records vanish, leaving only a log of actions taken. Surely they can access records that are only 5 years old?

I'd love to live somewhere where this situation is even an issue.

Re:Single Payer Cost Board Says "No"

[h4rr4r]

See, this is the sort of BS we have to deal with in the USA.

We have an entire political party that makes the claims that jackass spouted.

Re:Single Payer Cost Board Says "No"

[mjwalshe]

the NHS isn't the same model as single payer are you thinking of the German style model

Re:Single Payer Cost Board Says "No"

[jareth-0205]

I am thrilled to hear that we have a cure for cancer.

If you look carefully, I think you will find that all healthcare systems let people with cancer die.

Oh... don't be a dick. You know very well that he's talking about the provision of appropriate treatment regardless of current financial state.

And yes, we currently have a cure for several types of cancer.

Re:Single Payer Cost Board Says "No"

[Obfuscant]

With no care at all? That claim does not reflect reality.

Yes, that claim does not reflect reality. Until we get the appointed board that controls the costs of Obamacare by deciding who is worth getting treated and who isn't.

By the way, cancer isn't treated in ERs. Funny how an ER doctor wouldn't treat it, huh?

Re:Single Payer Cost Board Says "No"

[mjwalshe]

you don't "select" a hospital in the NHS system you go to your local one or to a specialized one in your trust's area eg i have gone to cambridge for bone density and to Lister to see the nephrologist.

Re:Single Payer Cost Board Says "No"

[Telvin_3d]

The top Canadian tax bracket is 29% federally and between 10% and 21% provincially.

On top of that there are a few employment insurance type things and most provinces have a sales tax but even with everything the top brackets absolutly max out around 60%. And that is before any deductions. In Alberta it maxes out around 45%.

We just spend our money better. No for-profit medical industry and a significantly reduced for-profit insurance industry means our cash goes a lot further.

Re:Single Payer Cost Board Says "No"

[Em Adespoton]

Oh, and don't forget that the government tax load in Canada is more like 70% of your income. That is what it is going to take here as well, if not more. With the local taxes and state taxes added in you may find yourself getting 10% of your gross pay as take-home.

I was with you up until here.

http://www.cra-arc.gc.ca/tx/ndvdls/fq/txrts-eng.html

So worst case scenario (where you're making over $150,000/yr in Nova Scotia -- where you can live comfortably on $50,000/yr), you're paying around 36% total in income taxes and 10% sales tax. Most people are paying closer to 28% income tax and 12% sales tax.

Even if you had to pay sales tax on everything you earned/payed out and were the richest Canadian living in the worst possible location, you'd only be paying 60% of your money to the government -- and this implies you're making 4 figures or more (hint, you likely have enough money to have a team of accountants find you all sorts of tax dodges so you don't have to pay more than around 28%).

After deferred savings/donations/various rebates, I think 25% is a more average actual taxation level in Canada 1/4 of income, not 3/4 to 9/10.

And yet the medical system still functions. The only reason people think it's failing is that all the baby boomers are getting old and dying, so both the US and Canada are suddenly losing a significant portion of the population controlling the wealth of the nations year-over-year.

Hey... I have family members happily living healthy productive lives in their 90's thanks to Canadian Medicare, as well as relatives who are dealing with conditions that would have impoverished them had they lived in the US -- and they're still giving back to society through both taxes and increasing GDP.

Re:Single Payer Cost Board Says "No"

[Em Adespoton]

First paragraph of TFA (emphasis added):

Andrew Brown, 49, requested a copy of a cardiac ultrasound he had in 2004 at the Worcestershire Royal Hospital.

2004 means nobody can reasonably claim that it's obsolete to the tune of £2000. Dude needs to sue the hospital and the government. This isn't a failing of single payer, it's corruption through and through.

2004 is 8 years ago -- I'm amazed that they still have the ultrasound on file and know where to find it!

Re:Single Payer Cost Board Says "No"

[Anonymous Coward]

571,950 deaths from cancer are projected to occur in the U.S. in 2011

nearly 1.3 million people (717,398 men and 565,703 women) will die from cancer in the EU in 2012

You were saying?

Re:Single Payer Cost Board Says "No"

[sdguero]

I don't think your statement is accurate about uninsured cancer patients. My roommate is a cardiologist (obviously he doesn't treat cancer patients very often but I believe this still applies) and he is adamant that patients in the current system (at least at UCSD medical center in San Diego, a very nice hospital system) receive the same care independent of their insurance status. It may destroy the patients finances and force them into bankruptcy, but not having health insurance doesn't mean hospitals won't treat you. Now if a cancer patient doesn't have insurance, and doesn't want to lose their house for their treatment, they may choose to go the painkiller route (having seen friends and family go through cancer treatment, this is the route I would likely choose), but they can certainly choose to bury themselves in debt before they die if they want too.

I think the "non-treatment" fallacy is a big mis-truth that supporters of public healthcare covet and really don't understand... Just because you don't have insurance doesn't mean you won't be treated for your problem. In my limited experience, the quality of care is more dependent on the facility than whether or not the patent is insured. And in many cases, uninsured patients may actually pay less due to their financial situation than an insured patients pays for a deductible.

Since this post is getting long I might as well say that I think lawyers are the problem, not privatized healthcare. Something like 50% of the private practice expenses go to malpractice insurance, hospitals pay an amazing amount of money towards it as well. Limiting the amount of money people could sue hospitals and doctors for (say $500,000 or something more more reasonable than the current infinity dollars) would go a long way to reducing the cost of health care and insurance. Unfortunately the lawyers that litigate those cases hold a lot of sway in the US political system. They are chomping at the bit to start suing the government backed/regulated/mandated insurance schemes that are coming into effect with obamacare.

Re:Single Payer Cost Board Says "No"

[Formalin]

Oh, and don't forget that the government tax load in Canada is more like 70% of your income. That is what it is going to take here as well, if not more. With the local taxes and state taxes added in you may find yourself getting 10% of your gross pay as take-home.

-5, completely fucking wrong.

Re:Single Payer Cost Board Says "No"

[Dr_Barnowl]

Just to clarify further, the USA pays nearly twice per capita what the UK does (for roughly equivalent outcomes), but that only covers around 50M of their 320M citizens.

The UK population is around 63M people.

Yes, you pay roughly 12 times as much as us per treated patient, to treat fewer people with similar outcomes.

( 320 / 50 is 1 sixth of your population, you pay about double what the UK does per capita population, so that's 12 times as much per patient who actually gets treated)

Re:Single Payer Cost Board Says "No"

[tompaulco]

Are you suggesting that in a system like what we have today, someone would actually spend the $3000+ they're asking to retrieve the records?
I sure wouldn't. I have transferred my records a number of times and have never been charged and would not expect to be charged. That is part of the providers cost of doing business which they generously pad into their care of me.

Re:Single Payer Cost Board Says "No"

[stymy]

First of all, it doesn't make much sense to talk of the "Canadian system." While the federal government does provide some funding and services, most healthcare in Canada is run by the provinces, so quality varies significantly between them. Secondly, the tax burden is nowhere near 70% in Canada. If you earn over $150000, you might pay 50% of your salary in taxes, but more than that is unheard of. If you have a good accountant and create a corporation you own to funnel your earnings through, and to own your property, you can pay below 20%, depending on the situation (there are many tax breaks for the first 200 000 in revenue a small company generates, you can depreciate your house, car, etc. and use that as an expense, and so forth). An average, middle-class person probably pays 25-35% in taxes.

Re:Single Payer Cost Board Says "No"

[tompaulco]

So who would have been paying the 2000 if he had been living in the US?
In the U.S., the provider eats that cost.

Re:Single Payer Cost Board Says "No"

[tompaulco]

The USA spends about $6000 per capita *more* than the UK (and despite this the USA does not even manage to cover everyone).
So, in my family of 6, I pay $36,000 more for healthcare than a family in the U.K. Well, let's see, I paid about $4,500 last year, so in the U.K., the healthcare system pays the average family more than $31,500 a year?
I am interested to know how they figure the per capita costs. Do they actually break down your taxes in the UK and say X amount was for healthcare, or do they hide the expenses like Obama did for us by using proceeds from selling houses to pad the healthcare budget.

Re:Single Payer Cost Board Says "No"

[Gordonjcp]

Just to make matters worse, not only does the US pay twice as much in terms of percentage of GDP as the UK for healthcare, the life expectancy in the US is drastically shorter.

Re:Single Payer Cost Board Says "No"

[tibit]

Just to give you a solid idea: it's about $1300/month for a decent family coverage on a small business group plan. That is about $16k per year in medical insurance cost. It's not peanuts, I give you that.

Re:Single Payer Cost Board Says "No"

[Draknor]

Obamacare is causing all small & medium sized hospitals to go bankrupt, huh?

The fact is, hospitals have been losing money on Medicare inpatients for 10 years or more, and making up for it with private insurance patients. With the increase in uninsured patients (who only go to the ER if they go to the hospital at all, and then don't pay the bill), and belt-tightening by private insurance, and the big move to electronic medical record systems (which has a huge cost to migrate to from paper), it's no wonder small organizations are struggling and often get bought up by large health care organizations -- same as in any other industry.

But it's pretty naive to blame this on Obamacare.

Re:Single Payer Cost Board Says "No"

[Solandri]

People always die, selecting who lives based on who has the most money is immoral.

Canada provides a basic level of universal health care. If you wish to supplement that with private insurance or personal funds, you can. So even there they do in fact select who lives based on who has the most money.

So perhaps it's more accurate to say "refusing to provide basic medical care (up to $x in cost) due to inability to pay is immoral." In that respect the U.S. is already there - it is illegal for hospital emergency rooms to turn away patients due to inability to pay.

The U.S. health care system is screwed up in a different way. Even before Obamacare, government spending on health care per capita exceeded what Canada was spending. That is, the U.S. government was already spending enough on health care to provide each of its citizens with Canadian-style coverage, and we still had a worse health care system. Canadians spending an extended time in the U.S. have to deal with this with supplemental insurance. The Canadian government will only pay for treatment in the U.S. up to what equivalent treatment would cost in Canada. Anything above that has to be paid out of pocket or by supplemental insurance.

Re:Single Payer Cost Board Says "No"

[Draknor]

So you are saying in Canada, that if the budget for an operation is used up, you have to wait until next year?

Whereas in the US, if you don't have health insurance, you NEVER get the procedure performed.
If you DO have health insurance, you get the procedure performed and then spend 2 years fighting the insurance company to actually pay for it.
Or you go broke (60% of bankruptcies are due to medical costs, and 3/4 of those had insurance), or both.

So, yeah... Canada's version doesn't sound so bad, all in all.

Re:Single Payer Cost Board Says "No"

[ColdWetDog]

Nice start. You lost it at "50% of the private practices expenses go to malpractice insurance". A total overhead of 50% of gross receipts would be an excellent rate of return for a private practice. But that would include ALL overhead - salaries, equipment, real estate and malpractice. Most practices probably run around a 40% ROR - it will vary depending on the specialty and location but it's not all malpractice, not by a long shot.

Nobody really knows how much the American malpractice system costs everyone. Estimates are typically in the 10-20% of total expenditures range. Still a lot.

Re:Single Payer Cost Board Says "No"

[Anonymous Coward]

But it is more than 60% in Germany, where my family lives. I get much better care here in the USA and my insurance is much cheaper. Of course I work for a living -- something more and more americans just don't want to do.

Re:Single Payer Cost Board Says "No"

[wmelnick]

Then why did Danny Williams come to the US for his heart surgery?

Re:Single Payer Cost Board Says "No"

[filthpickle]

You looked in to high deductible? Doesn't work for everyone (although everyone is going to have it soon anyway), but I love it.

Re:Single Payer Cost Board Says "No"

[Sulphur]

Then why did Danny Williams come to the US for his heart surgery?

He didn't like that way they were playing Danny Boy at home?

Re:Single Payer Cost Board Says "No"

[LurkerXXX]

Are you an utter moron who believes everything that FAUX news tells you, or are you a liar spreading FUD on the GOP payroll?

Canada doesn't have anything like a 70% tax rate.

Got any citations? Of course not, because it's a lie.

Re:Single Payer Cost Board Says "No"

[filthpickle]

I was curious. Google seems the think it's the same.

http://www.disabled-world.com/calculators-charts/life-expectancy-statistics.php

Re:Single Payer Cost Board Says "No"

[interkin3tic]

Indeed. Here, the HMO would NEVER have admitted it so plainly. They would have found a way to make it sound like it wasn't their decision. MUCH BETTER.

Re:Single Payer Cost Board Says "No"

[Mabhatter]

Obamacare is trying to fix EXACTLY that problem. If you come into ER they have to "stabilize" you but not FIX you.

A great example is my wife's best friend. Her gallbladder was infected. For somebody with insurance they would try antibiotics ONCE then yank that thing in an OUTPATIENT operation. That's still $3-4k at insurance rates.

Enter "I don't have insurance". Week one, pump up with IV antibiotics and 2 overnights in ER and pain pils. Two weeks later, pain pills wear off and gallbladder is infected all to hell. Rather than get you in and get that out on the NEXT ER visit, we admit you for ANOTHER WEEK of antibiotics.. At which point, they don't work, and you have now spent a full week in the hospital trying to get WELL ENOUGH for the operation you SHOULD have had after the first week of antibiotics didn't work... And then you have after-hours emergency surgery, plus complications because you're getting gang green!

This "moocher" healthcare bill has been run up from $4k with insurance credits to $50k+. If you didn't have insurance you certainly can't PAY this bill. So basically the hospital has to eat it.

Now a busy hospital can probably eat some of these, because they can write them off profits. Medicare has squeezed SO HARD now that hospitals are getting paid less than the ACTUAL COST of the services.... It's not enough to cover wages, meds, and supplies now. Private insurance laws have their own issues with uninsured people because the hospital can't legally "cut you a break" because laws say hospitals MUST give insurance the best rate on the books. Insurance companies want 30% discounts for in network..

So you can imagine just how hard "cash price" is stepped on to make any money at all on people WITH insurance they think they are actually doing their duty to pay for.

Re:Single Payer Cost Board Says "No"

[loshwomp]

So, in my family of 6, I pay $36,000 more for healthcare than a family in the U.K. Well, let's see, I paid about $4,500 last year, so in the U.K., the healthcare system pays the average family more than $31,500 a year?

That's not what "per capita" means. If you are paying only $4500 per year, and that includes both your and your employer's share of the costs, and you have a $0 deductible, pay no co-payments or other charges, and you spend $0 on prescription and over-the-counter medications, then you are astronomically fortunate.

Such anecdotal information is irrelevant, though, since we're talking about per-capita (i.e. average) costs, which are exceedingly well documented at about $3000/year in the UK, and nearly $9000 in the USA (probably higher in 2012).

Re:Single Payer Cost Board Says "No"

[Mabhatter]

It's BETTER than what you got now!!! Have you READ and USED your insurance review practices? Just what till you need something that's $100k+ like "simple" breast cancer.. Where they chop off your boobs and leave big pits. (And insurance doesn't pay to make you look normal either) then you do hair-falls-out chemo. Then they come back 9 months later and your doctor missed some form... Which you could easily get... Except the notice was buried in hundreds of pages of statements... And it was sent with only two weeks left on the 90 day in the first pace. So suddenly they just don't pay 75% of the bill.

Or worse, your employer switched carriers improperly or mis-mailed one bill in the middle of your care. Obama's "death panels" are so much worse than being at the mercy of computer software and minimum wage call center employees that are intentionally poorly trained to mislead you on those major incidents.

There is some truth to the boards. They are not going to throw good money at multiple attempts with low chances. There is a lot of waste in "end of life care" that won't affect a change in outcome and just "abuses the dead meat" so the doctor doesn't have to tell you "time's up". That's how you end up with long, nonproductive hospital stays that amount to "not dying" of weeks when the doctor KNOW you aren't walking out. There is a point people are going o need to go home to die while they are "well" so they can enjoy one good week instead of three weeks barely conscious.

Re:Single Payer Cost Board Says "No"

[nedlohs]

You compare an overall rate with a marginal rate and you're surprised the marginal one is higher? Are you actually stupid enough to think that's a valid comparison or just trying to be deceptive?

22% marginal rate versus 25% marginal rate didn't fit your bias so you compared non-similar things to make the fact fit your view better?

And of course the state level taxes are significantly higher in Canada, at that income the marginal rate would be from 7% to 17.4% (depending on which province you were in) compared with from 0% to 9.3% in the US (again depending on which state you were in).

Of course deductions and rebates are different, as are the non plain income taxes, so it's still not a great comparison.

Re:Single Payer Cost Board Says "No"

[nedlohs]

US population is 315,000,000 with 12.8% being aged 65+.

EU population is 503,000,000 with 16.8% being aged 65+

Since cancer mostly effects the aged you would expect the US cancer deaths to be 48% of the EU ones, that would seem to explain a large chunk of the difference. That smoking rates are higher in the EU than in the US is going to explain some more of it. So what evidence have you got of any correlation to health care structures and funding?

Re:Single Payer Cost Board Says "No"

[Friggo]

Move to Sweden then. Here your records have to be archived for at least your lifetime, recommendation is life+5 years.

Re:Single Payer Cost Board Says "No"

[LordLimecat]

The criticism was that his post was so vague as to be applicable to anyone. Its akin to using weasel words so that you cannot easily be challenged in your argument.

Re:Single Payer Cost Board Says "No"

[h4rr4r]

No it is not.
More than half my family is german, I was born there.
50% is closer to the truth though.

The level of care is very comparable, except german doctors seem to be more likely to see you on time.

Re:Single Payer Cost Board Says "No"

[h4rr4r]

You like the insurance companies do?
Or where they take your money until you are sick then cancel your for forgetting about having the flu in the third grade?

ER doctors send you to an oncologist who will treat the insured. The uninsured gets nothing.

Re:Single Payer Cost Board Says "No"

[h4rr4r]

Perhaps his hospital will pass this cost on others, they never just eat it, but many will stop care once a patient is far enough behind on his bills.

If you roommates malpractice rates I don't want that butcher near me. No normal doctor pays that much. 10% is really pushing it.

Limiting the amounts people can recover will not do a lot to reduce this, since millions of dollars judgements are so rarely carried out. If the doctor wants to be less liable, then I suggest he reduces his prices. Instead he wants to keep that money and you know it.

Also it is champing at the bit, not chomping.

Re:Single Payer Cost Board Says "No"

[tompaulco]

nearly $9000 in the USA (probably higher in 2012).
Well, it is only $9,000 because people are paying for overpriced insurance. I used to pay $800 a month for insurance, and my employer paid another $150 or so. So that is almost $12,000 a year. However, this was ludicrous. I dropped my employer's plan completely and went with a high deductible plan where I pay about $225 a month and pay ALL out of pocket costs myself, but at the insurance company's discounted rate. Even if I hit my deductible, I will STILL pay less than I was paying under my employer's plan. Unfortunately, I hear Obama is trying to get rid of these policies, which actually meet the technical definition of "insurance" in favor of the higher cost options which benefit the insurance companies and take more money needlessly out of the hands of the citizens and transfer them to the insurance company.

Re:Single Payer Cost Board Says "No"

[tompaulco]

Bad form to reply to my own post. But I guess to put it more bluntly, I pay about $3000 a year for my INSURANCE, but I paid only about $500 last year for my HEALTHCARE. My insurance company did not pay dime one, so the entire burden of my healthcare was on me. I would say the average yearly cost of what me or my insurance company paid out over my entire adult life has been probably about $1,000 a year, and given deductibles, copay, and coinsurance, what the insurance companies paid out on average has probably been only about half of that. Now what I have paid INTO insurance over the course of my life has probably been about $7,200 a year, and as I mentioned I switched to a high deductible recently which has saved me a lot of money recently and would STILL save me money even if I had to pay my maximum out-of-pocket expense. Over my lifetime, the insurance company has been making about 90% profit on me and my family. With the high deductible plan, I am basically paying them $225 a month just to be on their pricing program, but it is definitely worth it. And if things really go to hell, they cover anything over $7,500 or $10k or whatever my limit is. And that is still cheaper than being on a full medical plan. Too bad Obama wants to do away with insurance, which is what this is, and try to convince us that medical plans are insurance and everybody needs to be on one.

Re:Single Payer Cost Board Says "No"

[andyteleco]

I live in Germany and I can only say good things about the health care system. True, taxes are high but you do get something in exchange and salaries are high enough too so you have a good paycheck at the end of the month.

If I wanted I could switch to private healthcare and step out of the public system for about 300 euros a month; I doubt that will cost you less in the states.

Re:Single Payer Cost Board Says "No"

[uglyduckling]

If the equipment was 20 years old in 2004, and they got rid of it in 2005 (I don't know if that's the case, just guessing) then it's entirely reasonable to claim it's obsolete, as it is - in fact - obsolete. I got rid of my Palmpilot in 2004 - would it be wrong to say that the records I had on there are obsolete?

Re:Single Payer Cost Board Says "No"

[uglyduckling]

You can, it's called "Choose and Book"

Re:Single Payer Cost Board Says "No"

[uglyduckling]

It's not bullshit, it's because he wants an irrelevant scan from old records on an old system that no longer exists. The "charge" isn't a charge, it's a statement of what the hospital would have to pay in order to convert the old data.

Re:Single Payer Cost Board Says "No"

[gnasher719]

In the U.S., the provider eats that cost.

The guy in question doesn't actually need these images for any medical purposes. He just wants them to put them "in his records". Just for his own pleasure. And the NHS told him that delivering the images would cost £2,000. Since he wants them only for his own pleasure, he has now the choice of stopping to be an arse and asking that the UK tax payers spend £2,000 for his enjoyment, or paying £2,000, or forcing the NHS to make a decision. If I was the one to make the decision, I'd probably be so shocked at his demand that I dropped and broke the video disk with his images, with the sharp remains having to be destroyed because they are a danger.

Re:Single Payer Cost Board Says "No"

[rwise2112]

Then why did Danny Williams come to the US for his heart surgery?

He was advised, incorectly, that a less invasive type of surgery was not available in Canada. Turns out it was, but he would have needed to go to another province to get it. He still could have had the operation in Newfoundland, but would have taken longer to recover.

Re:Single Payer Cost Board Says "No"

[tibit]

I don't think we can change that under our group plan. Having individual insurance would be so much more expensive that deductible-based rate reductions wouldn't cover the difference.

Re:Single Payer Cost Board Says "No"

[nbauman]

You've failed to mention that both systems will let folks with cancer die. Socialist medicine has proven to fail (Canada), and the steps we've taken towards it in USA have failed

Absolutely false. There have been many studies comparing the health care system in the US and Canada, and they all come to the same conclusion: Health care in Canada is just as good as health care in the US, and sometimes better.

Here's one: http://www.openmedicine.ca/article/view/8/1 A systematic review of studies comparing health outcomes in Canada and the United States (Basically it says that the outcomes are the same in both the US and Canada, but the US costs twice as much.)

There's a Wikipedia article comparing the US and Canadian health care systems. They link to dozens of studies, which overwhelmingly come to the same conclusion.

There are also studies comparing the US to other health care systems. They come to the same conclusion too.

There's one exception. When epidemiologists make international comparisons, they have to compare black Americans separately, because their health care is so much worse.

Somebody has to pay for it (before you say "government", where does gov't get its money? That's right, it's your money and my money).

Somehow conservatives think it's a great insight to tell people that their own money goes to pay taxes. Everybody knows that. I'm happy to pay taxes if I get something worthwhile for my money.

The issue is whether you would rather pay $5,000 in taxes, or $10,000 in private insurance premiums, for the same health care. I'd rather pay $5,000. Who would rather pay $10,000? Hands?

Re:Single Payer Cost Board Says "No"

[nbauman]

So perhaps it's more accurate to say "refusing to provide basic medical care (up to $x in cost) due to inability to pay is immoral." In that respect the U.S. is already there - it is illegal for hospital emergency rooms to turn away patients due to inability to pay.

Not quite. First, it's not illegal. If hospitals choose to get Medicare and Medicaid (as most do), they're required to admit people in an emergency and stabilize them. Then they can kick them out, and often do. A hospital can turn away a patient who is dying of cancer, until she's in an immediate crisis. Then they stabilize the crisis, and kick her out again. http://online.wsj.com/article/SB118781024289705455.html

Second, they can send the patient a bill. If the patient doesn't pay, they send it to collections. There are collection agencies which will hound the patient for decades, seizing their bank accounts and paychecks.

Re:Single Payer Cost Board Says "No"

[filthpickle]

I don't think you understand how it works. High deductible health insurance is great for people with regular, recurring medical costs. Anything you go see the doctor for counts towards your deductible. If you aren't dumb, you work out what you are going to have to spend every year on those recurring costs, and you pay (pre-tax) enough into your HSA/FSA to cover that.

I have hit my deductible before. It reminds me of the insurance I had thru my dad when I was a kid. Walk in, walk out, done.

Re:Single Payer Cost Board Says "No"

[nbauman]

Actually, cardiologists do treat cancer patients, because many of the cancer treatments cause heart damage.

But to your original point, it is true that hospitals turn away cancer patients. Here's a well-documented example. http://online.wsj.com/article/SB118781024289705455.html Remember, hospitals are required under Medicare rules to accept people in an emergency and stabilize them. They're not required to treat them for chronic conditions.

You say UCSD isn't like Texas? I'm not there, so I don't know for sure. But I do remember a letter to the New England Journal of Medicine. A doctor was addressing the claim that free-standing radiology clinics made x-ray services more accessible. She called up several free-standing clinics, gave them symptoms of a treatable brain tumor, told them that her doctor had suggested that she get a CT scan, and asked them if they would accept her if she couldn't pay. They refused, and suggested that she go to a University of California hospital. The doctor said that that hospital was her own institution, and she knew that their CT scanners were booked solid and weren't available for people who can't pay. (She called the centers again, gave them the name of the insurance plan she actually had, and asked them if she could come in for a (useless) CT scan for a sprained ankle. They offered to schedule her immediately.)

OK, that was a while back, before CTs were overbuilt. The NEJM had a recent article in which they did something similar. They had people call doctors, claim they were on Medicaid, and describe symptoms which would have been life-threatening. Many of the doctors refused to take them.

One last point: The cost of the medical malpractice system is about 2% of the total cost of health care. The malpractice crisis is to a certain extent bullshit propaganda propagated by insurance companies as an excuse to raise their premiums.

Re:Single Payer Cost Board Says "No"

[AF_Cheddar_Head]

Since most of Obamacare hasn't started yet please kindly explain what part of Obamacare caused the local hospital to close.

Oh right, the small local hospitals have been failing for years and now it is convient fof you to blame the new system beforegiving it a chance to suceed. If youwere objective you would look at the real numbers for the Canadian and Scandanavian systems before having right-wing spasms about socialized medecine.

If anything Obamacare will fail because it doesn't go far enough. The free market has given us exprnsive healthcare with poor outcomes compared to Canada, Australia and Sweeden. Time to try something else.

Re:Single Payer Cost Board Says "No"

[AF_Cheddar_Head]

If you stop paying $500 a month for shitty health insurance and we all pay $250 a month in healthcare tax(kind of like Social security) we all win. Eliminate the insurance company profit from the healthcare system would be the start we need.

Why should the patient have to pay?

[ZorinLynx]

Why should the patient have to pay 200 times as much money to access records when the difficulty isn't his fault?

The company that was incompetent and stored things in an inefficient manner should cover the cost. Charging this incompetence to the patient shouldn't be legal.

Re:Why should the patient have to pay?

[PlusFiveTroll]

Every old medical system I've seen is stored in some odd format or database. Most smaller clinic don't migrate records because of the insane costs that the vendors want to charge and instead migrate the information over on a client by client basis as they come in the office. If they patient doesn't come in for a number of years the records never get transferred. Since many of these systems cost yearly fees to run, after some point they are just shut off.

This isn't the patients fault. I will go as far and say that it isn't the hospitals fault either, it seems every system is proprietary, especially the older systems. What needs to occur is an open records format that is legislated.

Re:Why should the patient have to pay?

[h4rr4r]

It is the hospitals fault for selecting such a system. The hospital should have required any vendor provide the database schema and an export tool at the time the software was purchased.

Re:Why should the patient have to pay?

[jedidiah]

Cars are well documented and have a have a standard repair schedule

So this kind of shenanigan is unlikely to happen with a car.

THIS is why stuff needs to be maintainable. THIS is why computing devices and software needs to be just as open to those that might want to provide 3rd party support services.

This $2000 price tag sounds familiar...

Re:Why should the patient have to pay?

[h4rr4r]

At which point the hospitals should have contracted such a system. Accepting this situation is their own fault.

Re:Why should the patient have to pay?

[cdrguru]

You are joking, right?

The federal government has rules that say for a car to be sold in the US there must be a 10 year committment to supply parts for that car. Funny, but I had a 1998 Dodge Stealth which was actually made by Mitsubishi. In 2001 the antilock brake controller failed and I was told that not only was it a $2900 part but the part was no longer available and they would have to try to find one in a junkyard.

Government regulation only works when the regulations are followed.

By the way, the cost for this is certainly just to penalize someone - having worked with a number of companies that do obsolete format media conversion this is a price that says "I don't want to do this so the price is 10x normal". It could also be that the patient is just being annoying about this and being charged for being annoying. An 8-year-old test likely has as much relevance as an 8-year-old sandwich.

Re:Why should the patient have to pay?

[Anonymous Coward]

I work for a large company that develops medical record database software, so this is kinda my thing.

We refuse to allow even qualified local database/IT consultants touch anything in the database. A single update or delete statement ran on the live database invalidates their support contact if we wish. That's not to say the whole .db file is proprietary, we (begrudgingly) allow third party companies to access the database to pull email/reminder information. Or, in the case of the pharmaceutical companies: Client Name, address, phone number, invoices and prescriptions. Because you know, marketing. Ironically, it was this step - selling data to other companies, that finally put our division in the black. It's kinda nice not having to worry about HIPAA (veterinary industry).

We provide the conversions from almost all of our competitors and our legacy products. Conversion costs depend on what is converted, such as ONLY medical records, or billing history too? Images? Reminders? Inventory history? It can get pricey, sure, but that is the cost of the switch. Most of the time, conversions is only a small part of the cost of transitioning, the cost of retraining the staff is usually more than the software and hardware itself.

Re:Why should the patient have to pay?

[Sentrion]

Wrong analogy. The car is the human body, but there is nothing special about the patient's body that is causing the document retrieval fee to be £2,000.00. For your car analogy, it's more like "well, we took a look inside your engine to see what was wrong, and our technician Ted didn't write down what we found. But Ted quit just before lunch and won't tell us what we need to know unless you pay us an additional $100 to get Ted to talk. We could perform the diagnostics all over again, but that would cost $150. How do you wish to proceed?"

Naturally, if I came across this situation in real life, I would go straight to Slashdot!

Re:Why should the patient have to pay?

[tompaulco]

Why should I have to pay 10x as much to get my transmission repaired just because I chose the wrong car manufacturer!
That's not even the worst of it. You usually end up having to pay more depending on how incompetent your car repairperson is. If they are incompetent and can only guess at what is wrong based on error codes, then they may replace a dozen things before finding the thing that was actually bad, or they may never find what was bad, but they still charge you parts AND labor for all the time they spent monkeying around with something they had no clue about. Air Conditioning repair people are the same way.

Re:Why should the patient have to pay?

[jimicus]

They may have that information already. Doesn't mean they've used it to migrate records to a newer system - or for that matter to develop an easy mechanism for getting data off the old system for the odd time it's needed.

How much do you reckon it'd cost to hire a consultant to put together a bit of code to do this if they don't already have it? Having seen some of the database schemas for bigger systems, I reckon £2000 doesn't sound too far off. It'd probably take a few days just to digest the ER diagrams.

Re:Why should the patient have to pay?

[Darinbob]

And the vendor would have charged more money for that... Plus database schemes don't help if your old system involves exporting to a floppy disk and walking it down the hall, or retrieving data from magtape.

Re:Why should the patient have to pay?

[Draknor]

They don't have any choices. At least in the US, any electronic medical record system has to be certified, and there are NO open-source systems certified (that I'm aware of, anyway -- check for yourself).

Besides, it's possible they DID have the schema and reporting tools, but no one currently employed there has the documentation or the expertise to do it anymore. The $2000 might be the cost it would take to have a 3rd party retrieve the data. That's only 10-20 hours of work for a consultant, which is probably about right for them to spin up an old system, search through it, and retrieve the necessary data.

Re:Why should the patient have to pay?

[filthpickle]

You aren't necessarily wrong, but you are enjoying a nice slice of Key Lime at about 40 thousand feet.

Re:Why should the patient have to pay?

[h4rr4r]

What about what the VA is using?

This looks like something a non-profit should be doing, failing that the government itself.

Re:Why should the patient have to pay?

[stymy]

Hospitals aren't required to store patient information forever. I believe that they can destroy data after 7 years in the UK. So while it may be illegal for the company to charge him so much for the information, when there's a price limit for that sort of thing, he should be glad they kept it at all.

Re:Why should the patient have to pay?

[DefconAlpha]

I will go as far and say that it isn't the hospitals fault either, it seems every system is proprietary, especially the older systems. What needs to occur is an open records format that is legislated.

You can't really do that. Let me explain.

I develop an electronic medical record system specifically designed for hospices. I have extensive experience modelling clinical documents into electronic records. Each type of document has it's own set of required data points. On top of that, each federally issued mandate actually allows for some degree of interpretation, so each vendor may tailor their data collection to the needs of the clinicians and customers (this is a good thing). This allows me to add or remove data points. For example, I generally don't need to document data for pediatrics in hospice work. (OH: Pediatric hospice. Sad panda.)

I already implement changes to follow CMS regulations several times a year -- usually for billing purposes. This doesn't guarantee that when CMS mandated that each nurse's visit a patient received in a billing statement is the same kind of nurse visit that some other software vendor records. We both record a nurse visit in some capacity, but i'm certain that my visit is more relevant for my customers than software for optometrists.

By forcing me to use a mandated format, i would have to (potentially) rewrite my application to fit the data, migrate all of my data into the new format (which may or may not be efficient), fix reports that depend on those data pieces... The list keeps growing. This would require some amount of time (cost) that i would provide directly to my customers (read: price increase for everyone).

Once i do have my data migrated, why would my customers keep using my software? Why would they not just write their own and open source it? It could lower costs, for sure. Just cut out the software cost, right? You could use something like OpenEMR (http://www.oemr.org/)... but that is not suited for my clients. It's suited for a hospital. My clients work with patients in their homes and in various medical facilities (hospitals, nursing homes, long term care facilities, etc). The expression cutting flowers with chainsaw comes to mind. This is not to say that my software is as simple as a pair of scissors, just that the tools are appropriate for the job at hand.

Each software provides it's own data set. Forcing us to use one set of data would be absolute chaos and it would in the end creating a monopoly on the medical software industry. It would reduce innovation not only because of monopolistic tendencies (american broadband, anyone?), but also due to constraints on the data format (you can't change it, now). I prefer to have a choice between Ford and Ferrari. I don't want to just settle for a Toyota Camry simply because it was the last one left standing after regulation legislated everyone into irrelevance. Legislating a data format would undermine every free market principle of our economy -- especially since the data format is an integral part of the software industry. My data format is kind of why my clients pick my software and not G.E. or McKesson or AllScripts or Misys. That, and my support team rocks my customers' faces off daily.

Not only that, but the last time data formats were mandated, look at the fucked up repugnant shit we ended up with:
http://en.wikipedia.org/wiki/HL7
http://en.wikipedia.org/wiki/ASC_X12

Other than "You have terminal cancer,"

[MoonRabbit]

The last thing I want to hear at my doctor's office is "we're getting a new computer system."

Re:Other than "You have terminal cancer,"

[Beardo the Bearded]

As an electrical engineer that does consulting work, that's something I *want* to hear.

Re:Other than "You have terminal cancer,"

[Sulphur]

Well they'd need a new computer system, wouldn't they? You can't run a hospital with cancer in the terminals.

They could get mumps.

Re:Other than "You have terminal cancer,"

[Cro Magnon]

Even if it's replacing their olde 8088 DOS system? ;)

Re:Other than "You have terminal cancer,"

[vandamme]

The new computer is fine, but it's prone to PEBKAC/1D10T errors.

An inspiring new way to raise funds!

[InvisibleClergy]

So instead of having migration costs, just charge your customers for your migration! Think about it - if you go to the bank, the teller tells you that it will cost you $2,000 to withdraw money because the system in which they store your account info is still on Windows ME! It sounds glorious. I am doing this immediately.

Oh, wait, no. I only work on ancient systems. Whoops.

Records Retention?

[rhsanborn]

What are the record retention requirements in the UK? These records are from 2004. They'd have been destroyed at this point in Michigan (5 years last I looked). That said, if its within the record retention rules, you'd be a fool not to have them in some accessible format.

Re:Records Retention?

[h4rr4r]

Medical records are only kept for less than 5 years in Michigan?

That cannot be correct. Human medical histories have value a lot longer than that.

Re:Records Retention?

[jedidiah]

Hell. I DVD rips that are older than that. Most of my MP3 collection is twice older than that.

Perhaps it's time for open formats, thumb drives, and people doing for themselves.

Re:Records Retention?

[flimflammer]

That's bizarre. In California I found myself in the ER over a pretty bad infection. I hadn't been in the hospital since I was a little kid (I'm 26 now), so when they were asking for my contact info, they gave me the phone number I had when I was 5 years old and asked if it was correct. After giving them the relevant info, I jokingly asked when my last few visits were for, and they read off 4 entries all dating back to when I was 4 to 8. There were charts and all sorts of stuff attached to my file.

I was blown away, and also a bit creeped out at the same time.

Re:Records Retention?

[cdrguru]

But the relevance of a test from eight years ago is approximately zero.

The only possible use of such a test would be to compare it against something current, but likely as not any real relevance would only be obtained if you had tests more frequently to compare against. And still, what does the current doctor want with an eight year old test? Most of the time anything over three or four years old is ignored and new tests are ordered.

The truth of the matter is that people's bodies change over time.

Re:Records Retention?

[Dahamma]

They are not required to be *destroyed* after 5 years, they are required to be *kept* for 5 years. It's a minimum guarantee to patients, not a maximum.

It would be pretty awful medicine to require doctors not to be able to know your heath history longer than that!

Re:Records Retention?

[Em Adespoton]

Medical records are only kept for less than 5 years in Michigan?

That cannot be correct. Human medical histories have value a lot longer than that.

It's 5 years here too. If you want records kept longer than that, you have to do it yourself.
Your *medical history* file is as long as you are with your current GP, and can include medical history from previous GPs if you have requested a transfer. But the records themselves? Ultrasound results? X-Rays? CT Scans? MRIs? Biopsy reports? Blood test details? Those get turfed after 5 years.

Re:Records Retention?

[Draknor]

And that's why humans should keep track of their own medical records, and not leave it at the discretion of insurance companies & health care organizations.

Ford doesn't keep track of your automotive maintenance history, but if you don't you might find you violate the manufacturer's warranty.

Re:Records Retention?

[filthpickle]

A lot has been made over how long a provider is legally required to keep your records. While I am sure it happens that they don't keep them, I bet as many do as don't.

Re:Records Retention?

[rhsanborn]

In Michigan, for people under 18, I believe we have to keep their records until they are 18 + 5 or 7 years. I think California may require 10 years retention as well. So, it's not unreasonable that they had those records on file. We often keep demographic information if it was ever electronic (it's relatively small), but records, images, etc take up a good bit more space.

Re:Records Retention?

[rhsanborn]

You're right, it's not required, but storage isn't free, it's not even cheap. A lot of people have these records on paper, and when you multiply one patient record by the number of patients you've seen, the numbers can get pretty big pretty fast. As a rule, most healthcare organizations don't keep records longer than they are required because of the cost.

Re:Records Retention?

[nbauman]

It's true. In New York State, the retention requirements for medical records are 7 years. It's ridiculous.

Re:Records Retention?

[nbauman]

Real example: Suppose you have a chest x-ray and the doctor notices a spot on your lung. It could be cancer. He wants to do a (dangerous) biopsy. As it turns out, there are lots of spots on peoples' lungs. If you have an 8-year-old chest x-ray, you can look it up and see if the spot was there. If it was, and it's not growing, you know it's not cancer and you can skip the biopsy.

Hell, it's useful for a doctor to know what you weighed 8 years ago, and what your height was. Suppose you lost an inch in 8 years. You'd want to find out why.

Re:Records Retention?

[Dahamma]

Actually, all of my records have been available online for at least the last 7-8 years. I can even log in and look at them myself. That storage is in fact pretty cheap...

Hell, my Dad is a veterinarian (where technology in the office tends to lag human medicine by a fair bit) and he has had all of his records computerized for almost 10 years. He's even had all x-rays, ultrasounds, etc stored digitally for the last few years.

I can imagine most practices, hospitals, etc will not bother to digitize their old paper records, but the majority are definitely now storing things digitally. I really doubt "most healthcare organizations" are deleting digital records as soon as the legal requirements are up...

Re:Records Retention?

[rhsanborn]

Many hospitals don't have them that old, a lot of hospitals were on paper until the last 5-7 years. Those that are on electronic records are having destruction conversations. Diagnostic images are very large, and there is relatively little value to the hospital for keeping them. A bigger issue is that it costs a lot of money to continue to upgrade and convert the data. The diagnostic imaging software changed? Do you convert all your old images at considerable expense? Or bin them because they are beyond retention? About to upgrade to a new SAN, do you migrate the data that's out of it's retention period?

Won't happen...

[Anonymous Coward]

They may have asked him for £2,000 but he won't have to pay it:

From the UK Information Commissioner's Office:

http://www.ico.gov.uk/for_the_public/personal_information.aspx
You have the right to get a copy of the information that is held about you. This is known as a subject access request...Organisations may charge a fee of up to £10 (£2 if it is a request to a credit reference agency for information about your financial standing only).There are special rules that apply to fees for paper based health records (the maximum fee is currently £50) and education records (a sliding scale from £1 to £50 depending on the number of pages provided).

Re:mod 0p

[X0563511]

How many of you think this thing might just be the modern equivalent to a numbers station?

Mis-use of the term DRM

[HeckRuler]

and DRM-free, too?"

Do you understand what "DRM" and "DRM-free" would equate to when it comes to your medical records?

Re:Mis-use of the term DRM

[jedidiah]

> Do you understand what "DRM" and "DRM-free" would equate to when it comes to your medical records?

There would be some Linux tool that could decode it without being in any sort of legal grey area. I could always be sure that there is a decoder for the data even when the format becomes obsolete. I would not be at the mercy of the clinic or whatever medical device vendor they used.

Re:Mis-use of the term DRM

[Revotron]

^ this.

Calling this DRM is ridiculous. If I can't play AVI movies on an MPEG media player, that's not DRM, that's a format discrepancy.

Re:Mis-use of the term DRM

[CanHasDIY]

and DRM-free, too?"

Do you understand what "DRM" and "DRM-free" would equate to when it comes to your medical records?

No kidding - personally, I think medical records would be the one place you would want some pretty strong DRM...

Re:Mis-use of the term DRM

[HeckRuler]

Did you know that using the term "Pavlovian" triggers an emotional response? If you did, then why did you use the term?

Re:Mis-use of the term DRM

[Absolutely.Geek]

DRM is a bad thing and should not be used with something as important as medical records.

Encryption however should be used, it should be using open standards. An encrypted text file or similar is far more secure then a DRM encumbered file, how many DRM schemes are there that have been broken?

It should also be easy to move from one encryption standard to the next by simply: decrypt file -> encrypt using new standard.

Re:Mis-use of the term DRM

[CanHasDIY]

DRM is a bad thing and should not be used with something as important as medical records.

Tech isn't good or evil, only how it's implemented is.

I recommend putting the management part of DRM in the hands of the patients, not the hospitals.

Encryption however should be used, it should be using open standards. An encrypted text file or similar is far more secure then a DRM encumbered file, how many DRM schemes are there that have been broken?

One could easily argue that encryption is a type of DRM, as it fits the definition.

It should also be easy to move from one encryption standard to the next by simply: decrypt file -> encrypt using new standard.

Sure, assuming the equipment used to encrypt/decrypt is the same, and you have access to the keys, and Jupiter is in alignment with Venus...

Not to say encryption would be a bad thing (it's not), but rather that my experience with American healthcare is that fucking up is pretty much industry standard. So long as it's the patient in charge of the encryption and not some overpaid hospital bureaucrat, there should be no issue.

Re:Mis-use of the term DRM

[Absolutely.Geek]

I agree with what you say except I envision the follow scenario:
Doctor: Ok Mrs 6Pack where did Joe store his medical records and what was the decryption key?
Mary 6Pack: Oh he gave those to his momma in city on other side of country and what is a decryption key?
Doctor: Well we can get a copy from the archive, but we really are going to need that password!

Re:Mis-use of the term DRM

[HeckRuler]

Uh... ok. So you your medical records are encrypted. Where do you want them stored? Say you get in a car accident and you're rushed to the ER. Presumably, you want the hospital to store your medical records so the ambulance doesn't have to swing by your house on the way.

Who has the key?

The hospital, right? Because the doctors need actually see your medical records so they know that you're AB+ and allergic to nut-based insulin. That's kinda the whole point of medical records.

(Please let me know if I got any of the above assumptions incorrect)
Now lemme get this straight. You want your medical records securely encrypted in a database they can access at the hospital... and the hospital can also access the key to decrypt it.... And you think this is safe?

Realize that if you start to talk about who can access what keys, or how long they can view your records, or anything to track who is doing what with what info, you're now talking about DRM.
These are your records, you want certain other people to be able to use them at certain times for certain purposes. And you want to be secure that no-one else will be able to access these records. You have a right to privacy. And you want that to managed. DRM.

Encryption is not the magical silver bullet wielded by fairies to kill unicorns. DRM is not inherently evil. (However, DRM is inherently broken. If you want doctors to be able to access your medical records, you must, to some extent, trust your doctor.)

Re:Mis-use of the term DRM

[HeckRuler]

and display it, without the user having access to the decrypted content.

The "it" that it's displaying IS the decrypted content. The act of it being displayed IS access.

Re:Mis-use of the term DRM

[CanHasDIY]

I agree with what you say except I envision the follow scenario: Doctor: Ok Mrs 6Pack where did Joe store his medical records and what was the decryption key? Mary 6Pack: Oh he gave those to his momma in city on other side of country and what is a decryption key? Doctor: Well we can get a copy from the archive, but we really are going to need that password!

Yea, that could happen.

Of course, I can imagine a few nightmare scenarios for placing control in the hands of the for-profit healthcare industry.
Patient: Yea, hi, I decided to get a second opinion from [competing medical facility], Please hand over a copy of my records
Hospital Bureaucratic: Sorry, looks like you don't have the clearance to access that information... of course, we can adjust your clearance for a nominal fee...

Among others. I suppose the moral is, no system will ever be perfect.

Learning the hard way

[BeanThere]

You and ultimately only you are responsible for managing your own health. I learned a similar lesson when I left the only copies I had of an expensive MRI of my back, showing my back problems, at a doctor's office, and some time later requested them only to learn that "we threw them out, sorry, nothing we can do". The fact is that nobody is going to care about your own health like you are going to, so if any medical documents are important to you, keep records of them. This is your life, take responsibility for it .. it sucks, but he really should have made copies when it was still in an easily accessible format. I know, 20/20 hindsight. Young 'uns, learn from the mistakes of others.

Using force to compel every doctor or hospital to keep every record ever in a conveniently accessible way would be ridiculous, it's not only immoral, it would cause already overpriced healthcare to dramatically rise further in price, and we'd all have to pay higher costs so that all the doctors and hospitals could keep records that aren't actually important or will never be accessed.

Re:Learning the hard way

[h4rr4r]

It is immoral to force doctors to live up to some sort of standard?

Then what do you think of medical licensing or even education?

Storing a png of this record costs near nothing.

Re:Learning the hard way

[Lithdren]

That's the thing about healthcare, you may not realize you have something someone else really REALLY needs, until its too late.

I dont see whats 'immoral' about holding doctors to the same standard as i'd hold to an accountant, frankly. If anything they should be held to a higher standard, if thats something they cant handle, then maybe they shouldn't be doctors.

That said, you'd think they'd be the first folks on the front lines demanding things like open formats, to make this stuff easier for them. That wont happen unless they're actually held responsible for it however.

Re:Learning the hard way

[HaZardman27]

Storing a png of this record costs near nothing.

Sure, if you're the only patient the hospital has. The storage of the records is probably not as significant as the organizing and retrievability of specific records for specific patients in a system with thousands or hundreds of thousands of patients.

Re:Learning the hard way

[Obfuscant]

It is immoral to force doctors to live up to some sort of standard?

That depends on what that "some sort of" standard is, now doesn't it?

I mean, apparently, based on your previous comments, your standard is "never 'let' anyone with cancer die", which is, unfortunately, an impossible standard and would thus be immoral to try to enforce. Depending on the penalties for failure, you'd have a mass exodus from the field of oncology and nobody with cancer would be able to get treatment. Kinda like the high price of malpractice insurance limiting the availability of OBs.

If the standard is "goes to school to learn how to be a doctor and passes some exams to show a minimum level of knowledge", then that's not sush a high standard that it cannot be met and wouldn't be immoral to enforce.

Storing a png of this record costs near nothing.

Yes, but getting it into a PNG format might cost something, depending on the original format. A paper EKG, for example, would have a non-zero cost being converted, especially considering the expense of quality control on the process. Google can scan old books relatively cheaply because nobody will die if they have bad scans included in a book (and they have a lot of them).

The summary of this article is typically off-kilter. Obsolete formats don't have anything to do with DRM or "vendor independence". As just one example, floppies, for most people, are an obsolete format, and the data they contain is likely not DRMd nor is it vendor specific. I have a drawer of optical disks that are unreadable today, yet back when they were, they would fit in any industry standard magnetooptical drive, and the data they contain is, in large part, jpegs.

Re:Learning the hard way

[tompaulco]

if any medical documents are important to you, keep records of them.
If you can manage to get the provider to allow you to have them, then that is great. A lot of times they don't want to give up that information. You may take it to a competing doctor. Also, if you go to a competing doctor, he is not going to believe your records. He is going to want them from an officially licensed Doctor. It's more expensive that way.

Re:Learning the hard way

[Z34107]

If you're in America, you have a right to your documents under HIPAA. Since this is the UK, I don't think they have the same problem with competing practices.

Re:Learning the hard way

[BeanThere]

Then what do you think of medical licensing or even education?

Lol, straw-man much?

Yes, it IS immoral to use force against a doctor or hospital management for failing to spend a fortune to store very old records. That has absolutely nothing to do with educational and qualification standards, about which your view is also completely confused.

Re:Learning the hard way

[BeanThere]

Since you really are confused, even though you are posting stupid straw-man arguments and don't seem interested in becoming unconfused, I'll post a clarifier: There is a moral argument to be made for medical licensing on the simple following basis:

- Most patients (yes, NOT ALL) prefer to know their doctors have qualifications
- Practicing medicine and claiming to be qualified if you're not qualified, would constitute fraud
- There is a moral case against fraud (duh?), especially when it endangers lives
- Not upgrading ancient obsolete record systems that are hardly accessed any more does not constitute fraud (except when the practice or hospital promised to do so, which hasn't happened)

Re:Learning the hard way

[BeanThere]

Storing a png of this record costs near nothing.

If it costs nothing and is so super easy and trivial, i.e. if there is no burden, then why not just leave it to patients to do? It's a burden for patients but it's not a burden for hospitals? Can't have it both ways, either it's easy (in which case patients can do it) or it's not (in which case it's a burden and a cost that must be passed on to everyone).

Standards-Compliant System FTW

[Revotron]

That's ridiculous - why don't they have a computer and software left over from the old system that can access this data? Did somebody just not think and throw that out in their last device refresh?

The NHS made the right choice selecting a standards-compliant EHR system for their recent changeover. Adhering to industry standards like HL7 will ensure that this problem will never happen with the new system they have in place.

Re:Standards-Compliant System FTW

[Revotron]

The big players in the industry (Cerner, Epic,McKesson) who are actively embracing HL7 as an interface standard seem to understand it a lot better than you do.

Do you work for one of those dying companies that's hemorrhaging clients to the big 3 because you couldn't get your shit together? Or better yet, are you one of those "entrepreneurs" who wants to put our healthcare "in the cloud" with Ruby on Rails and MongoDB and other hipster developer shit that's horribly unstable and traps patient data with no reliable way out?

Re:Standards-Compliant System FTW

[Revotron]

The fact that you're posting as AC and don't realize that the biggest players in the industry have implemented HL7 with great success demonstrates how little YOU understand about what you speak.

No, not his right.

[Quick Reply]

The records are longer than the legal maximum retention period. You can't expect hospitals to keep every X-Ray you ever had forever, not only is there privacy issues (some people don't like the idea) the cost of unlimited data retention is enormous. He should have requested it while it was still within the legal time for it to be kept, otherwise anything more is just a favour to him that they can get it to him at all even with the fee, because it costs money to bring an obsolete system back online, as it was decommissioned since it is no longer required (past the legal maximum).

I'm sure the obsolete system was running just fine in parallel in new system while the records were still under legal obligation and without expensive fees.

It's better than most places that they will still have the obsolete system at all that CAN be bought online. Most places would have destroyed the data by now.

Apple for example, completely wiped the MobileMe data as soon as MobileMe was switched off. Actual conversion I had with them for someone else who didn't know it was been Shut Off until it actually stopped working:
Apple: Yes Sir the Service has just stopped working because it has been decommissioned for iCloud.
Me: How do I get the data back?
Apple: Well we have put out notices to your MobileMe email (that they never use) for months that it is going to be shut down and you need to transition before then, now it's been shut down and we can't transition the data anymore.
Me: How do I get the data back now?
Apple: The data has been physically wiped from the servers and can't be retrieved even if we wanted to.

Microsoft have done it too with Microsoft Office Live Small Business.

Or Google, switch it off so you can see it's not working and then normally give you a year to download your data from a killed product.

Not fair to ask the CEO to cover the cost of his extraordinary required. If these records are important to him, pay, If not that important, don't. The choice is his.

Re:No, not his right.

[CoderJoe]

You might want to check to see if Archive Team was able to save any of that person's MobileMe data. Here is a form you can use to find a user's data: http://www.archive.org/download/archiveteam-mobileme-index/mobileme-20120817.html

Note: that search page requires javascript in order to function.

Still a bargain.

[loshwomp]

Some perspective:

Every british citizen could get ripped off in this manner twice each year, and still come out way ahead compared to the USA. As bad as the $2000 fee sounds, if he moved to the USA he would pay an average of $6000 extra per year for his health care.

It's time for single payer, and if you disagree, this price differential is the bar your alternative proposal needs to clear before I bother paying attention to you.

Re:Still a bargain.

[loshwomp]

It's true because the countries' respective health care expenditures are well-documented facts.

Re:Still a bargain.

[loshwomp]

Yes, but how high are your taxes?

That's a separate issue. In the UK, nearly all health care expenses are paid from general taxation. In the US, it's a mixture. But, irrespective of the source, the total expenses in the US are about $6000 per capita per year higher than the total UK expenses.

Re:Still a bargain.

[Xest]

"And how long do you wait to see the doctor?"

If it's a GP (i.e. general illness at a doctor's practice rather than a hospital, covering things like flu, asthma, STDs, whatever else) then it's more about your schedule than anything, I've never been offered any appointment that wasn't same day, though if I want them to revolve around me, then it may take about a week to get the exact time slot I want - say for example if I want the last slot of the day so I can go after work to get a prescription for something. If I was particularly ill though I've always just called up first thing in the morning (8am) and had an appointment by about 11am at the latest. Within a 5 minute drive we have 4 of these practices to choose from, the closest is about 2 minutes away, and that includes locking the front door, getting my arse in the car, and parking, and I live in rural England. If I decided I didn't like the building or the doctor there I have a free choice of going to one of the others.

If it was something the GP couldn't deal with, then I'd go to hospital and it would depend on the seriousness. If it was something life threatening they'd get me in straight away. If I'd say, hurt my leg and was in a lot of pain, they'd get me medication within a few minutes to cut the pain, then maybe 30mins for an x-ray, unless they'd had a major influx, say a coach crash or something, then again, depending on what it is or how busy it might take anywhere from 10mins to give me some crutches and some medication if it was just damage that'll sort itself out, to maybe a few hours at most to get my leg in a cast depending on how busy they are.

Perhaps the biggest disparity though is in terms of operations, old people wanting hip or eye operations to improve their ability to walk/see can take a number of months depending on how specialist the operation is in question. In the US you could presumably pay to have this done faster, but this is really where the divide in philosophy between the UK and US becomes clear. In the US you'd either be able to pay to have it done within a few days (i.e. much more quickly), or you wouldn't be able to pay to have it done at all. In the UK you wouldn't have to pay to have it done, but you would probably have to wait longer but absolutely everyone that needs it can have it done. Note also that the UK still has private healthcare services too alongside the NHS, so if you did have the money to get it done quicker you still have the option of doing so and whilst some argue that this should mean they should get some of their taxes back they paid to the NHS they generally ignore the fact that even the private doctors etc. who would perform their priority operation are sometimes using tax payer funded facilities, or are tax payer trained making their argument stupid.

It's not perfect, sometimes things go wrong and people get lost on waiting lists and so forth, but it's not as though that's a purely socialised healthcare problem. Even in private healthcare things can sometimes go wrong in that way, though the right wing press here does like to make a big deal of it when it's the NHS.

As the other guy said the tax argument is irrelevant because he was referring to the total cost - i.e. the figure he gave for the UK option includes the tax value.

No one is ever happy with what they have, but all in all I think what we have in the UK is one of the better options out there. Life would be so much more stressful and so much more full of hassle if I had to dick around with medical insurance and worrying about cost if I got ill - it's annoying enough dealing with car insurance and house insurance etc. where we get ripped off every bloody year. At least with the NHS I know what I'm paying because my tax bill is fixed and know there's no insurer to fuck me over hard when I need them, or simply by upping costs every year with no excuse for it and as the GP pointed out, despite it being the easy option in this regard, it's cheaper too, and I've never felt like I've got poor service when I've used it

Re:Still a bargain.

[tompaulco]

But $6,000 is not what is spent on healthcare. That is what is spent on insurance. What is spent on healthcare is significantly less. Unfortunately, Obama has REQUIRED that we go through an insurance company and thus lose 1/2 of our buying power to the Insurance Company. Now, I will admit that that is still cheaper than paying cash at the doctor. If you go to the doctor, it may cost $1,000. If you went through an insurance company, they would probably pay the doctor $200, but charge you $500 (on average, over time in payments. Made up numbers, but you get the idea). The problem with out healthcare system is not that people don't have insurance, the problem is that people don't have access to affordable healthcare. By requiring insurance, all we do is make the insurance companies richer. We need to make healthcare more affordable to the masses. This means getting rid of the lawyers, not allowing people to sue when they were aware of the risks and signed on the dotted line and despite the doctor doing things right, something didn't go right. I mean gross negligence is one thing, but our society has become one of "that was an unfortunate and unlucky series of events, and now somebody's got to pay!".

2000 Pounds?

[Bill Hayden]

That's a ton of money!

Re:2000 Pounds?

[filthpickle]

already posted, so I can't mod you....but I laughed.

Re:2000 Pounds?

[91degrees]

In British slang, a ton is 100 pounds. So it's 20 tons of money.

isn't that....a database?

[Chirs]

Seriously? You're suggesting it's hard to store records indexed by patient in a database? Really?

Re:isn't that....a database?

[Qzukk]

But... but.. it's thousands of records! THOUSANDS!

Re:isn't that....a database?

[Draknor]

Not hard (relatively speaking) -- expensive.

No one just "stores a png of this record", to quote the GGP. Hospitals have record-keeping system[s] -- databases, if you will, and often many of them. These systems all have licensing costs, administrative costs and hardware costs. And over the last 10 years, most organizations have implemented new system(s), sometimes multiple times. Sometimes data gets converted, sometimes not -- sometimes its just partially converted. And once you are up on the new system(s) for a couple of years, knowledge of the old systems fades pretty rapidly, as they fall out of daily use and the staff turn over.

It's not like hospitals run a MySQL database with records like "John Doe","F:\mr_images\johndoe2008.png"

Re:isn't that....a database?

[BeanThere]

Here's a hypothetical situation - thousands of patients had information stored in an older type of system, and to upgrade that system to a new format will involve hiring programmers and paying tens of thousands of Pounds. Oh wait, that's not a hypothetical situation, it's the actual situation this whole thread is about. Multiple by every doctor's practice, every hospital and clinic.

Re:isn't that....a database?

[BeanThere]

Sure, doctors can just quickly whip something together using the programming and database skills they all learn in medical school (that's why doctor's don't pay for this sort of system, it costs nothing). That should also certainly satisfy legal requirements to confidentially store all medical records of all their patients, indefinitely!

The only real need ...

[Tim Ward]

... to get your records from the NHS that I've come across is when you want to transfer to a private doctor. In which case when the right conversations have been had you don't even pay the £10.

Its not his fault

[Murdoch5]

Why should he have to pay more because his files are on an old computer system. For instance you don't pay your IT guy more when he puts a file on an old system and can't get it off. Now I know this is an old system but still someone must be able to go in and get it.

Re:Medical care.....

[Sentrion]

Given that the patient isn't spending £2,000.00 to each physician involved in each procedure like in the US, he should have enough money to cover the cost. The same could happen to an American just as easily, except that it wouldn't even count toward an American's $10k deductible.

Part of the problem is that most medical expenses are pulled out of someone's arse. If you show up at a hospital ER with a head injury, the hospital could call in their trauma physicians ($3,000.00 fee), and pull a trauma kit ($5,000.00 fee). The fact that the trauma physicians might already be working at the hospital and not called in from their personal time (like interrupting a wedding, or other special event) doesn't matter. And medical kits, such as "trauma kits" or "surgery kits" are just convenient prepackaged collections of tools, equipment, medicines, bandages, and other consumables that could ever conceivably be used for a variety of scenarios. A kit might be opened and items set out onto a tray in anticipation that they may be needed. Most items are not needed, and in many cases the "kit" didn't even need opening. But it is a great way to add costs to the patient or their insurance companies. Some hospitals ship opened kits to hospitals in 3rd world countries for a charitable tax write-off. Others resell them in bulk to re-packagers. The contents are individually wrapped in plastic (often kits within sets of kits), so unused items are not at any risk of contamination. Some items within kits have shorter shelf lives than others, so hospitals are motivated to "open" kits as often as justifiable to make sure a kit doesn't sit too long unused.

There's no law or regulation that says it has to be done this way, but it is profitable for physicians groups and hospitals. Even the non-profits get in on it since they can barely afford to care for the uninsured and it is a way to redistribute wealth from paying patients to those who cannot.

no this is just milking it

[Tastecicles]

he should offer to pay 1p/mo and get the refusal back in writing - he is still entitled to his information!

An American perspective

[Just Some Guy]

I just moved from a state where doctors are required to keep records for seven years, but with a significantly longer statute of limitations for medical malpractice lawsuits. Such lawsuits require access to medical records. Without records, there's no proof that a patient was even seen for the condition they're claiming a tort for. As a consequence, medical offices routinely purged all records more than 7 years old - often by going through an annual first-of-the-year process of pulling the "expired" charts and shredding them all at once.

In that situation, I could totally see a doctor's office trying to help a patient retrieve old records that they happen not to have purged yet, but realizing that they were in an ancient format based on proprietary software from a vendor that no longer exists and stored on an Amiga or some odd thing like that. The easy answer would be, "sorry, we don't have those anymore" and to set fire to the box of floppies they were stored on. The longer answer would be, "we have them, but it's going to be nearly impossible to get at them. If you need them, we'll try to help as much as we can. You'll need to pay our contractor for the work, though."

In that case, is the doctor's office being nice and helpful for trying to help the patient and not turning them away, or are they being jerks for not footing the bill for something they have no legal obligation to provide (and in fact are exposing themselves to liability for even admitting the existence of)?

I don't know if this is analogous to the case in the article or not. I just saw a lot of comments like "LOL STUPID DOCTORS" when it might be possible that there are other unmentioned factors.

This is not a problem...

[Genda]

After suing the appropriate folks £1990 for gross negligence and improper handling of vital personal records, the cost will still ultimately be £10 for the documents.

Re:The evil that is laser disc.

[ChumpusRex2003]

Probably magneto-optical disc, as those were widely used in medical imaging at that time. Although each generation of MO disc was supposedly backwards compatible, in general, the backwards compatibility was flaky as hell. So, although a 540 MB MO disc should be readable in a 5.2GB drive - in practice, this often wouldn't work. Only a 540 MB drive could be used.

In general, the workstations were supplied as a complete package with an expensive support contract, so no hardware modifications were possible. As MO was the standard method of archiving medical data in the late 1990s/early 2000s, when this device was likely acquired, there may not have been any other type of drive attached to the workstation. So, while the image could be displayed on screen, it could not be copied to a new medium (like a CD).

Alternatively, it's possible that the last 540 MB drive died, and none of their existing drives could read it. I know at one hospital where I was doing some research on MRI scans, I needed to retrieve some historical scans which were on 540 MB MO discs. We couldn't read them on anything in the hospital, even though are modern drives were supposedly compatible (or the OS was incompatible, e.g. the discs were formatted in ext, but the drive was connected to a windows box). In the end, I used some research funds to buy a refurb drive off ebay, and connected that to a linux box which could copy the data onto a more practical format. I could get away with doing that myself in a research context - if a hospital had to get an IT consultant in to source the drive and do the format conversion, then the bill could have been substantial.

UK has a history...

[mschaffer]

The UK has a history of letting information collected at great expense go stale---only to later spend yet even more money to receover the "archived" information later.
One of my favorite examples of this is the Domesday book and it's 900th anniversary commemoration. http://www.independent.co.uk/voices/commentators/philip-hensher/philip-hensher-domesday-lessons-for-the-egeneration-2283897.html

Data recovery places are everywhere

[dbIII]

Last year I got half a dozen nine inch reels from the 1970s transcribed with zero data loss and less than a week turnaround including interstate delivery. I had a few more done the year before and the year before that - same deal, and here you are giving excuses about 1990s or later technology.
The really big problem that every software industry that does not have a clue keeps hitting is the lack of published standards. It's published standards for data formats that mean once I have 1960s or 1970s data on readable media I can directly import it into software released this year. That's in the oil industry, so desktop office software really has no excuse about hiding their formats to be competitive since other industries do not need to hide behind the fiction that hiding their methods is required to remain competitive.

He doesn't actually need the images!

[DoctorOz]

Let me preface this by saying I'm a medical practitioner, and I read the story He has a written report of he cardiac ultrasound, and he has a written report of it. The data he wants are the 'still images' of his ultrasound. An ultrasound is a live, dynamic test that looks at the heart as it moves, its not like an xray or CT where a single image gives you the data you want. While single images are often recorded (mostly medico-legially I believe), at the end of the day, he wants to compare some still images from his cardiac ultrasound taken 10 years ago to the images taken recently. Not worth doing, exceeding rare that 'any' useful comparison could be made. I agree there is no need to store TB's of data for ultrasounds, though the fact that they still have it is interesting in itself!

Re:He doesn't actually need the images!

[unix_core]

So does he have a written report of it, or are you suggesting that he merely has a written report of it? I mean it, as in the report of it, perhaps of the report. Of it, if you follow.

Uhm..

[SuperDre]

It's not the patient's fault the information is stored on an inaccessible system, so why should he pay for the problem created by the IT department. I would sue the company for not storing the information properly..

Doc Martin

[ThatsNotPudding]

He knew better; just keep the records on post cards in sleeve jackets.

The other 'funny' thing about Doc Martin to this USian: no patient ever breaks down in tears, wailing "I can't afford this!!" Sigh.

Who says they phased out the old system.

[rhalstead]

They are still using XP up here....although Win 7 can still access it. There's is probably on some old mini. Don't forget that medical records (in the US) are supposed to be inaccessible to the outside world which would mean encryption if properly done. Actually, they finished up one system about a year ago and it too was XP. Hopefully Win 8 can still access NTSF, but it looks like about time to drop the dual boot and just stick with LINUX. OTOH I'd prefer they didn't update quite so often.

Paper

[nobaloney]

his copy will cost him £2,000 because the records are stored on an obsolete system that the current IT systems cannot access.

Paper copies? At £0.10/page that would only be 20,000 pages.