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.

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.

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

[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

[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]

, 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

[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

[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.

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.

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.

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."

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.

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.

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: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"

[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"

[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"

[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.

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!