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The Savvy Tech Strategy Behind Obamacare
snydeq writes "The U.S. health care industry is undergoing several massive transformations, not the least of which is the shift to interoperable EHR (electronic health records) systems. The ONC's Doug Fridsma discusses the various issues that many health care IT and medical providers have raised regarding use of these systems, which are mandated for 2014 under the HITECH Act of 2004, and are all the more important in light of the 2010 Patient Protection and Affordable Care Act, aka Obamacare. Key to the transition, says Fridsma, is transforming health IT for EHRs into something more akin to the Internet, and less like traditional ERP and IT systems. 'I think what we're trying to do is the equivalent of what you've got in the Internet, which is horizontal integration rather than vertical integration,' Fridsma says. 'We've done a lot of work looking at what other countries have done, and we've tried to learn from those experiences. Rather than trying to build this top down and create restrictions, we're really trying to ask, "What's the path of least regret in what we need to do?"'"
Before the govt started handing out $44k for docs to adopt shitty EHR systems and collect free money. We now have a plethora of shitty EHR systems in hospitals that don't solve any issues at all.
So, the government created this incentive (Which made a few companies insanely rich, like Epic, Cerner, and Athena) - and created this massive siloed data mess. Anyone who has worked in HIT knows what a complete failure this EHR rollout has been on every front.
Even better are the CHIIT "certification" standards (aka, a complete pile of shit) which were to ensure that EHR software met a bunch of standards to get that $44k. One of the hallmarks was "Interoperability" - which to CHIIT meant "systems can communicate with themselves" - derp.
The EHR rollout was a complete failure, mainly due to the govt pushing shit out on the marketplace with their stupid incentives. It is going to take over a decade to untangle the mess of complete crap.
Why not just parse the existing NSA database?
No point in reinventing the wheel. Like a good neighbor, Big Brother is there!
Scruting the inscrutable for over 50 years.
I just filled out my BS bingo card when they called both "horizontal integration" and "vertical integration".
On topic: The path of least regret would have been single payer system, but we somehow ended up with a Republican profit-utopia called "Obamacare".
There is nothing necessary about what they're mandating.
Thanks to the way Washington, D.C., works, the end result will be smug bureaucrats patting each other on the back, and doctors wondering if they should just find a different field to work in.
In SOVIET RUSSIA... erm...NSA AMERICA, the Internet logs onto YOU!
Because the NSA can't hack paper.
This all sounds good... It sounds good like using Skype to make phone calls until you find out everything has been freely handed to the NSA... Now, everything in your medical records is available to the NSA and Obama... I'm not at all happy about the prospect!
Costs three times as much as the originally budgeted cost, is delivered five times past the deadline and doesn't do a tenth of what was promised.
Other countries have single payer health care, which delivers better outcomes at a lower cost. Try learning from that.
Give me Classic Slashdot or give me death!
Remember the EDI systems of old? Have you worked with XML today?
Those data transfer systems only work because the information formats are standardized amongst the products that claim to support them.
Unfortunately, EDI standards were often a "kitchen sink" approach with a bazillion "optional" message components to cater to the "special features" of vendors who had enough clout to demand that they be supported.
A rational, clean, genuine reworking and reengineering of data streams would lead to interoperability and the ability to share information between all the different components involved, while allowing specialized features to be tailored to the vertical segments of the marketplace (doctor's office, hospital, pharmacy, and so on.)
The unfortunate thing for the IT industry is that there are very few verticals within the horizontal, so if the "big players" provide for those markets, there is little to no market left for anyone who wants to get a foot in the door. I'd be willing to bet that 90% or more of the negative comments in this thread about the initiative are from people who work with or for those smaller players, and who see their jobs disappearing as the megaproviders take over.
I do not fail; I succeed at finding out what does not work.
As one in the field the only thing "savvy" about the [fill-in-the-blank-government-agency] strategy is the salespeople getting the government to throw boatloads of money at shit that once again WILL FAIL TO DELIVER.
Other countries have single payer health care, which delivers better outcomes at a lower cost. Try learning from that.
Those are free, democratic and egalitarian societies with a socialist bent.
We in the US, OTOH, are a feudal republic with an ignorant population that is under the delusion that all they have to do is work hard and they'll be rich.
>> 'I think what we're trying to do is the equivalent of what you've got in the Internet, which is horizontal integration rather than vertical integration...'
It's always fun listening to a suit try to describe the interwebs using MBA terminology.
Next we can look forward to listening to health care issues described as "target markets" and "economies of scale".
So, we are to turn our health IT environment into one of the most easily abused and hostile IT environments ever created. What could POSSIBLY go wrong?
ObamaCare Train Wreck on the Twitter: Administration PR Team Launches Google Hangout to Online Derision, Part II
it's not too late, we could still pass HR 676, Medicare for All.
It sounds like making more of your personal information available to the NSA to me.
It's kind of hard to blame any of it on the Republicans since they were not at all involved in the meetings and didn't vote for it.
And those countries do that by either gaming the statistics, or having a homogenized society where social pressure to conserve public resources can be successfully applied.
Or look to the German or Swiss models which have private insurance companies, but must be run as non-profits.
1. "We need to pass [the Obamacare bill] to find out what's in it!" --Nancy Pelosi
2. We want to give this great healthcare to everybody! (except us - Congress & unions are exempt) -- Barack Obama
3. "2014 elections aren't looking too great for Democrats, so we're delaying Obamacare until after." --White House
SAVVY!
"What's the path of least regret in what we need to do?"
Repeal.
The U.S. government's track record on security, efficiency and effectiveness is unmatched. This is sure to succeed!
"Computers are useless. They can only give you answers."
-- Pablo Picasso
I have no problem with whatever anyone wants to do with regards to health care reform, but I value my privacy, so my doctors aren't allowed to store my medical records electronically.
According to what I've read (Does the press ever get anything technical correct?) It appears that at least in some software already in use there are no audit trails. USED TO BE the FDA required all software used in the medical industry to be validated. This is not the engineering validation, but rather you have to prove every single operation, starting with the log in. Take that log-in for example. You had to log-in with a valid name and PW. Print the screen before pressing enter and again after to prove the results. Then you log in with a valid name and PW with one extra character appended to the PW. Print screen before and after. Next it is a valid name and PW, minus one character on the PW and again, print screen before and after. Now repeat withe name + and - one character. You also had to do it with empty fields. Test results were not only typed and length critical. IE numeric, character, number of digits, and if appropriate, digits each side of the decimal.. I started with a list a bit over 1" thick. When I finished I had a stack of printouts over 4 feet tall. Every entry had an audit trail as well. So with all these requirements, how could the mistakes happen that the press is talking about and blaming the software? Did Obama, in his great wisdom decide that we programmers and engineers are good enough the software doesn't need to be tested, or is the press making up stories to sell? Me? I believe there is a very high probability of both. Obama has proven, like the general public he has little to no knowledge of anything technical. If he thinks it is so, then it has to be so. The press OTOH has taken to invention of many stories that are patently false and ignore those that oppose their beliefs. True reporting has disappeared and the press is just emulating the talking heads. Long gone are the days where trustworthy information came from the press. at least 30 or 40 years ago they at least made the attempt. Now they don't even try to hide the bias. I have seen the electronic medical system work great. Any doctor "within that system" can instantly access all of your medical records. Cardiologist, neurologist,family Doctor, and even Physical therapist have instant access to all your records. Medications are visible, compared for side effects and interactions. to prevent one Dr from proscribing something that could dangerously interact with what you are already taking. Get badly hurt in an accident and the ER has everything at their fingertips. So is this an isolated example, is the press reporting on isolated examples, the press reporting on anecdotal reports, or are there really cases of non validated, crappy software being allowed to be implemented without following FDA requirements? They've taken many shortcuts in other areas that make the entire affordable care act neither affordable or safe and looking like it was crafted by a bunch of amateurs who had no idea as to what was needed.