Unemployment would quadruple overnight if 90% of the "Medical" staff at a hospital were no longer needed to do paperwork for the insurance companies.
Hell no, make more paperwork not less, the country needs jobs.
EMR solutions don't touch the medical billing side of things; that's been computerized forever (and is still hugely overburdensome).
However, once paper charts go out of style (a practice typically continues to pull and use paper charts for at least a year after switching on an EMR), the people whose job it is to pull, file, and fetch charts will be out of those jobs.
OTOH, the total amount of money spent on things is unchanged (or higher), because now you're paying for people to update and maintain the computerized system. You can't retrain the same people for those jobs, though, and probably there aren't as many of them... but each one is higher paid.
I agree. You've made a great point. The same could be said for transportation, imho.
Which is why we have an interstate system, and large urban areas operate public transit systems, which people can ride for free or at very low cost if they're indigent and/or disabled.
If we had the ability to *buy* medicaid coverage, with premiums that slide based on income, it'd be better coverage, because there would be a financial incentive for it to be better. As it is, I've heard from many folks who have been on medicaid and private insurance that, in many ways, medicaid offers better service.
What this will mean is that when you (or someone else) runs for office, your medical history will be leaked to the press. "Oh, Candidate X, I see you took anti-depression medicine after your divorce." "Oh, Candidate Y, I see you got treated for an STD in college."
The purpose of the digitized medical records is to provide an automated muck-racking system for people who run against the favored party.
Yes, I'm so glad this can't happen now. So is Britney Spears.
Paper charts are just as vulnerable as digital records, and moreso in some ways. Get yourself the right kind of lab coat and an ID badge that will pass casual inspection, and you can probably slip into the chart room at most major hospitals. From there, if you have the patient's medical record number (that you saw over the shoulder of the doctor as they walked out of the patient's room), you just pull their chart and use your camera phone to take pictures of all the juicy pages.
The only way in which paper charts are more difficult to access than electronic ones is that they're bulkier and harder to copy. This is a detriment to treatment as well as a "security feature."
Have you ever requested a copy of your medical records? They can charge you a "reasonable fee" for duplication, which can be as much as a couple bucks a page. If your entire chart is 50 pages (and for a condition with a long treatment history, that's totally in gamut), that adds up fast. When records are digital, many clinics routinely hand the patient a copy of the doctor's notes and findings on their way out.
Meh. That's why people should just go enterprise. =)
"Just going enterprise" doesn't cut it. Sure, you can buy your PM and EMR from the same vendor, and in most cases, that's your best option (even though the PM from one vendor and the EMR from another may meet your needs better, neither company is going to play very nicely, so you'll end up wasting the increased efficiency in mediating the tussle over your data). But your pharmacy is going to be using a different system, and the hospital you have privileges at will be on another system, and your labs have to be able to talk to your system.
If you're using public funding in any way (FQHC, Medicaid, etc.), you're going to have other reporting requirements, such as the LINCS system in California for immunizations. If it's a Federal or State requirement, then chances are you'll find an EMR vendor who has already built support for it or who is willing to, but you'll still pay extra for the interface.
And then, there's the special case where you really, really have good reasons to want to share data across similar care providers. We're in that situation now, with three major clinics on Skid Row operated by three different organizations. Yes, our clients do shop from one to the other... "What's the wait time today? Ok, I'll go around the corner." Yes, they do duplicate services... "My broken leg is *really* hurting today, can I get a refill on my Percocet?" Multiply that x3 and you've made a nice profit on your broken bone. And yes, they do just forget where they're going and what their diagnosis is.
So, we've started a cross-agency registry that our patients can join, so that we can record when they have an encounter at each location (including several non-medical social service agencies). The HIPAA issues have been onerous, but the single biggest obstacle is how much it COSTS to connect our existing electronic systems to this system, which happens to be Open Source. We really had to pick an open system for the registry, because there was no way to fund the licenses for such a huge number of providers. We also didn't *need* the infrastructure of a full EMR for this purpose, so it would have been wasted money even if we could find a way to get it.
But we've got PM systems (and in one case, an EMR) already in place, and the idea of entering every patient a second time into a second system is daunting. so it cost $9,100 to connect our agency's PM system to the registry, and will cost about $10,000 to connect another agency's (our PM vendor did their end for free... the charges were all on the registry end... but for the other agency's, it's about $5000 each side).
"Going enterprise" just isn't feasible for a project like this. We have to have a way to specifically add patients to the registry *after* they've signed consent, so we can't use the same system for general records, since patients need to be able to withhold consent to be added to the cross-agency registry. We're looking at having to set up conduits for any agency that we want adding data on a regular basis, and it's going to be pricey.
And yet, EMRs also *save* lives, by reducing medical errors.
As with nearly all technology implementations, there are multiple dimensions in which things change. When examining security issues with EMRs, people get frightened about the fact that if someone just broke into the system at ONE point, they could get access to EVERYONE's records... which is true. However, that's no different from now, where someone could slip into the chart room (which is usually locked, but doors have to open sometime) and have the same access. The difference is, it's a lot harder to take the data with you, because paper is inherently more burdensome to access and copy than digital records... which is also why electronic charts provide advantages over paper ones.
However, with an electronic chart, you have *greater* security in another way, because you can grant access to only the part of the chart that a particular person needs in order to do their job. Now, there are relatively low-paid employees whose entire job consists of pulling charts, running them to whatever department needs them, duplicating whatever needs to be sent elsewhere, and then re-filing them. Those individuals have NO reason to EVER actually read what's in your chart... but there's no way to prevent them from doing it, either. They can even try not to, and sometimes, they'll accidentally see something. Electronic charts are not nearly as weak on that.
Similarly, while errors can happen in electronic charting that are more difficult in paper charting (such as having the wrong patient record open and not realizing it), there are also errors that can happen in paper charting that are far more difficult in electronic charting, such as misreading someone's notes, losing pages, or losing the entire chart. EMRs often provide what's called "decision support," where the computer system prompts the doctor to ask certain questions or recommend certain lab tests based on what they've included in the symptom summary or physical examination. While it would be catastrophic for a doctor to completely *rely* on the computer system to make all these decisions, human beings are more limited at processing information, and might miss a connection that a computer can check for in less than a second. With a competent and conscientious doctor using the system for support, people can get faster and more accurate diagnoses for their ailments in many cases, especially when they have an unusual problem.
And now, the top two reasons why healthcare spending is economic stimulus...
Both true, and very valid.
But there's also the way in which *most* spending is economic stimulus. Yesterday, our organization (a non-profit healthcare provider with Section 330 funding, so we're a Federally Qualified Health Center (FQHC)) learned that we'll be eligible to apply for a skosh over $400k in ARRA funding in the next couple of weeks. These funds are to be disbursed in two payments, the first of them by the end of the month. This is LIGHTNING speed for government funding; the typical RFP comes out about three months before the application deadline, and the awards are made about five months later. Then the payments are pro-rated over the course of the year.
The major requirement for this funding opportunity is that it will be used to either keep jobs that you'd otherwise have to cut, or to add new positions. We'll be using it for new hires; we already had a project that required over $200k in new positions we've been scrambling to find funding for.
But why are they in such a hurry to give us the money? Because we can't spend it *that* fast... but we'll put it in the bank. You know, banks? Failing? Needing cash infusions? Two birds, one stone.
More than two birds, though, because this will temporarily increase our reserves, which betters our chances for qualifying for other funding sources too, such as private foundations.
And what comes out in the end is better healthcare for people who can't just pick up and go to another doctor. The clinic that's going to get the bulk of our ARRA funding serves about 8,000 patients a year, most of whom are homeless. We're moving to a new larger facility, and will have additional services available on-site (such as dental and mental health), in a big cooperative deal with the County (who is paying the lease, and providing some of the mental health personnel). Turns out, it's *cheaper* to provide good access to quality routine and preventive care, than to wait until these folks show up in the ER and have to be admitted to the hospital.
In the end, we're talking about using money more efficiently. It galls some folks to think that people who "don't deserve it" will be benefiting from the spending, but the truth is, we'll spend the money on them now or later. It also isn't a good idea to let them die on the street; that causes HUGE public health concerns for everyone.
That's the dumbest idea ever besides using hydrogen in the Hindenburg. I own a small business, nationalising healthcare would do nothing but raise our taxes for ALL, thats bad.
Um.
Children dying from asthma attacks is bad, too.
As a small business owner, national health care would free you from any expectation of providing health benefits to your employees. You may not have employees, but you probably hope to be that big someday if you don't. You may currently use some sort of workaround (such as hiring people "on contract" or "part time") to avoid providing benefits, but that makes your listing less competitive, so you have to pay higher salaries. Also, if we had a government insurance-style system, the profit margin would be removed, which will lower the costs of operation.
Yes, you might pay more in taxes than you pay in health premiums... but you'll also *get* more. Go visit the ER of County General some night if you don't think we've got a healthcare crisis.
If you don't feel any sort of responsibility to the other members of society, there I can't help you. Evolution should have taken care of that a long time ago. Humans are social creatures; we survive better when our entire group is healthier.
I've never once seen anyone suggest we should take away health care choices... just that we should better fund health care, so that those who have no choices now actually can get some.
I have trouble believing you could prohibit the system of private health care that currently exists. However, if we devise some sort of national insurance program, and the government therefore stops compelling employers to provide benefits to their employees, people will have the choice of the government plan or paying out of pocket for a private health plan (or just to see the doctor of their choice). Funny thing is, when people have to pay for it themselves, they suddenly find it's not nearly so important to them.
Finally... if there's a national health plan, rather than all these siloed practice groups and coverage networks, I'll bet people will have a LOT more doctors to choose from. No more of this "Oh, well, we took your old insurance, but we don't take your new insurance, so you'll have to pay out of pocket or find a different doctor."
(b) STUDY AND REPORT ON AVAILABILITY OF OPEN SOURCE HEALTH INFORMATION TECHNOLOGY SYSTEMS. (1) STUDY. (A) IN GENERAL. - The Secretary of Health and Human Services shall, in consultation with the Under Secretary for Health of the Veterans Health Administration, the Director of the Indian Health Service, the Secretary of Defense, the Director of the Agency for Healthcare Research and Quality, the Administrator of the Health Resources and Services Administration, and the Chairman of the Federal Communications Commission, conduct a study on - (i) the current availability of open source health information technology systems to Federal safety net providers (including small, rural providers); (ii) the total cost of ownership of such systems in comparison to the cost of proprietary commercial products available; (iii) the ability of such systems to respond to the needs of, and be applied to, various populations (including children and disabled individuals); and (iv) the capacity of such systems to facilitate interoperability. (B) CONSIDERATIONS. - In conducting the study under subparagraph (A), the Secretary of Health and Human Services shall take into account the circumstances of smaller health care providers, health care providers located in rural or other medically underserved areas, and safety net providers that deliver a significant level of health care to uninsured individuals, Medicaid beneficiaries, SCHIP beneficiaries, and other vulnerable individuals. (2) REPORT. - Not later than October 1, 2010, the Secretary of Health and Human Services shall submit to Congress a report on the findings and the conclusions of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.
I'm planning on using this to justify why we're applying for ARHQ research funding for implementation of a non-CCHIT certified product... we're just trying to help them research open source options.;-)
ie, one central standard to which all insurance companies' individual crap should be translatable by, say 2011.
And mandate that the insurance companies must handle the translation themselves.
Why do people keep talking about insurance companies? Their stuff has been computerized forever. TFA and most of the discussion is about medical records in the clinic or hospital setting.
It has to do with insurance only peripherally, in that one of the driving forces behind digitization of medical records is to ease the billing process through better coding of medical procedures and reducing after-the-fact data entry, but being able to do billing from your system in an integrated fashion is a standard feature of all commercial EMR/PM solutions.
Similar for medical software - you could direct the spending so that you'll get extra features in the short-term and keep paying for them in the long-term. Alternatively you could pay to have it created under GPL license, and in the future you could always get competing bids when it comes to add features to the software, and you could add additional installations without further licensing costs.
Exactly. For our non-profit organization, which operates six clinics and two mobile units, EMR/PM bids are coming in at half a million for the first year and $200k and up each year after. The costs scale with our size, too; if we start seeing more patients or hire more doctors, we pay more for our EMR. This means we can't even *think* about switching to electronic records until we've secured funding for at least a few years, while we build that into the budget and our indirect cost agreements.
If instead, the government actually purchased one or two well-developed EMR systems and open-sourced them, then let all their Federally-Qualified Health Centers (FQHCs) and look-alikes use them for free, it'd cost more like $100k per grantee organization to implement... including hardware, which the costs above don't count... and the continuing costs would be negligible, probably one more person on your IT staff, or a low-cost helpdesk contract.
Instead, there's an RFP out right now that will spend $4.5 million on *six* FQHCs to implement EMRs. Only clinic systems with at least 30 sites, or consortiums of three or more clinics are eligible, so I'm guessing their target is to get 200-250 sites onto EMR systems with $4.5 million dollars. Not exactly cost-effective.
If you find one, send me the link, too. We're using OpenMRS as a cross-agency TB registry, but it's sooooo not a full-featured EMR compared to the proprietary solutions. The stuff that our agency is willing to look at isn't even web-based, so you're locked into Windows (or maybe emulation; no idea if that works) for your desktop machines too. One of the systems runs only on Windows servers with MSSQL. Gack.
It is an act of congress which allows corporations to exist. That act should not result in a violation of the bill of rights.
And it doesn't. You're quite free to post far and wide about this issue. Just not on Norton's board.
When the New York Times gets a visit from the Feds because they want to run a story about PIFTS.exe, call me. One company controlling user-submitted content on their own site is NOT censorship, it's just stupidity (in this case, anyway).
Are you able to get a replacement for your kindle?
Already have it. I submitted an inquiry on amazon.com, and they responded promptly telling me to use their tool on the website to speak with them via phone, which sounded kinda strange, but ok... so there's a page (after you log in and go to the manageyourkindle page) where you type in your phone number, and they call you RIGHT THAT SECOND. You still wait on hold for, gosh, maybe 30 seconds, but freaky anyway.;-) Then a rep with a Starbucks-caliber chipper friendliness in his attitude asked what I'd done to try to address the problem, and after I told him I'd done what you're supposed to do (I'd power-cycled and used the Reset button under the back cover), told me I'd have my replacement Monday, which I did. That was Friday night at 9:30 p.m.
They never even asked how it got broken. I'd been agonizing over whether to say "Gosh, I just pulled it out of my purse and it was like that" or tell them the truth... but it didn't even matter.
Way to go Norton! We may have to rename Streisand effect to Norton effect pretty soon...
They're slightly different, though. The Streisand effect has to do with not wanting people to see something; the Pifts effect (which is a far more fun name than Norton) has to do with not wanting people to talk about something.
Ok, I gotta go Devil's Advocate on you here. While they're not as prevalent, there certainly *are* quite a number of Windows web servers, also connected to fat pipes. Are they often botnet drones?
I'm thinking that web servers, due to their function and the skill level of the people administering them, are less likely to get infected and infections that do happen are far more obvious (because they'll dramatically change the bandwidth usage stats). So, it may not be particularly telling that Linux webservers aren't prone to botnet viruses.
I personally haven't ever seen a Linux desktop with a virus.
Windows spreads virus's in the same way AIDS spreads.
No, more like mononucleosis... you just have to share a drinking glass or otherwise swap spit with someone who's infected. AIDS is actually fairly difficult to transmit.
Censorship is done by people who censor, and has nothing to do with government at all. The only connection it has to government is the prevailing belief that it's "bad" when government does it and "ok" when anyone else does it.
Rather, let's say that in the US, "censorship" is illegal when done by the government (violating the First Amendment, aside from a handful well-documented exceptions in case law), and legal when done by private entities on their private property.
Norton cannot prohibit you or anyone else from writing a letter to the editor of your favorite newspaper or putting up your own site discussing the issue, provided you were not found to be violating laws concerning defamation, libel, etc. Even if you were found in violation of laws that provide exceptions to the First Amendment, Norton would require the government's intervention to compel you to shut up about it.
Note, in particular, that the 300 comments on this story on this site have not been "censored" by Norton. It would take a government to actually quash ALL discussion of the topic, which is why government censorship is generally illegal in free* countries and decried in oppressed* ones.
* Note that this is not an invitation to debate whether one country or another is truly "free" or "oppressed." These terms are shorthand groupings for countries that do or don't engage in wholesale government censorship.
And the same applies when you enter into China, but I'm not aware of anyone who thinks China's Internet Firewall censorship is acceptable practice. Infringement of a human right is infringement regardless if the perpetrator is China or Norton.
This is true... provided that Norton is your government.
There's a difference between censorship on a private message board operated by a private company, and censorship by a state with authority over its citizens. But that seems to be a really hard concept for the average internet user to grasp.
If e-paper ever improves enough, this would be an excellent place for it.
E-paper doesn't withstand drops well, either. I dropped my Kindle from a height of about 2 feet, it landed facing up, and the display was permanently broken. There was a diagonal "crack" in the matrix under the surface, and vertical and horizontal streaks leading up to it. It wasn't pretty.
Interestingly, it *did* hold the display until it tried to refresh. I didn't realize it was broken until I turned the page.
in your example; how would the gov know u have a genetic disorder?
isn't all medical data in the usa obtained in a hospital / clinic / etc which IS a private company?
Well, no. For one thing, there are government-operated clinics; they're usually run by County departments of Public Health. But for another thing, there are government health programs. Of particular relevance to the PP's hypothetical, the State of California operates a program to provide alphfetoprotein (AFP) testing to all pregnant women (unless they decline). This test gives a likelihood that the fetus has certain genetic disorders, such as Down Syndrome. The (private) doctor's office collects a blood sample, but sends it to a state clinic for analysis. That clinic then asks the pregnant woman in question for her insurance info.
There are also government-run insurance programs, such as Medicare (available to seniors) and Medicaid (available to the disabled and low-income; the program is Federally funded but run by the individual states). Those would, of course, have records of treatment that was billed to the program.
But of course, you make a valid point that private companies are trusted with our information every single day. My doctor's office might have a Google Apps subscription, and wouldn't ever have to tell me about it (they'd have a Business Associate Agreement with Google, and then the info flow is covered by their HIPAA NPP with no change). So the idea that the Government might (oh noes) use a private company to store and share data is somewhat disingenuous.
Then you would be acting unlawfully, here in the UK you have a right to be represented by a Union, not employing someone because of union related activities would be illegal in itself.
Slashdot Mirror
Unemployment would quadruple overnight if 90% of the "Medical" staff at a hospital were no longer needed to do paperwork for the insurance companies.
Hell no, make more paperwork not less, the country needs jobs.
EMR solutions don't touch the medical billing side of things; that's been computerized forever (and is still hugely overburdensome).
However, once paper charts go out of style (a practice typically continues to pull and use paper charts for at least a year after switching on an EMR), the people whose job it is to pull, file, and fetch charts will be out of those jobs.
OTOH, the total amount of money spent on things is unchanged (or higher), because now you're paying for people to update and maintain the computerized system. You can't retrain the same people for those jobs, though, and probably there aren't as many of them... but each one is higher paid.
I agree. You've made a great point. The same could be said for transportation, imho.
Which is why we have an interstate system, and large urban areas operate public transit systems, which people can ride for free or at very low cost if they're indigent and/or disabled.
If we had the ability to *buy* medicaid coverage, with premiums that slide based on income, it'd be better coverage, because there would be a financial incentive for it to be better. As it is, I've heard from many folks who have been on medicaid and private insurance that, in many ways, medicaid offers better service.
What this will mean is that when you (or someone else) runs for office, your medical history will be leaked to the press.
"Oh, Candidate X, I see you took anti-depression medicine after your divorce."
"Oh, Candidate Y, I see you got treated for an STD in college."
The purpose of the digitized medical records is to provide an automated muck-racking system for people who run against the favored party.
Yes, I'm so glad this can't happen now. So is Britney Spears.
Paper charts are just as vulnerable as digital records, and moreso in some ways. Get yourself the right kind of lab coat and an ID badge that will pass casual inspection, and you can probably slip into the chart room at most major hospitals. From there, if you have the patient's medical record number (that you saw over the shoulder of the doctor as they walked out of the patient's room), you just pull their chart and use your camera phone to take pictures of all the juicy pages.
The only way in which paper charts are more difficult to access than electronic ones is that they're bulkier and harder to copy. This is a detriment to treatment as well as a "security feature."
Have you ever requested a copy of your medical records? They can charge you a "reasonable fee" for duplication, which can be as much as a couple bucks a page. If your entire chart is 50 pages (and for a condition with a long treatment history, that's totally in gamut), that adds up fast. When records are digital, many clinics routinely hand the patient a copy of the doctor's notes and findings on their way out.
Meh. That's why people should just go enterprise. =)
"Just going enterprise" doesn't cut it. Sure, you can buy your PM and EMR from the same vendor, and in most cases, that's your best option (even though the PM from one vendor and the EMR from another may meet your needs better, neither company is going to play very nicely, so you'll end up wasting the increased efficiency in mediating the tussle over your data). But your pharmacy is going to be using a different system, and the hospital you have privileges at will be on another system, and your labs have to be able to talk to your system.
If you're using public funding in any way (FQHC, Medicaid, etc.), you're going to have other reporting requirements, such as the LINCS system in California for immunizations. If it's a Federal or State requirement, then chances are you'll find an EMR vendor who has already built support for it or who is willing to, but you'll still pay extra for the interface.
And then, there's the special case where you really, really have good reasons to want to share data across similar care providers. We're in that situation now, with three major clinics on Skid Row operated by three different organizations. Yes, our clients do shop from one to the other... "What's the wait time today? Ok, I'll go around the corner." Yes, they do duplicate services... "My broken leg is *really* hurting today, can I get a refill on my Percocet?" Multiply that x3 and you've made a nice profit on your broken bone. And yes, they do just forget where they're going and what their diagnosis is.
So, we've started a cross-agency registry that our patients can join, so that we can record when they have an encounter at each location (including several non-medical social service agencies). The HIPAA issues have been onerous, but the single biggest obstacle is how much it COSTS to connect our existing electronic systems to this system, which happens to be Open Source. We really had to pick an open system for the registry, because there was no way to fund the licenses for such a huge number of providers. We also didn't *need* the infrastructure of a full EMR for this purpose, so it would have been wasted money even if we could find a way to get it.
But we've got PM systems (and in one case, an EMR) already in place, and the idea of entering every patient a second time into a second system is daunting. so it cost $9,100 to connect our agency's PM system to the registry, and will cost about $10,000 to connect another agency's (our PM vendor did their end for free... the charges were all on the registry end... but for the other agency's, it's about $5000 each side).
"Going enterprise" just isn't feasible for a project like this. We have to have a way to specifically add patients to the registry *after* they've signed consent, so we can't use the same system for general records, since patients need to be able to withhold consent to be added to the cross-agency registry. We're looking at having to set up conduits for any agency that we want adding data on a regular basis, and it's going to be pricey.
And yet, EMRs also *save* lives, by reducing medical errors.
As with nearly all technology implementations, there are multiple dimensions in which things change. When examining security issues with EMRs, people get frightened about the fact that if someone just broke into the system at ONE point, they could get access to EVERYONE's records... which is true. However, that's no different from now, where someone could slip into the chart room (which is usually locked, but doors have to open sometime) and have the same access. The difference is, it's a lot harder to take the data with you, because paper is inherently more burdensome to access and copy than digital records... which is also why electronic charts provide advantages over paper ones.
However, with an electronic chart, you have *greater* security in another way, because you can grant access to only the part of the chart that a particular person needs in order to do their job. Now, there are relatively low-paid employees whose entire job consists of pulling charts, running them to whatever department needs them, duplicating whatever needs to be sent elsewhere, and then re-filing them. Those individuals have NO reason to EVER actually read what's in your chart... but there's no way to prevent them from doing it, either. They can even try not to, and sometimes, they'll accidentally see something. Electronic charts are not nearly as weak on that.
Similarly, while errors can happen in electronic charting that are more difficult in paper charting (such as having the wrong patient record open and not realizing it), there are also errors that can happen in paper charting that are far more difficult in electronic charting, such as misreading someone's notes, losing pages, or losing the entire chart. EMRs often provide what's called "decision support," where the computer system prompts the doctor to ask certain questions or recommend certain lab tests based on what they've included in the symptom summary or physical examination. While it would be catastrophic for a doctor to completely *rely* on the computer system to make all these decisions, human beings are more limited at processing information, and might miss a connection that a computer can check for in less than a second. With a competent and conscientious doctor using the system for support, people can get faster and more accurate diagnoses for their ailments in many cases, especially when they have an unusual problem.
What nitwit modded that comment insightful?
And now, the top two reasons why healthcare spending is economic stimulus...
Both true, and very valid.
But there's also the way in which *most* spending is economic stimulus. Yesterday, our organization (a non-profit healthcare provider with Section 330 funding, so we're a Federally Qualified Health Center (FQHC)) learned that we'll be eligible to apply for a skosh over $400k in ARRA funding in the next couple of weeks. These funds are to be disbursed in two payments, the first of them by the end of the month. This is LIGHTNING speed for government funding; the typical RFP comes out about three months before the application deadline, and the awards are made about five months later. Then the payments are pro-rated over the course of the year.
The major requirement for this funding opportunity is that it will be used to either keep jobs that you'd otherwise have to cut, or to add new positions. We'll be using it for new hires; we already had a project that required over $200k in new positions we've been scrambling to find funding for.
But why are they in such a hurry to give us the money? Because we can't spend it *that* fast... but we'll put it in the bank. You know, banks? Failing? Needing cash infusions? Two birds, one stone.
More than two birds, though, because this will temporarily increase our reserves, which betters our chances for qualifying for other funding sources too, such as private foundations.
And what comes out in the end is better healthcare for people who can't just pick up and go to another doctor. The clinic that's going to get the bulk of our ARRA funding serves about 8,000 patients a year, most of whom are homeless. We're moving to a new larger facility, and will have additional services available on-site (such as dental and mental health), in a big cooperative deal with the County (who is paying the lease, and providing some of the mental health personnel). Turns out, it's *cheaper* to provide good access to quality routine and preventive care, than to wait until these folks show up in the ER and have to be admitted to the hospital.
In the end, we're talking about using money more efficiently. It galls some folks to think that people who "don't deserve it" will be benefiting from the spending, but the truth is, we'll spend the money on them now or later. It also isn't a good idea to let them die on the street; that causes HUGE public health concerns for everyone.
That's the dumbest idea ever besides using hydrogen in the Hindenburg. I own a small business, nationalising healthcare would do nothing but raise our taxes for ALL, thats bad.
Um.
Children dying from asthma attacks is bad, too.
As a small business owner, national health care would free you from any expectation of providing health benefits to your employees. You may not have employees, but you probably hope to be that big someday if you don't. You may currently use some sort of workaround (such as hiring people "on contract" or "part time") to avoid providing benefits, but that makes your listing less competitive, so you have to pay higher salaries. Also, if we had a government insurance-style system, the profit margin would be removed, which will lower the costs of operation.
Yes, you might pay more in taxes than you pay in health premiums... but you'll also *get* more. Go visit the ER of County General some night if you don't think we've got a healthcare crisis.
If you don't feel any sort of responsibility to the other members of society, there I can't help you. Evolution should have taken care of that a long time ago. Humans are social creatures; we survive better when our entire group is healthier.
Not taking away his choice of health care...
I've never once seen anyone suggest we should take away health care choices... just that we should better fund health care, so that those who have no choices now actually can get some.
I have trouble believing you could prohibit the system of private health care that currently exists. However, if we devise some sort of national insurance program, and the government therefore stops compelling employers to provide benefits to their employees, people will have the choice of the government plan or paying out of pocket for a private health plan (or just to see the doctor of their choice). Funny thing is, when people have to pay for it themselves, they suddenly find it's not nearly so important to them.
Finally... if there's a national health plan, rather than all these siloed practice groups and coverage networks, I'll bet people will have a LOT more doctors to choose from. No more of this "Oh, well, we took your old insurance, but we don't take your new insurance, so you'll have to pay out of pocket or find a different doctor."
Wow. To put all that effort into coding your own solution but to choose that platform... ugh.
Page 488 of the ARRA:
(b) STUDY AND REPORT ON AVAILABILITY OF OPEN SOURCE HEALTH INFORMATION TECHNOLOGY SYSTEMS.
(1) STUDY.
(A) IN GENERAL. - The Secretary of Health and Human Services shall, in consultation with the Under Secretary for Health of the Veterans Health Administration, the Director of the Indian Health Service, the Secretary of Defense, the Director of the Agency for Healthcare Research and Quality, the Administrator of the Health Resources and Services Administration, and the Chairman of the Federal Communications Commission, conduct a study on -
(i) the current availability of open source health information technology systems to Federal safety net providers (including small, rural providers);
(ii) the total cost of ownership of such systems in comparison to the cost of proprietary commercial products available;
(iii) the ability of such systems to respond to the needs of, and be applied to, various populations (including children and disabled individuals); and
(iv) the capacity of such systems to facilitate interoperability.
(B) CONSIDERATIONS. - In conducting the study under subparagraph (A), the Secretary of Health and Human Services shall take into account the circumstances of smaller health care providers, health care providers located in rural or other medically underserved areas, and safety net providers that deliver a significant level of health care to uninsured individuals, Medicaid beneficiaries, SCHIP beneficiaries, and other vulnerable individuals.
(2) REPORT. - Not later than October 1, 2010, the Secretary of Health and Human Services shall submit to Congress a report on the findings and the conclusions of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.
I'm planning on using this to justify why we're applying for ARHQ research funding for implementation of a non-CCHIT certified product... we're just trying to help them research open source options. ;-)
ie, one central standard to which all insurance companies' individual crap should be translatable by, say 2011.
And mandate that the insurance companies must handle the translation themselves.
Why do people keep talking about insurance companies? Their stuff has been computerized forever. TFA and most of the discussion is about medical records in the clinic or hospital setting.
It has to do with insurance only peripherally, in that one of the driving forces behind digitization of medical records is to ease the billing process through better coding of medical procedures and reducing after-the-fact data entry, but being able to do billing from your system in an integrated fashion is a standard feature of all commercial EMR/PM solutions.
Similar for medical software - you could direct the spending so that you'll get extra features in the short-term and keep paying for them in the long-term. Alternatively you could pay to have it created under GPL license, and in the future you could always get competing bids when it comes to add features to the software, and you could add additional installations without further licensing costs.
Exactly. For our non-profit organization, which operates six clinics and two mobile units, EMR/PM bids are coming in at half a million for the first year and $200k and up each year after. The costs scale with our size, too; if we start seeing more patients or hire more doctors, we pay more for our EMR. This means we can't even *think* about switching to electronic records until we've secured funding for at least a few years, while we build that into the budget and our indirect cost agreements.
If instead, the government actually purchased one or two well-developed EMR systems and open-sourced them, then let all their Federally-Qualified Health Centers (FQHCs) and look-alikes use them for free, it'd cost more like $100k per grantee organization to implement... including hardware, which the costs above don't count... and the continuing costs would be negligible, probably one more person on your IT staff, or a low-cost helpdesk contract.
Instead, there's an RFP out right now that will spend $4.5 million on *six* FQHCs to implement EMRs. Only clinic systems with at least 30 sites, or consortiums of three or more clinics are eligible, so I'm guessing their target is to get 200-250 sites onto EMR systems with $4.5 million dollars. Not exactly cost-effective.
If you find one, send me the link, too. We're using OpenMRS as a cross-agency TB registry, but it's sooooo not a full-featured EMR compared to the proprietary solutions. The stuff that our agency is willing to look at isn't even web-based, so you're locked into Windows (or maybe emulation; no idea if that works) for your desktop machines too. One of the systems runs only on Windows servers with MSSQL. Gack.
It is an act of congress which allows corporations to exist. That act should not result in a violation of the bill of rights.
And it doesn't. You're quite free to post far and wide about this issue. Just not on Norton's board.
When the New York Times gets a visit from the Feds because they want to run a story about PIFTS.exe, call me. One company controlling user-submitted content on their own site is NOT censorship, it's just stupidity (in this case, anyway).
Really? Why hasn't your above post been deleted yet, then?
Are you able to get a replacement for your kindle?
Already have it. I submitted an inquiry on amazon.com, and they responded promptly telling me to use their tool on the website to speak with them via phone, which sounded kinda strange, but ok... so there's a page (after you log in and go to the manageyourkindle page) where you type in your phone number, and they call you RIGHT THAT SECOND. You still wait on hold for, gosh, maybe 30 seconds, but freaky anyway. ;-) Then a rep with a Starbucks-caliber chipper friendliness in his attitude asked what I'd done to try to address the problem, and after I told him I'd done what you're supposed to do (I'd power-cycled and used the Reset button under the back cover), told me I'd have my replacement Monday, which I did. That was Friday night at 9:30 p.m.
They never even asked how it got broken. I'd been agonizing over whether to say "Gosh, I just pulled it out of my purse and it was like that" or tell them the truth... but it didn't even matter.
Best. CS. Ever.
Way to go Norton! We may have to rename Streisand effect to Norton effect pretty soon...
They're slightly different, though. The Streisand effect has to do with not wanting people to see something; the Pifts effect (which is a far more fun name than Norton) has to do with not wanting people to talk about something.
Ok, I gotta go Devil's Advocate on you here. While they're not as prevalent, there certainly *are* quite a number of Windows web servers, also connected to fat pipes. Are they often botnet drones?
I'm thinking that web servers, due to their function and the skill level of the people administering them, are less likely to get infected and infections that do happen are far more obvious (because they'll dramatically change the bandwidth usage stats). So, it may not be particularly telling that Linux webservers aren't prone to botnet viruses.
Sir please take your tinfoil hate off so we can reprogram your brain.
That's it, let go of the tinfoil hate! I prefer plastic wrap love. heck, even wax paper indifference is better.
I personally haven't ever seen a Linux desktop with a virus.
Windows spreads virus's in the same way AIDS spreads.
No, more like mononucleosis... you just have to share a drinking glass or otherwise swap spit with someone who's infected. AIDS is actually fairly difficult to transmit.
"Censorship" is done by governments
Censorship is done by people who censor, and has nothing to do with government at all. The only connection it has to government is the prevailing belief that it's "bad" when government does it and "ok" when anyone else does it.
Rather, let's say that in the US, "censorship" is illegal when done by the government (violating the First Amendment, aside from a handful well-documented exceptions in case law), and legal when done by private entities on their private property.
Norton cannot prohibit you or anyone else from writing a letter to the editor of your favorite newspaper or putting up your own site discussing the issue, provided you were not found to be violating laws concerning defamation, libel, etc. Even if you were found in violation of laws that provide exceptions to the First Amendment, Norton would require the government's intervention to compel you to shut up about it.
Note, in particular, that the 300 comments on this story on this site have not been "censored" by Norton. It would take a government to actually quash ALL discussion of the topic, which is why government censorship is generally illegal in free* countries and decried in oppressed* ones.
* Note that this is not an invitation to debate whether one country or another is truly "free" or "oppressed." These terms are shorthand groupings for countries that do or don't engage in wholesale government censorship.
And the same applies when you enter into China, but I'm not aware of anyone who thinks China's Internet Firewall censorship is acceptable practice. Infringement of a human right is infringement regardless if the perpetrator is China or Norton.
This is true... provided that Norton is your government.
There's a difference between censorship on a private message board operated by a private company, and censorship by a state with authority over its citizens. But that seems to be a really hard concept for the average internet user to grasp.
If e-paper ever improves enough, this would be an excellent place for it.
E-paper doesn't withstand drops well, either. I dropped my Kindle from a height of about 2 feet, it landed facing up, and the display was permanently broken. There was a diagonal "crack" in the matrix under the surface, and vertical and horizontal streaks leading up to it. It wasn't pretty.
Interestingly, it *did* hold the display until it tried to refresh. I didn't realize it was broken until I turned the page.
in your example; how would the gov know u have a genetic disorder?
isn't all medical data in the usa obtained in a hospital / clinic / etc which IS a private company?
Well, no. For one thing, there are government-operated clinics; they're usually run by County departments of Public Health. But for another thing, there are government health programs. Of particular relevance to the PP's hypothetical, the State of California operates a program to provide alphfetoprotein (AFP) testing to all pregnant women (unless they decline). This test gives a likelihood that the fetus has certain genetic disorders, such as Down Syndrome. The (private) doctor's office collects a blood sample, but sends it to a state clinic for analysis. That clinic then asks the pregnant woman in question for her insurance info.
There are also government-run insurance programs, such as Medicare (available to seniors) and Medicaid (available to the disabled and low-income; the program is Federally funded but run by the individual states). Those would, of course, have records of treatment that was billed to the program.
But of course, you make a valid point that private companies are trusted with our information every single day. My doctor's office might have a Google Apps subscription, and wouldn't ever have to tell me about it (they'd have a Business Associate Agreement with Google, and then the info flow is covered by their HIPAA NPP with no change). So the idea that the Government might (oh noes) use a private company to store and share data is somewhat disingenuous.
Then you would be acting unlawfully, here in the UK you have a right to be represented by a Union, not employing someone because of union related activities would be illegal in itself.
It's also illegal in the US.