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Obama Proposes Digital Health Records
Posted by
CmdrTaco
on Mon Jan 12, 2009 09:36 AM
from the cuts-both-ways dept.
from the cuts-both-ways dept.
An anonymous reader writes "'President-elect Barack Obama, as part of the effort to revive the economy, has proposed a massive effort to modernize health care by making all health records standardized and electronic.' The plan includes having all conventional records converted to digital within 5 years. Independent studies are fixing this cost somewhere in the range of $75 to $100 Billion, with most of the money going to paying and training technical staff to work on the conversion. Early government estimates are showing 212,000 jobs could be created by this plan."
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Submission: Obama Proposes Digital Health Records by Anonymous Coward
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stupid question but..... (Score:5, Interesting)
If this can save so much money why isn't the health care industry already doing it? Are they really that stupid or are all the promises of big savings not likely to pan out?
Re:stupid question but..... (Score:5, Insightful)
Good point, but the other question to ask would be who saves the money?
Having these records would make it easier to switch providers. Without them, more tests might need to be done since "we don't have the records". Switching providers isn't in the providers' interest. Charging for lots of tests is.
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exatly (Score:5, Insightful)
Having health records as a standard brings more transparency to the Health care industry, start with that and then soon people will want them standardized invoicing and billing etc. Obfustication seems to be a popular method to profit.
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Re:exatly (Score:5, Insightful)
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Re:exatly (Score:5, Insightful)
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Re:exatly (Score:5, Insightful)
Even with "standardized" documentation, you have to fight the ridiculous rules of the noninsurance companies / death management organizations (HMO's).
True story: a friend of mine went in for a routine breast exam. Doctor told her she needed to have test X run. The way they would do this is, first they would do Test A (which required a biopsy about the size of a pencil eraser nub). Test A always comes back inconclusive. As in, they've been sending this test off for 10 years, and every fucking time it comes back "inconclusive." BUT, and here's the stupid part, once they've done Test A then the insurance companies/HMO's will approve Test X because Test A is "inconclusive." For Test X, they'll need to take a biopsy about the size of a nickel, same depth.
There is no way to jump straight past Test A and go to Test X; the insurance companies will disallow it on the grounds that "preliminary" work hasn't been done. So not only does her money get wasted (one copay for each procedure, plus copay for FOLLOWUP visit to get results of each procedure and approve next one, rather than just copay for one test) but a completely redundant and useless test is done, wasting the money of everyone else who's been paying into the insurance/HMO networks. Oh, and as an added bonus, she has to go through all the pain and healing process of a biopsy, not once but twice.
I don't think "digital documentation" will help for that.
Other things that get in the way of digital documentation, of course:
- Originals of a lot of records (x-rays for one example) do not transfer well to digital. Heck, transferring any analog recording, visual or auditory, to digital inevitably means a loss of fidelity at some point or another. You either save a far-too-small file that someone looks at and misses detail (or dismisses an important detail as compression artifacting) later, or your file is completely freaking huge.
- Digital copies are unusable if you lose power. The risk of data corruption is also present. Magnetic storage media has a certain lifespan before it demagnetizes. Optical media tends to die due to oxidization, either of the ink or the metal or the plastic layer (ever seen a 10-year-old CDR? Kinda frightening when the plastic is that cloudy). Physical shock can destroy both quite easily (woe to us when people need their records following a magnitude-8 shock out in Cali).
Now, I'm not 100% against digital records, or even the idea of all (or just mostly) typed records so that we don't have to deal with my doctor's crappy handwriting (how the pharmacist ever figures out what he prescribed and in what quantity, I have no idea). But we have to deal with the realities here, and weigh the benefits of going "all-digital", and there's a definite case for keeping originals of paper records and testing results (when possible) available.
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Re:exatly (Score:5, Informative)
Having worked in Radiology IT, I'd point out that the human eye is actually a limiting factor in our ability to see things. So, yes, you are correct in that an analog X-Ray had more diagnostic information encoded into it than a digital one. However, the human eye can only see so much data. The human eye isn't a microscope. So you don't need to scan an image to microscopic precision. You only need to scan it to a level of precision that the human eye can't detect a difference. And it turns out that to do a scan of an X-Ray at that level of details results in a file that's approximately 10.5MB in size. It's a very well known metric, actually.
And if you have a 600 bed hospital which sees 150,000 patients per year in the Department of Radiology, and 50% of those are X-Rays images, with 2 images (PA, Lateral) per exam, that results in, oh... about 75,000 x 0.5 x 2 x 10.5MB = 787 GB of data per year. Add some extra space for buffering, swap space, and so forth, and you're talking about a Terrabyte of data per year for the X-Rays at a large community hospital. MRI, CT, Ultrasound, Angiography, and all the rest will add more, of course.
The hospital I used to work at stored about 2.5 terabytes of images per year.
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Re:exatly (Score:5, Funny)
Add some extra space for buffering, swap space, and so forth, and you're talking about a Terrabyte of data per year for the X-Rays at a large community hospital. MRI, CT, Ultrasound, Angiography, and all the rest will add more, of course.
The hospital I used to work at stored about 2.5 terabytes of images per year.
Christ!!! That's almost $250 a year for storage!!!!! Or, $75,000,000,000 if you're the govment!
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Re:exatly (Score:5, Insightful)
That said, this is a huge plunge to take. In Britain they've been working on it [wikipedia.org] for about a decade. Of course it is over time and budget by several times. From our perspective, they've spent hundreds of millions on a prototype that we should study for every insight before such a massive undertaking.
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Re:stupid question but..... (Score:5, Insightful)
Having these records would make it easier to switch providers. Without them, more tests might need to be done since "we don't have the records". Switching providers isn't in the providers' interest. Charging for lots of tests is.
There is that possibility, but I'd be more inclined to believe inertia in record keeping is more to blame for them having different formats.
You know that all providers are going to need to pay out cash to get new software that obeys the rules and there will also have to be a data migration effort. And you also know who that cost will be passed on to. Hint: not the providers.
The question is: is it worth having health care customers pay for this? Will the investment be worth it? I think it might be, if it does help with the need to dispense with tests, retests, and other administrivia.
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Re:stupid question but..... (Score:5, Insightful)
Maybe the open source community should get off their butts and help to create client software and server software that will implement this standard, and provide it free to the medical community thus lowering the cost of entry into standardized medical records and systems.
This could be the best achievement of open source collaboration, and usher in a new era of open source projects that benefit mankind at the very basic level of existence.
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Re:stupid question but..... (Score:5, Insightful)
A standard isn't software; it's how to exchange information. That includes data formats, but also includes protocols and an awful lot of context. The standards work is a big job, and people have been working on it for years (see HL7 [hl7.org]). As eln points out below, it's boring as hell, but that doesn't make it unimportant. The industry has been in the process of moving from HL7 v.2 to v.3 for about a decade now.
If you want to get into the software part of the solution, have a look at the OHF Project [eclipse.org]. There are others, but that's a starting place.
I agree with tnk on the benign reason; the system as a whole will save money, but which individual players will save how much? Hospitals already spend very little on IT compared with other businesses, so spending a big whack that may end saving money for some insurance company isn't going to happen.
You want one big reason for doing this? If it can free up nurses from doing secretarial work chasing down documents in the mail and phoning around, it just might keep enough staff at the hospitals to serve the public. The U.S. department of health and human services prepared this report [hrsa.gov] on the subject. It's worth reading.
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Re:stupid question but..... (Score:5, Interesting)
There is that possibility, but with nearly a decade behind me in the health care industry, I'd be more inclined to believe it's the Not-Invented-Here syndrome.
Also, I'm very worried about a system like this from the user's point of view. If it breaks, the impact could be enormous. And breaking into a system becomes much more attractive when you can get everything in one place.
And who is to say that a future government won't use the data for nefarious purposes? If the data is there, the temptation might be high. Would you trust all the possible future governments to know who has had abortions in the past, was brought to the ER for drug pumping when 12 years old, who is lactose intolerant due to distant negroid ancestors, or who has and haven't had a bris?
There's also the problem that if a doctor enters something incorrect, imprecise or a red herring, it's going to stick there forever, and unless you demand to see your records, you may not even know about it. Speaking from experience, doctors are humans who will focus on the first interesting thing they see, and often have made up their mind based on your journal before even seeing you. Often they're right, but sometimes they're not, and when they're not, it tends to be the same patients who suffer over and over again, because the journals don't change -- they just get added to. (It could be that some doctor at one time entered 'fibromyalgia?' in a journal, and from that point on, every doctor who reads the journal will consciously or unconsciously think that any pain you report might be related to fibromyalgia. Whether or not you ever had it.)
I'm just surprised that privacy advocates aren't all up in arms about this dangerous proposal.
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Re:stupid question but..... (Score:5, Interesting)
Having these records would make it easier to switch providers
I don't know if I buy that. It's pretty easy to get your records now. You request them, sign a disclosure and receive them in a few days. Some providers will even copy them right there for you. Perhaps going electronic will eliminate the wait time to have your chart pulled and copied but perhaps it won't. Will there be legislation in place that requires them to give you copies faster? Or will the excuse just change from "we need to photocopy your chart" to "we need to get IT to open up your records for the new provider"?
There's also privacy issues that need to be addressed. I know people will scream 'HIPAA' at the top of their lungs but have you actually read your insurance contract lately? Yeah, law enforcement/civil parties can't generally subpoena your Doctor to get at your medical records -- but they can and do subpoena insurance companies for billing records, which tell them much the same things. Why that's allowed is beyond me but it is.
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Re:stupid question but..... (Score:4, Funny)
Why that's allowed is beyond me but it is.
Probably in cases of fraud. We've all seen the CSI/L&O/NYPDB where some poor widow has $1M in health care charges and magically pays it off after some alleged wrong doing with some kingpin.
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24% (Score:5, Informative)
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Re:24% (Score:5, Insightful)
I don't think that the reason for reduced overhead should be entirely attributed to digitalized medical records. You also have to remember that one of the main problems that medical companies don't do this already is liability problems created by HIPPA. Likewise, insurance is a nightmare to work with. These will both continue to be true whether or not records are digitalized.
One problem few people think about with regards to health care is that the U.S. is such a diverse society, you have a lot of different types of needs. In countries with a monoculture, it is much easier to have low overhead and have a one-size-fits-all way of doing things. Also, in other countries, privacy is not so much of an issue. Here, for some reason beyond my understanding, medical records have become almost the equivalent of classified documents in terms of how they are protected. This has probably cost us much more money than whether or not the records are digital.
I think it is _possible_ we could save money with digitization, but not the amount suggested by this post. On the other hand, based on previous experience with medical IT, I think it's possible it could actually lose money in the long run, especially if "being digital" becomes more important than actually solving the communication problem.
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The system DEPENDS on administrative inefficiency (Score:4, Insightful)
If we had a digital health records system that worked, the insurers would be quick to analyze those records and use the data in consumer-unfriendly ways. Since employers pay the insurers (and ultimately incur the cost of health care), they would be among the first to "score" the health cost of new job applicants. People with certain manageable conditions (eg, diabetes) would be unemployable and therefore uninsurable.
To prevent this, we have a hodgepodge of low-tech data capture methods, supported by back-end systems from offshore outsourcers. On a good day, it works just well enough to get the bills paid.
Making this data readily accessible would be a disaster. No matter how much privacy is built into the system, insurers and employers would require "waivers" before anyone could be insured or employed. So much for privacy.
How much of Taiwan's 2% is related to the fact that socialized medicine does not have any concern about who pays (or how much)? A single payer would BY ITSELF eliminate much of the overhead. Not that this is the ideal solution (as it creates other problems). But if the goal is administrative efficiency, the low hanging fruit is the nitpicking of invoices, negotiation of prices, and determining "coverage".
In the current world, we have someone who is AT BEST a non-practicing nurse who has never met the patient deciding whether or not to approve the doctor's treatment plan for that patient. All under the guise of "managed care". I'm surprised they can keep the administrative expense down to 24%.
There are many potential solutions to the healthcare problem, but any proposal that lets the insurance and pharmaceutical industry conduct "business as usual" is not solving anything.
Thanks Barak, but no thanks.
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Re:24% (Score:4, Interesting)
Do you realize that 24% overhead beats the crap out of any government program I've ever heard of? 24% might sound ridiculous to you, but when you have welfare programs fighting just to get the majority of their money to welfare recipients (ie, less than 50% overhead), 24% looks pretty damn good.
Also, I can't help but wonder what the number would look like if Medicaid filing requirements weren't incredibly convoluted. To attribute 22 percentage points of the 24% simply to the fact that we don't have standardized EHR -- which is what you implied -- is a little off. Take a look at government regulation of the health care industry and correlate it to the increase in costs. It's not going to be 1.0, but it's sure as hell not going to be 0.0 either.
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Re:stupid question but..... (Score:4, Informative)
About two years ago I came down with pneumonia. I thought it was the flu and so did the doctor at the urgent care clinic. After two weeks when I didn't get better they took X-rays and found that I was really in bad shape. They sent me to the hospital but they didn't have "privileges" at the hospital so they had to send me to the ER. They gave me a DVD with my X-Rays. When I got there they didn't know what to do with the DVD!. Well since I didn't look that bad and my ekg was good I waited about 10 hours!
I was in the hospital for a week. Buy they time I got in they where wondering if I should go into ICU since one lung was completely shutdown and only had half of the other one working.
I have to wonder if they could have just popped in the DVD if I would have gotten in sooner.
Oh and I do have a real doctor. Since I have always been so healthy in the past when I tried to get in they told me it would be three weeks.
The poor guy felt so bad that he office now has standing orders that if I say I really need to get in that I get in.
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Re:There is a pitfall though. (Score:5, Interesting)
On more than one occasion, we've had client companies, or prospective clients, come to us with requests for features and functionality that would be unethical, if not illegal. You are very correct - the idealistic principle of insurance is that it is a shared risk endeavor. That has been broken down by the insurance co's to a one-sided agenda where they know they have you by the balls and can deny for any reason under the sun, including those that specifically go against the grain of insurance (i.e. if you move to a different provider who provides 'substantially materially similar' benefits, at a separate rate, there should be no waiting period - statistics and probability don't work like that).
My wife uses chiro services. Non-insurance rate? $45. With insurance? $135. There is something very wrong with that picture, when you know that you are paying $500+ a month in health insurance, it's predominantly YOU paying that. Why not go to a HSA or FSA? Save that money, pay the cheaper rate - the only reason most people don't is for catastrophic coverage - so you'd think that catastrophic coverage only plans would be reasonably cheap, etc? No. Cheap, yes. After you pay some of the highest deductibles around (I've seen $7,500 personal, $20,000 family commonly).
It's a racket, and though anecdotal, there's something awry when someone whose income is derived from the insurance industry is agitating for universal health care (not that it'd go away entirely, but nonetheless), because as it stands now it is such a fundamentally broken system.
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Re:There is a pitfall though. (Score:5, Insightful)
Do you also think that your car insurance company should have zero access to your driving/accident record? How can you bear risk if you have no idea what that risk is?
You DO have an idea of what risk is, as a set of proportions or probability. You can compensate for that by determining your rates according to those general models rather than excluding people from first world status.
By the way, this is people's health, not their car.
How'd they create it? By insulating the general public from the costs? Doesn't the general public share some blame too if that's the case?
no, they don't. They are never told the costs, are compelled to take care of themselves, and have no bargaining or lobbying power against centralized corporate power.
The insurance industry, however, was exposed to the costs and could easily have engaged in bargaining and lobbying to put the abuses in check.
They still can now, but refuse to do so.
I'd like to add to this that driving involves choices, medical conditions don't. Many chronic conditions are genetic, and completely unrelated to lifestyle.
Kennedy, for instance, had adison's
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Re:stupid question but..... (Score:5, Interesting)
Standardization is one of those things that's good for everyone, but that would not be cost-effective for one player to attempt. When a bigger player (which in this case has to be the government) moves in and lays out standards for everyone to follow, everyone benefits.
You should be asking not why the industry isn't doing it, but why the government didn't step in a long time ago, to do this and a lot more. Many doctors -- people who have invested more time in training and education than almost any other group in our society -- are spending half of their work hours on paperwork and arguing with insurance companies. The level of inefficiency and waste in American medicine borders on criminal, and it translates not just to massive deficits for taxpayers, but second-rate health care for citizens.
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Re:stupid question but..... (Score:4, Interesting)
Many doctors -- people who have invested more time in training and education than almost any other group in our society -- are spending half of their work hours on paperwork and arguing with insurance companies
I'm aware. But simply going electronic is not going to fix this. All it will change is the data entry method from pen and paper to stylus and tablet. If you want to fix the arguing with insurance companies you are going to need to regulate how they can conduct their business -- which (while long overdue) is probably going to increase costs even further. Should the insurance company have a veto over the form of treatment or medication that your Doctor can proscribe? Probably not. But if you remove that veto costs will go up. It seems criminal to me that nobody is even bothering to acknowledge this.
There's also a number of other things that need to be fixed. As a random example, one of the tricks that drug companies use to extend patents is to "invent" an extended release version of the same drug they've been selling for years. Tort reform might also be in order. Have any friends in the medical field? Ask them what they pay for malpractice insurance and if there would be better ways they could spend that money.
The level of inefficiency and waste in American medicine borders on criminal
I agree. I've just never heard of Government as a solution for inefficiency and waste.......
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Re:stupid question but..... (Score:5, Interesting)
Should the insurance company have a veto over the form of treatment or medication that your Doctor can proscribe? Probably not. But if you remove that veto costs will go up. It seems criminal to me that nobody is even bothering to acknowledge this.
I think you're looking at this as though the industry where an effectively functioning, competitive free market. Do you really think costs of insurance are determined by how much it costs the insurance company plus a small profit? That would be stupid of insurance company executives when most purchasers have no choice of plans and have to go with what they are provided by their employer. It makes a lot more sense for them to provide kickbacks and large client discounts to lock in people, then use their bureaucracies to minimize payoff to people too sick and desperate to fight too hard.
Tort reform might also be in order. Have any friends in the medical field? Ask them what they pay for malpractice insurance and if there would be better ways they could spend that money.
Actually, this is symptom of a society with ineffective or too low of levels of socialist healthcare and disability insurance. Juries rule all the time that doctors should pay large sums to people who are sick and disabled because despite the facts of the case, they feel there is nothing else that is going to provide for the ill and disabled and they feel sorry for those people. They feel doctors can afford it and on a case by case basis, most people are in favor of society providing for the sick and disabled.
I agree. I've just never heard of Government as a solution for inefficiency and waste.......
This is, quite simply, the main argument I have against socialized healthcare programs, in general. On paper it saves money and benefits society in many, many ways most people never even consider. In practice, in most places around the world, it works better. The only real question is our government one of the worst and least efficient at performing tasks like these and is that likely to continue? Our government has already managed some of the worst implementations of social constructs around the world. Currently our healthcare system is one of them, but there are may more. Heck, look at how well we managed to implement broadband internet access. We paid triple in taxes (per person) more than the Swedes, who have almost the same population density and who had a huge amount of that money embezzled in the middle of the project. They still pay significantly less every month for significantly faster connections that reach an enormously larger percentage of their population. Our current healthcare is analogous (both times we tried the capitalist route, but lobbyists undermined the decision making). On solution that has worked for other countries is eating one's own dogfood. That is, whether it is healthcare or internet access, force everyone to rely on the same system. This means the lobbyists and government officials and decision makers all have to live with whatever solution results, affecting their quality of life. I have a lot more faith in congress critters voting in my best interests when they have to use the same medical system and can't bypass it an go to a private hospital they pay for with their wealth.
One final point I'd like to address. Many times here you mention costs, but costs are not the most important factor for economic recovery and societal benefit. Whether 10% of the money is wasted or 20% is wasted makes a lot less difference to society than you'd think. What matters more is who is paying what percentage. In our current system taxes pay some portion of healthcare for some people, but over the last 8 years the burden of the taxes have shifted more and more to people on the low end of the spectrum. As a result, wealth has been consolidating more and more at the top in fewer and fewer hands. This and no other factor, is the important one for our economy. Wasted money is mostly
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Re:stupid question but..... (Score:5, Insightful)
Interoperability is where the government steps in, for better or worse -- only the most ideological libertarian would deny that such a role exists.
I'm not a libertarian and I've never denied that Government has some roles. I'm just really skeptical about UHC. Here are just some of my concerns (off the top my head):
1) What evidence do we have that it will actually make health care more affordable? When has Government ever been able to do anything cheaply or efficiently?
2) Will Government in health care be used as yet another excuse to expand the nanny state? Will alcohol be taxed higher because it's bad for me? McDonalds? Doritos? Will all of this enforced by my employer similar to the way the so-called War on Drugs is enforced? Stop smoking or lose your job? Lose weight or lose your job?
3) What reason do we have to believe that our new Government overlords will be anymore benevolent than our existing insurance company overlords? I don't see how arguing with a Government bureaucrat over treatment is any preferable to arguing with a private sector bureaucrat. Who would you rather deal with: DMV or your auto-insurance company?
4) Will there be a way for me to opt-out if I don't see the benefits in having my health record instantly accessible from anywhere in the United States?
5) Will Government involvement in health care be used as an excuse to further erode the doctor-patient privilege? Go read the laws around credit reporting sometime -- the Government wrote in nice little exceptions for itself for all of the privacy laws related to credit reports. Will it do the same thing for medical records?
Just are just off the top of my head. I'd have to say that #2 is probably my biggest concern. I'm sick of the nanny state and the war on vice. And I see no signs that it's going to get any better. In fact [nydailynews.com] I see the exact opposite......
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Re:stupid question but..... (Score:4, Informative)
The fact that every other major industrialized nation has universal healthcare, provides outcomes comparable to or better than the US, and does so at lower expense (measured either per capita or as a share of GDP) than the US.
The first already is taxed higher, in part because of the health consequences, and proposals on the latter have been made independently of universal healthcare.
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Re:stupid question but..... (Score:4, Informative)
Speaking as the son of the owner of a body shop, you clearly have no idea the hell insurance companies put people through. The DMV can make you wake for 5 hours on a bad day, but the auto-insurance companies will spend months, and I've even seen years, denying or delaying payment. My dad spends just as much time dealing with the insurance companies as he does running the entire shop. Not to mention that they always want to get the cheap, less durable parts, or crappy after market parts, if it saves them any money, regardless of the impact it'd have on safety, or the vehicle for that matter.
And we already have a nanny state. You can't do most drugs, you already get taxed highly on cigarettes, smoking is already banned in public in many municipalities, etc. You realize that there are many industrialized nations which already HAVE universal health care right? It's not like this'd be some grand experiment for us. If anything, we're behind the curve on this.
On a side note, this is NOT Universal Health Care, as you seem to assume. This is standardization. This means everyone'd have the same information and be capable of sending it to other facilities and physicians without absurd hassles and delays which could cost a patient their life.
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Re:stupid question but..... (Score:4, Insightful)
And we already have a nanny state
And that's an argument for further expanding it?
You can't do most drugs, you already get taxed highly on cigarettes
And I disagree with both of those policies. So again I'll ask you, why should I be in favor of UHC if the logical outcome of UHC is even more governmental intrusion into my private life?
you clearly have no idea the hell insurance companies put people through
Actually I used to work for an independent agent so I do have a decent idea of the hell that insurance companies can put people through. I guess I view them differently than I do DMV for two reasons:
1) I know how to handle an insurance company bureaucrat. When they tried to dick over my girlfriend on paying her collision deductible after she was rear-ended I asked them which hospital she should visit for her neck pains. Had a check for the collision deductible the next day. Amazing how the prospect of a four digit no-fault claim puts a $500 collision deductible into perspective.....
2) I have a choice of which insurance company I deal with. If mine fucks me over I can go and find another one. I don't have this choice when it comes to DMV.
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Re:stupid question but..... (Score:5, Insightful)
Because it'll cost a fortune, and be a nightmare to implement. (Look at the mess the UK is making of their health computer system, with loads of interest groups, all pulling in different directions, pushing up the costs).
"Early government estimates are showing 212,000 jobs could be created by this plan."
Yeah, and how many paper pushers etc.., will it put out of work?
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Re:stupid question but..... (Score:5, Insightful)
Regulatory boondoggles. Girls singing to ABBA albums. It's like 1979 all over again.
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Re:stupid question but..... (Score:4, Insightful)
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Re:stupid question but..... (Score:4, Insightful)
If this can save so much money why isn't the health care industry already doing it?
Because in the short term it would divert money away from the really important things, like executive bonuses.
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Re:stupid question but..... (Score:5, Informative)
The idea is sound, but very difficult to properly implement. You'd think with all the benefits, healthcare providors would be clamoring to make the switch (some already have), but there are a lot of hidden problems associated with digital records.
I'm a healthcare technician in the USAF, where the DoD has already implemented a system called AHLTA. When a patient presents for a doctor's visit, all the screening, labs, tests, orders, prescriptions, and physician's notes are entered into the system, where they can be referred to easily for future visits. No need to store thousands of paper records, or train records techs to pull them and locate the appropriate exams.
Problems we experience: Privacy. It's difficult to ascertain just what records which type of doctor should be seeing, so right now we basically have a system where any variety of doctor or technician can see any variety of a particular patient's records (except Mental Health and STD visits, which are accessible only by password by default). This situation makes some patients rather uncomfortable.
Data load. That's a lot of records. And it requires a lot of trained technicians to keep track of it. And it requires frequent audits to ensure the information is current, and has not been illegally accessed. And the system has to communicate and exchange information with several other (often outdated) systems.
Server outages. When we have one, the clinic is virtually paralyzed. We can't refer to the patient's paper record for reliable case history, because the system was implemented five years ago. There won't be any recent records to refer to.
Good Old Boys. The transition has been difficult chiefly because, let's face it: doctors just don't wanna have to go to all the trouble of learning a whole new computer system. It's easier for them to scribble some notes on a sheet of paper, and stick it away in a paper record and be done with it.
There are clear advantages, but it just seems like we're not quite far enough along to handle such a system for just DoD personnel, let alone every single man, woman, and child in the US. A five-year plan is just not feasible from where I'm standing.
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Other issues (Score:5, Informative)
In terms of privacy, we audit all access to our medical records and have a team of auditors who monitor access. I've been responsible for writing exception reports and such. It's far easier to tell who's accessing your medical records than paper copies laying around.
Data load is a big deal. We have our main EMR and multiple data repositories where we can do reporting and other non-operational work. Lots of people support all that infrastructure. On the plus side, that infrastructure lets us do things that saves money and lives.
Server outages have been pretty bad, but we have assorted downtime procedures and downtime systems. An example is a downtime database located in the various medical record office that are constantly updated with patient allergies.
Our staff has gotten quite used to working with an EMR, but there are still cultural issues. For example, what a physician writes in a medical record may be visible to the patient. They have concerns about speaking plainly (e.g. describing a patient as alcoholic). At the same time, patients have a right to know how they're being treated.
My biggest worry about the new plan to convert paper records is that there are so many EMR systems. Will they pick one of the existing vendors? Build a new one? The ideal for the patient is to have a single nation-wide EMR that they can take wherever they go. This has a huge impact on existing EMR vendors and installs, though, so I doubt people will take that approach.
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Re:stupid question but..... (Score:4, Insightful)
Most hospitals and health care systems have electronic medical records.
"Only about 8% of the nation's 5,000 hospitals and 17% of its 800,000 physicians currently use the kind of common computerized record-keeping systems that Obama envisions for the whole nation."
This is the key. Most health information systems are not linked to any kind of national network. So for example, your hometown hospital has a detailed electronic medical record created on you from the last time you visited the ER with a bad case of the flu (ie your allergies, your RX history...). Then you go on vacation in Alabama and get into a bungee jumping accident which leaves you unconscious. The ER doesn't have quick access to your local hospital's electronic medical record so they either have to have the info faxed (if they can even determine who your primary care provider is) or redo all those tests for things like allergies and medications.
Getting all the big players in health information systems to play nice and share their patient data repositories is going to be interesting.
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Re:stupid question but..... (Score:4, Interesting)
They are not already doing it because of the cost for the hospitals to get off the big iron [wikipedia.org] they paid a ridiculous amount of money for in the 1970's. The proprietary, custom, and non-standard recording formats have always been determined to be too expensive to change, although they may be quite inconvenient.
Besides... who wants to pay for a gazillion lines of COBOL to be re-written. I'd theorize that the estimates of $75-100b and 212k jobs are woefully low. 5 years seems a bit light to me as well. I'm sure there is some potential for efficiency, but the accuracy requirement alone means lots of time and lots of bodies. It's not just hospitals either; add in insurance companies, and 3rd party billing. Then figure in the oversight/regulation for HIPPA [wikipedia.org] compliance.
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Re:stupid question but..... (Score:4, Informative)
If this can save so much money why isn't the health care industry already doing it? Are they really that stupid or are all the promises of big savings not likely to pan out?
Electronic Medical Records (EMR) are great, but there's a significant startup cost. Next time you go to a doctor's office, look at the cabinets full of charts. Now imagine buying a system, hardware, and training. Then there's a transition period where you're entering data into the new system and the old paper-based system (unless you're 100.0% positive that the new system will be completely reliable and that you didn't buy the wrong one and need to start over). Also consider huge storage costs, not for the EMR database(s) alone, but for scans of all the extra paperwork - insurance card, signed HIPAA paperwork, fax from the family doctor, X-rays, etc. Finally, consider the enormous workload of converting old records. It's one thing to start entering new data, but what do you do with the old stuff? Do you pay someone to do thousands of hours of data entry, or do you just scan every scrap of paper in and call it good?
We've already bought an EMR system for my wife's practice, but haven't gotten far into deployment for all of the above. We want to go electronic for all the reasons you could imagine, but it's not like you can flip a switch any more than a Fortune 500 company could decide that they're going to switch from Windows to Linux one day. There's a huge amount of preparation and migration involved unless you're making a clean start.
By the way, "not wanting to make it easy for patients to switch" is not an argument against EMR, at least for my wife. If a patient wants to see another doctor, it's mainly for one of three reasons. First, we want people to get a second opinion on my wife's advice if they choose. If the other doctor agrees, then the patient feels good about their treatment plan. If the other doctor disagrees, then the patient makes an informed choice about their treatment. Either way, they've become an active participant in their care which is a good thing. Second, if they're in another town and need emergency care, we'd love to be able to fire off an encrypted email (or FTP or whatever the standard becomes) to their treating physician. Third, if they want to switch doctors permanently, an electronic transfer is far easier than making copies of their entire record (since we're legally obligated to maintain 7 years of records on our own and can't just pass along the original copies of everything).
So we're onboard with the general sentiment. If there are any "flag days" for conversion, though, this better not be Yet Another Unfunded Mandate or a lot of older practices will simply close their doors. A doctor near retirement with tens of thousands of charts won't willingly spring for an expensive system plus all the labor involved.
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Re:stupid question but..... (Score:4, Funny)
The Government should auction off the format specification to help pay for the costs.
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stepping stones to universal health care (Score:5, Interesting)
A Better Idea... (Score:5, Interesting)
How about doing this for my 401K? My current one through my employer is impossible to manage, and the insecurity around the thing is downright scary. My rollover IRA through Fidelity is ok, though.
On that note, how about making it so that I can choose whoever I want to put my pre-tax money into vs. whatever firm my employer wants me to use?
On healthcare, stop allowing the 'insurance' companies to be in charge, for one. Let me see any doctor I want, and they cover me. Enough with the in network, out of network bullshit. Don't cover routine stuff, but do cover surgeries, long-term care, therapy, etc. I don't use my car insurance for oil changes </bad car analogy>
That estimate seems really high (Score:5, Insightful)
$100billion? There are millions of patient records, but they do not reside in millions of databases. Let's be generous and say there are thousands of databases. But most of those databases are already manned by DBAs. Some of them may not be up to the task, but most can convert their tables to the specified format if you tell them what that is.
So it seems the task is coming up with a standard format and enforcing it. Security is another question, but again it seems a matter of mandating healthcare providers adhere to a specified standard. But hospitals and insurance companies are quite used to such bureaucracy, so it's difficult to understand where they're pulling this $100billion figure from.
Saying they'd need to hire an entire new class of DBAs and techs to make it happen is silly, since they already exist.
Odds are the figure was thrown against the wall by companies hoping to win a fat contract, and counting on the knowledge that politicians have no sense of what it takes to get the job done. I hope Obama's CIO has the knowledge and grit to tell them to take a hike.
Re:That estimate seems really high (Score:4, Interesting)
So it seems the task is coming up with a standard format and enforcing it.
Which will cost FAR more than $100 billion, and be done so badly as to render the system nearly useless.
Ever parse a MAGE-ML doc that turns out to have the actual gene expression values in an "other" or "comments" field? Most "standard formats" are so arcane, complex and counter-intuitive that most people using them can't figure out the appropriate place to put the information.
Furthermore, medical terms change with time as new procedures are introduced and old procedures modified. The proposed format is going to either have to handle that or become the kind of straight-jacket that 501(k) process has been in medical devices.
Anyone contemplating touching any aspect of this project simply MUST read Stephen Flowers' "Software Failure: Management Failure", which is a collection of case studies of failed major software initiatives of just this kind. The book is in fact worth reading for anyone with an interest in why software systems fail, which should be everyone involved in software development.
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Doublespeak time! (Score:5, Insightful)
In case most of you had forgotten, Obama is basically copying John McCain who specifically mentioned doing this in the debates. Of course at the time McCain did it Slashdot thought it was an evil intrusion of privacy. But now that Obama wants to do the exact same thing it's an enlightened 21st century idea that only some Luddite old guy like McCain could ever oppose.
Hasn't this already been done? (Score:4, Interesting)
I'm pretty sure that health insurance companies have electronic records of all their customer's health care. Probably those records are scarily complete.
Wouldn't it be much cheaper, and faster, to just copy the data from the insurance companies, and write a few data format conversion programs? That would get 90% of the job done. THEN you can waste $100B on the other 10%.
Good luck, didn't work in UK (Score:5, Informative)
We have a similar "project" or rather it should be characterised as a "permanently stalled horror story." There are only 70 million or so people in the UK so nobody understood why the initial budget was in the billions. Now it's in the tens of billions and no end in sight. Google NHS IT if you really want to spoil your day.
Data Mining (Score:4, Informative)
I understand the potential problems with security, cost, screwups and stuff, but part of me wonders how much of this data could be used for diagnostic analysis by looking at symptoms, vital signs, treatments and outcomes over a very large population.
One hasty poor diagnosis is now a scarlet letter (Score:4, Insightful)
The current process accomodates doctors that still use paper records, and allows me to control which providers get access to particilar data. When I go to a new provider, i can get my entire record printed out where I can work with my new doctor to establish which records I believe are accurate and discuss why we (my doctor and I) came to the treatment plan we did.
I have a friend who got a "Drunk in Public" charge (after having gone to a club) and the court made him to to Addicticion medicine for n hours of drug and alcohol counseling, who also has (unrelated) back problems. Having that one flag in his records makes doctors at urgent care very very skidish about giving him cough syrup with codiene that they pass out like candy to folks like me or even giving him anything more powerful than ibuprofen when his back flairs up.
The problem with any centralized datasource like an arrest record, the credit scoring system, the DMV records, etc... is that any one provider, lender, billing firm or police department can make an honest (or intentional) mistake in those records and there can be almost no recourse to getting that data ammended that would have been a local problem, but is now a national problem. Even if the data can be ammended, it is a long difficult process that might take "years" to trickle down to the agencies using the data.
Create 212,000 jobs? (Score:5, Insightful)
So what they're saying is that this system will require 212,000 more people to operate than the current one. I have to ask then, why they're going to develop a new system that's more inefficient than the current one? Shouldn't a new system like this actually eliminate jobs?
Re:Format (Score:5, Insightful)
While your post is intended to be a dig at Microsoft, HIPAA may actually require a form of DRM.
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