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Obama Proposes Digital Health Records 563

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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Obama Proposes Digital Health Records

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  • by Phantom of the Opera ( 1867 ) on Monday January 12, 2009 @10:41AM (#26416601) Homepage

    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.

  • On the fence (Score:3, Insightful)

    by internerdj ( 1319281 ) on Monday January 12, 2009 @10:43AM (#26416611)
    Ok. There are plenty of abuses of this system but every time I go to a doctor I have to fill out the same information, often for multiple visits to the same doctor. My permanent address does not change once a month every month, thank you. It would also be nice for the hospital to have a digital record of what I'm allergic to, if I'm ever admitted unconconscious.
  • exatly (Score:5, Insightful)

    by JoeCommodore ( 567479 ) <larry@portcommodore.com> on Monday January 12, 2009 @10:45AM (#26416637) Homepage

    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.

  • by Phoenix666 ( 184391 ) on Monday January 12, 2009 @10:47AM (#26416657)

    $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.

  • by MindKata ( 957167 ) on Monday January 12, 2009 @10:47AM (#26416669) Journal
    "why isn't the health care industry already doing it"
    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? ... While it will create jobs, it will also wipe out existing jobs. Political drones just want it to sound like its creating jobs. Plus even if its adding more jobs overall, then surely its going to end up costing more money in total to keep funding the system?
  • by Anonymous Coward on Monday January 12, 2009 @10:48AM (#26416677)

    Of course they're going to be stored in a government database, or more likely a giant mega-corp's database who gets paid big bucks by the government to run the database... and the govt will have unfettered access to its contents too. And it'll be a federal felony to try to keep your medical records out of it.

  • by hypnagogue ( 700024 ) on Monday January 12, 2009 @10:48AM (#26416685)
    Note the part where this will "create 212,000 jobs". It's not supposed to save money, it's supposed to spend it -- and the sugar daddy footing the bill is you.

    Regulatory boondoggles. Girls singing to ABBA albums. It's like 1979 all over again.
  • Re:Format (Score:5, Insightful)

    by DaveV1.0 ( 203135 ) on Monday January 12, 2009 @10:49AM (#26416695) Journal

    While your post is intended to be a dig at Microsoft, HIPAA may actually require a form of DRM.

  • by tnk1 ( 899206 ) on Monday January 12, 2009 @10:49AM (#26416701)

    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.

  • by sunspot42 ( 455706 ) on Monday January 12, 2009 @10:53AM (#26416773)

    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.

  • by aengblom ( 123492 ) on Monday January 12, 2009 @10:54AM (#26416787) Homepage

    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.

    Uh, they don't reside in millions of databases, they reside in millions of paper filing cabinets managed by "DBAs" with the skills to match.

  • by Average_Joe_Sixpack ( 534373 ) on Monday January 12, 2009 @10:57AM (#26416829)

    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.

  • Doublespeak time! (Score:5, Insightful)

    by CajunArson ( 465943 ) on Monday January 12, 2009 @10:57AM (#26416833) Journal

    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.

  • by GigsVT ( 208848 ) on Monday January 12, 2009 @10:58AM (#26416843) Journal

    When you steal from one person to give to another person, nothing is created, it's only destroyed. So no, jobs won't be created, wealth will simply be redistributed.

    http://mises.org/story/3058 [mises.org]

  • by Shivetya ( 243324 ) on Monday January 12, 2009 @11:05AM (#26416935) Homepage Journal

    Privacy Privacy Privacy.

    Basically scare hospitals to the point that sharing becomes too financially risky to even mention. Throw in the Trial Lawyers who love to look for anything to sue a local hospital over and "accidental" disclosure or such becomes much easier if the data can be freely exchanged. Throw in possible errors, one opinion versus another (in the form of Doctor diagnoses), and treatment issues, and the can of worms become nasty.

    You can't even shop for insurance across state lines because of the government's regulations. Think it is any less burdensome on the businesses in that industry?

    The real problem, if the records can be accessed by outside agencies how long before it becomes a data mine for lawsuit happy agencies? How long before its leverage by some bureaucrat who has a bone to pick with a local hospital over treatments?

    As for the job creation, typical political bs to sell it. Mentioning a new program which eliminates jobs doesn't float. Then again if the government is doing it it will probably create more jobs and raises costs.

  • by qoncept ( 599709 ) on Monday January 12, 2009 @11:08AM (#26416985) Homepage
    It's called pump priming, and it's how you end recessions. You have to spend money to make money. Create 200k jobs and the economy improves. See the Hoover Dam. I think this is a great idea. I mean, the idea to digitalize and standardize health records is painfully obvious and should have been done years ago, but there is going to be an unbelievable amount of work created by it. I read the first half of the article and my first thought was how the hell are they going to do this? Reading on, I found out they are going to do it by creating thousands of jobs. This is just about the best idea I've ever heard from a politician.
  • by HetMes ( 1074585 ) on Monday January 12, 2009 @11:10AM (#26417033)
    Right, and McCain knew what he was talking about, and didn't just repeat what his speechwriter had written down...
    And even so, would it not be terribly stupid to dismiss a perfectly good idea, just because your one time opponent got media coverage about it first?
    What exactly is your point? That even you are surprised that McCain had some good ideas?
  • Re:Many problems (Score:3, Insightful)

    by u38cg ( 607297 ) <calum@callingthetune.co.uk> on Monday January 12, 2009 @11:20AM (#26417171) Homepage
    To be honest, it doesn't sound very different to what is requried in financial services, which use massive imaging stores (for documentation), require 100% data integrity in their records, and generally operate on workflows of the same level of complexity. They also have to meet security requirements of the same level of importance, so not an impossible challenge, I think.
  • by Anonymous Coward on Monday January 12, 2009 @11:20AM (#26417175)
    If someone could name one government program that has ever saved money, I will change my mind. But either directly out of pocket, or through taxes, every government initiative ever conceived has always cost more money and never saved it only shuffled it around and usually costs more than leaving things alone.
  • Re:exatly (Score:5, Insightful)

    by autocracy ( 192714 ) * <slashdot2007@s[ ... m ['tor' in gap]> on Monday January 12, 2009 @11:22AM (#26417201) Homepage
    ANSI 835 / 837 as mandated by HIPAA. I work with those things day in and day out. They (providers and insurers) do still find interesting ways to make me go "wtf" at least twice a week, though.
  • by Ohio Calvinist ( 895750 ) on Monday January 12, 2009 @11:23AM (#26417219)
    If we made all medical records the same "format" or made all Health systems capable of exporting data into a common format, the major problem is that those records are going to be missing valuable meta-data that is used by different providers to facilitate all kinds of functions such as billing, referals, preventative care pre-screening. The second problem is that even if the data is in a common format the problem is transferability; how to facilitate transfers between providers without a central database, in a timely manner, at a reasonable cost. fourth problem is that often times, I don't want records transfered from specific providers. I had a doctor make a really bone-head annotation in my records (I'm a Kaiser patient) and I still hear about it everytime I go into the office. I'd hate to go to some dollar-store urgent care facility when I am sick to get some antibiotics or some cough syrup and have them put that I have TB or something in my file and constantly have that one bad diagnosis by a glorified P.A. skew the view of all the doctors in the future.

    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.
  • by Anonymous Coward on Monday January 12, 2009 @11:28AM (#26417295)

    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.

  • Re:exatly (Score:5, Insightful)

    by trybywrench ( 584843 ) on Monday January 12, 2009 @11:31AM (#26417353)
    I work in the same industry. Lots and lots of our carriers refuse to provide ANSI 835 documents though. Of all our carriers about 5% actually comply and supply 835's. ( I work in pharmacy ) btw, 835's are a mess anyway. We have to write parsers almost on a carrier by carrier basis because so much of the spec is optional everyone does it in their own way. I'm sure you know my pain.
  • by tompaulco ( 629533 ) on Monday January 12, 2009 @11:31AM (#26417355) Homepage Journal
    I notice it doesn't mention how many jobs will be destroyed by this movement. I know that my entire company would go under, which represents a paltry 30 employees, but I would guess that there are at least a couple of million people employed in the art of getting the current paper based medical information into patient accounting systems. Granted many of them are doing it as only part of their job as a receptionist or office manager in a clinic, but large hospitals employ whole departments of these people.
  • by Anonymous Coward on Monday January 12, 2009 @11:33AM (#26417369)

    And just like the Hoover Dam after the job is done they workers can go back and stand in the soup lines...I doubt those 212,000 jobs are actual permenent jobs. So, you cut down unemployment this year, then when the job is done the unemployment raises again. Go look at the number during the New Deal...

  • by eln ( 21727 ) on Monday January 12, 2009 @11:34AM (#26417375)

    So what are you waiting for? Start an Open Source project and see if you can get contributors.

    Unfortunately, while I do encourage you to try, it could be an uphill battle. Medical records software is boring as hell to work on, and the people that need it are willing to pay lots of money to get it. These two things in combination make it much more attractive to build as a closed source commercial piece of software rather than open source.

  • by Shakrai ( 717556 ) on Monday January 12, 2009 @11:43AM (#26417539) Journal

    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......

  • Research (Score:2, Insightful)

    by Hawkeye477 ( 163893 ) on Monday January 12, 2009 @11:46AM (#26417621) Homepage

    I think people are missing the point. Like most projects that need funding you need a selling point, and a true point. And rarely are they the same. In this case the selling point is that digitizing the records will help reduce costs and save money. While this may be partially true I doubt the true reason behind the project is this, and that this is simply the selling point to get approval from the public and congress.

    I believe the true reason behind the digitizing of the records is for research. Think about the large scale research that can be done on these records, it is amazing just to contemplate. A perfect example would be Autism. Does the MMR shot actually give a child autism. Does autism ever develop before the shots? What is the average time after the shot? Does the shot not have anything to do with autism? You can extract such large amounts of data to target your smaller studies from, instead of taking guesses as they do today and where to start.

    Just my two cents...

  • Re:24% (Score:5, Insightful)

    by johnnyb ( 4816 ) <jonathan@bartlettpublishing.com> on Monday January 12, 2009 @11:50AM (#26417677) Homepage

    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.

  • by Anonymous Coward on Monday January 12, 2009 @11:53AM (#26417711)

    The privacy issue is a big one, so I full agree with your second paragraph.

    However your first paragraph is bunk. So I move to a new town so I need a new doctor. Or I need to go see a specialist. I need to go ahead and get records for every doctor I have ever visited? And I have to do that for every doctor I ever see?

    I guess I could go ahead and request copies every time I see a doctor and compile and keep them myself and bring them to every doctor's visit. Even better I could scan them all and just bring an electronic copy with me. Of course I would need a large format scanner to handle xrays and such, but those must only be a few hundred bucks right? Maybe some company could set up a service that would do it for me and transfer the records to the doctor for me. Oh wait, isn't that what we were already talking about?

    But seriously, there would not only be serious efficiencies to be gained, but also flat out better health care. With medicine, the more history on a patient the better long term health care will be, for a lot of pretty obvious reasons.

  • by Anonymous Coward on Monday January 12, 2009 @12:01PM (#26417853)

    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.

  • by Another, completely ( 812244 ) on Monday January 12, 2009 @12:16PM (#26418091)

    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.

  • by rednip ( 186217 ) on Monday January 12, 2009 @12:19PM (#26418151) Journal

    I'm fairly certain that the ease of malpractice suits and the rate at which they crop up is a huge reason for increased health costs.

    While I've seen this type of conjecture many, many times, I have never seen any real data on it. How many malpractice lawsuits are dismissed? Sure, some doctors are driven out of business by the price they pay for insurance, but some drivers can't afford car insurance; what's the average price for it? Unsurprisingly, bad doctors would pay more, just like bad drivers.

    No matter what the numbers at least many of the lawsuits were filed by good honest people who were hurt by malpractice. As the AMA is unwilling to create national database of bad doctors, and often seem to support even the worst of them, suing them out of business actually saves lives.

  • by Shakrai ( 717556 ) on Monday January 12, 2009 @12:25PM (#26418255) Journal

    The point of an insurance company is to bear risk, not avoid it.

    Medical insurance providers should have zero access, and in all reality should not be able to ask any health questions period.

    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?

    The presence of ubiquitous medical benefits has insulated the general public from the costs of medical care and prescriptions for a long time, allowing equipment, malpractice, and pharmaceutical providers to jack up their rates beyond all reason.

    The medical insurance industry has produced this market imbalance, and they should be forced to take responsibility for it

    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?

  • by BoberFett ( 127537 ) on Monday January 12, 2009 @12:28PM (#26418307)

    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?

  • by docdoc ( 518231 ) on Monday January 12, 2009 @12:40PM (#26418521)

    Actually, so far such costs are indeed passed on to the providers. Charges for services isn't something providers generally get to choose themselves -- simplistically, a specific diagnosis or complexity of a patient encounter is billed at a fixed cost determined by medicare, and by discounted contracts between provider groups and insurers (eg, "in this market we agree to get reimbursed 70% of the usual rate to have access to your patients"). So far, such costs for retooling with technology have been passed on to the providers.

    Providers have been very reluctant to put money and effort into large scale technologies because so far this has been essentially out of pocket, requires several years to implement, and is not subject to a standard. Our physicians group over the past few years has migrated to a fully electronic record and prescription system. It cost 10s of millions of dollars out of our practice. It slows us down compared to the old system so we can see fewer patients a day. It's limited in the sense that it forces you into certain "boxes" in terms of documentation that make the old flexibility of dictated charts go away. The upside is much more consistent access to data, simpler provision of records to other providers, etc. It still costs us several million dollars yearly to maintain, and still can't interact with other medical record or data systems, because there isn't a clear standard.

    In a nutshell, we paid for it, it's made us more efficient in some areas, less so in others, and it's not clear on balance if it was worth it for us.

    In another example, CMS (medicare) has implemented a "pay for performance" system, where providers identify several measure they'll get graded on and reimbursed higher if they meet those targets. Think grocery store shoppers club. So far providers are at best lukewarm -- after making substantial up-front investments (which again, we can't directly pass on to patients ourselves, but the system overall does in one way or another) we now have a byzantine system of reporting that nobody seems quite clear on how it works, and very limited reimbursement for our efforts that are making people think it would be cheaper overall just to take a loss on medicare reimbursement. So, standards and better information systems are an absolute must in many people's minds as doctors really do hate the tremendous inefficiency we currently have, but it's vastly more complicated and expensive than it seems...

  • Re:exatly (Score:5, Insightful)

    by timeOday ( 582209 ) on Monday January 12, 2009 @12:51PM (#26418717)
    It's not just about saving money either. People come into the emergency room and have to be treated with almost no idea of what diseases they have and prescriptions they're taking, and that is dangerous.

    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.

  • by plasmacutter ( 901737 ) on Monday January 12, 2009 @01:09PM (#26419055)

    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

  • by Garrett Fox ( 970174 ) on Monday January 12, 2009 @01:34PM (#26419401) Homepage
    Freedom is destroyed. As for taxation not being stealing, doesn't that depend on what authority is being used to justify it? I mean, if I grab your wallet and say "Tax!" that doesn't make it okay; nor does a democratic vote just because it's democratic. That's why we have so much sympathy for Robin Hood, whose victims were English feudal noblemen -- basically a protection racket.
  • by mattwarden ( 699984 ) on Monday January 12, 2009 @01:45PM (#26419597)

    So are you saying the benefits don't outweigh the costs? (sincere question)

    HIPAA requirements currently lead to a TON of office space being wasted just to store records for 7+ years. I think the question of why hasn't the market already done this is a good one, because the cost benefits seem so obvious that it might point to the implementation cost being much more than we might think.

  • Re:exatly (Score:5, Insightful)

    by Moryath ( 553296 ) on Monday January 12, 2009 @02:01PM (#26419881)

    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.

  • by Shakrai ( 717556 ) on Monday January 12, 2009 @03:02PM (#26420871) Journal

    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.

  • by plasmacutter ( 901737 ) on Monday January 12, 2009 @03:42PM (#26421615)

    Poor diet and the ensuing health issues are not something that deserves sympathy. If you choose to smoke and get lung cancer, no one should feel sorry for you. If you pig out on Doritos and Big Macs and end up a diabetic because of your poor choices, why the hell should anyone else have to pay for your lifestyle?

    Do you think hospital fees are so high because of the rent? you already pay for their lifestyle, except they live in greater pain and you actually pay more because you don't provide preventive care to them.

    Wellness programs should be a part of every insurance policy, obviously. Why should we insure ANYONE regardless of health since mcdonalds is obvously the most successful restaurant chain in the US. EVERYONE east there.

    By the way, way to go stereotyping. It's almost racist. I suffer in horrible pain and semi-disability and can't buy insurance at any price, and I have never been obese, never smoked, and can count the number of times i've been drunk on my hands. The disease I was diagnosed with has no scientifically determined cause yet, and i've had healthy eating habits from a young age.
    (ironically, because nutrition uptake is now impaired, I have to eat fast food, which I find disgusting, to get the calories I need)

    Additionally, I worked my ass off and have been severely hindered both in school and post-graduate because of this condition. I could be providing a lot of taxable income, but i'm in a catch-22. Group plans are the only way i will ever be insured, but my condition is impairing me to the point i'll probably never angle something which will provide one.

    It's really nice of people like you to punish me for the actions of others.

    "Better 1000 innocent people go to prison than 1 guilty man go free"

    Why does this sound a bit wrong.. oh wait.

  • Re:exatly (Score:3, Insightful)

    by shmlco ( 594907 ) on Monday January 12, 2009 @05:19PM (#26423191) Homepage

    "The risk of data corruption is also present."

    And fire, or humidity, or simple loss/misplacement/theft can easily cause the destruction of paper or film (x-rays). Six of one...

  • by GigsVT ( 208848 ) on Monday January 12, 2009 @05:41PM (#26423501) Journal

    It destroys a larger amount of wealth than it creates, necessarily. The people who the money was stolen from would have spent said money on things that were more valuable to them than the infrastructure was.

    The only time wealth can be created is when two people mutually agree to exchange consideration. Unilateral economic actions always lead to reduced wealth.

  • by reybrujo ( 177253 ) on Monday January 12, 2009 @09:41PM (#26426289) Homepage

    Nobody takes the industry seriously. I have been employed by a company that develops an EMR for over 6 years. First HIPAA [wikipedia.org], I remember our boss came once and told us that if we didn't implement HIPAA by April 15, 2003, we would be out of the market. Guess what? Nobody did know what the heck was HIPAA. We added a few passwords here and there, restrictions, things like that, and suddenly were HIPAA compliant. Why? Because you are not forced to make them, just "try in good faith to make them". What kind of regulation is that one?

    Now we have CCHIT [wikipedia.org]. One certification per year, since 2006. If you approve CCHIT, you can continue in the market. If you don't... you can continue in the market. Nothing happens. They are trying to consolidate the market, but without ideas. Just throw a lot of requirements you need to follow, and once they all pass them, bring more, and then bring more.

    EMR help doctors, but these regulations are aimed at shrinking the market. Will they continue shrinking it until there is a single EMR/EHR so that they don't have portability problems?

    Let's see if Obama is serious or not.

Logic is the chastity belt of the mind!