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."
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?
stepping stones to universal health care (Score:5, Interesting)
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.
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>
Re:stupid question but..... (Score:1, Interesting)
I work at a healthcare institution that's in the process of converting to electronic medical records. It should have benefits, but it's a huge expense in both money and time -- integrating with existing systems and workflows, training, new hardware, new software, new employees, and conversion of old records.
So, the industry is converting. There are some facilitues that might not have the cash needed for the upfront costs. Congress and the President seem more than happy to encourage failure and pusnish success, though.
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.
Re:stupid question but..... (Score:2, Interesting)
Re:Format (Score:3, Interesting)
Yup, you can sign up here:
https://www.google.com/health [google.com]
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%.
Many problems (Score:3, Interesting)
I see many problems with this. Here are the ones that seem most important:
First off, who is going to back this data up, how are they going to back it up, and how are the backups going to be tested? The public outcry that you'll have the first time a hospital administers medication that a patient is allergic to because the IT staff is still in the middle of restoring backups will (or at least should) be epic.
Secondly, quite a bit of "medical records" is high-resolution images (X-rays, ultrasounds, MRI, CAT scans, and probably a lot of stuff I haven't thought of). A typical patient may only have one or two images in their files, but we are talking hundreds (or thousands) of patients per doctor. The storage space required will be astronomical.
Third, all systems that can be abused will be; and any "safeguards" put in place to prevent abuse will only make it more difficult to uncover the abuse. I don't know what form this abuse will take, but it will happen.
I could probably come with half a dozen more if I tried, but I should be getting back to work.
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.
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.......
Re:That estimate seems really high (Score:2, Interesting)
$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.
Nonsense. There are thousands of hospitals alone and perhaps they all have single-system record keeping, but I doubt it. To take a famous example, the Cleveland Clinic is local to me, they employ about 800 IT staff; I know for a fact they have a cadre of Oracle DBAs as well as a team of SQL Server DBAs. I also know for a fact they have 200+ production databases throughout their organization--most of which contain patient records of some sort.
However my family doctor employs 0 IT staff. She uses commercial off-the-shelf software to manage her records, having gone digital a couple years ago. Yes, there's a database in there somewhere, but no DBA. And she still has tens of thousands of paper folders with paper records in them and no plan to digitize them--and don't forget this plan requires such records to be digitized. The logistics of doing such a thing for tens of thousands of single-doctor practices nationwide are staggering.
Again, I think it's a great project and we'd get way more than $100B back out of it in a generation, but if anything they underestimate the size of the project. I'm not saying it's complex, it's just huge and labor intensive.
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.
Re:There is a pitfall though. (Score:3, Interesting)
Damn... (Score:3, Interesting)
O.k. Damn, I'm mixed on this. After hearing the numbers, I think that they are willing to be leached for far too much to develop and roll this thing out. I'd like to know where all those 212,000 IT jobs are going to though. Are we talking 2,000 for development and running the back end and 210,000 data entry clerks? That's kinda of how I'd envision those numbers going.
I've not really read much in the article that would make this sound like a grand idea. I want access to my own medical records. I could see insurance, nurses, and doctors needing access. I could see schools and employers wanting access to it though. (Talk about folks that we don't want access to it.)
The thing is data entry clerks for all this crap should exist already so new jobs shouldn't be massively created. Another thing to think about is places where data entry clerks aren't there, you know who is the real data entry clerk... you. How many medical places have you been to where you've been handed a 2-3 page form and told to fill it out? We shouldn't have to do that much manual entry if we have a unified national medical management system. When you are born you'd get issued a medical record and it would stay with you for life. Everything related to you health wise would get dumped into it. School eye and hearing tests, vaccinations, every single time and place/doctor/nurse that has ever looked at you and their notes on what you had at the time, every known drug allergy, random drug tests, and general health recommendations would all be there, and your height and weight from birth to present as well. (Remember those school fat percentage tests and that plastic thingy that they put on your back to test if you had a bent spine? That would be there as well.) Heck, a part of me things PE records could be dumped into there as well. Why? They are a general health and fitness test and results.
Ideally, we just have them scan our national ID/real ID DL and presto every medical record that person has data entry rights too would show up. So if your PE teacher was testing you in 3rd grade, they'd be able to record height, weight, fat percentage, that spine test, and results from PE test scores. The person that the school has to do eye and hearing tests would only be authorized to pull up your previous results from those tests and enter your present current test results for that field only.
I just thought of a valid reason for schools and employers to demand and get access. If you claim to have had an absence do to any medical reason, then the school or employer should be able to query the medical system that you showed up at any medical place and got seen by any doctor. (They shouldn't be able to pull out actually where you went, who you saw, or what they said you had though.)
Re:A Better Idea... (Score:1, 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 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
Combining both notions, you have Health Savings Accounts (HSA), which employers are just starting to offer. What you have is an account that is filled by you and/or your employer with pre-tax money that you get to invest. It's paired with a high-deductible health plan ($5000/year deductible, minimum I believe). The money you put in grows over time and rolls over, and you use it to pay for medical care. Basically, you have insurance for when you need more than $5000/year, and pre-tax investable money for when you don't.
Best of all - when you retire, anything in the account can get rolled into your retirement account. A very good deal in many cases.
Re:Many problems (Score:1, Interesting)
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.
Re:stupid question but..... (Score:3, Interesting)
I'll give a counter point of when it works well. I don't particularly like my body (Rugby Player) and in the last year I've torn 2 ACLs and 1 UCL along with partially separated my SC joint. I've come to know my Orthopods very well.
EVERYTHING in their facility digital. Digital X-Rays (IMHO) are amazing. No more days of "Oh this one didn't turn out, go back for another set" The techs are pretty well trained and when the image pops up on their screen they know instantly if they need to redo it. The files are then tossed in some magical cloud. When I go to the visiting room with the Doc there's a computer that he uses to pull up my record and it has all my images (MRI and X-Ray) and you can scroll through them instantly. No more huge white boards. You could scroll through the layers of MRIs with the scroll wheel (pretty cool to me)
The surgery center, again everything is digital. All of the release forms are on tablet PCs. There's a large screen TV in the lobby with a secret PIN along with my status. The PIN was given to my ride. It would be updated instantly with Pre-Op, Op, Post Op 1, Post Op 2, Released.
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.
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.
Re:stupid question but..... (Score:3, Interesting)
Yes, but there's other things to consider.
Let's say a doctor updates a chart by the bed but accidentally walks off with it in hand. The patient crashes and they don't have the chart, so the staff on hand don't know the new medication the doctor just gave the patient. Push some adrenaline, epi, etc., boom, patient dead.
If the records were electronic, ideally every change or notation would be updated instantaneously nationwide. Do it in ambulances and doctors will know what to expect as soon as the patient comes through the door instead of the para having to rattle off stats in medical shorthand (and risk forgetting something).
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
Re:stupid question but..... (Score:2, Interesting)
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?
While I do share your concern regarding taxation of vices (I enjoy smoking occasionally and drinking often) you have to realize first off that this is already happening: businesses are realizing they can cut costs by 'encouraging' their employees to be healthy. This encouragement isn't really though - it's more of a discouragement of bad habits (ie, you pay a health 'fine' if you smoke). If it's not already happened, it will soon.
But apart from vices and genetics what do you suppose the main underlying cause of health problems? My guess is stress. If you want to keep people healthy keep them relaxed. Stress is not the sole cause of sickness but it is a major driver.
So while your company is conspiring to charge you extra for your lifestyle choices, they're more than willing to contribute to many more health problems through overtime, deadlines, mismanagement, etc. And what do they do to combat it? Put up an on-campus gym so you can work out and save time? Offer on-campus child-care so you don't have to worry about your children? Serve free healthy meals at the cafeteria? Reduce your work hours to take care of your family and personal life? Offer flex time so you can get a decent amount of sleep when your body is tired? Give you unlimited sick days with no reprisals?
Unless you work for Google, no. When things go bad companies are more than willing to turn the screw on their employees, subject them to stress (and all the bad habits that come about as a result) and deny them the ability to cope and lead a healthy life. Then they turn around and charge you more because you have to go to the doctor more often, you started smoking again to deal and you don't have any time for the gym. And you lose your job for taking too many personal days trying to save your marriage.
If the government gets into health care then yes, you may be fined for smoking, but maybe if we're lucky, your employer would (finally) be fined for treating you inhumanely and lowering your overall health.
Stating the Obvious (Score:2, Interesting)
Re:exactly (Score:4, Interesting)
As a patient who's had to try to dig up old records, I'm 100% in favor of digitizing. It makes it reasonable for me to be sent (via e-mail) and carry around with my all my records. A current problem is not with the lifespan of the storage medium, but the patient not remembering where the procedure was done. Hard to find that 3yo X-ray, CAT scan, whatever if you can't remember even which facility it was done in. Electronic storage could fix that easily.
Also, some routine things are a real pain to find in paper records. Try looking for your vaccination records. If you're 14, no problem, its a single sheet of routine vaccinations with checkboxes. When you're 40, not so easy - you've been stuck periodically over the last 20 years with this or that depending on your exposures, nothing routine about it. Or at least that's my case (I'm ESRD, get stuck for whatever miscellenous thing the transplant clinic thinks I need, and I/we/they are always losing track of when the last Hep B vaccine, or tetnus, or whatever was). No reason, computers should be able to answer that kind of question instantly.
This is a question most /. readers are not in a position to evaluate very well. Expect lots of paranoia about the gubermint, with very little experience of trying to locate the right information, or dealing with massive quantities of records from 20y of being progressively sicker and sicker. Damn kids! but... it will happen to you someday, unless you die young from a massive sedentary-lifestyle-earned coronary.