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."
Comment removed (Score:5, Interesting)
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.
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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Shhh!!! You're going to ruin it for everybody.
Re:exatly (Score:5, Insightful)
Re:exatly (Score:5, Insightful)
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.
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.
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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"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...
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.
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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Because while CPRS is a wonderful organizational success story, Britain's EMR is a national success story. And national scale is what we are looking at right now.
In US, EMRs came early and were great in academic centers and federally funded facilities. They did not work out so well for smaller practices.
For one, CPRS does not have billing and made adoption difficult in the past. Not to mention the fact that they kept rewriting it several times. The clinicians love it because it close fit they way they worke
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.
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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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.
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.
Re:stupid question but..... (Score:4, Informative)
It's not just the format that kills you...it's the dataset, too.
Fat lot of good it does for the government to list a set of specs, when at the same time they don't list a means for actually encoding the content of those specs. Something simple, like drugs in a drug database, can cause all sorts of havoc when you realize that the only freely-available standardized coding scheme (NDC) doesn't so much identify drugs as it does specify an exact drug, manufacturer, package type, and quantity. In other words, aspirin isn't aspirin, it's "Easprin Tablets, 975mg, tablets, 100-count, bottle, oral, NDC 10802-9757-*1". Yes, that's a correct spelling of "Easprin", and that's an "asterisk 1", just to make things interesting. Not quite the same as (somehow) identifying that the patient is taking "aspirin".
Now, there are multiple PROPRIETARY databases out there to identify these drugs, but fat lot of good it does to try to communicate those identifiers to someone else if they don't use the exact-same PROPRIETARY database that you do. Or if the wording of the drug description in THEIR proprietary database doesn't exactly match the wording description in the one that you're using. Or whatever.
In fact, some companies (SureScripts being one) have acknowledged the shortcoming by asking providers to provide a "representative NDC" in order to identify the med that you're trying to communicate in an e-script. So, you write a script for "generic drug foo", but you send a "representative NDC" that specifies drug "bar", which is an equivalent of "foo", and which has a specific NDC. The pharmacy fills the script using the "representative NDC" to help them determine which actual packaged drug (and therefore which NDC) they are going to dispense--let's call that "meh". Then, when they eventually ask for a refill, they ask for a refill of "meh", which you sent as "bar", when what you really wanted to give the patient was simply "foo". Confused yet?
So, it's not simply a matter of defining a data exchange format...we still have to figure out how to commonly define what "it" is that we're actually exchanging in the first place.
Add in the difficulties in trying to determine what "problems" a patient may actually have (is one diagnosis of hypertension indicative of an ongoing problem? Was it secondary to another acute condition? Was it a mistake?), the dilemma of possible mis-use of the information by employers, insurance companies, or even government agencies, and the somewhat-fundamental problem of needing some way to globally identify the patient in the first place (by law we can't use SSN--and heck, in a college town, many of the students/patients don't even HAVE a Social Security Number), a national heathcare ID number does not yet exist, and even if it DID exist there would be a huge bureaucracy around securing this number and the information that it points to...
Nope, just having an agreed-upon format for sending records back&forth doesn't really solve the entire problem. It's a valid first step, agreed, but once the format has been loosely defined, determining what goes in the fields of those formats...THAT is when things can get "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.
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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 pass
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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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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 co
24% (Score:5, Informative)
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.
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.
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: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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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 t
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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
Re:There is a pitfall though. (Score:4, Insightful)
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:There is a pitfall though. (Score:4, Informative)
Pardon me for asking, but what statistics are you using to cite your first "fact"? I find that claim quite hard to believe.
Actually there have been quite a few such studies recently, mostly as eaurpean countries attempt to figure out what laws make sense with their healthcare systems. The first one to show up in Google for me was:
van Baal PHM, Polder JJ, de Wit GA, Hoogenveen RT, Feenstra TL, et al. (2008) Lifetime medical costs of obesity: Prevention no cure for increasing health expenditure. PLoS Med 5(2): e29. doi:10.1371/journal.pmed.0050029
On the second point, optimizing system means reducing unnecessary demands on the system also.
I never argued that, only that laws and regulations tend to ignore what actually reduces demand on the system in favor of punishing what people dislike (obesity) while ignoring any evidence. Regardless of if smoking or obesity reduces the cost on the system for everyone, most people will favor rules banning it and claim justification using the healthcare systems because the desire to punish is stronger than the desire to make the system cheaper.
Wow, that's the first time I've heard that study applied to socializing medicine. I've always heard of it being used to illustrate the immense hate of "rich" people and justify confiscatory taxes on said "rich".
Don't understand the logic of such an application. How does one argue such a study justifies progressive taxes? How does hate justify taxes?
I think the real argument has nothing to do with that, though. If everyone is expected to share the costs of something, everyone should share the responsibility of keeping the costs down. Poor diet and the ensuing health issues are not something that deserves sympathy.
Sympathy? I have two concerns and neither has anything to do with sympathy. The first is reducing the amount of taxes that need to be spent on the socialized portion of the healthcare system. The second is personal freedom, where said freedom does not significantly impact others. My problem is others are inclined to remove freedom and increase costs because they want to punish people they feel are doing something wrong (overeating or smoking in their home). Personally, I'm medically underweight and don't smoke, but I'm a strong advocate for personal freedoms and I don't like my taxes wasted on regulations that just increase costs to me while reducing the freedoms of others. If people want to overeat or smoke, you'd better have some really convincing evidence that it is costing healthcare a lot more than it is saving before you will get my support on restricting their freedom to choose.
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?
If you exercise all the time and eat really well and as a result live twenty years longer why should anyone else have to pay for your lifestyle? Oh yeah, because paying for everyone's lifestyle saves money overall as well as bring numerous other societal benefits like reduced crime and a more stable economy.
They end up having to wait in line (especially when you start seeing the inevitable rationing that comes from socialized medicine) for the bums that chose to live poorly and have health issues because of it.
Sorry, these scare tactics don't work on me. I spent years waiting in lines in the good ole USofA when I developed a serious medical condition. I came within months of marrying a friend and moving to Canada just for the healthcare. Objective reviews of healthcare systems around the world don't exactly paint the US's system as the top of the heap, especially considering how much more we pay. Investing the same amount in a socialized healthcare system would not inevitably lead to any longer wait times for the average person than we have now. They would pro
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: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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I agree. I've just never heard of Government as a solution for inefficiency and waste.......
That should give you some indication of just how inefficient and wasteful the medical industry is...
:(
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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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 unwi
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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.
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: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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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:stupid question but..... (Score:5, Insightful)
Regulatory boondoggles. Girls singing to ABBA albums. It's like 1979 all over again.
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I agree that the mandate is more "get people employed" rather than doing this thing right.
I fear a repeat of the "cablecard" fiasco, where companies technically follow the letter of the law, but still make things so infuriatingly unworkable that people just give up fighting.
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Re:stupid question but..... (Score:4, Insightful)
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Because each member of the health care team needs to be able to chart in different ways and have access to different pieces of information without exposing them to more than required to do their job (part of HIPAA) (doctors, CNAs/PCTs, lab tech, RTs, OTs, PTs,
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They are doing this. Sort of. Electronic Medical Records are being developed all over the place. The thing is, this being private industry, just about everybody is doing it their own way. There is no standard. There are existing standards for data interchange, but there are no standards for electronic records.
If Obama's plan pans out, all these companies that have spent all this money on all these different systems are going to have to spend a bunch more money switching to the standard. They're get Go
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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It's a question of "Not Invented Here", everyone wants their methods and system to be implemented, not someone elses.
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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.
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.
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.
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.
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.
Because the Feds are in the way (Score:3, Insightful)
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
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Insurance companies don't want to pay for it, so the government decides that "digital" medical records will create zillions of jobs, help the economy, and other BS and ZING there goes another 100 billion.
"Alternative" energy suppliers don't want to pay for their own R&D and infrastructure so they need the government to promise zillions of jobs and ZING, there goes 100 billion.
Why should insurance companies have to pay for something that would benefit them when big-daddy government will take advantage of
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.
KP already does (Score:3, Informative)
Just casual observations as a Kaiser Permanente member...
It looks like most of their records are digital already. I suppose the biggest roadblocks are patient confidentiality and government privacy regulations. So I'm assuming Obama's plan would/should focus on security more than anything else.
There are some interesting details with how KP handles things:
* All email correspondence goes through their own secure webmail servers. They only send you notices like "You have new email on our servers, log in to
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Because no one knows what the standard should be about. There is no standard electronic medical record system. At the moment, everyone interprets it differently. Some scan paper and say that's enough for them. Others just type full text in. Few have them more structured. What the format will contain will depend on the intended features of the medical record and there is no clear agreement on that.
Believe it or not, health care is far more complex than what software nerds think it is and making a data format
storage (Score:2)
stepping stones to universal health care (Score:5, Interesting)
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Format (Score:3, Funny)
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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Yup, you can sign up here:
https://www.google.com/health [google.com]
On the fence (Score:3, Insightful)
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.
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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.
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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$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
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Well here in the UK we have the exact same thing for approx 60 million people. The estimated cost? 18 billion dollars and probably more. What's the population of the U.S.A.?
Creating jobs? (Score:3, Informative)
> Early government estimates are showing 212,000 jobs could be created by this plan."
Uhhh, what? Adding computer automation generally _decreases_ employment - that's the idea anyway.
Part time jobs maybe? If so, that seems pretty important to mention.
Maury
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Most of those 212,000 jobs would be temporary jobs converting the records from paper to digital. Some will remain, but most will go away as the records are converted.
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.
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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.
Well, McCain is just an old rich white guy. Obviously, you haven't seen Obama's credentials [separate-equal.net].
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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%.
Nothing is created. (Score:2, Insightful)
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]
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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.
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Gotta love the sugar (Score:2, Troll)
standards and gov't interference. (Score:2)
Medical records are, for the most part in the US, stored in standardized formats on paper. The standards are pervasive enough that colleges can teach transcription and billing classes, med and nurses courses can be consistent.
What we really need is some lawyer telling every business how to do their jobs. I really hope Obama decides to switch the "national data structures system" to the binary search tree and outlaws the link-list-based stack. Irrespective of the fact that a: it's not his business; and b: t
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.
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.)
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?