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Obama Proposes Digital Health Records

CmdrTaco posted more than 5 years ago | from the cuts-both-ways dept.

Government 563

An anonymous reader writes "'President-elect Barack Obama, as part of the effort to revive the economy, has proposed a massive effort to modernize health care by making all health records standardized and electronic.' The plan includes having all conventional records converted to digital within 5 years. Independent studies are fixing this cost somewhere in the range of $75 to $100 Billion, with most of the money going to paying and training technical staff to work on the conversion. Early government estimates are showing 212,000 jobs could be created by this plan."

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stupid question but..... (5, Interesting)

Shakrai (717556) | more than 5 years ago | (#26416541)

If this can save so much money why isn't the health care industry already doing it? Are they really that stupid or are all the promises of big savings not likely to pan out?

Re:stupid question but..... (5, Insightful)

Phantom of the Opera (1867) | more than 5 years ago | (#26416601)

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 (5, Insightful)

JoeCommodore (567479) | more than 5 years ago | (#26416637)

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.

Re:exatly (3, Funny)

Anonymous Coward | more than 5 years ago | (#26416655)

Shhh!!! You're going to ruin it for everybody.

Re:stupid question but..... (5, Insightful)

tnk1 (899206) | more than 5 years ago | (#26416701)

Having these records would make it easier to switch providers. Without them, more tests might need to be done since "we don't have the records". Switching providers isn't in the providers' interest. Charging for lots of tests is.

There is that possibility, but I'd be more inclined to believe inertia in record keeping is more to blame for them having different formats.

You know that all providers are going to need to pay out cash to get new software that obeys the rules and there will also have to be a data migration effort. And you also know who that cost will be passed on to. Hint: not the providers.

The question is: is it worth having health care customers pay for this? Will the investment be worth it? I think it might be, if it does help with the need to dispense with tests, retests, and other administrivia.

Re:stupid question but..... (5, Interesting)

Shakrai (717556) | more than 5 years ago | (#26416715)

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.

There is a pitfall though. (1)

plasmacutter (901737) | more than 5 years ago | (#26416837)

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.

This is very clearly useful, but the pitfall is the insurance industry slipping loopholes into the formal bill allowing them to datamine peoples' records to further exclude anyone who actually requires medical care.

"i'm sorry sir, but your records show you're prone to sinus infection" [denied]

Re:There is a pitfall though. (2, Interesting)

PalmKiller (174161) | more than 5 years ago | (#26416989)

Their search ability could be limited much like the limited credit searches of those who are wanting to provide you credit, ie they can't see the whole picture unless they are actually your provider or you have approved them to.

24% (5, Informative)

MazzThePianoman (996530) | more than 5 years ago | (#26416855)

Almost a quarter of every dollar we spend on health care is used by administrative expenses. In Taiwan where they have digitalized medical records their overhead is only 2%. There is plenty of examples around the world to why electronic records are better economically. Also there is the benefit of less mistakes since cross referencing medications and such can be done electronically for drug interactions etc. Frontline had an excellent episode were they looked at the health care systems of several other modern democratic countries. A must watch for anybody who cares about the health care debate. http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/ [pbs.org]

Re:stupid question but..... (3, Informative)

LWATCDR (28044) | more than 5 years ago | (#26417013)

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.

The Great Troll War 2.0 (-1, Offtopic)

Anonymous Coward | more than 5 years ago | (#26416627)

In the War against well formed and insightful posts that are on topic, there needs to be trolls and pieces of flamebait that must fight back. I have noticed that the quality of trolls have started going down, which has resulted in the following:

- Less of otherwise intelligent people responding to these trolls making themselves look stupid
- Less people getting innocently marked as Offtopic or Troll by being provoked by comments
- A decline in the amount of funny off-color joke material marked down

With a new type of web there needs to be a better quality of troll. I want to propose that we work in random chaos to achieve some sort of super troll. We need to not only counter-balance the well thought out comments of well adjusted members of society, but we need to go above and beyond. We need to make users of Slashdot, and especially paying subscribers, so sick of slashdot that they threaten to leave the site.

Now we have the site owners incompetence to our advantage. With the slow and nearly unusable state of their random javascript and their obnoxious flash ads, I think Commander Taco might be siding with us trolls for a change. We need to go to each and every news story and we need to piss a lot of people off. Here are some guidelines for our war against intelligence and common sense:

- A troll about African Americans (recommended to call them niggers) raping white men (Women can work too but white men rape is funnier)

- Attack a programmer by taunting and making fun of whatever language they may be using. On Slashdot it may be some variation of C or C++ so just attack and totally deconstruct their language as nothing more and dog turds in penis factory.

- Attacking Apple is always a great way to provoke Slashdotters who have invested in a Mac. Taunting should go into attacking the company, its users, or Steve Jobs. A jab about Starbucks is recommended

- Some sort of jab against Jews always works. Make sure to make work cited by Adolf Hitroll.

- The sky is usually the limit.

Borrowing and modifying old trolls are also acceptable as there is no copyright on these trolls. Honestly, what maladjusted basement dweller is going to take credit for half the shit on this site, troll or not. Make sure to get the point across by pasting multiple copies of your troll in each successive story.

Most importantly try to keep it original and offensive. If you can get at least one person angry or even to leave slashdot for a while you have done your job of dismantling the web one user at a time. Take for example, the slashdot user AlexPKeatonInDa. He probably hung himself because of all the troll chasing happening to him. I also consider KFG another victory as I believe the excessive trolls gave him terminal colon cancer. So now go out there and start writing and posting the most offensive noise your brain can shit out.

Re:stupid question but..... (5, Interesting)

jamie (78724) | more than 5 years ago | (#26416643)

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.

Re:stupid question but..... (3, Interesting)

Shakrai (717556) | more than 5 years ago | (#26416891)

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:stupid question but..... (1)

salimma (115327) | more than 5 years ago | (#26417143)

Indeed; this is just like the Internet -- it originated from the government/academia (DARPANET); there are commercial networks (AOL, CompuServe, etc.) but they were walled gardens.

Interoperability is where the government steps in, for better or worse -- only the most ideological libertarian would deny that such a role exists.

Re:stupid question but..... (5, Insightful)

MindKata (957167) | more than 5 years ago | (#26416669)

"why isn't the health care industry already doing it"
Because it'll cost a fortune, and be a nightmare to implement. (Look at the mess the UK is making of their health computer system, with loads of interest groups, all pulling in different directions, pushing up the costs).

"Early government estimates are showing 212,000 jobs could be created by this plan."
Yeah, and how many paper pushers etc.., will it put out of work? ... While it will create jobs, it will also wipe out existing jobs. Political drones just want it to sound like its creating jobs. Plus even if its adding more jobs overall, then surely its going to end up costing more money in total to keep funding the system?

Re:stupid question but..... (1)

zappepcs (820751) | more than 5 years ago | (#26417039)

Nice goals they set, and predict benefits in creating jobs. Some of those jobs will be temporary staff to transcribe paper records to digital form, then they'll be unemployed again.

Google will step in with scanning software that does this with little to no extra workers... if they can mine the data sans personeal information.

Government types will lap this up (while on vacation paid for by insurance lobbyists) because now tracking teh crimsnals will be easier. Can you say massive genetics database?

Meanwhile, back at your local patch, you are paying a surcharge for the 'enhanced records' of the new service as required now by your insurance company. Your insurance rates go up to cover the costs so your co-pay doesn't increase but your monthly/yearly costs do. (frogs in boiling water effect)

Now, all that is happening and you have no more control over your health record than you did before, in fact less control because now all these other people can access your data extremely easily and you still have to pay to get an updated copy.

The only possible upside in this is having a more complete record so that when malpractice occurs you might have a better chance of winning in court.... oops, unless your record is doctored.

Okay, someone please explain the upsides to this for joe public?

Re:stupid question but..... (4, Insightful)

hypnagogue (700024) | more than 5 years ago | (#26416685)

Note the part where this will "create 212,000 jobs". It's not supposed to save money, it's supposed to spend it -- and the sugar daddy footing the bill is you.

Regulatory boondoggles. Girls singing to ABBA albums. It's like 1979 all over again.

Re:stupid question but..... (1)

gambit3 (463693) | more than 5 years ago | (#26416809)

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.

Re:stupid question but..... (3, Insightful)

qoncept (599709) | more than 5 years ago | (#26416985)

It's called pump priming, and it's how you end recessions. You have to spend money to make money. Create 200k jobs and the economy improves. See the Hoover Dam. I think this is a great idea. I mean, the idea to digitalize and standardize health records is painfully obvious and should have been done years ago, but there is going to be an unbelievable amount of work created by it. I read the first half of the article and my first thought was how the hell are they going to do this? Reading on, I found out they are going to do it by creating thousands of jobs. This is just about the best idea I've ever heard from a politician.

Re:stupid question but..... (1, Interesting)

Anonymous Coward | more than 5 years ago | (#26416693)

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..... (2, Informative)

Cerberus7 (66071) | more than 5 years ago | (#26416705)

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 Gov't assistance, of course, but they still need to train their people on the new stuff so soon after they were trained on the proprietary systems.

Re:stupid question but..... (4, Funny)

lwriemen (763666) | more than 5 years ago | (#26416763)

The Government should auction off the format specification to help pay for the costs.

Re:stupid question but..... (1)

ixer (1423597) | more than 5 years ago | (#26416725)

The medical industry isn't stupid, they are just cheap.

Re:stupid question but..... (1)

AaronBS (685204) | more than 5 years ago | (#26416727)

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?

Two reasons. First, it's a collective action problem: if all companies but one were digitizing records in a common format, then the last company would indeed jump on board without government prodding. But it might be inefficient to be the first-mover.

Second, in this economy, businesses are unwilling to post short-term losses for long-term gains because their margins are so thin right now. And even if they wanted to make that trade-off, banks are hoarding their money [washingtonpost.com] and might not make the loan.

Re:stupid question but..... (1)

betterunixthanunix (980855) | more than 5 years ago | (#26416729)

Probably because most of the healthcare industry is buying software from third parties, and those third parties do not stand to save a lot of money by doing this.

Re:stupid question but..... (1)

Z00L00K (682162) | more than 5 years ago | (#26416731)

It's a question of "Not Invented Here", everyone wants their methods and system to be implemented, not someone elses.

Re:stupid question but..... (1)

WmLGann (1143005) | more than 5 years ago | (#26416743)

Because they don't have any notion of interoperability and because an individual practitioner (or hospital, for that matter) won't realize any direct cost savings.

But interconnected health systems are key to patient well-being and cross-the-board cost savings. Health care specialists are great for fixing localized problems, but if my cardiologist and my dentist don't talk about my prolapsed mitrial valve, I can get an infection and drop dead sometime between having a mouth full of cotton and spitting into the little sink you can never quite reach from the chair. (OK, maybe not that fast but you get the point I hope.)

This is a big idea initiative that can benefit our society so greatly in so many ways it's staggering (consider the medical research possibilities of mining such a database, not to mention the possibility of genuine customer care). This is the kind of thing that government has to do because private industry has no motivation.

The problem is that precious few people around here (including me) would want to get involved doing technical work for the government. I have a feeling it won't be as easy or as cheap as they seem to think, even though at its heart it's a really easy (if labor-intensive) project, because a lot of the high-grade nerds can't stand the way government does things.

Re:stupid question but..... (2, Interesting)

m0s3m8n (1335861) | more than 5 years ago | (#26416771)

I work for a group of Eye Docs (retinal specialists). The practice is slowly moving to medical records. One of the issues we foresee is a reduction in doctor productivity when they have to begin interfacing with the EMR system. Our three docs ARE THE ONLY SOURCE OF INCOME TO THE PRACTICE. Everyone else is drag. If they loss productivity we loss income. It is that simple. Sure, EMR vendors will argue all day long that other efficiencies will offset this loss but none will guarantee such statements. And one last thing, don't bitch about doc salaries - I'm sure retinal surgery is easy to learn.

Re:stupid question but..... (3, Insightful)

sunspot42 (455706) | more than 5 years ago | (#26416773)

If this can save so much money why isn't the health care industry already doing it?

Because in the short term it would divert money away from the really important things, like executive bonuses.

Re:stupid question but..... (5, Informative)

protodevilin (1304731) | more than 5 years ago | (#26416793)

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.

Re:stupid question but..... (1)

pipboy9999 (1088005) | more than 5 years ago | (#26416815)

I didn't realize there are still places using paper records. The medical foundation I work for has been all digital for almost a decade I think. Although I can see how it would be a pain for small operations. We have an entire department that has dozens of full time staff to develop an maintain the records applications.

Re:stupid question but..... (3, Insightful)

Average_Joe_Sixpack (534373) | more than 5 years ago | (#26416829)

Most hospitals and health care systems have electronic medical records.

"Only about 8% of the nation's 5,000 hospitals and 17% of its 800,000 physicians currently use the kind of common computerized record-keeping systems that Obama envisions for the whole nation."

This is the key. Most health information systems are not linked to any kind of national network. So for example, your hometown hospital has a detailed electronic medical record created on you from the last time you visited the ER with a bad case of the flu (ie your allergies, your RX history...). Then you go on vacation in Alabama and get into a bungee jumping accident which leaves you unconscious. The ER doesn't have quick access to your local hospital's electronic medical record so they either have to have the info faxed (if they can even determine who your primary care provider is) or redo all those tests for things like allergies and medications.

Getting all the big players in health information systems to play nice and share their patient data repositories is going to be interesting.

Re:stupid question but..... (1)

Extremus (1043274) | more than 5 years ago | (#26416847)

The problem is the the lack of a standard that everybody agrees on. How to model the views of all the medical staff over this data? How to make them agree in even simpler things. Did you ever try to make Doctors agree on something? :)

Re:stupid question but..... (1)

Hodar (105577) | more than 5 years ago | (#26416869)

"If this can save so much money why isn't the health care industry already doing it?"

Who is going to define the format? The medical industry is in this for medical reasons, not software. The medical groups each have whatever format they 'liked' in place. There has been no overwhelming reason for them to create a standardized form, because it has not been in their fiscal interest to do so.

This is not to say that there isn't a good reason - we would all profit by having some 'universal' format that all hospitals and MD's could access. But, why would you, as an independant hospital or clinic develope this? Conversely, there is a flourishing industry of Medical Transcriptionists that make a living by transferring this information into a program like "Medi-soft" for insurance billing. If you create a digital standard for your medical information, then you have to make sure that every clinic and hospital can import/export this new format into their existing billing and insurance software. Too bad the Medical industry doesn't have a IT steering committee like most other technical groups.

Re:stupid question but..... (3, Interesting)

Sun.Jedi (1280674) | more than 5 years ago | (#26416907)

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 (2, Insightful)

Shivetya (243324) | more than 5 years ago | (#26416935)

Privacy Privacy Privacy.

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

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

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

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

Re:stupid question but..... (1, Troll)

clam666 (1178429) | more than 5 years ago | (#26416945)

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 this massive over-blown economic recession to shuttle trillions of your dollars. Why wouldn't government use an opportunity to create another database with information about you that you have the "patriotic" duty to pay for?

I'm pretty sure this is just sticking to the government playbook.

The only thing digital records will do is make it easier to write a bot that will be able to download millions of medical records instead of having to do it one at a time.

Personally, I don't want "digital" records of my medical information. I'd prefer a good old folder filled with notes and paper and information such as that. I'd like to go to a doctor and NOT have my medical history completely available to him/her so I can get an actual diagnosis rather than just making assumptions because the last 6 morons have all said the same things. I want to be able to say that no, I didn't have an MRI, let's do another one with a different set of eyes, not my MRI following me everywhere so no one feels the urge to do a new one.

I like forcing my doctor to listen to the words coming out of my mouth about a medical issue, not running my big XML record through a parser to make a "guess" of what I have and print me a receipt for a prescription pill that isn't going to help me, but will bounce up against a marketing database to see what latest Pfizer development I should take. I'm sure in order to "streamline" and "reduce expences" of medical care, the government will pass the "Patient Free Choice Act" that will offer prescription medicine through kiosks ("Just Type In Your Medical Id Number") so you can get the Pfizer dream-pill of their choice ("No doctor needed!").

We're separated enough from our doctors because of insurance companies and government regulation as it is, I don't see the slightest benefit to making it easier for me to be ignored and shoved through the "in-and-out-burger" medical system by speeding me through the system.

Creating digital records is going to just make it more cost effective for insurance companies (and government medical rationing requirements once "nationalized" medicine comes into effect) to categorize you, treat you as a "group" of patients instead of an individual.

The "benefit" of easily shuttling your records around place to place in a standardized format would be great, if I had the slightest hope that it would be used strictly for that, and not completely abused for purposes that negatively affect me.

I mean, it's not like a social security number has been used in any way other than the purpose for which it was intended.

Re:stupid question but..... (0)

Anonymous Coward | more than 5 years ago | (#26416979)

Take HL7 for example. The ugliest shittiest protocol ever for transferring any kind of data.

If you have the privilege of paying hundreds of dollars just to look at the specification for that sack of shit, you might get an idea of why the health care industry hasn't completely embraced electronic records.

Re:stupid question but..... (1)

necro81 (917438) | more than 5 years ago | (#26416995)

There's a long list of things that can substantially save money and pay for themselves that people and businesses do not avail themselves to, simply because they can't come up with the upfront costs.

A big problem in implementing this so far is that the savings are largely for insurers and administrators, whereas the costs are largely borne by providers. An existing solo or small group practice isn't going to shell out $100,000 for an electronic medical record system just to save Medicare and the local HMO money, certainly not when it's bound to be incompatible with everyone else's EMR.

In the case of hospitals or multi-site health systems networks, the savings can work out in their favor. But the scale of the system needed, the capital costs, and the headaches and possible liabilities to get it up and running are daunting.

Obama says we all must sacrifice... (0)

Anonymous Coward | more than 5 years ago | (#26417041)

during these "hard" times. No doubt he means everyone but himself and the rest of the political class. A gesture of good faith on his part would be to scale back his $50 Million inaugural orgy to just a live TV swearing-in in the oval office, followed by a brief televised speech. I'm guessing that the chosen one will not choose the path of least public adoration, though...

Re:stupid question but..... (3, Informative)

Just Some Guy (3352) | more than 5 years ago | (#26417045)

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.

Re:stupid question but..... (0)

Anonymous Coward | more than 5 years ago | (#26417057)

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?

Actually, there are many places that using electronic medial records already, several in boston. a common program is called EpiCare but there are others.

KP already does (2, Informative)

rwa2 (4391) | more than 5 years ago | (#26417087)

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 our secure servers to read it" to unencrypted mail on external email accounts.

* The data appears to be tied to a particular medical centers, so when we moved from one center to another, they had to transfer our record over. So apparently things are compartmentalized, so any random doctor can't look up information on every KP patient, just ones assigned to their medical center (and maybe their department). I'm not sure if that means each center has its own database server, but I'd assume not... it'd make more sense if they had two or more data centers in different cities with some redundancy and mirroring between them.

* Accounts for my spouse and kids can be linked to mine so I can make appointment requests and stuff for them, but it seems like it's still possible for them to hide their own medical appointments and records from me if they wanted to, I think. At least until I get a bill in the mail for things not covered by insurance :P

* There are not really any useful medical records available via the online interface, other than your email trail with doctors/nurses. It would be neat to be able to log in and download the kids' growth records and ultrasound pics. But if you really want stuff like that, you still need to get it from the doctor during a visit.

* You memorize your MRN (medical record number) real fast, because just about everyone you talk to (whether in person or on the phone) asks for it. They don't seem to "cache" it so they can start talking to you by name, nor do they transfer your MRN to the next person in the chain. OK, I guess the doctor, when you finally get to one, talks to you by name.

* Doesn't seem to have sped up any part of the process... it typically takes about 3 hours to do a visit, between checking in with registration, seeing the nurse, seeing the doctor, checking into the pharmacist, and then picking up a prescription.

Overall, I'm actually pretty happy with the service, because my family mostly tries to avoid going to the doctor so it doesn't bother me that they mostly avoid seeing me. But it could stand to be a bit more efficient. Having digital records doesn't seem to have help or hurt much in either respect.

Re:stupid question but..... (1)

CrimsonAvenger (580665) | more than 5 years ago | (#26417091)

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?

It won't save any money for the healthcare industry. If it were really going to save $200 billion per year, then the cost ($10 billion per year) would be so trivial that it would have been done already.

It might save some money for the health insurance companies, but the big draw seems to be that it'll create 212,000 jobs. At a cost of $100 billion. $500,000 per job over ten years. If the jobs are permanent, then it'll cost the healthcare industry an additional $10 billion per year forever. If not, then at the end of ten years, we get a bunch of new unemployed.

Fortunately, that'll be after Obama is out of office, so noone will blame him for it.

storage (1)

yincrash (854885) | more than 5 years ago | (#26416559)

where exactly are all these records going to be stored? on a gov't server? private server? or only at the doctors you currently go to and they can send electronic copies to other offices?

Don't be so naiive. (1, Insightful)

Anonymous Coward | more than 5 years ago | (#26416677)

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

subject (0)

Anonymous Coward | more than 5 years ago | (#26416577)

Nope, they're just stupid

stepping stones to universal health care (5, Interesting)

viridari (1138635) | more than 5 years ago | (#26416591)

Getting all of the records into a standardized format is a stepping stone to universal health care. By biting it off in pieces, he's going to be able to make the apparent cost of the transition lower because much of the expensive work will have already been done by initiatives like this.

Re:stepping stones to universal health care (1)

brian0918 (638904) | more than 5 years ago | (#26416791)

This seems like the most likely explanation. Otherwise he's just throwing out random ideas.

Re:stepping stones to universal health care (1)

betterunixthanunix (980855) | more than 5 years ago | (#26416853)

I think there is a bit more depth to it: by breaking up a transition to universal healthcare, it is a lot easier to form a compromise with opponents to the idea. One big step could be help up by the senate for years on end, but even if half of the smaller steps are held up, that still means that we managed to get halfway to implementing universal healthcare. Opponents to universal healthcare generally only oppose one or two facets of it, and so while those facets are likely to remain caught up in debate, we can move forward with less controversial aspects.

Re:stepping stones to universal health care (1)

Notquitecajun (1073646) | more than 5 years ago | (#26417037)

I actually agree on this point. I oppose universal healthcare (it just gives the government more power, and I don't think that we see the free market really working in healthcare now - the consumer isn't in the loop; it also doesn't promote preventative care so much - no incentives).

If we can get something like universal electronic record keeping implemented where it is secure and convenient, THEN we can talk about whether or not we really need universal healthcare with one of the major obstacles - technology - removed. We will get rid of one of the common complaints - record-keeping - that universal/single-payer proponents throw out that doesn't have to find its solution in socialized medicine.

Format (3, Funny)

ulairix (756597) | more than 5 years ago | (#26416593)

No doubt Microsoft is already working on their own closed source Microsoft Health Information File Format, with its own special brand of DRM and licensing scheme.

Re:Format (0)

Anonymous Coward | more than 5 years ago | (#26416689)

Just as Google is assuredly working on something quite similar.

Re:Format (2, Interesting)

jlar (584848) | more than 5 years ago | (#26416783)

Yup, you can sign up here:

https://www.google.com/health [google.com]

mod parent up! (1)

weber (36246) | more than 5 years ago | (#26417029)

and it's in beta - real Google style :-)

Re:Format (4, Insightful)

DaveV1.0 (203135) | more than 5 years ago | (#26416695)

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

Re:Format (1)

fprintf (82740) | more than 5 years ago | (#26416765)

Who knows what Microsoft, Google and others have in mind. You can be sure, however, that employer interest in Personal Health Records (PHR) is going to encourage the transition to whatever universal format eventually arrives. Also, Google Health and Microsoft Health Vault are already in place for millions of subscribers. They recognized a long time ago that there was value in providing portable storage for personal health information, as well as easy access to that information from providers. They are already quite secure, though the federal government (big brother) does not yet have access to those records. Providers are slowly coming on board with recognizing the value of these records, though they currently prefer their own most due to trust - it isn't that they don't trust MS or Google, it is that they don't trust what the patient might have modified on their health record, either deleting or adding data that can misdirect care. In this age of litigiousness, that is not a risk any provider wants to take.

Re:Format (1)

0racle (667029) | more than 5 years ago | (#26416991)

Hate to break it to you, but this is a problem that DRM was designed to be a part of the solution to.

Re:Format (1)

Xelios (822510) | more than 5 years ago | (#26417021)

I think you mean their Medical Information Lexicon Format. Personally, I can't wait to have a .milf of my very own. As long as I can access my .milf whenever I choose, and I'd want strict protection placed on my .milf, the last thing I want is for my .milf to fall into the wrong hands.

Re:Format (1)

weber (36246) | more than 5 years ago | (#26417079)

And they'll call it Open Office eXchange Medics Language (OOXML) to create several layers of confusion.

Re:Format (1)

Niartov (727073) | more than 5 years ago | (#26417139)

They might be but, there is already a standard. It is called HL7.

On the fence (2, Insightful)

internerdj (1319281) | more than 5 years ago | (#26416611)

Ok. There are plenty of abuses of this system but every time I go to a doctor I have to fill out the same information, often for multiple visits to the same doctor. My permanent address does not change once a month every month, thank you. It would also be nice for the hospital to have a digital record of what I'm allergic to, if I'm ever admitted unconconscious.

A Better Idea... (4, Interesting)

SCHecklerX (229973) | more than 5 years ago | (#26416653)

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:A Better Idea... (1, Interesting)

Anonymous Coward | more than 5 years ago | (#26417101)

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.

That estimate seems really high (5, Insightful)

Phoenix666 (184391) | more than 5 years ago | (#26416657)

$100billion? There are millions of patient records, but they do not reside in millions of databases. Let's be generous and say there are thousands of databases. But most of those databases are already manned by DBAs. Some of them may not be up to the task, but most can convert their tables to the specified format if you tell them what that is.

So it seems the task is coming up with a standard format and enforcing it. Security is another question, but again it seems a matter of mandating healthcare providers adhere to a specified standard. But hospitals and insurance companies are quite used to such bureaucracy, so it's difficult to understand where they're pulling this $100billion figure from.

Saying they'd need to hire an entire new class of DBAs and techs to make it happen is silly, since they already exist.

Odds are the figure was thrown against the wall by companies hoping to win a fat contract, and counting on the knowledge that politicians have no sense of what it takes to get the job done. I hope Obama's CIO has the knowledge and grit to tell them to take a hike.

Re:That estimate seems really high (2, Insightful)

aengblom (123492) | more than 5 years ago | (#26416787)

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 (3, Interesting)

radtea (464814) | more than 5 years ago | (#26416849)

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:That estimate seems really high (2, Interesting)

WmLGann (1143005) | more than 5 years ago | (#26416901)

$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:That estimate seems really high (1)

rhsanborn (773855) | more than 5 years ago | (#26416955)

Most of those records are in a broad number of systems, many of which still use proprietary database. Further, many hospitals still exist using paper charts that are never digitized. Scanning those charts, and implementing scanning solutions, and purchasing and implementing a new medical records system is extremely expensive. In many cases it may require replacing or upgrading several other systems. This can easily cost up to several hundreds of thousands of dollars per hospital, that doesn't begin to address the even higher number of smaller doctor's offices.

Re:That estimate seems really high (1)

east coast (590680) | more than 5 years ago | (#26416969)

And don't forget about the number of apps that will need to be rewriten if there is a single standard set in place. The data in these databases didn't get there on it's own. It was put in over many years by nurses, interns and others. Converting the data is not that big of an issue compared to making sure that the thousands of homebrew apps that are used in the fashions are brought up to spec.

Re:That estimate seems really high (1)

Sun.Jedi (1280674) | more than 5 years ago | (#26417053)

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.

I'd wager that a majority of this information is not in Oracle/SQL, but that its on DB/2 on a IBM390. I'd also think that the format shift of the data isn't really the big deal, but the data entry, workflow between hospital and insurance, encryption, and regulation are really big issues.

so it's difficult to understand where they're pulling this $100billion figure from.

I think that figure is a bit low.

A step forward and a step backward. (1)

akcpe (1438869) | more than 5 years ago | (#26416667)

It seems as if this is a step forward and a step backward. A standard health record seems like a great idea but... I still feel that most firms are not knowledgeable regarding the security of their electronic data. This poses the question, "Who will store the data?" If it is to be the federal government, I feel this is a step, or two back. (Forward if you're excited about the beginning of realizing Gattaca). Electronic records, unfortunately, pose more threat to the safety of your data and the abuse you will receive from the government (universal healthcare or not) and private health care companies both.

Creating jobs? (2, Informative)

Maury Markowitz (452832) | more than 5 years ago | (#26416679)

> 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

Re:Creating jobs? (1)

DaveV1.0 (203135) | more than 5 years ago | (#26416737)

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.

Re:Creating jobs? (1)

Dun Kick The Noob (904001) | more than 5 years ago | (#26417081)

Not So I think. Consider these jobs
  1. A Standards Comittee to review a 3000 page document, one xml file and one data dictionary
  2. An Government Oversight Body to Oversee the Standards Comittee
  3. A political analyst to analyze what the above 2 are doing.
  4. Lobbyist from pharma companies to lobby putting company specific medicine in suggest medication drop down.
  5. Patent clerks to process patent like "webased interactions with a indexable search information source that works over the internets"
  6. Programmers to have the interface in blue/green
  7. Database analysts to integrate custom private databases which keep additional data like "gawks at the nurse"
  8. Lawyers who will be eventually tapped when information is leaked and lawsuits fly
  9. Additional Help desk to answer "why the thing is so slow?"
  10. Network/ System analyst to spend hours in the data centers figuring why the "network is slow"
  11. A Business Consultant to tell you that you need a "faster network" to fix the "why the things is too slow" and they have a $10,000 router with $100 cat5e cables.
  12. A Tech manager to manage the project and send out "well done emails"
  13. A business manager to manage the tech managers and send out "well done and this will help productivity emails"
  14. A CIO to oversee the project and go to the press discussing the new strategic approach to searching the database
  15. Last but not least the only programmer to actually do the programming/maintenance/troubleshooting/documentation

Re:Creating jobs? (1)

Just Some Guy (3352) | more than 5 years ago | (#26417123)

Most of those 212,000 jobs would be temporary jobs converting the records from paper to digital.

And whether they're paid by the government (via taxes) or industry (via increased fees), we're on the hook for another 212,000 paychecks.

Re:Creating jobs? (0)

Anonymous Coward | more than 5 years ago | (#26416751)

> Early government estimates are showing 212,000 jobs could be created by this plan."

That's the good news. The bad news is that they'll all be offshore.

Good idea (1)

ZekoMal (1404259) | more than 5 years ago | (#26416683)

I've had my records get 'misplaced' several times. Having moved from Maryland to Vermont, it was downright depressing to discover that the office down in Maryland wasn't that willing to give me up. At first, they said they lost my records. Then, they claimed I had to physically go to the office, get the records, and then go to the new doctor. Finally, on the third call, they faxed the records over.

If it was electronic, the only excuse they could bring up if they didn't feel like doing work is that the server was down.

I like modernizing things...it's creepy that the industry which keeps us from dying from small pox still remains only partially digital.

Pick one now, avoid format war. (1)

HetMes (1074585) | more than 5 years ago | (#26416739)

Are we still going to be using paper records in a hundred years? I don't think so. So, if we want to avoid many, many years of format wars in the future, ending with a crappy format no one is happy with, let's pick a decent one now and go with it, albeit slowly.

Re:Pick one now, avoid format war. (1)

GigsVT (208848) | more than 5 years ago | (#26416877)

CSV is fine.

Re:Pick one now, avoid format war. (1)

east coast (590680) | more than 5 years ago | (#26417095)

While it's an interesting and well founded point you bring up we also need to consider that the face of healthcare isn't likely to be the same in 100 years. We can not let this format be based on 2009 health care practices or even 2009 technology as a limitation.

Absolutely horrific idea (0)

Anonymous Coward | more than 5 years ago | (#26416777)

Now it'll be even easier for providers to sell my information. If you read HIPPA closely you'll see that for 'academic' or 'government' use, health care providers can and will send your data to third parties.

Jobs of the Future (0)

Anonymous Coward | more than 5 years ago | (#26416831)

212,000 data-entry jobs? Just what any high-tech, 21st century economy needs.

Doublespeak time! (5, Insightful)

CajunArson (465943) | more than 5 years ago | (#26416833)

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.

Re:Doublespeak time! (2, Insightful)

HetMes (1074585) | more than 5 years ago | (#26417033)

Right, and McCain knew what he was talking about, and didn't just repeat what his speechwriter had written down...
And even so, would it not be terribly stupid to dismiss a perfectly good idea, just because your one time opponent got media coverage about it first?
What exactly is your point? That even you are surprised that McCain had some good ideas?

Re:Doublespeak time! (2, Funny)

Starayo (989319) | more than 5 years ago | (#26417097)

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] .

Re:Doublespeak time! (1)

weber (36246) | more than 5 years ago | (#26417135)

In case most of you had forgotten, Obama is basically copying John McCain who specifically mentioned doing this in the debates.

Well, Obama strikes me as a very pragmatic politician so I'm not surprised that he copies others' good ideas.

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.

I didn't see it as evil then, and I don't think everyone here agrees to that.

Hasn't this already been done? (4, Interesting)

kiick (102190) | more than 5 years ago | (#26416841)

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. (1, Insightful)

GigsVT (208848) | more than 5 years ago | (#26416843)

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]

Re:Nothing is created. (1)

Notquitecajun (1073646) | more than 5 years ago | (#26417065)

It's a bit of an oversimplification, but I do believe that government jobs really don't count all that much in job creation statistics.

Many problems (2, Interesting)

Ender_Stonebender (60900) | more than 5 years ago | (#26416845)

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:Many problems (1)

betterunixthanunix (980855) | more than 5 years ago | (#26416997)

"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."

There has been a lot of research into high reliability systems, and mainframe systems can remain operational with no interruptions in service for decades on end. It is even possible to hot swap motherboards on a mainframe. This is one of the reasons mainframes will not die just yet: high reliability systems will always be needed, even in large scale setups like banks or hospitals.

"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."

Sounds like a typical engineering challenge.

"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."

Take a look at the NIST security criteria for certified systems some time. A lot of thought was put into this very issue, and I would hope that a transition to electronic records would involve those publications or the use of certified systems based on those publications.

Gotta love the sugar (1, Troll)

Xelios (822510) | more than 5 years ago | (#26416879)

I'll hold my judgment on whether digital records are a good idea, but I'm fascinated by the attempt at sugar coating the cost of this program. 212,000 jobs? Great, that's enough to put half the people entering welfare last week alone back to work, a few years from now. And it's only going to cost $100 billion during an economic crisis? Sounds like a bargain to me!

standards and gov't interference. (1)

gandhi_2 (1108023) | more than 5 years ago | (#26416915)

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: the practitioners will chose the best tool for the job.

If the president wants to mandate his government to perform a certain way...great. If he wants to do that to private business, it's just another loss of liberty. But....think of the children!

data security and privacy (1)

infotek (868362) | more than 5 years ago | (#26417015)

Before they digitize all of that data... should we not define more clearly how that data is secured and who can view it in the future? I do not feel that HIPAA is good enough for my personal information. Once digitized, it would be easy for insurance companies to obtain and abuse that data.

Good luck, didn't work in UK (5, Informative)

badzilla (50355) | more than 5 years ago | (#26417047)

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... (2, Interesting)

kabocox (199019) | more than 5 years ago | (#26417099)

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.)

modernizing (2, Informative)

ejwong (1026306) | more than 5 years ago | (#26417105)

we should change to the metric system while we're at it.

Data Mining (3, Informative)

Fear the Clam (230933) | more than 5 years ago | (#26417137)

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.

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