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Stimulus Avoids Serious Solutions For Health IT

kdawson posted more than 5 years ago | from the add-just-one-sentence dept.

Medicine 184

ivaldes3 writes in to note his post up on Linux Medical News, pointing out the severe shortcomings of the Health IT provisions of the just-passed stimulus bill. "The government has authorized enough money to purchase EMR freedom for the nation. Instead the government appears set to double down on proprietary lock-down. The government currently appears poised to purchase serfdom instead of freedom and performance for patients, practitioners and the nation. An intellectual and financial servitude to proprietary EMR companies for little or no gain. A truly bad bargain."

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first stimulus (-1, Troll)

Anonymous Coward | more than 5 years ago | (#27141233)

eat my pork-flavored asshole.

Re:first stimulus (0)

Anonymous Coward | more than 5 years ago | (#27141301)

I'll show you MY stimulus package!

Re:first stimulus (0)

Anonymous Coward | more than 5 years ago | (#27141439)

You package isn't large enough to stimulate a single female, let alone the economy of a nation of 300+ million people.

Re:first stimulus (0, Offtopic)

weirdcrashingnoises (1151951) | more than 5 years ago | (#27141491)

but chuck norris can.

Re:first stimulus (1)

Tanktalus (794810) | more than 5 years ago | (#27141867)

Chuck Norris doesn't need to stimulate the economy of a nation of 300+ million people. He just stands there and the economy stimulates ... er, nevermind.

Opinionated much? (3, Insightful)

religious freak (1005821) | more than 5 years ago | (#27141291)

A little too opinionated in TFS. What news is this post actually trying to tell us?

Re:Opinionated much? (3, Insightful)

Nethead (1563) | more than 5 years ago | (#27141359)

What news is this post actually trying to tell us?

They didn't get the money sent to them so they are calling the others bad names and getting all pissy about it.

Re:Opinionated much? (1)

sleigher (961421) | more than 5 years ago | (#27141403)

I think what they are trying to say is that United States Health Information Technology is exactly that. United S.H.I.T.

Maybe that depends on who you ask. I am sure many companies will love this.

Re:Opinionated much? (4, Interesting)

glueball (232492) | more than 5 years ago | (#27141931)

I use the proprietary systems and had attempts at open systems (there are always "shoot outs" at the medical conferences) and I can say that the proprietary systems suck much less.

It's all about workflow. The open systems fail to understand this concept.

Re:Opinionated much? (4, Funny)

conureman (748753) | more than 5 years ago | (#27142803)

With some extra cash, maybe the proprietary system vendors could widen that gap. Or at least hire some lobbyists to explain why they'll need more money next year. Failure seems to be our new economic engine.

Accessed much? (0)

Anonymous Coward | more than 5 years ago | (#27143379)

"It's all about workflow. The open systems fail to understand this concept."

It's easy to have a failure to understand of something that most don't have access to.

Re:Opinionated much? (5, Insightful)

tverbeek (457094) | more than 5 years ago | (#27142021)

This article is a poorly written, useless rant. It contains little information about what pisses the writer off, and even less about what should be done instead. I'd love to read a thoughtful, informative article about the subject, since I've recently started an IT job in the health care field, but this isn't it. Any suggestions?

Re:Opinionated much? (4, Informative)

Anonymous Coward | more than 5 years ago | (#27142161)

He has the same rant about proprietary applications without interchangeable data formats in the medical field that people have with MS Office. Health Systems are just as bad if not worse than the other closed proprietary systems that people here constantly rail about. It's very likely that you'll have to buy a special program to read the medical information that you get from your doctor. It's a closed silo system that won't get any better based on the new funding.

Re:Opinionated much? (1)

Ironica (124657) | more than 5 years ago | (#27142339)

If you find one, send me the link, too. We're using OpenMRS as a cross-agency TB registry, but it's sooooo not a full-featured EMR compared to the proprietary solutions. The stuff that our agency is willing to look at isn't even web-based, so you're locked into Windows (or maybe emulation; no idea if that works) for your desktop machines too. One of the systems runs only on Windows servers with MSSQL. Gack.

Re:Opinionated much? (0)

Anonymous Coward | more than 5 years ago | (#27142031)

I must say, I've never been one of the kdawson haters, but some of the "news" items in the last couple of days are starting to make me reconsider...

Re:Opinionated much? (1)

cayenne8 (626475) | more than 5 years ago | (#27142593)

Yeah, but is any of this really surprising?

I mean, the whole fiasco of a spending bill was ram-rodded through congress, no one really read it....etc.

YOu have to guess nothing in it was well thought out...and it is a shame, especially with items concerning a very important topic, our private health records.

Re:Opinionated much? (0)

Anonymous Coward | more than 5 years ago | (#27142329)

Wow. Moderated insightful for:
  1. Not reading the article.
  2. Asking what the article is about.
  3. Apparently unjustified comment on the summary. (I mean, he didn't read the article, right?)

Is this really insightful, guys?

Re:Opinionated much? (0)

Anonymous Coward | more than 5 years ago | (#27142457)

"Posted by kdawson..."

'nuff said.

Avoids serious solutions? (1)

iminplaya (723125) | more than 5 years ago | (#27141307)

Sounds to me like all objectives were met.
As Richard Nixon said, "Solutions are not the answer."

first post (-1, Troll)

Anonymous Coward | more than 5 years ago | (#27141327)

frosty ones!

goatse [microsoft.com]

Why Is Health Care even in the Stimulus (3, Insightful)

Anonymous Coward | more than 5 years ago | (#27141345)

On top of all the other crap that certainly won't really stimulat the economy.

Here's the bottom line. The problem with the economic crisis today lies with the financial and banking system. Health care wasn't the reason for the collapse, and fixing health care isn't the core issue here.

Its funny how liberals were complaining that invading Iraq had nothing to do the GWOT. This is the liberals version of 9/11, using the crisis as a pretext to remake the US economy and set their agenda.

Re:Why Is Health Care even in the Stimulus (4, Insightful)

Captain Splendid (673276) | more than 5 years ago | (#27141501)

This is the liberals version of 9/11, using the crisis as a pretext to remake the US economy and set their agenda.

It's tempting to think that, but the truth is McCain would've done pretty much the same thing. Except he would have cried more.

Re:Why Is Health Care even in the Stimulus (2, Insightful)

ravenshrike (808508) | more than 5 years ago | (#27142433)

Of course, McCain also joined in McCain-Feingold, so clearly he's not a conservative barometer.

Re:Why Is Health Care even in the Stimulus (2, Interesting)

iminplaya (723125) | more than 5 years ago | (#27141503)

Health care is big business. Moves(washes) lots of money. Government and big business always help each other. The insurance companies are the democrats' "Halliburton".

All seriousness aside, the truth is that health care is as much part of our infrastructure as the the lights and roads are. Perfectly within the government's interests to see that everybody has access. Handing it over to private interests has proven disastrous for everybody not involved the business. Most of all the patients. But, like everything else...

Re:Why Is Health Care even in the Stimulus (0)

tthomas48 (180798) | more than 5 years ago | (#27141679)

This also goes to show that Republicans aren't really the party of small business. One of the biggest ways that small business struggles to compete with big business is in the realm of health care costs. Big businesses have better bargaining power and pay less per employee. Small business can't simply compete with salaries, they have to compete on benefits, and they have to pay more for them than largeer businesses.

The best way to create a boom in all sectors is to nationalize health care premiums. Companies and employees would have more in their pocket. Employers could hire more, and could pay their current employees more, which would be great for the economy.

Re:Why Is Health Care even in the Stimulus (4, Insightful)

Em Emalb (452530) | more than 5 years ago | (#27141749)

This also goes to show that Republicans aren't really the party of small business.

Neither party is the party of small business. They're the party of the party, for the party, by the party.

It's not a democrats versus republican thing, it's an US versus Politicians thing.

Re:Why Is Health Care even in the Stimulus (1)

tthomas48 (180798) | more than 5 years ago | (#27141911)

It's people. Politicans are PEEEEOPPPLEEEE!!! They're using people to make decisions. Next thing you know they'll create a democracy and make us vote!

Republicans always talk up the small business. (2, Insightful)

FatSean (18753) | more than 5 years ago | (#27143265)

See: Joe the Plumber. Republicans often campaign on small business issues.

Democrats? Not so much.

Re:Why Is Health Care even in the Stimulus (3, Interesting)

Anonymous Coward | more than 5 years ago | (#27141889)

On top of all the other crap that certainly won't really stimulat the economy.

In the short term, paying people to hop up and down on one foot would stimulate the economy - as long as the people were going to spend the money rather than stuff it in their mattress.

Here's the bottom line. The problem with the economic crisis today lies with the financial and banking system. Health care wasn't the reason for the collapse, and fixing health care isn't the core issue here.

Ah, but why do we care about the financial crisis at all? Because some CEO might not be able to afford to buy his second mistress a third vacation home? Not so much.

Rather, because ordinary people end up out of work and can't afford basic necessities like health care. Fixing health might not help people this time around (just like the GWOT didn't go back in time and prevent 9/11) but it might help next time around.

Its funny how liberals were complaining that invading Iraq had nothing to do the GWOT. This is the liberals version of 9/11, using the crisis as a pretext to remake the US economy and set their agenda.

The only reason that makes sense as to why Bush invaded Iraq is that he was doing a favor for his associates in the war, oil, and religion industries (plus his friends in Saudi Arabia).

On the other hand, I get the sense that Obama really does care about helping poor people. I may turn out to be wrong about Obama's motives and, even if I'm not, Obama's only guy (up against a sea of simple-minded people like yourself).

But, at the end of the day, I feel better about helping poor people than Bush's associates (plus, Obama's methods don't involve killing so many people).

LOL, right he's simple minded. (1, Troll)

HornWumpus (783565) | more than 5 years ago | (#27142205)

But you believe Obama really cares about helping poor people.

Simpleton.

Re:LOL, right he's simple minded. (1, Insightful)

Anonymous Coward | more than 5 years ago | (#27142567)

Since when is trolling considered Informative?

Re:LOL, right he's simple minded. (1, Troll)

HornWumpus (783565) | more than 5 years ago | (#27142661)

It's only a troll to you because you are in denial.

Re:LOL, right he's simple minded. (2)

An Onerous Coward (222037) | more than 5 years ago | (#27142745)

Would you like to lay out your alternative theory in detail?

Re:LOL, right he's simple minded. (2, Insightful)

HornWumpus (783565) | more than 5 years ago | (#27143083)

Obama likes power.

He knows which side his bread is buttered on and will serve his masters (none are poor) in order to be re-elected.

Same as all politicians.

Re:Why Is Health Care even in the Stimulus (3, Insightful)

cgenman (325138) | more than 5 years ago | (#27142731)

Our economy is broken in more ways than just the financial system. Our Car companies have been mismanaged for years, our healthcare system is derided worldwide for being incredibly expensive and backwater, our education system is a joke.

What we need to get out of any economic downturn is higher per-capita productivity. Health Care has been a big drain on our economy for years, and a distributed automated health records system is long overdue. My Mechanic has better records of the work done on my car than My Doctor. I've seen doctors prescribe to my grandmother treatments that had serious interactions with drugs she was already taking, and treatments that she was simply allergic to.

We need growth and efficiencies, and this is one area where a little expenditure would save a lot of lives. And I hate to sound this crass, but saving lives cheaply is good for the economy.

Re:Why Is Health Care even in the Stimulus (0)

Anonymous Coward | more than 5 years ago | (#27143579)

My Mechanic has better records of the work done on my car than My Doctor.

Well of course he does. Why would your doctor care about your car?

Re:Why Is Health Care even in the Stimulus (5, Insightful)

DragonWriter (970822) | more than 5 years ago | (#27142829)

The problem with the economic crisis today lies with the financial and banking system.

No, the problem lies with the lack of availability of credit and the lack of consumer demand. The primary direct cause of that may have been actions in and affecting the financial services industry including the banks, but that doesn't mean that the most effective way of dealing with it is exclusively with policies directed at that industry, in the same way that bad diet and inadequate exercise may be the principal cause of a heart attack, but the best response to a heart attack may not be limited to diet and exercise changes.

Its funny how liberals were complaining that invading Iraq had nothing to do the GWOT.

Liberals, in fact, were not generally complaining about that. Liberals were complaining that Iraq (not "invading Iraq") had nothing to do with 9/11 (not "the war on terror") and that invading Iraq was directly counterproductive in (not "had nothing to do with") the war against the people who had actually attacked the United States on 9/11, and that contributed to producing more people who would be more easily recruitable by groups wanting to attack the United States through terrorism.

The first half relates to the justification, the second to utility. Confusing different parts of two distinct-though-related criticisms of the invasion of Iraq misses the point of both criticisms rather completely.

This is the liberals version of 9/11, using the crisis as a pretext to remake the US economy and set their agenda.

That doesn't make sense. The economy is broken. Liberals are proposing a particular way of fixing it that, they argue, apply both to the immediate problem and the longer-term structural problems that make problems like the immediate one both more likely to occur and more damaging to individual citizens when they occur. As you note, what they are doing is directed at the economy, which is where you admit the problem is, not at some unrelated thing. Now, you might argue that the proposals are not directed well to fix the problems in the economy, which would be a legitimate point to debate, but you fail to make that argument, instead making an argument by analogy (though, as noted, a poorly-crafted analogy that reveals poor understanding both of the immediate situation and the one to which an analogy is drawn) that seems to rely on the idea that it is not directed at principal immediate cause of the problem, rather than arguing that it is ineffective at solving the problem. But being effective at addressing a set of undesirable conditions is logically orthogonal to being directed at the events and conditions which contributed to the development of those conditions.

Criticisms and a Better plan (5, Interesting)

tjstork (137384) | more than 5 years ago | (#27141389)

I read the article.

The guy's central point is that corporate systems are bad, and open, federally funded systems are good, with the further implication that government is good, and corporations are bad.

Now, the reason, though, that he gives for this is that a private corporation owns his data in the present system, but if the government owned, then, somehow, he'd own it more.

That's the crazy thing. There's no such thing as "public ownership". You own as much of something that is public as you do a car by walking past a Ford factory. Ownership at its most practical is, who controls it, and you really don't have any control over the daily disposition of property managed by the government. In effect, when you argue for publicly owned health care, or publicly owned anything, what you are really arguing for is to pay your own taxes to buy something for some administrator either elected or appointed or a lifelong civil servant. In any case, its not you.

There's a lot of good reasons to adopt open source in health care. For one, the creation of a single standard document for representing a medical history would go a long way towards enabling applications across the medical spectrum to coexist.

This will be easier said than done.

A good example is that there were some efforts to do this in insuring property for catastrophic losses - a build is remarkably complex for insurance purposes, but that specification has essentially died by its own complexity. The industry largely and thankfully essentially resorted to using SQL Server copies of the leading vendor of property and casualty software for CAT. Is it proprietary? Yes. But, it allows all the insurers to exchange books in a way that is relatively practical and easy to use.

The moral here is that its not good enough to say that a standard is open for data interoperability. Ease of use and ease of transportability becomes paramount and if open source wants to drive health insurance, it stands to reason that there needs to be a pervasive application that goes along with it.

Re:Criticisms and a Better plan (1)

Em Emalb (452530) | more than 5 years ago | (#27141487)

Wow, you got all that out of the article?

Good for you.

All I got was that the guy is pissed off and wants people to play in his particular sandbox and not "some big companies".

Re:Criticisms and a Better plan (4, Insightful)

Nethead (1563) | more than 5 years ago | (#27141537)

I think it was Heinlein that said something like: You only truly own that which you can carry in both arms at a dead run.

Re:Criticisms and a Better plan (4, Insightful)

be0wulfe (252432) | more than 5 years ago | (#27141933)

You're only half right. The problem is that HIT vendors are generally well behind the times, slow to innovate and closed and proprietary as all get out. You think MS is bad? You haven't seen highyway robbery until you've seen the shit in a box most HIT vendors push. The technical implementation is lacking and the SOLE focus, the SOLE focus of every sale is simply to further ensare the particular customer still deeper into more from the same proprietary stack. Integration is a joke, made challenging by intention rather than accident.

This is a HIGHLY lucrative market. Any given vendor has ZERO interest in open systems and will push to make sure you buy their entire stack.

Thankfully, there are exceptions to the rule and there are many CIOs and CEOs that are wising up to their antics.

This stimulus plan, unfortunately, only makes things WORSE backing proprietary vendors and closed systems over open standards - real standards, not the recommendations AKA HL7.

Re:Criticisms and a Better plan (1)

tverbeek (457094) | more than 5 years ago | (#27142067)

When it comes to what's done by the government, I have only one vote. But that's one more vote than I have when it comes to what's done by private businesses, and it guarantees me a right to participate in the process.

Thomas Jefferson disagrees with you (4, Insightful)

jeko (179919) | more than 5 years ago | (#27142159)

Now, the reason, though, that he gives for this is that a private corporation owns his data in the present system, but if the government owned, then, somehow, he'd own it more.

That's the crazy thing. There's no such thing as "public ownership".

I visited Washington DC a while back. I stood on the Mall. I stood on the Lincoln Memorial. I own a piece of it. So do you. I ran my fingers down the names on the black Wall, and I knew that my family had bought a piece of it at the cost of blood. I looked up at the top of that giant obelisk and knew that Washington had given me a piece of it. I walked through Arlington. I for damn sure own a piece of that.

Yes, if the government owns it, you absolutely own it more. You own it more because there's a huge difference between being a citizen and being a customer. I own it more because generations of my kin have stood in uniform and fought and bled for it.

If there's truly no such thing as "public ownership," then why is my family pulling on uniforms and strapping on guns to fight for it?

Re:Thomas Jefferson disagrees with you (4, Insightful)

HornWumpus (783565) | more than 5 years ago | (#27142305)

You don't own any of it.

If you own something then you can sell it.

Try and sell 'your share' of the Washington memorial.

You family protected the nation. The nation government used to mind its own business (courts, national defense, some infrastructure...nothing else) and mostly leave us alone.

You can say you have a stake in the commons, but that is nothing like ownership.

With businesses you can choose which company you deal with. Government pretty much always grants itself a monopoly.

Re:Thomas Jefferson disagrees with you (1)

Logic and Reason (952833) | more than 5 years ago | (#27142351)

I visited Washington DC a while back. I stood on the Mall. I stood on the Lincoln Memorial. I own a piece of it.

Do you? Really? Can you sell your piece of it, or give it away? Can you take your piece somewhere else, or destroy it if you feel like it? If not, you sure have a funny definition of "own".

Re:Thomas Jefferson disagrees with you (0)

Anonymous Coward | more than 5 years ago | (#27143029)

or give it away?

Yes, you can renounce your citizenship.

More seriously, what do you think happens to the money from selling your radio waves, your oil, and so on? Ideally, that money would be spent by the government as money it would not have to take from you, though in the past few decades of "spend and spend" governments, it would just be extra pocket change on top of the money its extracting from you.

The law may prevent you from selling your citizenship (legally, ask any of the immigrants with your ID how much they paid for your citizenship) but that doesn't make you not an owner.

Re:Criticisms and a Better plan (1)

ColdWetDog (752185) | more than 5 years ago | (#27142165)

There's a lot of good reasons to adopt open source in health care. For one, the creation of a single standard document for representing a medical history would go a long way towards enabling applications across the medical spectrum to coexist.

This is exactly right, and a bit wrong. We don't need open SOURCE code, we need STANDARDS and DATA STRUCTURES. I don't care if GE writes the database and front end using FORTRAN or Visual Basic. But we do need commonality in the record so that the GE system can talk to Epicare and, more importantly, you can switch systems without trying to key in all the data.

TFA really has the right idea, but a screaming rant isn't going to impress anybody.

Re:Criticisms and a Better plan (1)

falsified (638041) | more than 5 years ago | (#27142581)

You mean HL7?

Re:Criticisms and a Better plan (1)

imamac (1083405) | more than 5 years ago | (#27143677)

That's great for a data/transmission standard, but another big problem is proprietary databases. Every application has it's own "under-the-hood" storage structure. Imagine if there was a standardized database structure, don't you think that would go a long way towards better interoperability and communication?

Re:Criticisms and a Better plan (1)

californication (1145791) | more than 5 years ago | (#27143711)

HL7 isn't a standardized format to store medical information, but rather to transfer medical information from one system to the next. Private companies and medical centers still have to configure their systems to spit out the HL7 from their proprietary data structures and databases so it can be transferred to/from their systems. It's also a very loosely defined standard, purposely so that it allows the people developing the applications as much flexibility as possible.

Re:Criticisms and a Better plan (1)

Asic Eng (193332) | more than 5 years ago | (#27142273)

I think a stimulus bill should be an investment bill. Initially there is extra spending which causes economic activity of some kind, and that helps in the short-term. However the spending needs to be directed, so that long-term public costs are reduced. If that doesn't happen your debt may get out of control. One way of investing in that way, could be to pay for software to be written so you own it, rather than owning a license to use it.

If you buy e.g. an installation of MS Office, then you own merely the right to use it on one computer. Maybe you want to buy it at many sites because it has feature X which OpenOffice doesn't have. Rather than spending the money to buy many installations you could spend it to have it added to OpenOffice. This could have similar short-term cost, but in the long-term you could access this new feature wherever you needed it, without extra cost.

Similar for medical software - you could direct the spending so that you'll get extra features in the short-term and keep paying for them in the long-term. Alternatively you could pay to have it created under GPL license, and in the future you could always get competing bids when it comes to add features to the software, and you could add additional installations without further licensing costs.

Re:Criticisms and a Better plan (1)

Ironica (124657) | more than 5 years ago | (#27142587)

Similar for medical software - you could direct the spending so that you'll get extra features in the short-term and keep paying for them in the long-term. Alternatively you could pay to have it created under GPL license, and in the future you could always get competing bids when it comes to add features to the software, and you could add additional installations without further licensing costs.

Exactly. For our non-profit organization, which operates six clinics and two mobile units, EMR/PM bids are coming in at half a million for the first year and $200k and up each year after. The costs scale with our size, too; if we start seeing more patients or hire more doctors, we pay more for our EMR. This means we can't even *think* about switching to electronic records until we've secured funding for at least a few years, while we build that into the budget and our indirect cost agreements.

If instead, the government actually purchased one or two well-developed EMR systems and open-sourced them, then let all their Federally-Qualified Health Centers (FQHCs) and look-alikes use them for free, it'd cost more like $100k per grantee organization to implement... including hardware, which the costs above don't count... and the continuing costs would be negligible, probably one more person on your IT staff, or a low-cost helpdesk contract.

Instead, there's an RFP out right now that will spend $4.5 million on *six* FQHCs to implement EMRs. Only clinic systems with at least 30 sites, or consortiums of three or more clinics are eligible, so I'm guessing their target is to get 200-250 sites onto EMR systems with $4.5 million dollars. Not exactly cost-effective.

Re:Criticisms and a Better plan (1, Interesting)

Anonymous Coward | more than 5 years ago | (#27142423)

Now, the reason, though, that he gives for this is that a private corporation owns his data in the present system, but if the government owned, then, somehow, he'd own it more.

That's the crazy thing. There's no such thing as "public ownership".

I took my kid to a public park the other day. We showed up, played on the play structures for while and left.

Would that have been possible if the land had been owned by a private corporation? Sort of. It's possible the corporation would have set up some kind of pay-to-play situation. Some of the cost would probably go to maintaining the play structures but some of the cost would also go the owners (or management) of the corporation as "profits".

The essence of capitalism is that some people get paid for doing work and other people get paid for owning "capital" - that's right, some people get paid for doing nothing other than being rich. So, who gets paid for owning the land the park is on? If the land is owned privately, then whoever owns the land gets paid for doing nothing other than owning the land. If the land is owned publicly then no one really gets paid, per se, but people who use the park don't have to pay some rich person for doing nothing other than owing the land.

In effect, when you argue for publicly owned health care, or publicly owned anything, what you are really arguing for is to pay your own taxes to buy something for some administrator either elected or appointed or a lifelong civil servant.

That depends on whether you think government officials can be compelled to act in the public interest.

The recent business with Bush invading Iraq for the benefit of his friends in the oil (and war) industries does suggest that there is a strong tendency for government leaders to spend tax dollars for their own benefit.

On the other hand, getting back to the public park example, the land the park was on was very clearly not being used exclusively for the benefit of a government official (for example, as a private residence).

Bottom line. It's not quite as black and white as you claim.

Re:Criticisms and a Better plan (1)

StopKoolaidPoliticsT (1010439) | more than 5 years ago | (#27142981)

I took my kid to a public park the other day. We showed up, played on the play structures for while and left.

Would that have been possible if the land had been owned by a private corporation? Sort of. It's possible the corporation would have set up some kind of pay-to-play situation. Some of the cost would probably go to maintaining the play structures but some of the cost would also go the owners (or management) of the corporation as "profits".

The essence of capitalism is that some people get paid for doing work and other people get paid for owning "capital" - that's right, some people get paid for doing nothing other than being rich. So, who gets paid for owning the land the park is on? If the land is owned privately, then whoever owns the land gets paid for doing nothing other than owning the land. If the land is owned publicly then no one really gets paid, per se, but people who use the park don't have to pay some rich person for doing nothing other than owing the land.

I stopped at McDonalds with my niece a couple weeks ago... if you haven't heard of them, they're a huge multi-national corporation (and I happen to own no stock in them, so I have no ownership claim). Get this, they had a play area complete with slides, video games, etc and I didn't have to pay a thing for my neice to use it. There wasn't even an evil overlord there demanding that I buy some food to use it.

Private ownership doesn't mean you have to pay some evil capitalist to use their property. Some of those evil bastards may allow free usage to garner some good will or simply out of charity. The key is, they do it of their own free will without forcing anyone else to pay for it.

Contrast that to the government... Back about a decade ago, my town wanted to buy "the last undeveloped piece of land" on our lake. It went up for a referendum and the people of the town voted it down. The town board turned around and bought it anyway, at an even higher price, against the will of the people, and then promptly developed it, killing that whole notion of it being the only undeveloped piece of property on the lake and also contradicting the will of the people. Thousands of people that said no were forced to pay for something they didn't want and yet it only benefits a handful of people (they turned it into a half assed flower garden right next to another park four times its size and virtually nobody goes over there unless they're using it for a wedding). Oh, and the town board put in memorials dedicated to their friends and family (might not be a private residence, but I'd say the memorials are an exclusive benefit of the politicians).

You most certainly do have to pay for that park even if they don't charge an entrance fee. One way or another, depending on where you live, you pay a tax to finance that park. In my case, I paid $422 for my portion of that park that nobody wanted just to buy it... and then another $100 or so to develop it. And then there's another amount I pay every year to maintain it (I don't know the budget line on that off the top of my head, but we'll call it another $20 a year). How exactly is that free?

So which is the more equitable system for the little guy, being forced to pay for something they clearly didn't want (in conjunction with a majority of their neighbors) through government monopolization or being allowed to use something for free because of the generosity of a capitalist? Not all capitalists are so generous, but just because the government owns something doesn't mean you aren't paying for it... and you have virtually no choice in the matter, so I'd say the government isn't all that generous either. But at least with the capitalist, I have an actual choice in the matter.

Re:Criticisms and a Better plan (0)

Anonymous Coward | more than 5 years ago | (#27143809)

Get this, they had a play area complete with slides, video games, etc and I didn't have to pay a thing for my neice to use it. There wasn't even an evil overlord there demanding that I buy some food to use it.

My understanding was that the play areas at fast food restaurants were only for paying customers: if you didn't buy food, technically you were trespassing on private property. But maybe I'm misinformed; do you have a link to the McDonalds website where they indicate that their play areas are available to the general public (who don't buy food)?

You most certainly do have to pay for that park even if they don't charge an entrance fee. One way or another, depending on where you live, you pay a tax to finance that park.

You're kind of missing the point - which was that "capital" (in this case, the land itself) produces value.

But let's look at your point that the actual play structures cost money. OK, fair enough, in a public park these play structures are paid for by tax payers.

But who pays for these structures at McDonalds? The play structures didn't just spring into existence out of thin air. The CEO of McDonalds didn't even build them as a hobby in his spare time. Oh, that's right, they are paid for as increased cost of the food at McDonalds.

People who bought food at McDonalds paid for the play area that your niece was playing in "for free". Did the people who bought food have a choice? Did McDonalds say "How would you like to pay extra for your burger so we can build a play area for some random guy's niece?" Hardly.

So which is the more equitable system for the little guy, being forced to pay for something they clearly didn't want (in conjunction with a majority of their neighbors) through government monopolization or being allowed to use something for free because of the generosity of a capitalist?

When it comes to the Iraq war, I'd agree with you. If Bush's friends in the oil industry wanted the USA to invade Iraq they should have paid for it themselves. In fact, I'd like to see a law that, in the future, the US military will be funded exclusively with private donations.

Re:Criticisms and a Better plan (1)

jerdenn (86993) | more than 5 years ago | (#27142443)

For one, the creation of a single standard document for representing a medical history would go a long way towards enabling applications across the medical spectrum to coexist.

This document type does exist. Please review the emerging HL7 v3 documentation. Pay particular attention to CDA/CCD.

The bottom line is that once there is convergence around interoperability, which proprietary EMR solution a Healthcare Organization utilizes matter much less less. Prior to CCHIT and changes in STARK, vendors had little incentive to develop interoperable solutions - vendor lock-in is part of the HIT business model.

For once, the government is actually driving positive change into an industry. Through provider-based incentives (carrot vs. the stick), HCOs (Healthcare Organizations) will have positive incentive to implement interoperable solutions.

It's a facinating time in HIT, and I'm frankly enjoying being on the vendor side of right. I expect fundamental change over the next 5-7 years in HIT, unlike anything we've seen in the last 15. Great stuff, really.

-jd

Re:Criticisms and a Better plan (1)

ColdWetDog (752185) | more than 5 years ago | (#27143791)

Have you ever seen a medical record from one vendor successfully brought into to another vendor's EHR? I'd like to believe that it's really being done at this point in time, but I've never actually seen this behavior in the wild....

The point of the system: Ammo against your enemies (1, Insightful)

Anonymous Coward | more than 5 years ago | (#27142659)

The point of digitizing your health records is not to "lower costs" the point is to maintain a record of your political enemy's health issues.

Take a look at the "leaks" of the taxes, etc. of Joe the Plumber once he became a political liability.
Or take a look at how often political candidates "sealed" divorce papers are leaked to the press.
I believe there is an instance of the ex-husband of 7 of 9's divorce records becoming "oops, unsealed". Allowing a certain candidate to run unopposed.

What this will mean is that when you (or someone else) runs for office, your medical history will be leaked to the press.
"Oh, Candidate X, I see you took anti-depression medicine after your divorce."
"Oh, Candidate Y, I see you got treated for an STD in college."

  The purpose of the digitized medical records is to provide an automated muck-racking system for people who run against the favored party.

Re:Criticisms and a Better plan (1)

tyrr (306852) | more than 5 years ago | (#27142991)

The problem with your response is that you have no knowledge of the economic and legal concept called public goods [wikipedia.org] . Look it up. Public ownership and public property in fact exists in order to provide benefits that are non-rivaled and non-excludable.

Health services should be just that non-rivaled and non-excludable. If you turn health care, or heath insurance for that matter, into a profit-seeking growth industry you get just what you have in the United States - expensive and tremendously inefficient system. It may be a novel concept to you, but in many cases government can actually create a more efficient enterprise then the private industry.

Not as big of a deal as you might think (1)

Dr Reducto (665121) | more than 5 years ago | (#27141395)

The people building health information sharing networks have taken this into consideration and have designed "translators" for all the health record formats.

I'm peripherally attached to the team working on the first state-wide health information network (in Maryland), so I can tell you a lot of these problems have already been solved long ago

Re:Not as big of a deal as you might think (2, Insightful)

DamnStupidElf (649844) | more than 5 years ago | (#27141535)

Quick, what's the proper race code to send in PID-10? What about PID-17 (that was a fun one to standardize)? Not to mention the mess with PID-18, PID-2 and PID-3 across disparate systems, and every mind-boggling combination of ways that different systems treat persons, encounters, orders, results, reports, and images.

Basically, the government will have to throw out or severely limit the use of most medical software, and enforce its replacement with something standard if they want to make health information electronically available to any provider. Otherwise the "solution" will be sending PNGs of medical records back and forth.

Re:Not as big of a deal as you might think (1)

VP (32928) | more than 5 years ago | (#27141847)

PID-2 has been deprecated for ages.

Re:Not as big of a deal as you might think (1)

Qzukk (229616) | more than 5 years ago | (#27143221)

So in other words, it's required in every system older than 5 years, and an error in any system newer?

Re:Not as big of a deal as you might think (1)

DragonWriter (970822) | more than 5 years ago | (#27142891)

Basically, the government will have to throw out or severely limit the use of most medical software, and enforce its replacement with something standard if they want to make health information electronically available to any provider.

Which is what the government has done (more than once) with existing billing software, by specifying (and then updating) standards for electronic health care claims and related transactions under the HIPAA Transactions and Code Sets rule. (These standards aren't open, but they were for quite some time free-as-in-beer for interested parties to get electronic copies of and use, until the government stopped subsidizing them.)

It makes more sense to do that with medical records, since the benefits of interchangeability are much higher than with billing-related transactions, but it definitely needs to have a suitable lead time and support for transition costs, because you don't want to drive providers out of business with the mandate.

Re:Not as big of a deal as you might think (1)

bugs2squash (1132591) | more than 5 years ago | (#27141739)

wouldn't the government then do better to define a "Lingua Franca" for all medical records. ie, one central standard to which all insurance companies' individual crap should be translatable by, say 2011. And mandate that the insurance companies must handle the translation themselves.

Re:Not as big of a deal as you might think (1)

Ironica (124657) | more than 5 years ago | (#27142629)

ie, one central standard to which all insurance companies' individual crap should be translatable by, say 2011.

And mandate that the insurance companies must handle the translation themselves.

Why do people keep talking about insurance companies? Their stuff has been computerized forever. TFA and most of the discussion is about medical records in the clinic or hospital setting.

It has to do with insurance only peripherally, in that one of the driving forces behind digitization of medical records is to ease the billing process through better coding of medical procedures and reducing after-the-fact data entry, but being able to do billing from your system in an integrated fashion is a standard feature of all commercial EMR/PM solutions.

While reading the blogpost... (1)

NeutronCowboy (896098) | more than 5 years ago | (#27141415)

... I thought for a second that Slashdot had again updated its interface. Then I realized that this is a random internet rant. Really, not much different from a NYT or WSJ rant, but those at least pretend to have outside expert sources.

Yes, I would like Medical institutions to use GPL'ed software. Yes, I'm disappointed that the government still doesn't think that software freedom and dumb pipes are the keys to a networked future. But am I surprised? No, not really.

Re:While reading the blogpost... (1)

QuantumRiff (120817) | more than 5 years ago | (#27141857)

I really don't care who makes/manages the software, as long as the file format, and method's of talking to it are standardized, public, and open.

*blink* (0, Insightful)

Anonymous Coward | more than 5 years ago | (#27141425)

Say what? Can someone tell me what language that summary is written in so I can work on getting it translated.

From the poorly written article it sounds like the healthcare industry is sticking with proprietary hardware/software/whatever. Is this really big news in a highly specialized and highly accountable field? (If my code explodes a few records in a database may be lost. If healthcare code/hardware explodes someone literally dies.) Personally, I wouldn't want to take on that kind of responsibility as an open source developer.

Healthcare is full of closed apps (5, Insightful)

joeflies (529536) | more than 5 years ago | (#27141437)

Healthcare is dominated by application vendors who each make their own megaplatform for healthcare records. Cerner, Meditech, Siemens, et al. are all trying to keep as much of their system closed as possible, and aren't particularly interested in opening it up to third party systems. They don't particularly want open interfaces, their goal is to keep their customer locked in as much as possible.

So the healthcare IT companies get what they want, i.e. a bigger push for electronic records, selling the software they already have.

The stimulas package isn't going to add an open spec for EMR because nobody in the healthcare industry is bringing it up that they want one.

Re:Healthcare is full of closed apps (2, Interesting)

californication (1145791) | more than 5 years ago | (#27143861)

I work for an EMR company and we have been working towards giving customers more freedom of choice, at the customer's request. For example, previously the customer had to purchase software AND hardware from us, now they can purchase the software standalone and bring their own hardware to use. Also, a lot of medical information is available for transfer or synchronization from one system to the next using HL7 interfaces. You can use a third party system to schedule exams and use our system to perform the exams, all the information is synchronized via HL7 interfaces.

You are right on the money that there is currently no demand for an open EMR spec. If customers were asking for it, believe me they would get it, but that's honestly the last thing on their minds. They want more features to reduce the amount of resources (people, time, materials) that they need, thereby saving them money.

Not to mention the fact that forcing all EMR software companies to support a completely new spec in addition to their existing one would cost these companies a lot of money. That's time that could be spent improving the functionality of the existing software.

OK, help me out here... (1)

Em Emalb (452530) | more than 5 years ago | (#27141449)

Here's the last line of the rant/article:

This time it is no different: 'All Electronic Medical Record software purchased with federal funds must be licensed under the Affero General Public License version 3.' This guarantees the requisite transparency. This needs to be written into the law yesterday to ensure our nations Health IT future is a bright one.

So then, not knowing what the Affero GPL is, I go to wikipedia (yeah, I know, whatever, most of the time Wikipedia is good) to see what the heck this version of the GPL is. Apparently it closes an ASP loophole in the GPL. Anyway, while I'm reading that, I see that one of the authors of the Affero GPL is RMS, the other is Henry Poole. Henry Poole created a company called Affero which apparently "is a service which enables personal ratings and donations to causes on behalf of individuals who freely share with others."

Ok. So the author is upset that the government isn't using Open Source software (I am assuming the Affero.com webpage is free, didn't look) and wants them to...because of security concerns?

Is that it? Because the blog/rant/article reads like an angry rambling rant to me. Not trying to troll, just saying if this guy wants to be taken serious, stop with the "people have been telling me to tone it down" rhetoric. Post the facts, not emotion.

Try A Different Pot Of Money (4, Informative)

damn_registrars (1103043) | more than 5 years ago | (#27141505)

The National Institutes of Health [nih.gov] just announced the NIH Challenge Grants [nih.gov] that is used for doling out stimulus money to small projects. In it they identified several high-priority topics [nih.gov] , which if you look through, you will find includes Information Technology for Processing Health Care Data [nih.gov] .

So there certainly is money available for this type of work. And for those not familiar with grant funding by the US government, the NIH is the single largest grant provider for the life science in the US.

Given that nobody read the bill... (-1, Troll)

Anonymous Coward | more than 5 years ago | (#27141565)

...is this surprising?

This Health IT section of the Porkulus Maximus bill was written by some rent seeking lobbyist. Its there to funnel money to buddies of some un-named Democrat congressman, not to solve an actual problem.

That's what you get when you vote Democrat kids, always has been.

Re:Given that nobody read the bill... (2, Insightful)

Tanktalus (794810) | more than 5 years ago | (#27141965)

Not that I'm particularly a fan of Democrats, and in fact prefer the Repubs on almost (not quite) every issue, but I suspect that if you just scratch "Democrat" from both occurrences in your post, you'd probably still be right.

Before and after: (0)

Anonymous Coward | more than 5 years ago | (#27141587)

Before: ZOMG a Stimulus bill shouldn't have any healthcare provisions in it, what the hell are you thinking?

After: ZOMG this stimulus bill didn't have any healthcare provisions in it, what the hell were you thinking?

Seriously, make up your damned minds.

Not entirely true (4, Interesting)

Dishwasha (125561) | more than 5 years ago | (#27141657)

At least down here in Texas, any grant money funded through DSHS [state.tx.us] as well as HRSA [state.tx.us] at the federal level have specific sections that state that any system proposed that makes use of the VistA [va.gov] system will receive higher consideration to getting funded above any proprietary solution. Unfortunately the available solutions are still very high risk and many hospitals and other healthcare entities really don't like the look and feel when compared against proprietary browser-based systems.

What, are you nuts (1)

bugs2squash (1132591) | more than 5 years ago | (#27141681)

Unemployment would quadruple overnight if 90% of the "Medical" staff at a hospital were no longer needed to do paperwork for the insurance companies.

Hell no, make more paperwork not less, the country needs jobs.

Re:What, are you nuts (1)

An Onerous Coward (222037) | more than 5 years ago | (#27142951)

:)

I know you're only half serious. But in the short term, the number of people employed by the changeover to the new records systems is going to dramatically outweigh the number of people that the new systems make unnecessary. It's only once the systems start coming online that the carnage begins.

deja vu! (0)

Anonymous Coward | more than 5 years ago | (#27141691)

It sounds like we struggle with the same issues up here in Canada that you do. The main obstacle is rarely technology, and commonly politics.

Please, get the government OUT of healthcare (0)

Anonymous Coward | more than 5 years ago | (#27141731)

Do you really think government bureaucrats making decisions about your LIFE is an improvement?

Health care is NOT and CAN NOT be free since it is so resource intensive. SOMEONE MUST PAY FOR IT! And since someone must pay for it and health care resources aren't infinite, ACCESS TO HEALTH CARE MUST BE CONTROLLED IN SOME WAY!!!!

So, why is GOVERNMENT BUREAUCRACY BETTER THAN FREE MARKETS?

I don't see too many USians going to Canada for health care, but there sure are a lot of Canadians fleeing their FREE GOVERNMENT HEALTH CARE for the "evils" of the US system.

Re:Please, get the government OUT of healthcare (1)

Tanktalus (794810) | more than 5 years ago | (#27142839)

As a Canuckian who realises that we already have two- or three-tiered health care already, despite all the politicians who deny it (a base level, like the US's medicare, but a bit more pervasive; another level for those who can afford extra health insurance above that; and yet another level for those who get health insurance from their employer, none of which are unlimited health care options), and can't imagine a purely government-run system working pretty much at all, I'll just point out the difference for you: it's a matter of who is making the calls on whether the procedure you want/need is covered. In the case of publicly-funded health care, it's the bureaucracy who calls the shots: people who are beholden only to their next level of management, and the overall budget they've been assigned by the government. An arbitrary line is drawn that weighs cost and perceived lifespan should the procedure be done, and if you fall on the bad side of the line, you're denied with basically no recourse.

In the case of private, for-profit health care, there is an obvious bias toward profitability. It's a delicate line to toe, because if you make an obviously bad decision, you'll end up in court and lose all the profit and then some from that customer, and you'll also get bad PR, which hurts profitability. The former is easier to deal with (bury the plaintiff with your corporate lawyers), but the latter can be a bit more difficult with plaintiffs that show a backbone. Of course, there's the obvious way around both: deny every claim to start with, and pay out all claims that appeal. As long as that doesn't get out, you'll probably pay out next to nothing, with few lawsuits and little in the way of negative PR.

Re:Please, get the government OUT of healthcare (3, Insightful)

Dr_Barnowl (709838) | more than 5 years ago | (#27143111)

Isn't it the other way round? Don't Americans by the thousand drive across the border to get their drugs from Canadian pharmacies?

The bureaucracy of the American system is much, much higher than that of the UK NHS (which is no model of streamlined elegance). Just looking at the messaging protocols for the IT systems will tell you that. We don't have to implement half the messages because they relate to billing.

On top of that, the US system is treated as a for-profit endeavour. I'm told that a 15% profit margin is considered to be at the low end.

In the UK we spend only 40% per head what the US does, yet we have universal coverage, flat-rate prescription costs, and no co-pay. Access to treament is based on what is cost effective within the NHS budget, not which loophole your policy manager can use to yank the rug out from under you.

I'd much rather be ill here in the UK, especially if I was poor, than in the USA.

Health care reform and payment is the real issue. (2, Interesting)

Samschnooks (1415697) | more than 5 years ago | (#27141759)

He brought up some interesting points. But the real problem with health care in this country has to do with the payment system. Here's an example on how to do it well: I don't know about your dentist, but mine informs me about costs upfront. I know how much something will cost and I can make the decision, based on his or another dentist's advice, on what to do and how to spend my money - which includes what my dental insurance eventually pays because I am the one paying the premiums after all and I am the one paying the co-pay.

Medical care, on the other hand, has an obfuscated price structure. Do you want to know how much something will cost? You can't find out. There's a price for the insurance company which is a trade secret [salon.com] , a cost for cash paying customers, and another cost for government. What really pisses me off is that there's a price to pay in cash, assuming the doctor won't cut you a discount, is MORE than the insurance price! The insurer will take their sweet ass time to pay the doc (I've seen over a year!) and yet, if I pay NOW, it costs more! I tell you doctors are pretty stupid when it comes to business!

Do you know who the true customer is? The one who pays. That's right! The insurance company is the REAL customer! They're the ones that the docs answer to: not us. That's why health care is so over the top! And the other thing is keeping folks alive for another month or so. My wife had an 89 year old patient who had a heart valve replaced. The doc who did it said that the patient will be gone in a couple of months because he was too old to handle the surgery - at a cost of tens of thousands of dollars to the tax payer. Why are we spending so much money keeping people who should be dead alive for a couple of more months? I'm not suggesting a Soylent Green scenario, but we have to face the facts of life that we can't live forever. Sure the doc could be wrong and that old guy could live to 100, but the odds are, he'll be gone and our health care costs continue to spiral out of control. I'm sorry for being callous, but I have a real problem with spending thousands and thousands of dollars on people who should be dead: they're too old, they lived hard (smoked, drank, fucked everything in sight, etc...)

Nope, IT is not going to help anything. We, as a society really need to reevaluate our priorities and and how we pay for our care.

Re:Health care reform and payment is the real issu (1)

be0wulfe (252432) | more than 5 years ago | (#27142001)

I agree and disagree with you! :)

You are SO right that the whole BUSINESS of healthcare is rotten because of exactly the picture you drew - well drawn.

However, I also disagree that IT is not going to help anything! Quite the contrary, IT, BETTER IT, will definitely help Healthcare out of the stoneage that it's at. When you can integrate better you can complete better. Offerings like carol.com are the tip of the coming iceberg unless the Obama Stimulus melts them. IT can certainly help bring transparency, cost-savings and competitiveness, but not alone no.

Re:Health care reform and payment is the real issu (1)

rattaroaz (1491445) | more than 5 years ago | (#27143973)

>and yet, if I pay NOW, it costs more! I tell you doctors are pretty stupid when it comes to business!

I do not think anyone would disagree with you on this one, but think about why it does cost more to pay cash. I'll give you a hint: many insurances still pay a percentage of billed charges, and any drop in billed charges = a drop in collected charges.

>I'm not suggesting a Soylent Green scenario ...

I think the problem is that, as a society, we have not decided who gets to live and who does not. Life is about probability, and medicine is no different. The real issue is value for the risk. In other words, if my probability of living 3 more days is one out of a million, but it costs me $0, them why not risk everything? Not my money! But what if living another 6 months, cost me $10 million? Is it worth putting several generations of my descendants out on the streets? Maybe, maybe not. Now the next question would be, what is the magic number where value and probability intersect? Once we decide that, as a society, I think we have our answer. No, we will never get the answer, and that is why we are in the mess we are in.

Health IT making right steps (1)

wally40 (991525) | more than 5 years ago | (#27141941)

Being someone that works in health IT, things are going in the right direction, much to what this article says. There are certifications for the software that state to be certified, compatibility must be included in the software including HL7 (Standards for electronic interchange of clinical, financial, and administrative information among health care oriented computer systems) www.hl7.org. The main certification for the software is CCHIT www.cchit.org. Our clinic has been on an EHR (which is CCHIT certified) for over 4 years. It began as proprietary software, but now with a little help from the software vendor, works very well. I will agree most started out not wanting to share data, but that was only because sharing the data was not a thought back when EHR's were started. PS - Just my opinion, most are now called EHR, Electronic Health Records. :)

Privacy protections are lagging (1, Informative)

Anonymous Coward | more than 5 years ago | (#27142013)

The privacy laws aren't anywhere close to where they need to be before this step is taken. Your data is going to be stolen/lost and resold. It is only a matter of time until it ends up in the hands of off-shore brokers who are beyond the reach of US "regulators".

With all of this information sharing, where is the protection for pre-existing conditions? People who have paid insurance their entire lives, then change jobs or move out of state and are denied coverage. Maybe because they simply forgot to disclose some conversation or question they asked their doctor. Humana applications go back FIVE years and they want to know everything you've ever discussed or asked your doctor about.

It is too easy for insurers to deny coverage in order to pump up quarterly profits.

Those issues need to be solved... along with the issue of who owns "my" personal information.

Re:Privacy protections are lagging (1)

Logic Worshiper (1480539) | more than 5 years ago | (#27143669)

The protection for pre-existing conditions was gone long ago. We have to fix the medical system, not the medical information system.

Meaningless rant (1)

zuperduperman (1206922) | more than 5 years ago | (#27142115)

I read all the way through this looking for a single line of content and found none. The author seems to be demanding that it be legislated that all health IT software be licensed under some obscure variant of the GPL that he personally favors. Regardless of what you think about Free software this point of view is completely bananas and makes no sense whatsoever.

IMHO, the only action the government actually needs to take is to mandate consumer access to health records in a standard format. It matters not which format or how good or bad it is. The minute universal access to health records is guaranteed in a fixed format there will be a health IT boom like never seen before as every existing and thousands of new companies spring up to support it, not to mention hundreds of open source offerings. The only thing the government should fund is an open source reference implementation that will kick things off and set a baseline for others to follow.

Re:Meaningless rant (1)

Boomerang Fish (205215) | more than 5 years ago | (#27142425)

And a minute later, some software company is "extending" the format because it doesn't let them include data from Blah in the format of BlahBlah usable by their blahblahblah equipment...

Standards are great, but a federally mandated standard is sure way to stifle innovation because it makes it difficult if not illegal to exceed the standard.

I've yet to go to a hospital and have them tell me the information sent to them from my previous doctor is unusable and they have to redo all my tests and throw out my previous medical history... otoh I'll admit I haven't had to go in often, so I can't comment on how big of a problem this might be... but I'll bet that for most of us, it isn't.

Standards evolve because they help the industry... if they haven't evolved, isn't it possible that the industry won't benefit from them? I mean I like a good industrial conspiracy as much as the next guy... but sometimes they're just a good bed time story...

--
I drank what?

Re:Meaningless rant (1)

Logic Worshiper (1480539) | more than 5 years ago | (#27143741)

The standard should be changeable to fit the circumstances, but any change to the standard should have to made on GPL, so others can read and modify the new standard.

Solutions, bit by bite (1)

josefrederick (1496601) | more than 5 years ago | (#27142465)

Ever thought of capturing data already generated by most of us who exercise? Why? To create a health platform with already existing technologies and allow those in better shape to pay lower insurance premiums, if any. This implies sharing information which yes, can be sensitive, but with proper regulation from Congress should not go astray. I am actually doing this experiment in (not the USA) but Spain, and of course I get NO support from insurance companies so far because as you all agree they have no interest in innovating given they have hoarded cash for decades without any questioning from the general public. But, slowly bite after bite I am creating a database that will be open and available to all insurance coÂs that will then have to lower premiums to thos e who are healthy or otherwise they loose the client. No need to invent anything today. Just apply what we have, which is far too much in terms of IT and R&D in this HIT world. ;-)

Dr. Valdes, ... (1)

ninjagin (631183) | more than 5 years ago | (#27142559)

It sounds like you're being ignored because you're coming off as bombastic and shrill.

I have no doubt that you feel passionately about patient care, open source software, open standards, EMR and the range of other issues that come into play, but I also get the sense that you're unlikely to change your position or find a middle path, given that large healthcare companies already occupy a lot of the thought-space. As I listen to you, I get the sense that you see the pool as having already been peed in, and made unfit for you at the outset.

First: Open source software is great for some things, but when it doesn't work, you have nobody to sue.

As for the assertion that healthcare IT companies get their certifications because they have "purchasing power", I fear you are misled. Getting your software to meet the certification requirements, and doing that safely, securely, and in such a way that privacy is assured, is a very long and complex process that takes hundreds of thousands of engineering hours over the course of YEARS. It doesn't come by writing some check. There's a lot of hard work, and a lot of testing and evaluation that takes place. Only the big players have the resources to do that, and do it quickly, admittedly.

The notion that performance can only be judged by having non-proprietary EMR is also a red herring. Clinicians and administrators are able to gather and assess their own metrics to ascertain the quality of adoption and performance. Granted, open (and secure!) EMR standards are desirable and we're not there yet, but the lack of open standards at this time is no direct impediment to assessing performance of Healthcare IT at the hospitals, clinics and offices where it is being used.

I hope that you continue to shake things up, and I have a feeling that you will.

The TFA doesn't seem to have noticed... (2, Informative)

Ironica (124657) | more than 5 years ago | (#27142767)

Page 488 of the ARRA [loc.gov] :

(b) STUDY AND REPORT ON AVAILABILITY OF OPEN SOURCE HEALTH INFORMATION TECHNOLOGY SYSTEMS.
(1) STUDY.
(A) IN GENERAL. - The Secretary of Health and Human Services shall, in consultation with the Under Secretary for Health of the Veterans Health Administration, the Director of the Indian Health Service, the Secretary of Defense, the Director of the Agency for Healthcare Research and Quality, the Administrator of the Health Resources and Services Administration, and the Chairman of the Federal Communications Commission, conduct a study on -
(i) the current availability of open source health information technology systems to Federal safety net providers (including small, rural providers);
(ii) the total cost of ownership of such systems in comparison to the cost of proprietary commercial products available;
(iii) the ability of such systems to respond to the needs of, and be applied to, various populations (including children and disabled individuals); and
(iv) the capacity of such systems to facilitate interoperability.
(B) CONSIDERATIONS. - In conducting the study under subparagraph (A), the Secretary of Health and Human Services shall take into account the circumstances of smaller health care providers, health care providers located in rural or other medically underserved areas, and safety net providers that deliver a significant level of health care to uninsured individuals, Medicaid beneficiaries, SCHIP beneficiaries, and other vulnerable individuals.
(2) REPORT. - Not later than October 1, 2010, the Secretary of Health and Human Services shall submit to Congress a report on the findings and the conclusions of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.

I'm planning on using this to justify why we're applying for ARHQ research funding for implementation of a non-CCHIT certified product... we're just trying to help them research open source options. ;-)

$30 billion (0)

Anonymous Coward | more than 5 years ago | (#27142901)

"...the nation will spend $30 billion on Health IT..."

Couldn't people just make medical reports with vi and latex? That would be cheaper I think.

Translation Please? (1)

thethibs (882667) | more than 5 years ago | (#27143551)

This article is not in any dialect of english that I know of. Can anyone out there translate this for us?

HL7? Anyone? (0)

Anonymous Coward | more than 5 years ago | (#27143601)

Apparently, despite writing for a site dealing with medical technology, and ranting on about the lack of openness in EMR, the author of the article has never heard of HL7 [hl7.org] . That is, an open ANSI-standard EMR platform that has been around since 2003. Oh, but I'm sure that doesn't relate to the article.

Or would the fact that most medical records HAVE to be in a non-proprietary format since they must be passed between so many systems that are operating in a Hospital. Do you think one single proprietary software application handles all of the different departments, plus billing, plus insurance, plus pharmacy, plus the lab tests and results, etc? Most hospitals use different software to cover each phase and shift data between each application's database, or use HL7 to pass them as messages.
Even the large software applications which handle everything pass data through HL7. I know.. I've worked with many of the top ones.

If it's made with public money it should be GPL (1)

Logic Worshiper (1480539) | more than 5 years ago | (#27143707)

even if making the program was contracted out. The public deserves that kind of accountability, and other corporations deserve the ability to compete they'll only have when it's not a proprietary system.

Open Source medical software in Canada (2, Interesting)

kbahey (102895) | more than 5 years ago | (#27143725)

I recently got delayed in an airport, and sat next to a Canadian doctor.

The discussion led to what I work with and hence Open Source. He said that doctors in Canada use open source software. So I looked it up and found OSCAR [oscarcanada.org] which is indeed open source.

No proprietary lock-in for formats, no vendor lock in, and minimal costs.

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