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Health Care Providers Failing To Adopt e-Records, Says RAND

samzenpus posted about 2 years ago | from the there-are-no-bad-ideas dept.

Software 228

Nerval's Lobster writes "Back in 2005, RAND Corporation published an analysis suggesting that hospitals and other health-care facilities could save more than $81 billion a year by adopting electronic health records. While e-records have earned a ton of buzz, the reality hasn't quite worked out: seven years later, RAND's new study suggests that health care providers have largely failed to upgrade their respective IT systems in a way that allows them to take full advantage of e-records. Meanwhile, the health care system in the United States continues to waste hundreds of billions of dollars a year, by some estimates. 'The failure of health information technology to quickly deliver on its promise is not caused by its lack of potential, but rather because of the shortcomings in the design of the IT systems that are currently in place,' Dr. Art Kellerman, senior author of the RAND study, wrote in a Jan. 7 statement. Slow pace of adoption, he added, has further delayed the productivity gains from e-records."

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Not so fast (5, Interesting)

TheRealMindChild (743925) | about 2 years ago | (#42586023)

It has been my experience that every health care provider that I have dealt with that offers electronic records, also charges you an "administrative fee" to get a copy of said records at over $1 per page (regardless if it is an electronic document emailed to you).

Need an example? Altoona Regional Health System [altoonaregional.org]

Re:Not so fast (1)

Synerg1y (2169962) | about 2 years ago | (#42586345)

That administrative fee is just that, administrative, somebody has to go get the document and email it to you. I don't think there's any fully automated secure HIPAA compliant self-retrieval system out there. Charging on a per page level is just an aspect of business and is like one of those $100 to email zutterberg type things to prevent abuse of the system. I'm not exactly quite sure who owns your medical records though, or if there's a free way to get at them, maybe in the non-electronic realm.

Re:Not so fast (2, Insightful)

Malenx (1453851) | about 2 years ago | (#42586473)

HIPPA states providers can charge up to x dollars per page for records requests.

Re:Not so fast (0)

Anonymous Coward | about 2 years ago | (#42587225)

Well, in my experience I just nicely asked the technician if I could have a copy of the ~half a gigabyte CT scan of my lower back, and they gave it to me. It was very cool to be able to look at the data at home (there are free programs and one was included on the disk too), understand the basics of what was going on (it was freaking obvious something was amiss even to a non-doctor), and then go to the doctor, who had already received the file electronically as well (almost everything is sent/stored/retrieved that way), and talk about the medical issue and treatment together after seeing the actual data. The same thing happened when I had a retinal scan one time -- I asked for a copy of the data, and they just gave it to me. No questions, no charges.

Apparently experience varies widely.

I don't know if it matters, but I'm in Canada. Records keeping does cost a significant amount of money, and it has to come from somewhere. It's not "free". At best it is "already paid for". A human still has to retrieve the record even to e-mail it, and network and computers costs money too. Even if they aren't in it for profit, scaling the revenue with the number of requests does make sense, although $1/page seems rather excessive.

We can trade fraud, waste, and abuse for ID theft? (3, Funny)

Bodhammer (559311) | about 2 years ago | (#42586025)

Because the credit card companies have done such a good job with information protection...

Re:We can trade fraud, waste, and abuse for ID the (5, Interesting)

Frobnicator (565869) | about 2 years ago | (#42586149)

My physician's office explicitly tells me why they stick with paper-only records: They don't want to deal with the data security mess. They are a medical office, not an IT shop.

Amazingly after all these years on paper records, I don't get double-billed, I've never had a problem between them and the insurance company, and they manage to handle my billing in a timely manner.

Go figure.

Re:We can trade fraud, waste, and abuse for ID the (4, Informative)

xSauronx (608805) | about 2 years ago | (#42587315)

There are a ridiculous number of emr systems out there, several with available 3rd party support to manage your IT setup, and some that will offer a VPN or secure citrix environment to work in.

I worked as an intern in IT for a large medical group a couple of years ago, and the consulting firm i work with now does a lot of support for just clinics/doctor offices and the IT aspect alone is expensive. In particular we help them upgrade IT infrastructure in a clinic so they can go live with their central EMR system.

there are workflow assessments to be done, and IT assessments to be done. We charge $95/hour per person, i can spend 3 - 8 hours doing an assessment and documentation for an office. They have staff to do the workflow assessments. We have assessed and rolled out 40+ offices in the last 12 months.

There are PCs to buy (Figure ~1 grand each, though they use thin clients now and again....just not often) and even a small clinic may need 6, a large one may need 30 or even more. Dont forget printers, patients are required to receive after visit summaries from their providers. and a couple of scanners for each clinic.

There is cabling to run...a lot of older buildings have zero cat5/6 wiring so that can be expensive.

there is networking equipment to buy (switches and wireless APs)

there is bandwidth to pay for (most clinics for this group have metro to get them to the main IT office)

there are laptops to buy (often with rolling carts for mobility/convenience)

sometimes we install mounts for the desktops in patient rooms.

there is labor required to image and prep the PCs and laptops, and labor required to roll them out and train the users on the very basic IT concepts they need.

There is training needed to prep users for the EMR system and massive training to get into details and customize the EMR system for a practice or provider.

I don't want to know what the average cost is to take a clinic live with EMR for this group. I know we billed out $300k in IT and cabling services last year, so thats several grand per clinic, minimum, in IT support. nevermind the emr staff and all of the equipment needed. Then the follow up IT support for misc PC issues, misc EMR issues, misc printing issues.

Some clinics already had a 3rd party supported EMR system that got replaced, but they have to keep it available for years. some of them were on their second system before we took them live on the new one...i have no idea how the very first one is supposed to get supported as legally required, but they were told to keep vendor support for anything they can as long as legally required because the medical group cant support anything but their own system.

for some clinics its a nice, welcome change. for some they equate to some level of hell. for everyone clinic there is a pretty serious cost to consider, and a lot of clinics had a very old or limited IT infrastructure to support what they already had.

Quality of Care (3, Interesting)

ZombieBraintrust (1685608) | about 2 years ago | (#42586233)

Quality of care is also important. I have a relative with a mental illness. Occassionally they need to be confined to a hospital. Everytime they go in, the hospital doesn't have their records. This means the doctors start from scratch each time. They start off with the same treatment that doesn't work. They then rerun the same tests and experiment to find a treatement that works. 3 or 4 days to get records is a long time.
If I call the hospital to speak to my relative my call is forwarded to a nurses station. That station then looks up the patient list on paper and if my relative is not found they forward my call to a different station. After 3 or 4 forwards I get my relative. Some hospitals in the USA are still in the 1980s.

Re:Quality of Care (1)

greatcelerystalk (981442) | about 2 years ago | (#42586577)

I don't know if there are some EMR exemptions/waviers for psychiatric hospitals or not. I recently had a relative re-enter a private psychiatric facility, and they also had no record of previous admissions.

As a healthcare provider working in critical care I am a bit gobsmacked. I can easily go back 5-10 years on most of my patients if I have a justified medical need to do so, so I am not certain why psychiatric facilities are not on-board with tracking patient history.

Upgrades aren't cheap (4, Insightful)

jdastrup (1075795) | about 2 years ago | (#42586029)

I support several small medical practices. They don't (or say they don't) have enough money to upgrade their systems. Like any small business, potential savings in the future don't always translate to extra income now. New systems are expensive and often included monthly fees from the software providers. In addition, if their analog, handwritten system has been working for decades, there's not a lot of incentive to switch.

Re:Upgrades aren't cheap (3, Insightful)

Scutter (18425) | about 2 years ago | (#42586099)

It's not just that. It's that there are so many different systems out there, and even with standards for treatment and diagnosis codes getting systems to talk to each other can be a major challenge. Frequently, even between different departments in the same hospital, you'll find different systems. You'll see care givers re-entering the same information into each one.

Re:Upgrades aren't cheap (4, Insightful)

tepples (727027) | about 2 years ago | (#42586119)

Then why not just adopt the VistA system developed by the US Department of Veterans Affairs for use by veterans' hospitals? Like all other works of the United States Government, it's public domain.

Re:Upgrades aren't cheap (5, Insightful)

realmolo (574068) | about 2 years ago | (#42586179)

That would be a good idea. But you know why it doesn't happen?

Because the various competing "e-record" systems providers don't WANT an open standard. There is FAR more money to be made in proprietary systems, and expensive "translation layers" to talk to OTHER proprietary systems.

Basically, we don't have e-records because the healthcare system in this country is riddled with greed. Efficiency and quality are NOT a priority, and in fact, are generally DISCOURAGED.

Re:Upgrades aren't cheap (0)

Anonymous Coward | about 2 years ago | (#42586267)

This is a bad theory. You know why? Because all the so-called "ungreedy" health care systems that you are probably pining over don't have consistent medical records either. In fact, the NHS uses many of these proprietary American EMRs you are complaining about. Is it because of greed?

Re:Upgrades aren't cheap (2)

modmans2ndcoming (929661) | about 2 years ago | (#42586655)

Part of the meaningful use standards requires hospitals to implement data exchanges so the information can be requested from other health systems in near real time.

Re:Upgrades aren't cheap (2)

peragrin (659227) | about 2 years ago | (#42586877)

hahahahahahahahahaha

you think standards allow for data exchanges. That is so funny. when every standard is backed by massive patents that are only partially shared.

I look at it this way. it has taken nearly 20 years for software companies to design decent POS software. Even at that there are many on the market today with features that are just plain stupid. Go swipe your debit/credit card at a gas pump, grocery store, etc. how many different button options are available? does it take debit first or credit? how do you decline a debit transaction into a credit one? This is a simple piece of software that every manufacturer does differently and it makes you have to stop read and interpret the User interface for EVERY device you use every time you use it.

  E health care records have another 10-15 years to go before they will become useful. Because that is how long it will take the software engineers to figure out how to duplicate the existing paper records.

Re:Upgrades aren't cheap (1)

modmans2ndcoming (929661) | about 2 years ago | (#42587091)

sorry...I meant requirements...Meaningful use is not a standard....

Re:Upgrades aren't cheap (1)

timeOday (582209) | about 2 years ago | (#42587001)

That answer is too easy. Look at what actually happened in the UK [wikipedia.org] when they tried to consolidate records for their single-payer system:

Originally expected to cost £2.3 billion (bn) over three years, in June 2006 the total cost was estimated by the National Audit Office to be £12.4bn over 10 years, and the NAO also noted that "...it was not demonstrated that the financial value of the benefits exceeds the cost of the Programme"....

While the Daily Mail announced on 22 September 2011 that "£12bn NHS computer system is scrapped...",[5] The Guardian noted that the announcement from the Department of Health on 9 September,[6] had been "part of a process towards localising NHS IT that has been under way for several years".[7] Whilst remaining aspects of the National Programme for IT were cancelled, most of the spending would proceed with the Department of Health seeking for local software solutions rather than a single nationally imposed system.[8]

In other words, they backed down from a single, unified solution, after spending 5x what they thought it would cost when they set out.

I really don't understand it. You would think by now there would be affordable out-of-the-box solutions, akin to QuickBooks.

Re:Upgrades aren't cheap (0)

Anonymous Coward | about 2 years ago | (#42586217)

One size does NOT fit all. How does it handle medication doses? Can it calculate the correct amount of a drug to give an infant vs. an overweight man? How long does it take to schedule/admit a patient and page out for an emergency CT scan? Health care isn't just "I have a headache" you know...

Bariatric more likely than pediatric (1)

tepples (727027) | about 2 years ago | (#42586319)

Anonymous Coward wrote:

Can [VistA] calculate the correct amount of a drug to give an infant vs. an overweight man?

I don't know much about the pediatric capability (or lack thereof) in VistA. But I imagine that there are plenty of fat veterans, especially given the "diabesity" epidemic that's comorbid with "affluenza".

Re:Upgrades aren't cheap (1)

Goose In Orbit (199293) | about 2 years ago | (#42587113)

That's what rule-based systems are for...

I was working with one 20 years back, so they must have come on a fair way since then

Re:Upgrades aren't cheap (1)

Anonymous Coward | about 2 years ago | (#42586185)

HEAR HEAR!! Nice to see fellow members of the trenches commenting. Upgrading a critical system just because it's older is not always the best option.

Re:Upgrades aren't cheap (1)

Billly Gates (198444) | about 2 years ago | (#42586653)

It is called EPIC. That is the big one most hospitals are switching too they can do it all. The technology exists and in this case it makes an ROI to cut on costs and labor.

Re:Upgrades aren't cheap (0)

Anonymous Coward | about 2 years ago | (#42587059)

Epic is a costly mistake, the organization I work for was 100 million behind on billing in the first 6 months after epic roll out. They delayed physician payment because of it.
oh and one other thing, when it breaks it is a disaster (try and manage a patient when you cant access their records and they expect that their meds and chronic conditions are "in the computer".

Re:Upgrades aren't cheap (0)

Anonymous Coward | about 2 years ago | (#42587069)

But Beaker still doesn't do everything it should do.

Re:Upgrades aren't cheap (0)

Anonymous Coward | about 2 years ago | (#42586261)

Not mention because of HIPAA medical IT systems have to be substantially higher security than the IT systems of similarly sized businesses. Then add all the liability costs the software manufactures have. Its completely un-affordable to small to mid sized practices.

Re:Upgrades aren't cheap (1)

Billly Gates (198444) | about 2 years ago | (#42586613)

I support several small medical practices. They don't (or say they don't) have enough money to upgrade their systems. Like any small business, potential savings in the future don't always translate to extra income now. New systems are expensive and often included monthly fees from the software providers. In addition, if their analog, handwritten system has been working for decades, there's not a lot of incentive to switch.

According TFA "United States continues to waste hundreds of billions of dollars a year". Again it is the corporate excuse of looking good on an asset Excel spreadsheet so the beancounter can get his bonus while being penny wise, but dollar foolish.

There is a cost and NO it is NOT A cost center in this scenario as it saves money. No such term as a savings center.

In the good old days IT were the guys to save money and streamline business processes. Now it is the foul cost that needs to be contained and distracting of the real value of pinching pennies. It sounds like hospitals have inadaquite MBAs in addition to inadaquite IT departments as they refuse to see the big pictures.

Every hospital I have ever been too still uses IE 6 as well but at least there is a solid reason if they have $300,000 MRI scanners that people want to browse facebook with a more modern browser.

Re:Upgrades aren't cheap (1)

Charliemopps (1157495) | about 2 years ago | (#42586859)

exactly. It's easy enough for a major HMO in a large city to adopt a new system like this. But in a town of 5000 and a local Doctors office? No way in hell is this cost effective. There's a reason large HMOs don't have offices in towns like that. I think one of the biggest problems we have in this country is that we continue to elect people to office that have never lived in a small town, and have no idea how those towns work. Yet, the majority of this country is made up of small towns.

Meanwhile in France... (-1)

Anonymous Coward | about 2 years ago | (#42586033)

Yeah, that's right, suck it dude, the Cheese-eating Surrender Monkeys did it first.

Have a Bagette and a Beret.

Will the e-records... (1)

Fallingcow (213461) | about 2 years ago | (#42586037)

... help them actually code procedures correctly for insurance, and maybe assemble one whole entire bill without committing at least one major error, and to stop sending me bills that I shouldn't have gotten at all then telling me to just ignore it when I call?

Because not having to call someone—usually more than once—to get the hospital's billing fuckups fixed after a majority of visits would be awesome.

Re:Will the e-records... (2)

nefus (952656) | about 2 years ago | (#42586159)

It's been my experience that requiring e-records in the office have actually increased the number of items that get billed. The charges are higher than they have before simply because the physicians must record everything now as a bill-able item. No more freebies from your doctor. They have to itemize every medical issue you ask about now. I support a bunch of offices and it's happening in 100% of the offices. Ironically the doctors hate it because they spend all their time looking at a screen entering data rather than paying attention to you. Plus the fact that the software was designed by engineers who haven't spent a lot of time with physicians doing those jobs. Previously 1 lab report on a sick patient now could turn into 15 separate actions that have to be done one at a time. So much for your doctor having time to spend with you.

Re:Will the e-records... (1)

bbelt16ag (744938) | about 2 years ago | (#42586573)

hmm, perhaps TTS AI that can encode those into the DB would be beneficial.. There is no reason for the man to do what the machine can almost do better. We need to be focusing on making systems that for work the consturct of our world not against it. They should do it better then we can error free or they are not worth their weight in salt.

Re:Will the e-records... (2)

modmans2ndcoming (929661) | about 2 years ago | (#42586637)

If they are build right... absolutely...The two dominant systems (Epic and Cerner) and only as good as the people who installed it for the facility.

Are you kidding me? (5, Insightful)

Synerg1y (2169962) | about 2 years ago | (#42586093)

I'm contracting in the industry right now, and... The problem with e-records is draconian HIPAA [aafp.org] requirements. Also all our systems have to be able to pass an audit by the FDA, meaning if I add a piece of javascript to check for numerics... re-validation! I'm not saying the government should back down, medical records need to be private, but they've got IT management and senior staff here trembling at the mention of their existence. Supposedly, it's kept the main production system from being update for the last couple of decades or so simply because nobody wants to take on the responsibility of potentially getting the business shut down... then again that's operations, and they can be a bit dirka dir, but it's definitely a problem from both sides of the fence.

Re:Are you kidding me? (0)

Anonymous Coward | about 2 years ago | (#42586253)

The FDA has been very sketchy about their definition of a Medical Device Data System and the requirements for testing and validation of FDA regulated 510k software

This has kept a large number of potential competitors out of the market and has allowed a small number of existing players to dominate it

The lack of competition has led to the proliferation of existing closed systems and does nothing to promote new systems that could make use of methods to encourage data exchange

If I am working with a common system such as Oracle EAS, I have a dozen methods to write out data and import it, from APIs to XML gateways, if I am working with an FDA 510k system, the vendor literally locks me out of the system and provides no methods to either query or load data

Re:Are you kidding me? (2)

modmans2ndcoming (929661) | about 2 years ago | (#42586601)

The data exchange standard that is used for medical device integration is called HL7.

Re:Are you kidding me? (0)

Anonymous Coward | about 2 years ago | (#42587117)

That is just a specification. When I first looked at it, it was more of a data spec and even then it was very weak in its handling of 'donor' data

Where I live is at the implementation end and I can attest that the hoops that you need to get through are vast and worrisome to most organizations

Take for instance the use of a content management system to allow for the storage and retrieval of information... seems simple, huh

Well, what if ANY of that data MIGHT be used in the future to make a medical decision... well hell, that's a MDDS, and as regulated software you need to follow the FDA 'guidelines' for validation

And just in case you have never read FDA 'guidelines', they are more akin to a pirate's map than anything... they lead you into a general direction, and then you are left to create a viable methodology on your own, or hire some company who claims to have done this before, only to find that they cannot even answer direct questions with a yes or no and fall back on piling on even more BS just to pull CYA in case the FDA comes in for an audit

So, mod, your answer was trite at best and I hope that you actually do get to 'have fun' with the FDA in the future

Re:Are you kidding me? (2)

jbmartin6 (1232050) | about 2 years ago | (#42586539)

Not all systems require FDA validation, only those classified as 'medical devices', which sadly includes EHR systems. Anything that is used by a doctor to make a treatment decision. You are free to do whatever you like with your Exchange servers.

Re:Are you kidding me? (1)

Synerg1y (2169962) | about 2 years ago | (#42586707)

So... it's EHR systems and systems that use those systems, anything that handles customer data basically... for us that's most of our systems, does it send an email to the customer? regulations! Exchange, active directory, & stuff like terminal services have nothing to do with the EHR whatsoever. I also wonder how close HIPAA requirements came to requiring encrypted emails for EHR data.

Re:Are you kidding me? (1)

tlhIngan (30335) | about 2 years ago | (#42586845)

So anything a doctor uses to make a treatment decision must be FDA validated. Which also includes the EHR system because the doctor needs to know the medical history as well as any drugs or other things you're taking (your chart is part of the EHR)....

Re:Are you kidding me? (1)

modmans2ndcoming (929661) | about 2 years ago | (#42586615)

FDA only needs to be involved is a small set of use cases.

Re:Are you kidding me? (0)

Anonymous Coward | about 2 years ago | (#42587145)

FDA can audit any damn this that they want if you are using regulated systems, don't fool yourself

Re:Are you kidding me? (0)

Anonymous Coward | about 2 years ago | (#42586725)

Your subject line is an excellent reply to this whole line of nonsense. As stated many times here and elsewhere by many different people: there is not now, never has been and never will be such a thing as a "secure server" and especially not on the internet! Medical records are likely better off buried in some filing cabinet in your doctor's office or, in some cases, in a furnace.

Re:Are you kidding me? (1)

Paleolibertarian (930578) | about 2 years ago | (#42586727)

A sure way to screw up a system is to cede control to the government.

I consult with 2 medical clinics which will be implementing EMR this year. I'm sure to make a lot of money but I'm not looking forward to it.

The Veterans Administration uses an EMR system with the odd acronym of VISTA. There could be a clue there somewhere.

Re:Are you kidding me? (1)

Goose In Orbit (199293) | about 2 years ago | (#42587155)

Odd? Do some bleeping research...

VistA = Veterans (Health) Information Systems and Technology Architecture

It never ends (1)

NMBob (772954) | about 2 years ago | (#42586129)

And as soon as a provider gets their system updated it will be out of date. Think this is another 'follow the money' idea?

Not all IT created equal (1)

Anonymous Coward | about 2 years ago | (#42586137)

Working for a health care company that has had an EMR since 2004, it's not a matter of just upgrading their systems. Yes, many smaller health care IT shops didn't plan or have the talent to build accordingly but that's not the only reason they have not moved to EMR.

State, county and yes even Federal regulations have a lot to say for what you can and cannot do. There's this little thing called HIPAA which highly regulates what can and can't be done in regards to access to records. Medicare/Medicaid reimbursals still require us to use a DOS/Windows NT system to submit for reimbursement, because the system at the state's end has not been upgrade. That's not something we can just arbitrarily upgrade/replace.

New provider applicaton/submission? Fax the form over. Why? State regulations specifically list email as unacceptable, it's not "secure", but a phone number on an analog line is. All this article says to me is "flame bate"

Frankly the software stinks (4, Interesting)

banbeans (122547) | about 2 years ago | (#42586157)

I am involved as a consultant to several practices and frankly the software stinks.
Buggy, incomplete, error prone, and over priced.
If I had a nickel for every time I have been told it will be fixed in the next release I would be a millionaire.
I feel sorry for the medical professionals who have to deal with the garbage software on a day to day basis and the consumers who get sub-par service both medical and billing because of it.

One example is:
If one thing is billed another is automatically added to the bill because they were often used together.
The problem: They are no longer recommended to be used together as a better and cheaper test has replaced one of them.
A year and a half later the problem is still in the software and if someone forgets to manually remove it the insurance rejects payment and the patient gets a bogus bill for several hundred dollars.

Re:Frankly the software stinks (2)

sribe (304414) | about 2 years ago | (#42586197)

Yep, most of it stinks. In fact, if you google a bit it's not hard to find studies showing much revenue drs lose in the first year or two of using electronic medical records. That's right, they lose money, because they see fewer patients, because the software slows them down enough to have a material effect on their productivity.

There's a morass of reasons why the software evolved to be so user-hostile--way more than I'd go into for a /. post. But I will say that now federal regulations will prevent any substantial progress in the near future...

Re:Frankly the software stinks (1)

modmans2ndcoming (929661) | about 2 years ago | (#42586579)

have you worked with Cerner or Epic? both systems allow health care systems to achieve HIMSS level 7 fairly quickly with very little effort.

Epic is CRAP! (0)

Anonymous Coward | about 2 years ago | (#42586873)

Epic is a useless sack of crap, it is clearly designed to make practicing medicine an unlivable hell, it is also clearly set up to make communication with other Physicians miserable. Epic is designed for managers to get incentives and for billers to optimize billing. It is also designed to punish Physicians.

Re:Epic is CRAP! (1)

modmans2ndcoming (929661) | about 2 years ago | (#42587075)

Spoken like someone who has not used the system since 2004 and implemented by idiots.

Re:Frankly the software stinks (2)

sribe (304414) | about 2 years ago | (#42587127)

have you worked with Cerner or Epic? both systems allow health care systems to achieve HIMSS level 7 fairly quickly with very little effort.

Well, I guess I know who's a consultant, eh? Yeah, because substituting jargon like "HIMSS Level 7" in place of any meaningful discussion regarding the speed and effectiveness of the software's user interface is just classic consultantese bullshit.

FYI, I have developed a custom--yes that's right a true one-off--EMR for a particular clinical specialty operating in a medical school/hospital environment. We stopped adding paper to charts and creating new paper charts in 2007 (IIRC), scanned and put all the active charts in storage in 2010. So I do know a little bit about this stuff ;-)

Re:Frankly the software stinks (1)

bbelt16ag (744938) | about 2 years ago | (#42586593)

maybe you should make a bussiness to solve this problem? band together those doctors you know with their 100k salaries and some investors and then get your team together.

Re:Frankly the software stinks (1)

flibbidyfloo (451053) | about 2 years ago | (#42586697)

Is this a chicken or egg problem? Providers don't switch because the software is overpriced and crappy, and the software is that way because there's no competition, and there's no competition because not enough providers are switching?

Sounds like Linus Torvalds, Apple, and Microsoft need to get in a development war in the healthcare space so we can get some decent software :)

Re:Frankly the software stinks (0)

Anonymous Coward | about 2 years ago | (#42586875)

What's the name of the software?

Follow the MONEY (4, Informative)

Anonymous Coward | about 2 years ago | (#42586205)

"RAND’s 2005 report was paid for by a group of companies, including General Electric and Cerner Corporation, that have profited by developing and selling electronic records systems to hospitals and physician practices. Cerner’s revenue has nearly tripled since the report was released, to a projected $3 billion in 2013, from $1 billion in 2005."

I think part of it (3, Insightful)

kilodelta (843627) | about 2 years ago | (#42586221)

Is due to the fact there's no standardization for medical records from hospital to hospital. To accomplish it we first need to nationalize and unify every hospital in the United States. I use the VA Hospitals as my model. They have electronic record interchange already.

Then you can use best practice to standardize all procedures from actual medical procedure to operational procedure and everything in between. Then once you've nationalized the hospitals, setup several NATIONAL universities that grant M.D.'s and integrate the training.

Re:I think part of it (2)

Bremic (2703997) | about 2 years ago | (#42586351)

More than this when I was dealing with a hospital with IT, they had a policy of "nothing critical exists unless it is on paper." Apparently they once had a system crash while trying to get information about medication for a patient, and they stopped using their eRecord system overnight.
Blue Screen of Death isn't funny when it could cause an actual death.

Re:I think part of it (1)

kilodelta (843627) | about 2 years ago | (#42586397)

That's all fine and good but there are ways to make the data redundant. That's what databases do son, plus you can make replicas, use commit/charge etc.

Re:I think part of it (1)

Synerg1y (2169962) | about 2 years ago | (#42586611)

So either the server failed, or the data in the database was missing / corrupt. He said crash implying a software bug... rolling back the database: not an option. If they didn't have failover in place that can get into regulations real quick, but sounds like a software bug, not acceptable in a medical system.

Re:I think part of it (1)

modmans2ndcoming (929661) | about 2 years ago | (#42586553)

Epic and Cerner are the two EHRs that are getting deployed by most health systems in the US...There is already a working exchange on a common data request (not HL7's joke of a data interface) that both of those systems support.

Re:I think part of it (0)

Anonymous Coward | about 2 years ago | (#42587373)

I have privileges at one system (hospital) and work at another (clinic) both use epic hyperspace (one chart). Guess what, when a patient follows up from one at the other, we have to get records faxed over to see them. (then the records get scanned in). Even with two health systems using Epic. Epic is a steaming pile of shit, as a physician I recommend against using it!

Re:Not even intra-hospital standardization (1)

lbates_35476 (901961) | about 2 years ago | (#42586557)

At the hospital I use (fairly large regional hospital), they don't even have electronic standardization between different departments. They keep asking the same questions over, and over, and over... and often I'm not in the system when they send me to another department so I have to fill out another personal health history. I don't believe there is ANY incentive to get this properly implemented between practices (General Practitioner -> Specialist, etc.) because there are too many proprietary systems out there that don't share data.

Re:Not even intra-hospital standardization (1)

kilodelta (843627) | about 2 years ago | (#42586711)

And it isn't just hospitals. Even school system record keeping is all over the place. A friend of mine is head shrink at a school. He laments the database conversion done where they assured him everything would be fine only to find a lot of data just missing.

To the point where they want me to re-engineer their old app and add some functionality to it.

Re:I think part of it (1)

modmans2ndcoming (929661) | about 2 years ago | (#42586561)

BTW... the VA just signed a contract to deploy Epic as their EHR.

Re:I think part of it (1)

TheTerseOne (2447418) | about 2 years ago | (#42587119)

Citation?

Re:I think part of it (0)

Anonymous Coward | about 2 years ago | (#42587041)

HL7 is pretty standard.

Follow the MONEY (0)

ChatWithaNinja (931013) | about 2 years ago | (#42586239)

"RAND’s 2005 report was paid for by a group of companies, including General Electric and Cerner Corporation, that have profited by developing and selling electronic records systems to hospitals and physician practices. Cerner’s revenue has nearly tripled since the report was released, to a projected $3 billion in 2013, from $1 billion in 2005."

Re:Follow the MONEY (0)

Anonymous Coward | about 2 years ago | (#42586603)

Well in their defense, HIPAA's requirements are driving the adoption of HIS in massive numbers, not to mention the fact that there are federal dollars on the table for demonstrating meaningful use. I guess my point is, Cerner was set to make a pretty penny with or without that report.

E-Health? (1)

DavidClarkeHR (2769805) | about 2 years ago | (#42586285)

If want to see a terrible example of electronic document conversion, google e-health ontario. Between government incompetence and contractor dishonesty, we ended up (as a province) spending millions in order to get ... nothing.

And that's with ONLY 13 million people.

Needs a better reason (1)

vlm (69642) | about 2 years ago | (#42586299)

could save more than $81 billion a year by adopting electronic health records

Needs a better reason. You'd pay anything for your health, right? And with the miracle of insurance you don't have to pay anything at all...

So why would patients or hospitals be even remotely interested in this?

Re:Needs a better reason (2)

AwesomeMcgee (2437070) | about 2 years ago | (#42586419)

Hah don't have to pay anything at all. Clearly you've never seen a medical bill. Get real, it's more accurate to say, you don't get to choose whether or not you pay due to insurance, so why is the health establishment going to bother? They make an absolute killing already, they have no interest in risking any of their huge profits on projects that don't have guaranteed measurable yields such as all IT projects; predictability is near none. So they stick with the predictably enormously rising prices they keep charging for health care. 81 billion dollars a year? HAH. Drop in the bucket. To that industry billions are as good as pennies.

Re:Needs a better reason (0)

Anonymous Coward | about 2 years ago | (#42586629)

Uh, because if it's true, hospitals can reduce their cost and increase their margin? They don't have to lower prices to consumers or the insurance carriers. They can just put the difference in their pocket.

There really is no benefit (5, Insightful)

Anonymous Coward | about 2 years ago | (#42586371)

I am a physician and operate a small practice. The issue for my practice is simply the cost. To make the switch I will have to invest thousands in IT upgrades, and pay thousands of dollars every year for the privilege of continuing to use the software. Further, if this slows me down to the point that I see one fewer patient per day, it will cost me an additional $10,000+ per year in lost revenue. I'm sure an EMR would streamline things for insurance companies, but my practice will see none of the benefits. I feel I provide high quality care with my current system and I don't believe a different record system will improve that. At the end of the day, switching to an EMR means a huge paycut with no improvement in patient care. I just don't see how that makes sense.

Re:There really is no benefit (2)

modmans2ndcoming (929661) | about 2 years ago | (#42586523)

how much will you lose in medicare reimbursements in 2015 if you do not make your meaningful use deadline?

Re:There really is no benefit (0)

Anonymous Coward | about 2 years ago | (#42586853)

Most doctors are dropping medicare patients as quickly as they think they can get away with it because in many cases it costs them money to see the paitent by the time medicare actually pays them. If it becomes know that not having an EMR means they can't take medicare patients then I would think a lot of them would toss out any existing EMR and use that as an escuse.

Medicare [physicianspractice.com]

So you think you are being cute, but in reality you are describing a wanted feature of not having an EMR. Don't worry, I'm sure the thousands that have already dropped Medicare are just outliers and there won't be more in the future.

meaningfull bullshit (0)

Anonymous Coward | about 2 years ago | (#42587291)

large organizations force their physicians to lie to meet meaningful use criteria (such as after visit summaries). (small organizations will also arrange data to meet these criteria.)
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html
I was forced to sign my right for my organization to obtain the meaningful money, I am still liable at the end of the day.

Re:There really is no benefit (0)

Anonymous Coward | about 2 years ago | (#42586829)

I am a physician and operate a small practice. The issue for my practice is simply the cost. To make the switch I will have to invest thousands in IT upgrades, and pay thousands of dollars every year for the privilege of continuing to use the software. Further, if this slows me down to the point that I see one fewer patient per day, it will cost me an additional $10,000+ per year in lost revenue. I'm sure an EMR would streamline things for insurance companies, but my practice will see none of the benefits. I feel I provide high quality care with my current system and I don't believe a different record system will improve that. At the end of the day, switching to an EMR means a huge paycut with no improvement in patient care. I just don't see how that makes sense.

You may also lose tech-savvy and privacy-conscious patients if you put your patient records online.

two comments here (1)

Anonymous Coward | about 2 years ago | (#42586399)

I work in supply chain management, and one thing that is a very recent development is an increase in the awareness in hospitals that they do not run the business end of their facilities very well. The reason is quite simple: the board of directors that runs a hospital is mostly staffed by doctors, therefore the focus of the management of the hospital is always on providing patient care and having good procedures. Anything "business" related was typically a process improvement done mostly to reduce the time constraints of doctors and nurses, but very little if any attention was paid to issues such as quantity buys to obtain discounts on supplies, such as needles, bandages, gauze, etc, managing inventory and how much money should be tied up in supplies at any given time, or even the shipping methodology of those supplies. A friend of mine became a supply chain guy after originally going to school as an RN because the hospital needed someone to handle those issues, so he got stuck with the work. He found his hospital would not order new materials until they ran out, and then since they were out it was always a rush to get it so they were always shipping new materials by air. He implemented some basic forecasting and planning methodology so they could ship by truck, now they never run out and he reduced their freight bill by 90%. But unfortunately these concepts are relatively new to the healthcare world.

Second, I'd just like to point out that insurance carriers are part of the problem in rising healthcare costs when it comes to "wasting money". I recently switched to a high deductible plan ($3,000 annual deductible) and an HSA; with my deductible I'm basically paying for my own medical expenses wherever I go. My chiropractor basically charged me his "uninsured rate" whcih was a 40% discount. A therapist I am seeing for some issues is giving me a 40% discount for not having to go through my insurance. And my prevantitve stuff is all free. My high deductible costs less than 10% of my old insurance, and the remainder of what I used to spend is mine in my HSA, not my insurance company's. The total cost to me is acutally cheaper than my old insurance (an HMO) with it's co-pays.

Ignorance is bliss (1)

twistedcubic (577194) | about 2 years ago | (#42586431)

I used to regularly visit an ophthamologist for a chronic eye condition. Every visit the doctor would sketch by hand an image of the irregularities on my retina. Imagine the licensing costs of software and hardware required to do this, vs a plain paper template. Not everyone at RAND is a genius...

Re:Ignorance is bliss (1)

timeOday (582209) | about 2 years ago | (#42587089)

Perhaps you're talking about different irregularities, but these days they use a scanner like this [justanswer.com] on your eyes to map it out instantly.

Better Title (0)

Anonymous Coward | about 2 years ago | (#42586449)

I have a better title, "Utter Crap Software Failing To Live Up To Provider Expectations".

Why the switch? (2)

CimmerianX (2478270) | about 2 years ago | (#42586485)

When my data is on paper in a doctor's office, I know who can see it... the doctor and anyone I ask him to send to. Why do you think there is such a manic PUSH for all the digitized records? The cynic in me says it's a Data Mining Goldmine for insurers, advertisers, those stupid background checkers, anything at all.... There is so much money to be made from 3rd party access to our records, it's just disgusting. It's like jackals circling in for a piece of the carcass. And don't tell me any BS about "congress ensures only people who need to see the info will see it". Not only is all computer security laughable, just wait. Maybe not this congress or the next, or the next, but eventually, some congress will say "we are now allowing access to this information for the good of the children". Then collect all the fees for the use of our private info. Just wait.

Epic systems will win the day (1)

modmans2ndcoming (929661) | about 2 years ago | (#42586503)

right now there is a huge rush to get EHRs up and running to meet meaningful use. Epic has one of the better EHRs. One of the best features in the patient portal. Super easy to setup and super easy for your patients to grab their data and monitor their test results.

Re:Epic systems is a load of crap. (0)

Anonymous Coward | about 2 years ago | (#42586947)

Physicians are leaving large organizations who implement it.

Re:Epic systems is a load of crap. (1)

modmans2ndcoming (929661) | about 2 years ago | (#42587057)

Physicians are always leaving organizations....most hospitals will be on Cerner or Epic in 10 years. Both systems are only as good as the people who implement them.

Re:Epic systems is a load of crap. (0)

Anonymous Coward | about 2 years ago | (#42587247)

A lot of people are leaving our organization

?You- fail it (-1)

Anonymous Coward | about 2 years ago | (#42586505)

OpenBSD Wanker Theo reciprocating bad Kiil myself like Is perhaps

Electronic Medical Records (1)

Anonymous Coward | about 2 years ago | (#42586519)

The evidence is very mixed on this topic. RAND's isn't the only study out there. The overall concensus is that such systems don't necessarily save money but certainly do improve the quality of care. The VA, for example, has used a system for years, and the error rate on prescription fills, for example, is on the order of a fraction of a percent, wheras out in the "wild" it is closer to 7%. Also, their records were the only ones to survive Katrina. The real solution to financial sustainability is a single-payer system, where the single poayer handles all billing. Again, the VA, a single payer, pays about half of what Medicare pays for drugs (even though Medicare is a single payer it is prohibited from negotiating for drug prices for unexplained and certainly unsupportable reasons).

Hmm... (1)

Anonymous Coward | about 2 years ago | (#42586537)

Could it be that RAND has it wrong? My wife just finished residency, and I don't think they are including the cost of "upgrading" the physicians. To make it more clear, many older doctors are fairly rigid and set in their ways. It will NOT be easy to get 60+ year old doctors to simply move to a system they aren't comfortable with. They have options and will move on. Add in the costs of HIPAA compliance and they could be grossly underestimating the real costs of an upgrade.

Legal risk??? (1)

davidwr (791652) | about 2 years ago | (#42586571)

Slow pace of adoption, he added, has further delayed the productivity gains from e-records

Perhaps it should read:

Slow pace of adoption ... has further delayed the massive lawsuits that fly when things go bad and patient date leaks on a massive scale.

First do no harm (0)

Anonymous Coward | about 2 years ago | (#42586643)

Healthcare providers are averse to taking risks when their patients' well-being could be affected. For better or for worse that's part of their professional ethics. Add to this draconian and indiscriminate regulatory environment, including HIPAA, MU and FDA, and you've got a prescription for killing innovation industry-wide. To navigate this mess you need to be an insider with deep insight and connections, which come from years of industry experience. If you are just an entrepreneur with fresh ideas -- forget it.

TYPO: date=data (1)

davidwr (791652) | about 2 years ago | (#42586659)

Imagine the possible chaos if I'd made that typo entering patient data in an electronic health record.....

This will take a generation to solve (3, Interesting)

Cryptosmith (692059) | about 2 years ago | (#42586689)

My wife is an MD and (relatively speaking) is computer literate. She can touch type and navigate typical desktop machines.

Her clinic converted to EHRs several years ago and she still hasn't reached the level of efficiency she had with paper charts. At this point she's gone back to dictating parts of her chart (via speech recognition) to try to regain some of her lost productivity.

A lot of the problem is that the data is VERY free form. The mundane measurements (height, weight, temp, BP, etc) are easy to insert and digitize, and you can pass it off to another health worker to enter it. The really important information, however, doesn't fit into an established structure.

MDs learn how to collect and document patient status during med school and residency. The details vary from one program to the next. The efficiency of an office visit and its subsequent documentation all depend on how well the EMR flow (and even the number of clicks) fits how the MD does an office visit and/or documents a medical procedure.

The disconnect between habits and automation will continue to affect MDs until we have a generation of experience.

For some things we find e-forms don't work (2)

WillAffleckUW (858324) | about 2 years ago | (#42586795)

While we are finding that medications, drugs, and various substances in fact are reduced in error rates due to adoption of electronic forms, due to table lookups and the lack of data corruption on transcription, it is not always a panacea.

For data capture of patient histories, especially in medical research, due to the complexity and fallibility of the humans involved - our source data, if you will - we find that paper records sometimes are better at allowing us to capture a more correct record of what is happening.

Hence some of the resistance.

Some of the electronic forms take longer to record data with, and slow down patient/doctor communication and observation. Some of the electronic forms incorrectly presume that the patient has all their limbs, or that data is correct as first given. We have a lot of problems with veterans in terms of such data.

But that's my personal observation.

Just because you can capture things electronically, doesn't mean it's always the best method.

I Do Not Allow My Health Data To Be Stored Electro (-1)

Anonymous Coward | about 2 years ago | (#42586809)

nically. Sorry, but it's in a paper folder or not at all. I'll change doctors if they try to pull that. This is my call, not the government's.

Cheaper but not in dividual case (1)

gelfling (6534) | about 2 years ago | (#42586869)

It might be cheaper to the nation but in each individual medical stand up it's an enormous investment.

So what? (0)

Anonymous Coward | about 2 years ago | (#42587197)

Any savings would be kept by them. Patients would never see it.

when the pre-existing conditions went away (1)

Joe_Dragon (2206452) | about 2 years ago | (#42587241)

That took out some of the luster in having a nice E backlist system.

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