
Obama's big idea: Digital health records - thingsilearned
http://money.cnn.com/2009/01/12/technology/stimulus_health_care/index.htm?postversion=2009011204
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yummyfajitas
Obama's big idea?

“By computerizing health records, we can avoid dangerous medical mistakes,
reduce costs, and improve care.”

\--President George W. Bush, State of the Union Address, January 20, 2004

[http://www.whitehouse.gov/infocus/technology/economic_policy...](http://www.whitehouse.gov/infocus/technology/economic_policy200404/chap3.html)

It isn't hard to see that electronic medical records are "the next big thing"
in medicine. Every hospital administrator knows it is coming, and many big
software companies are trying to build it.

[http://www-304.ibm.com/jct03004c/businesscenter/smb/us/en/he...](http://www-304.ibm.com/jct03004c/businesscenter/smb/us/en/healthcareemr/nav_id/healthcareintro)

[http://www.emc.com/solutions/samples/healthcare-life-
science...](http://www.emc.com/solutions/samples/healthcare-life-
sciences/electronic-medical-health-records.htm)

Bush and Obama just want to have their name attached to some "electronic
medical records" law, that way they can take credit for it once it arrives.

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sachinag
Let me tell you why EHR/EMR is a joke:

There are no standards.

That's it. Epic, Cerner, GE, Dairyland, OpenVista, and the 180 other people
who make electronic medical/health record software all have proprietary file
formats and standards. The systems can't talk to each other, and there's a
ginormous industry in jury-rigging protocols to make them semi-sorta work.
It's a joke.

Of course, in the only place where we've had a standard, we've seen massive
innovation in technology. Radiology's DICOM standard is, to me, the single
reason why we've gone so far so fast. Because everything is portable, vendors
actually have to innovate rather than relying on lock-in.

If Obama wants to save lives through EMR, he's going to have to dictate a file
format standard. My contacts and friends at these firms have told me that it
would take up to three years of full-on full-time development for everyone to
change their software to work with a new file format. But until we do, every
dollar that goes to EMR is nothing more than corporate welfare.

~~~
biohacker42
I worked for a biotech startup which "elucidated" the proprietary file formats
of medical instrument vendors and thus commoditized the vendors.

It's a profitable business, but I'm not sure it's 100% legal.

~~~
sachinag
You know what? Your work probably helped save someone's life. I could give a
shit if it's legal - it was moral.

~~~
biohacker42
Thanks :)

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sh1mmer
What's interesting in this article to me is the clinical services community
acting like a nepotistic clique. "There aren't enough skilled people".
Bullshit.

Every industry has it's specialist knowledge. That should be some degree be
irrelevant to the IT community building their support tools. Not in the fact
that the needs of that community shouldn't be taken care of, but that the IT
folks don't need to be experts in whatever it is they are building for.

We should be experts in discovering the needs of our clients whatever their
industry, helping them figure out what would reaally make them more efficient
need and building that.

The idea that medical IT requires some kind of special half doctor half
programmer half ninja to get anything done is repulsive. My mother worked for
30 years managing the medical library for hospital which treats around 70,000
people a year. The number of half-baked crap-tastical systems I saw dumped on
her was astounding.

I for one would like to see this as a time where the needs of clinicians can
be standardized away from these lock-in vendors. Open the opportunities to
companies that will supply modern, well thought-out solutions.

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kcy
Do you think there are other industries that would be a good example for the
medical industry to follow? It seems like coming up with standards for such a
complex area has been a stumbling block for healthcare. Is healthcare more
complicated than other areas that have seen massive success with IT or is that
just an excuse?

Does anyone have any good resources that describe frameworks for developing
standards or examples of other industries that have done a good job with
standards?

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thingsilearned
Web app that costs:

212,000 employees "$75 billion to $100 billion over the ten years they think
the hospitals would need to implement program. "

~~~
Retric
Those costs seem insane. The sad part is it will probably cost more than that
and still save money over the next 20 years.

~~~
yummyfajitas
There are about 800,000 doctors in the US
(<http://www.census.gov/compendia/statab/ranks/rank18.html>); lets
conservatively estimate 5 times that many other medical workers providing
patient services (e.g., nurses, PA's, medical office assistants).

All these people need to be trained on the new system, except the ones who are
replaced by it (1). Every hospital and doctor's office in America need to
modify their business practices to fit the new electronic system, and more
than 300 million sets of medical records need to be entered into the new
system.

(There are about 300 million people with medical records, many of whom have
seen multiple doctors.)

The new system also needs to correctly deal with most aspects of medicine, and
be flexible enough that unforeseen circumstances can still be tracked.

I don't think $100 billion is unreasonable.

(1) [edit] amusing question: Obama talks about "212,000 new jobs created". I
wonder how that compares to the jobs which will be "stolen" by the new
technology he proposes? I'm all in favor of creative destruction, I just find
the language amusing.

~~~
stcredzero
The people whose jobs were "stolen" can be employed in more productive ways
than schlepping file folders around.

~~~
yummyfajitas
I agree, hence my use of scare quotes around "stolen."

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joe_the_user
Digitizing something that is broken will not fix it. In fact, digitizing a
broken system can keep it broken longer. Automation can let people engage in
counter-productive activity longer and be "more productive" at activities
which ultimately produce nothing of use.

The health care system in the US is seriously broken. The US expends far more
per person than any other nation for health care and receive poor medical care
in return, with many people excluded almost entirely from basic health care
(the emergency ward is the first and last option for those without insurance
).

The disaster that is US health care comes partly out of the adversarial
framework of private medical insurance. When one makes money by discovering
algorithms for denying care, one is performing an activity with negative
social value, akin to building a plant whose sole task is to pipe sulfuric
acid into the air.

But the problem is more any particular kind of enterprise. The overall
approach of having enterprises that not only seek to profit but seek to
increase their profits within the health care field automatically creates
abusive situations. Hospital companies routinely add unneeded hospital beds
and then charge every patient for the extra beds. Just as much, oversight with
that insurance companies have to use to prevent the hospital overruns and the
oversight various agencies demand to prevent insurance abuse only add to the
total cost which the for-profit system then attempts to pass on the consumer -
who is currently less and less able to pay.

