Who Can Do The Best Job Of Computerizing Health Records?
from the doctor-doctor dept
There's been a lot of talk for a long time about the benefits that could be derived from computerizing health care records as a means of introducing more efficiency to the US health system. It's an enormous task, but one in which the incoming administration is very interested. The costs are expected to be as high as $100 billion over ten years, and commentators aren't at a loss for words when describing the complexity of the task. One person quoted by CNN says it will be difficult to create a system that "thinks like a physician." Two points: first, should the system think like a physician? If the industry's current practices (and practitioners) have led it to its current state, can it be expected to generate the best, most efficient solution? Many hospitals are already discovering the value of looking outside the medical field to gain insights on ways to improve their operations, and creating a modernized health information system seems like it could benefit from fresh eyes and insights as well. The second point follows the first: is the government the best party to come up with the system? It's easy -- far too easy -- to find examples of huge government projects gone wrong, flawed either in their conception or implementation, or both. The government can play an effective role in helping to establish national standards, and in funding the project, but again, given the government's role in creating the current state of the healthcare system, would it be more effective to let the market, rather than the industry lead the way and develop its own innovative solutions?
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Filed Under: electronic health records, health records
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electronic health care records
We should be doing small pilot projects and letting them grow. Perhaps there are existing hospital systems that work and can be sold. Perhaps individual doctors groups can get something simple written and then have it spread. This top-down, designed for nationwide use approach is sure to fail.
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Only one answer
What company is better at selling a "bill-of-goods" at a "low ball price" and then taking 3x more in time AND money to complete the job.
They are perfect for "government work".
Best of all, they speak Deutsch and most of our government employees don't.
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Prepare to have your medical data become public
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Cutting IT costs
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One more answer
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Re: One more answer
From what I understand, the world's second-largest database distributor, InterSystems, has a database product specifically tailored to the healthcare field. American company.
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I have never heard of any violation of the data being used but that may be because he is with a local company that only operates in BC. I know he has never had a problem with it nor anyone else he knows who uses it.
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Is this a wise choice ?
What is the cost / benefit ratio ?
Looks like another sinkhole to me.
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think like a physician
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Why reinventing the wheel?
http://en.wikipedia.org/wiki/Veterans_Health_Information_Systems_and_Technology_Architectur e
and
http://www.vistasoftware.org/
for a working and fully implemented system.
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The system is fairly straight forward. The security layers are fairly straight forward. The largest and most complex issue it at least 25,000+ different systems the current doctors use in are small market place. Each doctor's office in the area has their own computer record keeping system (lots still on paper only). The doctors do not want to pay to have a system they already paid for. Some doctors want to keep their current system and have integrated as the front end to the database. Some doctors do not want to spend a cent for a computer to connect to the system. Some doctors do not want to train or hire staff to do this digital book keeping. Some doctors just fear the real audit trail it could leave - easy to just query to see which drug a specific doctor always prescribes his patients.
90% of the issue is getting everyone on board. Everyone wants a say and has a specific agenda that they strongly feel is absolutely required. Just to many cooks and poor/weak government politicians who want to appease every single person. Sad thing is politicians often change so the specifications can be altered and driven by a strong political motivation which also happens to control all the money and upper management staff. Scope creep is real problem in these political projects with endless amounts of money and very long development/implementation time frames.
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Stay away from physicans
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In reference to Matt Polmanteer's post -- you're half-right. The back-end of the system should be done correctly by database engineers, as mentioned. BUT, you will not be successful if you do not tailor your product to your customer. This takes a team of software engineers, user interface specialists, and, yes, physicians, working together to create something that's intuitive for the end-users. It's ridiculous to think a hospital should employ data-entry personnel. That would create more chance for error AND it still wouldn't resolve the issue of having paper records.
HIS is a strong field that will only get stronger in the future. There are already technologies that exist to handle these concerns, and with health and technology being huge industries right now, I think we can expect newer and better technologies to emerge from this initiative.
But, like I've mentioned elsewhere, the government may end up doing less good than private organisations. As we've seen with certain government programs (ie, Social Security), the government is not always the best when it comes to implementation. Following the Social Security example, 401(k)s are becoming a more favorable way of saving for retirement in many circles.
If the government wants to effect this transition, it should do so by providing tax and other monetary incentives to hospitals and other healthcare organisations. Allow them to write off the expenses of moving to an eMRS (electronic MR System) and, to be fair, allow hospitals that have already undertaken the initiative to write off their past expenses, adjusted for inflation.
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Re:
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The reformers' favorite panacea is health information technology. Obama promises to "make sure that every doctors office and hospital in this country is using cutting edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes, and help save billions of dollars each year"
The savings, however, are all hypothetical, long-term savings, and they are mostly destined for the insurance companies and government entities that are paying the bills. Converting a medical office to electronic records is extremely costly and disruptive. The cost in terms of diminished productivity continues for years, and is possibly permanent. Anything that slows patient flow is, of course, an advantage to payers (fewer patients, fewer payments)> Arguably, electronic medical records introduce more new errors than they prevent-and errors that may be impossible to expunge.
This was written by Jane Orient, M.D. Internist in Arizona. She is also executive director of the Association of American Physicians and Surgeons. The article is titled "Stay Healthy: Government Healthcare May Be Coming
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Call me old-fashioned but...
Medical records seem far too important to run the risk of data breaches. As Techdirt points out time and time again, there's no such thing as absolute security.
With all the malicious people out there, many of whom can already pull up your DMV records and other info at a whim, I must admit that I am terrified that such things could happen to your personal medical information too.
And aren't there more important things to be spending $100 billion on in the next 10 years?
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Re: Call me old-fashioned but...
You still have the same security issues. The records would still (conceivably) be stored in the same way -- in restricted areas, behind closed doors. Ideally, and I'm not sure how current implementations really work, the doctor would have to check out someone's eMR when they need to use it, an action that would result in the eMR being accessible over the network; the network would be encrypted and (obviously) separate from any network that could connect to an outside source (ie, the Internet); and the doctor would have to verify that he is indeed who he says he is (ie, a card that he would insert into his portable "tablet" device).
Are there still potentially security holes? Sure, but there are security holes in the paper system too.
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Re: Re: Call me old-fashioned but...
To be honest, though, there are already hospital organisations that use this kind of technology, seemingly without issues. If it becomes more widely used, will we start seeing issues? Of course. But the important thing is how those issues are handled: fixing the holes that are discovered, rather than reacting in a panicked and fearful way.
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This is being tried in the UK
The industry is moving in this direction. Hospitals, doctor's offices, and other healthcare providers are installing EMR systems. Integrating them would have some major advantages, but it's very difficult. If the government takes this on, I predict it will come in way late and way over budget.
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