Why The Healthcare Industry Doesn't Want Electronic Medical Records

from the it-would-reveal-the-business-model dept

I've been really confused by the whole push for "electronic healthcare records" as some sort of big step for improving our healthcare system. It's such a minor part of what's needed that it seems to be looking at curing a cough when someone has terminal cancer. The cough isn't the issue. Also, it's never been quite clear why hospitals didn't move to electronic healthcare records in the first place. Lots of other businesses with tons of paper records long ago realized that moving to electronic records and making things more efficient wasn't just a fantastic way to make money, but a way to expand their own market. The switch from paper stock certificates to electronic ones didn't just save printing costs -- it enabled the stock market to change in a massive way (perhaps too much, many will note).

Andy Kessler, who's been thinking an awful lot about these issues (and whose book The End of Medicine hasn't received nearly the attention it deserves) has an interesting article discussing why the industry has resisted the move to e-healthcare records. While it would save some money, he notes, it would also expose the entire scam of the healthcare system: which is that they make a ton of money from inefficiencies baked into the system, which are totally hidden from view. It's a massive boondoggle for the industry, and e-healthcare records would actually make it easier for people to understand that the healthcare system profits from people being sick and not from having them be well.

The incentives are totally screwed up for everyone.

Healthcare providers make more money the sicker you are. Pharmaceutical companies make easy money with gov't monopolies limiting the ability to spread useful drugs. The actual costs are nearly totally hidden from most consumers, so they don't make smart choices at all. There's a lot of built in artificial scarcities in the system, and opening up the flow of information changes that.

Of course, in the grand scheme of things, this is dumb. Focusing on preventative care and actually keeping people healthy would actually provide a massive economic benefit not just to the healthcare industry, but to the economy as a whole. More healthy people contributing to production, output and consumption can do quite a lot for the economy. The numbers on some studies are staggering (we're talking trillions of dollars). If the incentives could be aligned such that people paid for staying healthy, rather than having illness treated, then there's a ton of money to be made without resorting to the old inefficient mess that is today's healthcare system.

But rather than tackle any of that, we get attempts to fix the cough in the terminally ill patient -- and the patient likes the morphine drip so much that he'll do anything to avoid getting healthy. It's time to fix the healthcare system. And while I don't necessarily believe that a small step like electronic medical records is all that meaningful, if Kessler is right and it actually drives some awareness to the underlying mess, perhaps it's at least a good start.


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    Anonymous Coward, Jun 26th, 2009 @ 6:19am

    If you want to see huge change in the form of the consumer reporting overbilling to insurance companies, all the insurance companies need to start doing is list all the procedure codes on the Explanation of benefits.

    My insurance company won't give it to me. I have to demand it from the billing provider. When I get, I always find a few procedure codes that are just flat out incompatible with what was done.

     

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      Sean T Henry (profile), Jun 26th, 2009 @ 8:21am

      Re:

      I am a Certified Professional Coder (I bill insurance and fight with them). I have only seen a few insurance companies that do not have the CPTs (procedure codes) on the EOMBs (Explanation of Medical Benefits) and those are the worst insurance companies like Medicaid.

      I often have patients calling saying they did not have such and such a procedure when they were here. Many procedures have multiple parts that have to be charged for such as up till this year an echocardiogram (imaging of the heart to evaluate it's function) had three CPT codes for one study. Also if there was an office visit and an EKG there are two more codes. It is a rarity that we over bill and when it does happen it is billing a level four office visit (93354) instead of a level three (93353).

      I am not saying that it does not happen and you may be correct but patients do not have the access to the complete code descriptions. A new version of the CPT and ICD (diagnosis codes) books every year that have codes added, removed, or has the code description changed. Providers must buy new books reteach them selves things that have changed and keep up with changing insurance regulations that can and do change at ANY time.

      To help and save money what needs to be done it hold insurance payers to the same level as providers. Require that all coding lists are open and free since we are forced to use it. Also make all co-pays and deductibles payable to the insurance and not the provider since providers should report non-payment of these to the insurance for breach of contract but the insurance could careless.

       

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    wifezilla, Jun 26th, 2009 @ 6:19am

    "he healthcare system profits from people being sick and not from having them be well" I've been saying this for years. Nice to see it spelled out so well.

     

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      Anonymous Coward, Jun 26th, 2009 @ 8:22am

      Re:

      I have a slight skin infection that I got form a jacuzzi.

      Easily cured in almost any country except the US.

      In the US one must go to a doctor for a prescription.
      Doctor must send sample to lab.
      Doctor will then prescribe 2 tubes of medicine enough for 2 days and then return visit is required for a refill.

      If one goes to some country like Mexico one can simply go to pharmacists and buy medicine as needed.

       

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      Anonymous Coward, Jun 26th, 2009 @ 8:59am

      Re:

      It's common sense. A customer cured is a customer lost. See my post on red yeast rice and the FDA and
      http://forums.christianity.com/m_3777330/mpage_1/key_/tm.htm#3777330

      and the FDA and health

      http://forums.christianity.com/m_3795161/mpage_1/key_/tm.htm#3795161

      The FDA is in on it too. The whole system is a scam and there is substantial evidence to prove it.

      But we're all just a bunch of crazy conspiracy theorists for not believing everything that big corporations want us to believe. We are expected believe that they are completely benevolent and they NEVER do anything wrong because their code of ethics are so altruistic. and if you don't believe this you are a crazy deluded conspiracy theorist.

       

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    theskyrider (profile), Jun 26th, 2009 @ 6:29am

    Kinda like...

    "There's a lot of built in artificial scarcities in the system, and opening up the flow of information changes that."

    This reminds me of something else...

    Like Music and Movies online (filesharing) They made money as long as they had scarce goods. (A cd or dvd.) Once filesharing took off, that scarcity went away. Is it any wonder why the MAFIAA sues everything in sight?

    Anyways...

    There is also an artificial scarcity built into test records. They COULD give you a copy of an MRI on a DVD for little or no cost in a standard format, but they WANT you to pay $300.00 a copy, plus courier costs. Then, if you want a SECOND opinion...

    I would like to be able to carry my medical records around on a flash drive. I WANT to go get a second opinion without having to go through fifty pages of privacy act notices and then having to make another appointment because I missed some minute initial block on page 36.

    I would LOVE to be able to hand a flash drive over to my doctor and say...Here ya go doc, what do you think?

    Could you imagine your CHEM tests, laid out in a nice neat spreadsheet, so a doctor could look over ten or fifteen years of physical data just by moving a mouse, (or a touchpad, or ideally a big old 46" flatpanel touchscreen?)

    Look out, local hospital, the days of the $12.00 acetaminophen pill are numbered. Especially when a person can go to the local Wally-world and get 1200 for $12.00. (couldn't resist)

     

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      will (profile), Jun 27th, 2009 @ 2:39pm

      Re: Kinda like...

      Actually, this technology does exist and there are health facilities that are using it. What it sounds like you are wanting, however, is portability, the ability to take your records to any physician or facility. While a flash drive is one option, you also can create a personal health record in Microsoft HealthVault where you can list all of your recent visits, diagnoses, etc., so that it is available online whenever you need it. As more facilities and doctors shift to EHRs, the ability to communicate directly with your physician and share important information, will continue transpire.

       

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        Anonymous Coward, Jun 29th, 2009 @ 1:11pm

        Re: Re: Kinda like...

        Actually, this technology does exist and there are health facilities that are using it.

        Actually, I don't think anyone is saying that the technology doesn't exist or that no facility is using it. The point of the article is that many are resisting it.

        While a flash drive is one option, you also can create a personal health record in Microsoft HealthVault where you can list all of your recent visits, diagnoses, etc., so that it is available online whenever you need it.

        Err, that's a personal record of your own making. For that matter, you could even write that kind of stuff down on paper if you wanted to (and many people do). But that isn't the kind of healthcare provider generated record being discussed here. I think you're confused.

         

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    Nathania Johnson, Jun 26th, 2009 @ 6:42am

    Actually, having electronic records would help with cancer. As a cancer survivor, I used to have to keep track of all my records, make extra trips to pick up films - as if my appointments, tests and treatments weren't enough of a disruption.

    Plus, many times you have to pay for records and wait 30 days or more to receive them. It's a nightmare.

    Then I discovered the Duke medical system. They've employed an electronic system and it's awesome. I can MAKE APPOINTMENTS with my family care practice. Because of this, I can ALWAYS get a same day appointment. If I call - I almost always have to wait 3 days or more!

    Also, I can view labs online and request appointments for specialists online.

    I no longer have to carry around my records. I just go to doctors in the Duke system and they pull up my file on their computer.

    ONE MORE THING - since I can view labs, I can sometimes see results BEFORE my provider calls me - if they remember to call at all.

    This technology has been available for years. Streamlining the system not only makes patient care easier - it FREES UP DOLLARS that can be spent on cancer research.

     

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    Joe Beam, Jun 26th, 2009 @ 6:45am

    I don't think OCR could ever read a doctor's writing. That's probably what is holding it back.

     

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      Ben S, Jun 26th, 2009 @ 10:01am

      Re:

      @Joe Beam,

      I work for a document capture company (software manufacturer); we provide document scanning, import (from virtually every source you can think of: email, fax, many others), OCR, and many other tools designed to automate electronic records. We gather and perfect data from documents and then feed that data to other systems (storage, workflow, etc.). We are the manufacturer of a big chunk of the system at Duke University, which another commenter mentioned above.

      We apply OCR to just about any document we can. The benefits are tremendous - in addition to labor reduction (OCR reduces the need for manual tasks like document identification and data entry), we provide significant accuracy improvements via a number of data validation techniques - database look-ups are a good example... when we read a claim form with OCR, we can compare procedure codes, patient ID numbers, and most other data elements on a form with existing information from a database. When we find a discrepancy on a form (like a bad procedure code), we can automatically notify the health care provider or insurance company about the problem and have them correct it via a web interface. We apply similar rules to patients as well, simplifying the process of correcting bad information or verifying its accuracy.

      Your comment about doctor's bad handwriting, while somewhat valid, is a major oversimplification of the challenges of automatically reading documents with OCR technology. You may also be surprised with the state of OCR technology today. There are engines out there (search for A2iA, Parascript) than can and do read unconstrained (no boxes for each character), hand-printed forms with reasonably good accuracy. Of course, machine-printed text is vastly easier for an OCR engine to read, but over the last five years or so, OCR technology has really matured, resulting in many more practical applications of the technology.

      Don't dismiss OCR technology as impractical or unusable because it didn't work very well 5-10 years ago (I have been working in this industry since 2000). Good capture products provide tools built around OCR which make document capture automation easier and cheaper while providing significant benefits to all parties - providers make more money, are able to provide more accurate diagnosis, better prescriptions, and more accurate information to patients. Insurance companies save millions of dollars every year. Patients get better care. I could go on and on....

      If you go to a Walgreens pharmacy, you should see desktop scanners used to scan the prescription form... ask the pharmacist if his/her job is easier since they added document capture to the mix.

       

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    Dark Helmet (profile), Jun 26th, 2009 @ 6:47am

    What if

    What if doctor's and practitioners were paid the LESS a patient returned for illnesses based on their localization?

    I have no idea how to work out the logistics on this, but say, you get an colonoscopy w/some preventaitve and/or procedural measures to remove bad polyps and fill perscriptions (is there a scrip for a broke ass?), and the doc gets half his normal pay. 6 months later, if the patient hasn't returned for ass related injuries, he get's another 25%. At 2 years, he gets the final 25%.

    Just a thought on performance based medicine for docs. Pharma's another story, as they're just flatout evil.

     

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    Anonymous Coward, Jun 26th, 2009 @ 6:54am

    Untill we have universal healthcare all these points are moot.

     

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      DS, Jun 26th, 2009 @ 7:21am

      Re:

      When we have universal healthcare, all these points are moot.

      Because we'll have much worse issues to deal with.

       

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        Overcast (profile), Jun 26th, 2009 @ 7:27am

        Re: Re:

        When we have universal healthcare, all these points are moot.

        Because we'll have much worse issues to deal with.


        Yeah, think there's red tape in this mess now? Just wait until the Government starts running things.

        Before I went to college, and during - having kids early; I'm well familiar with government health care. It may actually help the magazine industry dramatically, as they will need a lot to keep people busy during the long waits.

         

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          Dark Helmet (profile), Jun 26th, 2009 @ 8:02am

          Re: Re: Re:

          Waaaah, we might have to contribute to the common good of keeping people alive. Waaaah, next you'll actually want us to take care of our wounded soldiers. Waaaah! We just want to roll around in our own money like Scrooge McDuck. Waaaaah!

           

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          Anonymous Coward, Jun 26th, 2009 @ 5:30pm

          Re: Re: Re:

          When we have universal healthcare, all these points are moot.

          Because we'll have much worse issues to deal with.

          Yeah, think there's red tape in this mess now? Just wait until the Government starts running things.


          Hey, don't like it? Don't use it! Simple!

           

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      another mike (profile), Jun 26th, 2009 @ 1:07pm

      Re:

      Every version of universal healthcare I've seen is just obligating the government to subsidize the current system. That will only build in more inefficiency and allow costs to continue spiraling upward.
      A major reason why the system is so broken and expensive is that there are no market forces to drive costs down. None of us here know how much our medical care costs. And I don't mean knowing your co-pay, or even your premium. That's like the cell phone bill that hides how much the handset is subsidized. You don't know the costs so you can't do any cost-benefit analysis or even just comparison shopping.
      That's the demand curve, now lets take a look at supply. The medical care providers have set themselves up as the gatekeepers. They've enacted artificial scarcity as an institution in a way the recording industry can only dream of. You can't go to your wilderness first responder trained neighbor for medical care. No, you have to go to the emerald city to see the licensed, degreed, debt-saddled, priest of the sacred order.
      So the correct answer is to drop all of these stupid universal debt-accumulation plans because that's all these plans can do is increase costs. Instead, expose the costs to the consumer so proper economic forces can put prices where they belong.

       

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    Hugh, Jun 26th, 2009 @ 6:54am

    I going to guess this guy didn't do a lot of research. The VA has had e-records for a good 5 years or more. Everything is electronic and the electronic forms does a lot than just be an easier way to keep track of costs. It helps with nurses not making med errors due to not being able to read the med that the doc wrote. It keeps everything readable by anyone, since some med records end up going to court and no one has to figure out what was written. VA only has paper in the charts now for when the nurse calls a doc to get a med changed or to have a procedure done, so the doc can sign that he ordered that, its kind of hard to sign after the nurse if your not there.

     

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    slacker525600 (profile), Jun 26th, 2009 @ 6:55am

    stuff in the way

    I feel like there are other reasons, that are in the way that although possible to work around and get through, are hurdles that nobody wants to spend the time on.

    Aside from the fact that training everybody in a hospital in a new system would take time that these overworked people do not have. Aside from the fact that deciding on standards that do not negatively impact at least one branch of health service is impossible. Aside from the fact that most hospitals have some electronic records in a highly proprietary format such that they cant get into an open format on their own. Aside from the fact that there exist different standards in different systems either country to country or state to state, in terms of who has access to information and who has what rights. Aside from the massive potential problems with keeping massive amounts of medical records in one format may cause. Aside from the traction in the system provided by the doctors who simply want to keep doing things their way.

    Then you get the bureaucracy.

     

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      jaxager (profile), Jun 26th, 2009 @ 9:02am

      Re: stuff in the way

      I repair ultrasounds in hospitals. There IS a universal format that all pieces of medical equipment that are hooked up to the network use. It is called DICOM. It stands for Digital Imaging and Communications in Medicine. It does not matter if the images are coming from a GE ultrasound or a Philips MRI or a Siemens CT Scanner, those images will be able to be viewed with DICOM. This standard is international. Here is a link if you want to know more - http://medical.nema.org/.

       

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    slacker525600 (profile), Jun 26th, 2009 @ 6:56am

    stuff in the way

    I feel like there are other reasons, that are in the way that although possible to work around and get through, are hurdles that nobody wants to spend the time on.

    Aside from the fact that training everybody in a hospital in a new system would take time that these overworked people do not have. Aside from the fact that deciding on standards that do not negatively impact at least one branch of health service is impossible. Aside from the fact that most hospitals have some electronic records in a highly proprietary format such that they cant get into an open format on their own. Aside from the fact that there exist different standards in different systems either country to country or state to state, in terms of who has access to information and who has what rights. Aside from the massive potential problems with keeping massive amounts of medical records in one format may cause. Aside from the traction in the system provided by the doctors who simply want to keep doing things their way.

    Then you get the bureaucracy.

     

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    Chuck Norris' Enemy (deceased) (profile), Jun 26th, 2009 @ 7:02am

    The paper business

    Maybe they don't want to put Dunder Mifflin out of business.

    So we see yet another industry who clings to old/inefficient business practices to maintain their easy money. Of course, if it was my livelihood that was going away because of some technology, I would be a little disgruntled and drag my feet...at least until I figure out how to make money from the new system. Most of the time I despise these dinosaurs for dragging their feet and vilifying technology but maybe they are just trying to figure it out.

     

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      Overcast (profile), Jun 26th, 2009 @ 7:24am

      Re: The paper business

      Most of the time I despise these dinosaurs for dragging their feet and vilifying technology but maybe they are just trying to figure it out.

      Well, the industry I'm in is directly impacted by things like this - paper. But some companies use foresight to re-tune their business model and/or products to keep them viable in the future. Sometimes; it's just the nature of things for some old businesses to die out; but it usually makes way for even more new ones.

      Computers for example - sure; they may reduce the important of mail carriers, for instance; but then the IT industry employs more now, I suspect, than post offices ever did.

       

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    DCX2, Jun 26th, 2009 @ 7:02am

    These inefficiencies create profit

    We have many more people than we actually have work for them to do. Thus, we create inefficiencies that raise the cost of health care, so that we can pay receptionists and insurance agents and all the myriad people that are part of this. If you cut out the inefficiencies, they lose their job.

     

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      Rebel Freek (profile), Jun 26th, 2009 @ 8:26am

      Re: These inefficiencies create profit

      I'm sorry, but that is no excuse for being inefficient. Actually, the fact these people are employed by this problem means they are a problem, more then likely raising costs that are artificially high as it is.

       

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        Anonymous Coward, Jun 26th, 2009 @ 6:55pm

        Re: Re: These inefficiencies create profit

        I'm sorry, but that is no excuse for being inefficient. Actually, the fact these people are employed by this problem means they are a problem, more then likely raising costs that are artificially high as it is.

        But that's the way it is. That's also one of the reasons that anytime there's talk of major health care reform, all sorts of people come out of the woodwork against it. They're all afraid that reform might mean some loss of inefficiency and thus their own jobs.

         

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    hegemon13, Jun 26th, 2009 @ 7:02am

    Idealistic

    "If the incentives could be aligned such that people paid for staying healthy, rather than having illness treated, then there's a ton of money to be made without resorting to the old inefficient mess that is today's healthcare system."

    I think you are confusing the medical industry with the health care industry. The health care industry is much larger than doctors and pharmacies. It includes gyms, fitness programs, vitamin and supplement manufacturers, alternative medicine (chiropractors, massage, etc), and more. Most of those things tend to be more focused on prevention than our medical system does.

    The fact is, there are already companies out there who have incentives to keep you healthy: fitness companies. The knowledge exists and the experts exist if you pick a reputable company. The problem is that most of the population does not bother. Heck, most people don't even bother with a regular physical. The medical system exists to treat illness. The wellness industry exists to keep us from needing the medical system. Unfortunately, most people are procrastinators, and they ignore the preventive measures until it is too late. There is only so much that doctors can do to keep us healthy when the majority of people lead stressful, busy lives, eat improperly, don't exercise, and don't go in for checkups.

     

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    thecaptain, Jun 26th, 2009 @ 7:05am

    That's why I love Canada

    There's a huge push here to move to electronic records because our system isn't run for profit.

    This means the efficiency and cost savings are something we DO want. Hospitals are realizing that they need a VERY accurate picture of what goes on to make accurate decision as to where the (sometimes dwindling) budget money goes.

     

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      Anonymous Coward, Jun 26th, 2009 @ 7:16am

      Re: That's why I love Canada

      See? Even Canadians are smart enough to have universal healthcare.

       

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      Anonymous Coward, Jun 26th, 2009 @ 7:48am

      Re: That's why I love Canada

      Yeah, healthcare in Canada is incredible. How long do I have to wait to see a doctor again?

       

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        Anonymous Coward, Jun 26th, 2009 @ 8:08am

        Re: Re: That's why I love Canada

        As a Canadian, I will say that it rarely takes more than a few hours to see a doctor, but it might take months to get to a specialist or into surgery for anything that isn't life threatening.

        if you want to see an efficient health care system, go to China. When my friends son was sick, we went to the children's hospital, got an x-ray within minutes, a diagnosis within 30, and he was on a ward within the hour getting medication.

         

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          Corwin (profile), Jun 26th, 2009 @ 8:16am

          Re: Re: Re: That's why I love Canada

          I am pretty sure there are some strings attached with Chinese healthcare.

           

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          Chuck Norris' Enemy (deceased) (profile), Jun 26th, 2009 @ 8:23am

          Re: Re: Re: That's why I love Canada

          Probably would have been treated differently if they were Chinese. Foreigners most likely get speedy service so the Chinese can have the appearance of good health care. Like the amount of money spent on the opening ceremony of the Olympics while people are starving throughout the country.

           

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            Anonymous Coward, Jun 26th, 2009 @ 7:01pm

            Re: Re: Re: Re: That's why I love Canada

            Like the amount of money spent on the opening ceremony of the Olympics while people are starving throughout the country.

            Or like in countries where money that would make that look like a drop in the ocean is spent on the military while people are in need of medical care through the country.

             

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        Pete Dixon, Jun 26th, 2009 @ 12:11pm

        Re: Re: That's why I love Canada

        I'm usually same day or the next. Rarely it's 3 days. This is in Toronto.

         

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        thecaptain, Jun 26th, 2009 @ 12:54pm

        Re: Re: That's why I love Canada

        I see my doctor every couple of months without issue.

        And I don't go into debt whenever I need to see a specialist or go to the emergency room.

        The one time I needed emergency treatment, I was treated quite quickly.

        My insurance payments every month are zero (how much are yours?)

        What was your point again? Ah yes...your ignorance. Let me show you it.

         

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        Anonymous Coward, Jun 26th, 2009 @ 7:02pm

        Re: Re: That's why I love Canada

        "Yeah, healthcare in Canada is incredible. How long do I have to wait to see a doctor again?"

        Not very long, why?

         

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    Anonymous Coward, Jun 26th, 2009 @ 7:09am

    I feel like there are other reasons, that are in the way that although possible to work around and get through, are hurdles that nobody wants to spend the time on.

    Aside from the fact that training everybody in a hospital in a new system would take time that these overworked people do not have. Aside from the fact that deciding on standards that do not negatively impact at least one branch of health service is impossible. Aside from the fact that most hospitals have some electronic records in a highly proprietary format such that they cant get into an open format on their own. Aside from the fact that there exist different standards in different systems either country to country or state to state, in terms of who has access to information and who has what rights. Aside from the massive potential problems with keeping massive amounts of medical records in one format may cause. Aside from the traction in the system provided by the doctors who simply want to keep doing things their way.

    Then you get the bureaucracy.

     

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    lulz, Jun 26th, 2009 @ 7:12am

    I think you are confusing the medical industry with the health care industry. The health care industry is much larger than doctors and pharmacies. It includes gyms, fitness programs, vitamin and supplement manufacturers, alternative medicine

    The wellness industry exists to keep us from needing the medical system.

    When did "the healthcare industry" become "the wellness industry". Including GNC stores and gyms into "the healthcare industry" is just playing with semantics. We need "the healthcare industry" to not be so crooked

    From the article:

    In those medical records lie the ugly truth about the business of medicine: sickness is profitable. The greater the number of treatments, procedures, and hospital stays, the larger the profit. There is little incentive for doctors and hospitals to identify or reduce wasteful spending in medicine.

     

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      hegemon13, Jun 26th, 2009 @ 1:05pm

      Re:

      My point is that companies already exist whose have an incentive to keep you well. I really wasn't talking about GNC stores, as they don't actually employ experts. I was referring more to professional nutritionists (not the store-aisle variety), professional trainers, etc, whose job it is to keep you in shape and eating right. If they don't do their job well, they lose their clients.

      I mean, really, what can a doctor do? They can advise you on diet and exercise, but the responsibility to follow through comes from the patient.

      If a person goes to their doctor for an annual physical, a lot of problems can be stopped before they become serious. Doctor's already offer this and insurance companies already cover it 100%, yet people don't bother.

      I guess I just don't understand what Mike is suggesting. How are doctors supposed to make sure we "stay healthy," when at least half of the problem lies in people's tendency to ignore the doctor until they get sick? If he is suggesting that doctors are deliberately giving people the wrong treatments in order to make sure they stay sick, he needs to take off his tin-foil hat. An individual doctor's career revolves around his reputation, so the incentive to keep his patients healthy is very strong for the individual.

      The fact is that ALL repair service industries stand to profit when something is broken. In the medical industry, they are repairing your body. But mechanics, IT, plumbers, electricians, etc, all profit when something breaks. Does that mean we should go after mechanics so that they are incentivized to keep my car running rather than fixing it? How the hell are they going to do that?

       

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    Anonymous Coward, Jun 26th, 2009 @ 7:13am

    How about drug patents? I have high blood pressure and finally found a pill that works without side effects. There's two drugs in the pill one is available in generic one is not. I lost my job at the beginning of the year and have no health insurance. 30 days of these pills (it's Azor) cost $467.00. The patent on it lasts until 2016 so it will not be lower cost or have generics available until then! Luckily I have a good cardio doc that gives me free samples every month right now.

     

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    El Guapo, Jun 26th, 2009 @ 7:14am

    Icelandic Health Care

    All of Iceland's medical records are electronic. I had what looked like a foot infection recently. Took three calls but I was seen by a doctor and given a prescription within 30 minutes. Blood test done in a different facility in 20 minutes. X-Rays in another facility in 30. All of this was orchestrated electronically. Since the prescription was in the electronic system it was filled within 10 minutes at the X-Ray facility. Total out-of-pocket expenses including taxis was $40. I was giving a diagnosis that same evening. If that had happened to me in the States they would have locked me in the loony bin for raving that I had entered the Twilight Zone.

     

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    Corwin, Jun 26th, 2009 @ 7:19am

    EMR is old news.

    Electronic Medical Records have been around for a long time.

    I remember consulting on an installation for a single physician practice 15 years ago. It was an investment to prepare to sell the practice.

    It's a great idea, but as with ideas, there are other things that need to be done to get everyone to buy-in. One of them as previously mentioned is that standards need to be set, not just domestically, but internationally.

    Most doctors would buy-in but sometimes the costs are very high. In the long run it will save them money, but the initial capital expenditure may be prohibitive for some practices. As someone who has worked with and for physicians for 20 years I have seen what many of them make, and many of you would be surprised to know that they are not all "rolling in the dough".

    Changes in policy (making copies of the EMR available to patients) will also need to occur to provide more transparency.

    The prevailing bureaucracy is actually moving towards EMR.

    Just some not well laid out thoughts for all to ponder on.

     

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      dk, Jun 26th, 2009 @ 7:27am

      Re: EMR is old news.

      I think HL7 is pretty much the standard. There are interface engines to transform between the different standards that exist. I think the standards are there. People being too lazy/scared or incompetent to implement them properly is the problem.

       

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        aguywhoneedstenbucks (profile), Jun 26th, 2009 @ 7:39am

        Re: Re: EMR is old news.

        HL7 is a guideline, not a standard. It evolved badly so it is a pain in the ass to get it to work properly. Once it does work there aren't usually any serious problems but setting it up can be a bitch.

         

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      Kevin, Jun 26th, 2009 @ 8:17am

      Re: EMR is old news.

      It's a great idea, but as with ideas, there are other things that need to be done to get everyone to buy-in. One of them as previously mentioned is that standards need to be set, not just domestically, but internationally.

      You know, I keep seeing the same comment showing up in magazines and forums around EMRs about people claiming that the standards aren't there. Guess what? The standards ARE there, and have been for years. HL7 (for patient data) and DICOM (for imaging) are just two of the major standards that have been implemented over the years. I've worked in healthcare IT off and on over the years, and we always had electronic systems that were interconnected, even from different vendors. The standards for information exchange are already there...what's the holdup?

       

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        Anonymous Coward, Jun 26th, 2009 @ 7:24pm

        Re: Re: EMR is old news.

        I've worked in healthcare IT off and on over the years, and we always had electronic systems that were interconnected, even from different vendors. The standards for information exchange are already there...what's the holdup?

        That must be IT in a different healthcare industry than the one I work in. I do work for small offices and they all use proprietary systems that lock up the patient in proprietary electronic formats purposely designed for that purpose. What's more, they won't provide information on the formats that would allow the data to be imported into other systems (except for later versions of their own systems, of course). Now some of my clients would love to change to different systems but they can't move the data over. At least not electronically. The only possibility, as suggested by one of the system vendors, is to install the new system in parallel with the old system and then hire people to come in and manually read the data from the screens of the old system and type it into the new system. I think I heard them laughing in the background as they suggested that.

         

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    DS, Jun 26th, 2009 @ 7:23am

    Have you ever been to TheDailyWTF? The current state of healtcare software is bloody awful. I wouldn't want to go whole hog either.

     

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    dk, Jun 26th, 2009 @ 7:25am

    As a Healthcare IT worker...

    Since I work in healthcare IT I should point out that this article is spot on in some ways, but on a positive note, younger generations of doctors and nurses are much more likely to accept EMR. Our doctors own our private clinic and actually voted to implement EMR. We've just implemented EMR at all our clinics and so far it has saved plenty of money. Sure, the older doctors hate it and complain. The administrators absolutely hate it. And yes, naturally, the medical records staff hates it since they are losing their jobs. Really these people are on their way out the door though. The medical industry is moving to EMR without the government's help. (Yes it is taking a long time to cut through the layers of bureaucracy, but it is happening) I think the government would be best to let fail those who cannot cut through their own layers of bureaucracy. At our clinics we've implemented it early and we are succeeding. Those who are too shortsighted to take action should be left alone with their high costs. Most likely insurance companies will stop covering costs from those places, which is a good thing!

    Just to give you an example of some of the cool things being done in IT here. Transcription is now done by voice recognition, then we hire relatively low cost retirees to be "editors". They listen and make sure the voice recognition is accurate (and the software learns from these edits) and in return the editors get medical benefits at our clinic and minimum wage. They love it because it is very flexible and they are only working for the benefits at that age anyhow.

    All of our charts are now electronic.

    We also have automatic prescription dispatch. So the doctor sees a patient. Prescribes a transcription and it is sent electronically to the pharmacy of the patients choice. It is usually ready to pick up when they get there since the doctor doesn't have to find time to make a phone call. The next step of our implementation will allow us to send bills electronically. We already itemize procedures to show what the costs are.

    I guess my point is that the majority of the health care industry doesn't want EMR because they are scared for their jobs. Those of us in medical IT, however, are looking forward to stepping in to cut costs and gain accuracy.

     

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      Anonymous Coward, Jun 26th, 2009 @ 7:40pm

      Re: As a Healthcare IT worker...

      Just to give you an example of some of the cool things being done in IT here. Transcription is now done by voice recognition, then we hire relatively low cost retirees to be "editors". They listen and make sure the voice recognition is accurate (and the software learns from these edits) and in return the editors get medical benefits at our clinic and minimum wage. They love it because it is very flexible and they are only working for the benefits at that age anyhow.

      You must be using domestic transcriptionists. At the offices I work with they've found it to be much cheaper to send that work overseas, mostly India. You send them the audio files over the net and they send the transcriptions back.

      We also have automatic prescription dispatch. So the doctor sees a patient. Prescribes a transcription and it is sent electronically to the pharmacy of the patients choice.

      And the pharmacies really like that too because it tends to eliminate price competition. The patient has to choose a pharmacy to fill the prescription without calling around checking prices first. Woo hoo!

       

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    yogi, Jun 26th, 2009 @ 7:34am

    Chinese

    This reminds me of a documentary I once saw on Chinese traditional medicine.
    I recall that the doctor got paid as long as the patients - the villagers - stayed healthy!

    Now that is an incentive.

     

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    HL7 Coder, Jun 26th, 2009 @ 7:34am

    The Problem is the Systems don't talk to each other

    There already exist many electronic Health Records. My primary care physician's office has been using laptops for charts for 5 years. I am also familiar (through my work) with the Duke and VA implementations.

    The problem is, should Ms Johnson (post #4) move from North Carolina to another area, the records are not portable. The odds of her new healthcare provider being able to make avail of those e-records are, unfortunately, very low.

    There exists a schema for the exchange of health information, it is called HL7. I work with it every day in assisting my company's customers with the transmission of data from disparate systems to their LIS/HIS.

    The problem is that there are many flavors of HL7, and, while the newer ones are XML-based (and thus extensible), they are not backwards-compatible, and the investment to hard for many institutions to justify.

    I agree with the author's basic premise: that institutions are resistant to change because it would make it difficult to profit by obfuscation.

     

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      Anonymous Coward, Jun 26th, 2009 @ 8:01pm

      Re: The Problem is the Systems don't talk to each other

      There already exist many electronic Health Records. My primary care physician's office has been using laptops for charts for 5 years.

      I'd be concerned about that physician if I were you. You see, medical images are an important part of medical records and medical imaging devices must be FDA approved to ensure that they provide accurate diagnostic quality images. Now, as far as I know, there are no laptop displays yet approved for such purposes. So, if your physician is using them for such, then he is essentially using unapproved and substandard medical equipment in your treatment. Is that what you want from your doctor? Not me. I don't suppose you'd tell us who this doctor is, would you?

       

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    Anonymous Coward, Jun 26th, 2009 @ 7:40am

    Mike, have you not brought up often the theory that anything that is made electronic can be hacked?

     

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    mjb5406 (profile), Jun 26th, 2009 @ 7:44am

    Better Coordination

    I have 9 different doctors (that's not an exaggeration) due to my many health conditions. I see my endocrinologist every 3 months and my kidney specialist every 6 months. They both do blood tests but. because one uses EMR (Electronic Medical Records) and the other does not, one does not know what the other needs so they order redundant tests. Sometimes insurance will pay for it, sometimes not. Over and above the transparency aspects of EMRs, it would allow for better coordination of care when people use multiple specialists. Unfortunately, the day of the general practitioner seems long gone and everyone is a specialist.

     

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      Anonymous Coward, Jun 26th, 2009 @ 7:45pm

      Re: Better Coordination

      I have 9 different doctors (that's not an exaggeration) due to my many health conditions. I see my endocrinologist every 3 months and my kidney specialist every 6 months. They both do blood tests but. because one uses EMR (Electronic Medical Records) and the other does not, one does not know what the other needs so they order redundant tests.

      Unfortunately, even if they were all using EMR they likely would not be able to exchange information with each other due to the proprietary formats used.

       

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    Andrew Calcutt, Jun 26th, 2009 @ 7:53am

    I think it is obvious the EMR is good for patients and hospitals. From a patient perspective is is a good this that the system will expose overcharging

    A friend of mine works in health care IT and what it offers to doctors seems like a great benifit. Instant access to things like xrays and other records all in one place. Once they overcame the learning curve of moving from their paper system I have heard nothing but good things of the system.

     

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    Corwin (profile), Jun 26th, 2009 @ 8:03am

    Exposing Overcharging

    Maybe I missed it but since I've read a few comments about it, but I did not see an initiative to maintain electronic healthcare finance records, I was under the impression that it is about MEDICAL records.

    This initiative is, as far as I know, about providing better access to patient health records, not about trying to find overcharging or waste.

    If I am wrong, thank you for enlightening me.

     

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      aguywhoneedstenbucks (profile), Jun 26th, 2009 @ 8:18am

      Re: Exposing Overcharging

      You're right...mostly. Since EMR is such a big deal right now, new Practice Management software (which does all the payment stuff) is being developed everywhere, including by companies who do EMR software. This is so those companies can sell the whole suite. The medical records go electronic, the billing goes more electronic (basic PM has been available since the 1980s, but the new stuff is really good).

      Short version: Electronic Healthcare Financial Records are mostly electronic in some form right now (although there is still a LOT of faxing that needs to go the hell away). It's becoming more integrated with the EMR software and adding more billing functionality as we speak.

       

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    Ikonoclasm, Jun 26th, 2009 @ 8:24am

    I work in a single-practitioner office that converted to EMR back in 2007. Our patients are primarily elderly and Hispanic, so there's no need for us to pad our billing because the patients all have at least a handful of chronic medical conditions.

    For us, EMR has been a huge boon to patient care and efficiency. The bottleneck in our office operations are now anything involving human interaction with patients, not fiddling with charts or filling out progress notes.

    It would be wise to be careful not to characterize the entire medical industry as being intentionally slow to adopt EMR for cynical or self-serving reasons. Doctors' egos are fearsome beasts and they love their routines. All the other doctors in my area have been slow to adopt EMR not because they're concerned with billing or having discrepancies exposed, but because they're complacent and converting a practice over to EMR is an incredibly daunting task.

     

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      arelas, Jun 26th, 2009 @ 8:49am

      Re:

      100% agreed. I work in medical IT for a 12 doctor practice. The docs here are not afraid of what might be discovered with EMR. The major holdup for ANY new technology is workflow, Period. Anything that could slow them down or change the way things are done are met with resistance. In the face of that, I have been about to convert our practice to EMR, PACS, and a current practice management system. Our remote office can share charting data in real time. And for the guy that was talking about $300 for a copy of his MRI, we charge $5...that's right...$5.

       

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    COD (profile), Jun 26th, 2009 @ 8:46am

    //As a Canadian, I will say that it rarely takes more than a few hours to see a doctor, but it might take months to get to a specialist or into surgery for anything that isn't life threatening.//

    It's no different in the US. I can get into my primary care doc in 24 hours. It takes 2+ months to get an appointment with a specialist if it's not a life threatening emergency. I've talked to several friends in Canada and the doctor access issue is a wash. It's no different than the current state of affairs in the US. There may be many arguments against a Canadian style health system, but access to medical care is not one of them

     

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    Anonymous Coward, Jun 26th, 2009 @ 8:50am

    The gvmnt doesn't want you to live longer

    The longer someone lives, the more the government has to pay out in medicare and social security so they do not have a strong financial incentive to make people live longer.
    EMR is more important than the article relays as evidenced by the comments from other medical providers. It helps with immediate access to information and minimizes errors.

     

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      Hulser (profile), Jun 26th, 2009 @ 9:08am

      Re: The gvmnt doesn't want you to live longer

      The longer someone lives, the more the government has to pay out in medicare and social security so they do not have a strong financial incentive to make people live longer.

      I don't buy into this at all. Basically, I agree with Mike's statement...

      "Focusing on preventative care and actually keeping people healthy would actually provide a massive economic benefit not just to the healthcare industry, but to the economy as a whole."

      Your statement is based on the assumption that because you live longer, you're more of a financial burden on the government. But this isn't necesarilly so. If we focused on preventive care, then people would live longer, healthier lives. Sick people are a burden on the economy no matter how old they are. Sure, older people have more of a chance of being sick, but by making everyone healtheir, regardless of age, you can actually gain substantial savings.

       

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    Hulser (profile), Jun 26th, 2009 @ 9:02am

    Confused? It's the cost, stupid.

    I've been really confused by the whole push for "electronic healthcare records" as some sort of big step for improving our healthcare system. It's such a minor part of what's needed that it seems to be looking at curing a cough when someone has terminal cancer.

    Based on what I've seen on the news, one of the main goals of implementing electronic healthcare records is the cost savings. So, it's not (just) about improving individual healthcare; it's about saving money. So, to use Mike's cough analogy, it's not like treating the cough of a person who has cancer, it's like spending $4000 dollars on someone who just has a cough.

    Sure, I think that electronic healthcare records can also have a huge beneficial impact on individual healthcare, but if anything is going to drive the entire medical healthcare industry to move to electronic records, it's going to be reducing cost, not improving healthcare. I don't think the medical industry wants us sick; they just want to make money. And if avoiding the use of electronic records means they can make more money by hiding the innefficiencies of the system and we're more sick as a result, well then...that's OK to them.

    So, if you look at the problem in terms of cost, I don't see why there's any confusion. As Mike pointed out...

    The actual costs are nearly totally hidden from most consumers, so they don't make smart choices at all.

    Electronic medical records will help expose these hidden costs which will help lower these costs which will "[improve] our healthcare system". What's to be confused about?

     

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    Grant Hamilton, Jun 26th, 2009 @ 9:14am

    This is so far off the mark...

    This is so wrong, I don't know where to begin. First, I've never met a colleague who tried to keep a patient sick to make more money. There is no conspiracy, people. Second, the reason I dislike the present implementation of the EMR is the same reason you, as a patient, should hate it. It turns me into a typist, facing away from you and looking at the computer. It makes the clinic slower so I can either see fewer patients in a day or make you wait longer. EMR is fantastic for pharmacies, coders, billers and IT people. The problem is that this software is almost always designed with those people in mind and not the doctors. I've used the VA system and it is awful. Our clinic use to see 60 patients a day. After the EMR, it is 20. Forever. Progress?

     

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      Mike Masnick (profile), Jun 26th, 2009 @ 9:41am

      Re: This is so far off the mark...

      This is so wrong, I don't know where to begin. First, I've never met a colleague who tried to keep a patient sick to make more money.

      No, no. You miss the point. No one is saying that any doctor does this on purpose. We're saying that the overall incentives of the system set it up so it's the way it works. There's little effort put towards preventative care from insurance companies, because that's not profitable.

       

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        Corwin (profile), Jun 26th, 2009 @ 9:58am

        Re: Re: This is so far off the mark...

        You need to re-learn your economics. Preventative care saves the insurance money - $One pill

         

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          Corwin (profile), Jun 26th, 2009 @ 10:02am

          Re: Re: Re: This is so far off the mark...

          You need to re-learn your economics. Preventative care saves the insurance money - $One pill

           

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            Dark Helmet (profile), Jun 26th, 2009 @ 10:22am

            Re: Re: Re: Re: This is so far off the mark...

            "You need to re-learn your economics. Preventative care saves the insurance money - $One pill"

            ...kind of, except that you also have to take into consideration that the large Insurance Agencies, Large Pharma firms, and WHO/NHO have throughout most of the last 120 years all been the same people. Kind of throws things in a different light.

             

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          Hulser (profile), Jun 26th, 2009 @ 10:11am

          Re: Re: Re: This is so far off the mark...

          It's not a matter of economics; it's human psychology. If every economic decision was based on straight evaluations of economic principles the world wouldn't be in the financial mess it is today. Case in point, preventive care may save an insurance company as a whole money, but if this would the reduce the size of the kingdom over which its leaders preside and, worse yet, cut their salaries, it ain't gonna happen no matter what economics says.

          (BTW, when is TD going to fix the bug where every post under a Mike post appears with a blue background? Shouldn't it be only the original Mike post that has this format?)

           

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        Grant Hamilton, Jun 26th, 2009 @ 12:50pm

        Re: Re: This is so far off the mark...

        I agree with that but this is what you get with a 3rd party payor system. They make money by NOT covering things. Since the long-term doesn't matter in insurance (people change insurers and the new company gets the benefit of the first paying for preventive care), they don't pay for prevention.

        The country needs to answer a few tough questions if it really wants health-care reform. The first is whether we want health care for society (which would involve rationing) or health care for individuals (do everything you can). The second is to determine if healthcare is a right. I don't think that anyone should be able to demand my services for free (definition of a right).

        I also think it is strange that the patient's responsibilities are never discussed when talking about reform. If healthcare is "free" then where is the incentive to care for oneself?

        So, I agree that the incentives are in the wrong place but none of the proposed solutions do anything to address that. If we had a fee-for-service model, patients could compare prices much easier, they would have an incentive to take care of themselves and not get diabetes and heart disease, the prices would fall because of competition and the fact that collections would be near 100% instead of the current 30%, patients (who are footing the bill) might ask more questions about whether or not the expensive test about to be ordered is really necessary, doctors/hospitals could lower prices due to MUCH lower overhead (I spend WAY too much of my day doing paperwork), and so on...

        As long as we have a third party payor system, the incentive will be in teh wrong place.

         

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          another mike (profile), Jun 26th, 2009 @ 1:27pm

          Re: Re: Re: This is so far off the mark...

          Well said. I like having insurance in case something major comes up, but the way things are set up, there is no reason for me to choose a cost-effective solution over the half-dozen things the doctor wants to try.
          The proper way to fix things isn't to subsidize care for everyone, but re-align the incentives for patients, doctors, and insurance companies to prefer prevention and cost-effective solutions.

           

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        Anonymous Coward, Jun 27th, 2009 @ 8:00am

        Re: Re: This is so far off the mark...

        The alternative is to reward them for "healthy" by who's standards? Do you give them a bonus when the discharge people? If they live 3 months past the treatment?

        I could see where this would lead to some doctors being motivated to short term treatments that cover up issues rather than going for the full fight.

         

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        dan kurt (profile), Jun 27th, 2009 @ 11:48am

        Re: This is so far off the mark...

        There are many intelligent commenters seen here. Unfortunately, most of the commenters are truly incorrect in their attitudes, expectations and knowledge of medicine and how it works. I read Andy Kessler's book The End of Medicine when it was published and his URL is on my daily read list. He may be rich and smart but he doesn't have a clue.

        Let me put it in simple form:

        1) You (plural you) will get what you pay for.
        2) Screw the Physicians and over time you will get mediocre practitioners.
        3) Social Engineering does not work, e.g., Affirmative Action, Malpractice, "Universal Health Care", etc. If Socialism appears to work, you are fooling only yourself. Read Bastiat as a beginning to gain understanding.
        4) You (singular you) will suffer aging, illness and accidents. Your health will only marginally be controllable as you age. No known human intervention can alter this fact and delay only seems to increase the terminal cost of coping with decrepitude. Doubt me, visit a nursing home.
        5) Electronic Medical Records rammed down the throats of medical practitioners is stupidity. EMR technology will be voluntarily adopted when the technology makes sense just as personal computers were adopted over the past 30+ years.
        6) TO REALLY IMPROVE MEDICINE DO YOUR BEST TO TRAIN PHYSICIANS WITH THE HIGHEST IQs THAT CAN BE OBTAINED FROM THE POOL OF CANDIDATES WHO WANT TO BE COME PHYSICIANS. POLICIES THAT EFFECT THAT END SHOULD BE THE PLAN.

         

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          Anonymous Coward, Jun 28th, 2009 @ 2:05pm

          Re: Re: This is so far off the mark...

          1) You (plural you) will get what you pay for.
          2)...


          You just lost all credibility right there as far as I'm concerned. While you may generally pay for what you get, the inverse is by no means any kind of truism and I don't pay much attention to those who claim it is.

           

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            dan kurt (profile), Jun 28th, 2009 @ 4:16pm

            Re: Re: Re: This is so far off the mark...

            re: "Re: Re: This is so far off the mark...
            by Anonymous Coward on Jun 28th, 2009 @ 2:05pm
            1) You (plural you) will get what you pay for.
            2)...

            You just lost all credibility right there as far as I'm concerned. While you may generally pay for what you get, the inverse is by no means any kind of truism and I don't pay much attention to those who claim it is."

            As an Anonymous Coward you have no credibility, or is it Craven Coward?

            I suspect you, Craven Coward, are rather young, have not been burned much in life, and are headed for a fall. If you can not hide behind the naivete of youth, you must be just stupid.

            There are few truisms that serve one well through life's journey but one that has worked for me has been: buy the best, pay cash and take delivery. That one will get what one pays for holds for not just individuals but society at large: the Market can not be mocked for long. Understand Caveat Emptor holds.

            Cheers,

            Dan Kurt

             

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              Dan's Real Daddy, Jun 29th, 2009 @ 12:45pm

              Re: Re: Re: Re: This is so far off the mark...

              As an Anonymous Coward you have no credibility, or is it Craven Coward?

              Hey dan kurt (or is it dandy hypoctrite?)
              That's pretty funny, coming from some anonymous poster.
              Pot, meet Kettle.

              I suspect you, Craven Coward, are rather young, have not been burned much in life, and are headed for a fall. If you can not hide behind the naivete of youth, you must be just stupid.

              Talk about stupid. No, it is life which has taught me that you don't always get what you pay for. A crappy product (or service) is still going to be a crappy product no matter how much you pay for it. Overpaying for stuff in order to "prove" how good it is is for snobs with more money than brains who like to go around bragging about how much they spend.

              There are few truisms that serve one well through life's journey but one that has worked for me has been: buy the best, pay cash and take delivery.

              And it's really easy to determine which is best: just look for the highest price, right? If you really believe that, then what a lazy, unthinking buyer you must be. Man, I'd love to sell you some stuff. And I can guarantee you it'll be the best (i.e. most expensive) around. Just let me know what you want, OK? I'll be glad to take your money.

              *(Oh, and here's a truism that you obviously haven't heard: a fool and his money are soon parted.)

              Cheers,

              Dan's Real Daddy

               

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          Mike Masnick (profile), Jun 29th, 2009 @ 3:53am

          Re: Re: This is so far off the mark...

          1) You (plural you) will get what you pay for.

          You seem to ignore an awful lot of the *facts* behind the healthcare system, including that US citizens pay significantly more for healthcare, but are no better off than countries that pay less. So "you get what you pay for" isn't exactly true, now is it?

          You get what you pay for is simply untrue in many instances. Sounds nice. Not backed up by the facts. Too bad.

          2) Screw the Physicians and over time you will get mediocre practitioners.

          Who said otherwise? In fact, if you understand the issues properly, the physicians would be better off.

          3) Social Engineering does not work, e.g., Affirmative Action, Malpractice, "Universal Health Care", etc. If Socialism appears to work, you are fooling only yourself. Read Bastiat as a beginning to gain understanding.

          Who said otherwise? Kessler certainly isn't suggesting such an approach.

          4) You (singular you) will suffer aging, illness and accidents. Your health will only marginally be controllable as you age. No known human intervention can alter this fact and delay only seems to increase the terminal cost of coping with decrepitude. Doubt me, visit a nursing home.

          Who said otherwise?

          5) Electronic Medical Records rammed down the throats of medical practitioners is stupidity. EMR technology will be voluntarily adopted when the technology makes sense just as personal computers were adopted over the past 30+ years.

          Hmm. Again, please explain why every other industry seems to have gone digital, but healthcare has not? Then look at the major differences between the healthcare industry (third party payers, subsidization, hidden incentives) and question why that is.

          6) TO REALLY IMPROVE MEDICINE DO YOUR BEST TO TRAIN PHYSICIANS WITH THE HIGHEST IQs THAT CAN BE OBTAINED FROM THE POOL OF CANDIDATES WHO WANT TO BE COME PHYSICIANS. POLICIES THAT EFFECT THAT END SHOULD BE THE PLAN.

          Who said otherwise? Not sure what that has to do with the other points though.

           

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    Anonymous Coward, Jun 26th, 2009 @ 9:20am

    The Major Players Want EHR

    As someone who works on EHR and Practice Management software, I can tell you that the major players in the game seem to have embraced as much EHR as possible--provided it's their systems. The CCHIT certification is the key: if your software isn't certified by them (upwards of $30,000 just for the one-day, three-person jury trial, have to re-certify if you want to be on each year's list), then many major customers won't use it. They are pushing to make the CCHIT standard one that is officially recognized by the federal government, and the requirements are so extensive and detailed that it's a pretty blatant attempt to push out anyone who isn't a major player.

     

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    Anonymous Coward, Jun 26th, 2009 @ 10:05am

    Mike generally I am a fan of your opinions but this is pretty egregious example of 'when all you have is a hammer' thinking. True, Kessler makes some reasonable points in his book but in general it is a thin excuse for another one of his egocentric outpourings. There are quite a few very valid issues that both of you are glossing over such as the crippling effect of regulations such as HIPAA, unfunded mandates (EMTALA) and a highly, fragmented system that prevents the kind of collaboration and transparency that lead to beneficial innovations (see: open-source). The biggest challenges to EHR's is not resistance to the transparency, nor even the cost but rather, to be frank, that the current EHR technology sucks. Even the big name vendors are putting out a product that is cumbersome to users and not well aligned with the human workflows around medical care. If there was a great EHR providers would snap it up in an instant, regardless of cost.
    To be fair there are absolutely scams in healthcare and entire business models built off of profiting from the "inefficiencies baked into the system" but there are also plenty of legitimate providers that are just as (and even more) frustrated by the morass of players as any politician stumping on health reform these days. I suggest that in the future you turn to more informed sources (Gwande's The Cost Conundrum is a good place to start). The current state of the US health system is pathetic and untenable but the rather than some evil empire conspiring to profit off of human suffer it has been the absence of any rational system or anyone behind the wheel that has lead to the current situation.

     

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      Hulser (profile), Jun 26th, 2009 @ 10:42am

      Re:

      The biggest challenges to EHR's is not resistance to the transparency, nor even the cost but rather, to be frank, that the current EHR technology sucks.

      Interesting point, but have you considered that the technology sucks for the very reason that Mike is spotlighting? In other words, maybe it sucks because it's not getting the funding and/or acceptance from the overall healthcare industry and this in turn is happening because the overall healthcare industry doesn't want the technology because that would expose their gross inefficiencies. If you're comfortable in an environment where you can sell hammers at a huge profit, why would risk that by paying someone to invent a better nailgun?

       

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    Anonymous Coward, Jun 26th, 2009 @ 11:28am

    Medical Sales

     

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    ddbb (profile), Jun 26th, 2009 @ 11:39am

    I have worked with entrepreneurs who tried EMR and harnassing the power of the Web, etc. . .

    There are a number of reasons why it would take so long and doesn't work very well. Determining standards for coding procedures for something that can be a very individual circumstance, differences in treatment standards geographically and across specialties, administrative differences between providers, and so on.

    There is also the question of who would develop the platform and the technological standards. If you think DVD vs. Blue Ray vs. Whatever or even Mp3 vs. Wav vs. Wma vs. AAC is a tough battle, wait until you see this fight. If the government decides who wins, you can bet the system will be miserable.

    However, like Mike mentioned, none of this addresses the basic issue of cost. The excessive spending has little to do with paper records and everything to do with the third party payor system. If someone else (your employer, insurance company, Medicare, Medicaid, VA) is paying the freight, you do not have any incentive to shop around nor do the providers have any incentive to publish prices. Through various rationing provisions, there is an attempt to hold prices down, but political pressures exist to provide ever-expanding benefits. The move to universal health care will only exacerbate this issue as there is no incentive to incur additional capital costs for an expensive IT system when the government is adjusting your fees downward. It is the separation of payor from customer that drives medical costs.

     

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    Anonymous Coward, Jun 26th, 2009 @ 1:07pm

    Why not electronic records?

    Because doctors are afraid we will finally be able to read what they wrote?

     

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    dk, Jun 26th, 2009 @ 1:51pm

    I'll say it

    I think the solution is twofold.

    1) Fire most of the administrators. They don't contribute to care, they contribute to the idea of furthering the clutter in the industry. We're all clear on that point.

    2) Lobby against insurance companies, not because of your high premiums they charge us but because of the premiums they are charging doctors. Let's face it, if you are going to be a higher cost to the system, you should damn well pay a higher premium. It doesn't have to be directly proportional, but it should be higher. Doctors on the other hand are going to pass their malpractice costs on to us no matter what. So the only solution is lobbying against those higher costs at the health insurance level. Doctors who migrate to EMR don't need subsidies, they need breaks on malpractice insurance. This accomplishes both the goal of migrating to EMR and saving on costs that are ultimately passed to the consumer.

     

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    bvl (profile), Jun 26th, 2009 @ 2:56pm

    My two cents

    So you ask why are healthcare cost so absurd in the US compared to other countries? The myriad of pieces of paper of all different sizes that health insurers require before they'll pay is one thing, and this is where IT can help, but you need standards and without the big dog in the room (ie the federal gov't), this is a pipe dream. Why is it that doctor's offices have at least one or two employees devoted full time to filling in all these forms depending on which insurance company you may be using? They don't come free either, and the spiral turns every higher. . .

    The real reason is that most of medicine is defensive. Defensive against the likelihood of being sued! This is the most litigious country in the world with more lawyers per capita then any other, and doctors in fear of making a mistake, order more and more tests whether you need them or not.

    Then again why all the fully equipped hospitals and clinics at every corner with their own MRIs and laboratories? Who's paying for those? You are in terms of higher premiums. I doubt other countries have all this stuff at every corner, nor do they (or we) need it. And if you don't have insurance, you get the benefit of this lavish infrastructure too. Someone else will pay.

    I could rant on further, but I'll see how much flack this engenders first.

     

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    Anonymous Coward, Jun 26th, 2009 @ 8:35pm

    Another Reason They Don't Want It

    If medical records are converted to EMR then patients are more likely to explore the idea of changing doctors with the idea that their records can be quickly sent to whatever doctor they choose. The fear of patient churn is reason enough for some providers to oppose EMR, but wait, it gets worse. Once patients realize that their records can be easily sent across town, they may begin to wonder why they can't be sent across the globe. And then they may begin to question why they can't have the thing that truly strikes fear into the hearts of US providers: Telemedicine!

    So imagine that an office visit to a typical US doctor costs $100, but a virtual visit to a doctor in, say, India, costs $10 and you don't even have to leave home! Which one do you think a lot of people are gong to choose? Which one do you think a lot of insurance companies are going to choose? Considering that that $100 US doctor might have come from India anyway, I think the answer is pretty clear. And THAT'S why the US healthcare industry is afarid of EMR. Even now, there are people who need expensive (in the US) procedures that they can't afford who are traveling to India to obtain them where they can afford it (even with travel and lodging expenses). It's often called "medical tourism".

    Right now, such telemedicine is illegal in the US and your local pharmacy won't accept electronic prescriptions from doctors in India. But if a large number of patients were to become aware of the technical feasibility of such a thing, then there might emerge a political movement to change the law. One that perhaps even the AMA with all their lobbying dollars couldn't derail.

     

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      Grant Hamilton, Jun 27th, 2009 @ 12:36pm

      Re: Another Reason They Don't Want It

      First of all, the charge for the visit might be $100 but the reimbursement from Medicare is likely to be about $17 (no joke). Second, it only takes one signature (which is till required–even with an EMR) to get your records sent to another doctor. So there's no real barrier there. Third, you want medical care from a doctor who can't examine you? The telemedicine that you describe is illegal (?) because it would be colossally dangerous.

      Please, I implore you, there is no conspiracy. If you want your relationship with your doctor to improve, get rid of the payor in the middle.

      Here is an example: A patient needs surgery. Her insurance says that they do not require pre-approval for that operation. I do the operation. We bill the insurance. Insurance denies the claim. Patient is now on the hook for the "insurance" price which is way higher than it would have been if she'd paid cash in the first place. Illegal to adjust the price down after submitting to insurance. Patient mad at me.

      See the problem?

       

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    The Cenobyte, Jun 27th, 2009 @ 12:15pm

    I have been saying this for years!!!

    The HMOs and PPOs and the like out there are really only a very small part of the issue here. They have learned to piggy back on a system that was so broken to begin with that they can't help but look broken.

    The medical profession is not the great mystery it once was, the average education of a C+ student in average High School could easily be a good nurse, nurse practitioner, and in many cases a doctor, surgeon, or pharmacologist, but medical schools in this country artificially graduate a low number of doctors based on systems of competition and required learning of biological systems that the average family practice doctor would never have any reason to understand or work with. This overtraining most specifically of doctors creates an artificial shortage of care but is compounded by the fact that even the most basic care requires the supervision of a doctor.

    Then the Pharmacology system in this country requires that even the trained pharmacologist and nurses not be allowed to prescribe medication to a patient without a doctor’s ok. Plus the FDA compounds the issue by requiring the most stringent (And often flawed but FDA required) testing system for even medications that have been on the market years during simple reformulation. This leaves medications that could easily be used for curing some of the world’s worst issues on shelves because the cost of R&D plus FDA approval is so expensive that no company is willing to do it for a drug that is coming off or already has come off patent. (Remember money makes the world go round) So you now have limited access to a limited number of expensive drugs.

    Only after you remove the scarcity of healthcare can you really start to look at the costs. Govt. intervention and old school thinking about medical practices, mixed with AMA (And the likes) lobbing have left us with a system that cost too much to begin with. Once that is removed I think you will find that the health care industry while still likely taking the same amount in 'overhead' (I heard the number $.33 on the dollar but don't quote me on that) if you are paying only 25% of what you where paying before, huge profits become a thing of the past. This is not to say that it should not be trimmed but if basic medical care is so cheap that companies provided or cash are affordable alternatives, insurance companies will find new ways to compete and trim their prices. (Which I am going to bet will include electronic medical records)

    In short, if we a) Stop overtraining doctors and increase the numbers that graduate, b) allow basic care and prescriptions to be handled without a doctor, c) Reduce artificial barriers to drug manufacture, d) allow insurance companies to operate in a market not artificially constrained, we will reduce the overall cost of medical in this country by staggering amounts.

     

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      Grant Hamilton, Jun 27th, 2009 @ 12:29pm

      Re: I have been saying this for years!!!

      So you want a system where the professionals have less training and less oversight for new medications? SHort-term costs might go down but I don't think that is a recipe for better care.

       

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    Rex, Jun 29th, 2009 @ 12:10pm

    to set the record straight ...

    My recall that the automated record keeping for stock transactions was not done voluntarily by the securities industry. The mandate for automated record keeping was done by congress to assure that stock owners were paying their taxes on cap-gains and dividends. Hence the requirement for stock registration, registrars and transfer agents.

    I worked on systems in the early 1970s in implementing the intent of the legislation.

     

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    Christopher Heayn (profile), Jun 30th, 2009 @ 12:58am

    Problems with the system and cost

    I know from personal experience that the whole paper records is a rip off and the only reason is to try and get every last penny you have even for simple doctors notes. Having medical record in electronic forms would be beneficial on the whole since it allows people to not have to worry about transferring medical records from one doctor(s) to another. Also it eliminates the fees that occur during these transfers. It also reduces the risk of problems during diagnosis/treatment since it allows the doctor to properly treat the patient regardless of the situation. The only resistance is do to ignorance, refusal to spend the money on equipment, and/or the old school doctors that have no idea how to type/use a computer.

    Obviously the medical industry is trying to make money the problem is they waste so much of there own money by refusing to do such things as electronic medical records, simplified and standardized documentation/records. Even though electronic medical records may seem small it is part of a much larger problem is probably one of the first steps to fixing such a huge overwhelming problem with the health care industry.

     

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    dan kurt (profile), Jun 30th, 2009 @ 8:05am

    re: Comments on this board.

    First visit here and probably last.

    This is too sophomoric. The two commenters that responded to my post don't exhibit knowledge of anything about the topic [ providing medical care ] and couldn't think rationally about it even if they did.

    Dan Kurt

     

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    JoeNYC, Jun 30th, 2009 @ 8:23am

    Amazed at the misinformation here

    As someone who has had a strong relationship with the public healthcare system, I'm frankly amazed at the misinformation posted here. A few notable exceptions (Grant Hamilton).

    Most of the opinions given by people are anecdotal at ground level. To really understand the problem, you need to look much higher, people. Here's where you should be looking:

    1) Unfunded government mandates-- the amount of FREE healthcare required of hosptials and healthcare professionals is staggering and quickly rising.

    2) Medicare, HMO, PPO reimbursement rates-- these giants are deciding how much hospitals and healthcare professionals get paid per procedure. They decide what procedures get done, not your doctor, due to economics. There are procedures which are profitable (they get done) vs. those which are losers (they don't get done). Oh and they also decide which hospitals are profitable-- two hospitals in the same city don't get the same reimbursement rates for the same procedure-- amazing, huh?

    3) Draconiam Medical Coding Requirements- the reimbursement system (the paperwork your hospital or MD must submit to get paid)are outrageously convoluted and always changing. MD offices need to hire teams of people to handle the paperwork which drives up their costs. Why is the system so complex? If the codes and documentation aren't perfect the insurer gets to reject the claim-- saving them billions by rejecting legitimate claims. Guess who makes up the difference?

    4) Illegals, Undocumented Aliens, whatever you want to call them-- they are a tremondous drain on the hospitals-- the hospitals were able to absorb all this free care when it was %5 of the total-- now, it's 15%+-- been to an ER lately? Loaded with people who use it as a GP office. Result-- overloaded ERs which resemble MASH units where true emergencies are not given the proper treatment.

    5) Medical Malpractice Insurance-- the system is broke costing billions in legal fees-- even where the doctor was not at fault.

     

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    Doug Wallace, Sep 4th, 2009 @ 3:19pm

    Electronic Medical Records

    Couldn't agree more. The current goal of healthcare reform seems to prey on "47 million uninsured Americans". Why not float a two year program to insure these uninsured, and take the proper amount of time to assess the monster that is the interddependencies of doctors, patients, insurance, lawyers and pharmas? The current Administration took more time evaluating the family dog than it has in overhauling 18% of US GDP. Oh, yes, and it all aligns with reelection cycles. Surely, any current rush will be a win for ALL of us...
    CLICK HERE TO GO TO MYEMRCHOICE

     

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    cecil grass (profile), Jul 1st, 2010 @ 8:23am

    emr systems

    While emr systems are only part of fixing health care, I feel them to be an important part and this is actually a little startling to read. I myself have been using the emr system at http://www.drfirst.com and I think you can't beat the convenience of it all. The free demo would surely impress anyone.

     

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    marry, Dec 10th, 2010 @ 9:27pm

    http://wlancontroller.com can be used for scanner and access point

     

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    ned, Jan 7th, 2011 @ 2:45pm

    They are crooks

    The biggest reason they do want the records to be on computers, is because of the records the routinely remove completely, and records that clearly show their corruption. Doctors primary job is to decide who lives well and who is sick. Their administer illness. That's why they are so good a cures, cause it is their caused illness they are curing. To cure it, all they of to do is stop administering the illness, and the patient is amazed.

     

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    Ned, Jan 7th, 2011 @ 3:11pm

    True first hand accounts of psychiatry

    Patient complains about depression and thoughts of suicide. Psychiatrist formulates a diagnosis. By in large Psychiatrist decides you are bi-polar or schizophrenic in the worst cases, otherwise a milder version or something less incriminating(if they like you). Then they administer drugs. Practically, everyone says, it doesn't help, or I feel sick from the drugs, but back to the specific case I witnessed. Patient says, I still feel depressed and suicidal. Doctor tries and different combination of drugs, variations of dosages, different diagnosis and on and on. This re-evaluation of drug therapy and diagnosis can go on for months in the hospital, and re-diagnosis happen years after you see a doctor. But back to the specific case I witnessed. The patient, after trying a bunch of different drugs and combinations over a couple months of inpatient therapy says 'No doctor, the drugs aren't helping, I still feel suicidal and depressed'. The Doctors say, ok, this is my last concoction of a drug therapy and if this doesn't work, we will have to try Electro Shock Therapy. Patient met with Doctor and says "yep Dr. I feel better now, I think its working". This patient told me himself, the drugs aren't working, but I finally told the Psychiatrist they are because I was scared of ECT's(Electro Shock Therapy). Another case, I witnessed. Basically the same as previously mentioned but over many more years, and stays at the hospital, at which point the patient bravely said "ok Dr. lets try ECT's". This poor girl had her brain shocked with electricity early in the morning on an empty stomach a few times a week for a couple of months or so. She would retain from the therapy barely able to sit up and in a daze. At the end of it all, I overheard her confiding in the nurse, that her depression and suicidal thought have not gone away and she is just as she would. The nurse advised her to pretend she's feeling better, go back to her home and see how it goes from there, and mentioned that the Psychiatrists at this point is just going to advise more shock therapy, so go and see, cause maybe they fried you brain enough -hopefully.
    Another case. Everyone in mental ward are advised and pressured or forced to take drugs. And the dosages are continually advised, pressured and forced to increase. Everyone learns this immediately. There was one patient who was loyal to the state or rebellious or wanted to proved something. He would ask himself to have to dosages increased. I overheard one of his councilors discussing, 'that was easy, he is asking to up the dosage himself'. No pressure was required, and so they kept upping the dosage. He told me they were making him feel like shit, but he could handle it. He likened himself as a soldier, planned to join the military, got tatoes of those sorts and what not. He kept upping in, but the drugs are severe. He finally gave in and told the Dr he cant handle the drugs. Since I last saw him, a fully cooperative patient willing to accept the highest dosages, he remained depressed and suicidal.
    A final note. The side effects of these drugs prescribed for depression and suicidal tendencies include suicidal tendencies.

    A note on corruption. In my resistance to refuse drugs and my diagnosis, I faced outright corruption at the hands of local employers, police, emergency room staff, nurses in emergency and psychiatric nurses, Medical Doctors, Psychiatric Doctors, Patient advocacy rights office, Legal Aid Lawyers, Prison transport guards, Superior Court Justice of the Peace, Appeals Courts of Ontario. THE ENTIRE SYSTEM OF CANADA is ABSOLUTELY AND COMPLETELY CORRUPT. WE ARE NOT FREE. THIS IS NOT FREEDOM LAND.

     

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    Tracey Morris, Jul 5th, 2012 @ 6:29am

    Electronic Medical Records

    I believe its a huge breach in confideniality beteen pt and Doctor. It also takes away from the one on one care with your your doctor. I do not want my medical chart done this way. I want to talk to the Doctor not the computer or nurse or any other electronic device.

     

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