Who Can Do The Best Job Of Computerizing Health Records?

from the doctor-doctor dept

There’s been a lot of talk for a long time about the benefits that could be derived from computerizing health care records as a means of introducing more efficiency to the US health system. It’s an enormous task, but one in which the incoming administration is very interested. The costs are expected to be as high as $100 billion over ten years, and commentators aren’t at a loss for words when describing the complexity of the task. One person quoted by CNN says it will be difficult to create a system that “thinks like a physician.” Two points: first, should the system think like a physician? If the industry’s current practices (and practitioners) have led it to its current state, can it be expected to generate the best, most efficient solution? Many hospitals are already discovering the value of looking outside the medical field to gain insights on ways to improve their operations, and creating a modernized health information system seems like it could benefit from fresh eyes and insights as well. The second point follows the first: is the government the best party to come up with the system? It’s easy — far too easy — to find examples of huge government projects gone wrong, flawed either in their conception or implementation, or both. The government can play an effective role in helping to establish national standards, and in funding the project, but again, given the government’s role in creating the current state of the healthcare system, would it be more effective to let the market, rather than the industry lead the way and develop its own innovative solutions?

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Comments on “Who Can Do The Best Job Of Computerizing Health Records?”

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Michael Goodfellow says:

electronic health care records

The Feds have a record of really expensive, completely wasted IT efforts. I think that includes FBI records, IRS modernization, new FAA air traffic control systems. Each project spent $100 million or more and failed completely, with no results at all, and had to be redone from scratch. I also read that the British NHS is spending billions on their record system, and it’s late and over budget.

We should be doing small pilot projects and letting them grow. Perhaps there are existing hospital systems that work and can be sold. Perhaps individual doctors groups can get something simple written and then have it spread. This top-down, designed for nationwide use approach is sure to fail.

Bunny says:

Prepare to have your medical data become public

When they say they are looking outside of the medical community for input, they are referring to a list of fortune 500 corporations who are already perfectly aligned with their goals of total surveillance. These will then come back and tell them precisely what they want to hear: let us buy and sell it. This is what I expect to happen unless Obama has the power to dismantle the total surveillance regime, and I doubt that. The best he can do is hit the pause button on this thing before it assimilates him as well and he just becomes another spin doctor trying to put a good face on it.

BJ says:

Cutting IT costs

We need to cut costs of health care IT to make these electronic solutions more affordable to the average physician/practice. There are already companies out there realizing this and jumping on the bandwagon. For example if you check out Mirth, you can see how they use open source to cut licensing costs and provide cheaper alternatives to these providers that want to integrate their health information systems. Saving $$$ is always appealing to providers 😉

Tephy says:

My father is a doctor and has moved to a digital filing system. So has everyone else in their office. They’ve had it for about three years now and have never looked back. They use very little paper and have been able to dispose of many paper charts because of the digital copies in the system. It is very robust in what it can do and allows him to access patients charts when he is at home / away from the office. Plus he is able to dictate his notes + medication recommendations directly into the system and leave little room for error in transcribing or loss of data.

I have never heard of any violation of the data being used but that may be because he is with a local company that only operates in BC. I know he has never had a problem with it nor anyone else he knows who uses it.

Anonymous Coward says:

We are working on a electronic health care system. Each doctor, pharmacy, hospital etc can access your personnel health records at defined security levels (with restricted views, inputs, etc.) over a highly redundant secure (with automatic audit checks, etc) system.
The system is fairly straight forward. The security layers are fairly straight forward. The largest and most complex issue it at least 25,000+ different systems the current doctors use in are small market place. Each doctor’s office in the area has their own computer record keeping system (lots still on paper only). The doctors do not want to pay to have a system they already paid for. Some doctors want to keep their current system and have integrated as the front end to the database. Some doctors do not want to spend a cent for a computer to connect to the system. Some doctors do not want to train or hire staff to do this digital book keeping. Some doctors just fear the real audit trail it could leave – easy to just query to see which drug a specific doctor always prescribes his patients.
90% of the issue is getting everyone on board. Everyone wants a say and has a specific agenda that they strongly feel is absolutely required. Just to many cooks and poor/weak government politicians who want to appease every single person. Sad thing is politicians often change so the specifications can be altered and driven by a strong political motivation which also happens to control all the money and upper management staff. Scope creep is real problem in these political projects with endless amounts of money and very long development/implementation time frames.

Matt Polmanteer (profile) says:

Stay away from physicans

I currently program Electronic Medical Records for the company I work for and we have to submit to certain societies that have been created by groups of Physicians. I can tell you right now they have no clue about databases and the actual people entering in the data. And I hate to say it but many of them have the God complex which means they are unwilling to compromise and learn because they already know it all. You need Tech people, data entry people, and Nurses.

Xiera says:

Should it think like a physician? Well, yes and no. Successful software revolves around a friendly, intuitive, easy-to-use interface, but there has to be some give on both sides — the physicians need to adapt to the technology like the technology will hopefully try to adapt to physicians.

In reference to Matt Polmanteer’s post — you’re half-right. The back-end of the system should be done correctly by database engineers, as mentioned. BUT, you will not be successful if you do not tailor your product to your customer. This takes a team of software engineers, user interface specialists, and, yes, physicians, working together to create something that’s intuitive for the end-users. It’s ridiculous to think a hospital should employ data-entry personnel. That would create more chance for error AND it still wouldn’t resolve the issue of having paper records.

HIS is a strong field that will only get stronger in the future. There are already technologies that exist to handle these concerns, and with health and technology being huge industries right now, I think we can expect newer and better technologies to emerge from this initiative.

But, like I’ve mentioned elsewhere, the government may end up doing less good than private organisations. As we’ve seen with certain government programs (ie, Social Security), the government is not always the best when it comes to implementation. Following the Social Security example, 401(k)s are becoming a more favorable way of saving for retirement in many circles.

If the government wants to effect this transition, it should do so by providing tax and other monetary incentives to hospitals and other healthcare organisations. Allow them to write off the expenses of moving to an eMRS (electronic MR System) and, to be fair, allow hospitals that have already undertaken the initiative to write off their past expenses, adjusted for inflation.

Anonymous Coward says:

“And finally, we’re also promised savings through nationwide investment in an electronic office management system for doctors’ offices. A critical feature of reformed healthcare will be interoperable electronic health records. This “modernization” of the system is supposed to save tens of billions of dollars, at some point, after a hefty initial investment. But its main purpose is to monitor and enforce standards for quality, “medical necessity,” reduction of “disparities,” and proper billing and coding.

The reformers’ favorite panacea is health information technology. Obama promises to “make sure that every doctors office and hospital in this country is using cutting edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes, and help save billions of dollars each year”

The savings, however, are all hypothetical, long-term savings, and they are mostly destined for the insurance companies and government entities that are paying the bills. Converting a medical office to electronic records is extremely costly and disruptive. The cost in terms of diminished productivity continues for years, and is possibly permanent. Anything that slows patient flow is, of course, an advantage to payers (fewer patients, fewer payments)> Arguably, electronic medical records introduce more new errors than they prevent-and errors that may be impossible to expunge.

This was written by Jane Orient, M.D. Internist in Arizona. She is also executive director of the Association of American Physicians and Surgeons. The article is titled “Stay Healthy: Government Healthcare May Be Coming

Anonymous Coward says:

Call me old-fashioned but...

I’m no expert on anything, and I’ll be the first to admit it, but…

Medical records seem far too important to run the risk of data breaches. As Techdirt points out time and time again, there’s no such thing as absolute security.

With all the malicious people out there, many of whom can already pull up your DMV records and other info at a whim, I must admit that I am terrified that such things could happen to your personal medical information too.

And aren’t there more important things to be spending $100 billion on in the next 10 years?

Xiera says:

Re: Call me old-fashioned but...

And this is different than paper records because…?

You still have the same security issues. The records would still (conceivably) be stored in the same way — in restricted areas, behind closed doors. Ideally, and I’m not sure how current implementations really work, the doctor would have to check out someone’s eMR when they need to use it, an action that would result in the eMR being accessible over the network; the network would be encrypted and (obviously) separate from any network that could connect to an outside source (ie, the Internet); and the doctor would have to verify that he is indeed who he says he is (ie, a card that he would insert into his portable “tablet” device).

Are there still potentially security holes? Sure, but there are security holes in the paper system too.

Xiera says:

Re: Re: Call me old-fashioned but...

Hmm, I seem to have neglected the inter-facility aspect of this idea.

To be honest, though, there are already hospital organisations that use this kind of technology, seemingly without issues. If it becomes more widely used, will we start seeing issues? Of course. But the important thing is how those issues are handled: fixing the holes that are discovered, rather than reacting in a panicked and fearful way.

Miles says:

This is being tried in the UK

I used to work for a company that does Electronic Medical Records (EMR) systems. We got a contract with the UK government (the NHS) to build a unified system across the entire country. It’s been a huge boondoggle. It’s been a struggle to install such a massive system that everybody is happy with.

The industry is moving in this direction. Hospitals, doctor’s offices, and other healthcare providers are installing EMR systems. Integrating them would have some major advantages, but it’s very difficult. If the government takes this on, I predict it will come in way late and way over budget.

Janet Altman says:

Security cannot be at any time absolute. True. But in this case, the best interest of the patient and the medical community is served by having this information easily accessible. What we can shoot for is that digital security will always make a forward plotting attempt to KEEP UP with technology as best it can. But, it is absolutely necessary.

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