Obama's big idea: Digital health records | Hacker News Reader

Obama's big idea: Digital health records

money.cnn.com

Obama's big idea?

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

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

http://www.whitehouse.gov/infocus/technology/economic_policy...

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

http://www-304.ibm.com/jct03004c/businesscenter/smb/us/en/he...

http://www.emc.com/solutions/samples/healthcare-life-science...

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

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

There are no standards.

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

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

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

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

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

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

Thanks :)

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

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

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

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

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

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

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

Web app that costs:

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

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

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

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

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

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

I don't think $100 billion is unreasonable.

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

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

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

100 billion / (6 * 800,000) = 20,000 per person. Let's say 25% of that is HW and software that gives 15,000 in training per person. Just how hard to they expect this stuff to be?

I imagine it will be equivalent of 1-2 semesters of college courses ($3-5,000). It's not like we can just throw a highly discoverable UI at them and hope most nurses can figure it out.

The medical office assistant now needs to understand the whole system well enough to figure out which external records are mine (and not those of another guy with the same name as me living in Buffalo). That's trickier than figuring out ebay.

It might be a bit short of $15k/person, but its not too far off.

There are deployment costs. Existing business practices will need to be changed. The transition will need to be seamless, or else treatment orders get lost. Add in the costs of it being a government operation, and you get a number on the order of $100 billion.

Maybe $50 billion is a better number than $100 billion, but $1 billion is probably far short of what it should be.

Rather than getting your fuzzy estimate by dividing, use a more accurate website to see there were 633,000 doctors in the US in 2006 (http://www.bls.gov/oco/ocos074.htm).

The rhetoric of the Obama stimulus is to create state jobs now that will somehow make the US economy more efficient later and then decreasing state jobs when economy is in better shape and letting private sector take over. I am not saying that is what will happen, mind you.

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

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

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

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

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