Medical Records R Us
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This is the first of probably three columns on health care. The Obama Administration right now has in Congress legislation for reforming the U.S. health system so that sets my agenda. But the point of these columns isn’t to comment, per se, on the current proposals, but instead to look at what I believe to be my two areas of some strength — Information Technology and understanding complex systems — and see how they can be applied to this problem.
And it IS a problem. That’s the only part of this debate that all sides agree on. The doctors feel beleaguered and Lord knows that sick and uninsured people sure do, too. Even corporate fat cats are appalled at the explosive growth in health spending which today takes more of our GDP than any other expense category, costing approximately $2.5 TRILLION per year.
So if we can all agree on the goals of better and more efficient health care with some way to make it available to the largest possible number of people, the question then becomes what’s the best way to do that?
Government isn’t very good at answering such questions, but then in many cases neither is industry if their business model has to include ever-increasing earnings.
Imagine, just for a moment, what the U.S. health care industry would look like if it were managed solely by that paragon of capitalism, Goldman Sachs. The 48 million Americans without health insurance would probably be ignored completely while those who could pay more would get boutique medical services beyond belief and doctors would come to rely on substantial year-end bonuses. For some, such a system would be better but for most it would be worse, though supremely profitable. And when that “most of us” come to constitute most of the American working population, too, it will ultimately come to effect U.S. productivity and then we’re hosed.
So while it is convenient and fun to criticize government programs, let they who are without sin cast the first stones.
There are some things government is actually good at, among which are setting goals for good behavior. The Clean Air Act and Clean Water Act in the 1960s changed America for the better by setting environmental goals then letting the marketplace figure out how best to reach those goals. Without a target and a penalty for not reaching it, we wouldn’t have improved our environment as much.
So let’s step gently into this health care debate by looking at one area where Information Technology is central — health records.
There are lots of advantages to computerizing health records. A couple of years ago I visited the Mayo Clinic in Rochester, Minnesota, to discuss this very issue. Mayo has been in the forefront of digitizing all of its six million patient records. This is a bigger job than most of us realize since it involves not just blood tests and doctor’s notes but also X-Rays and CAT scans.
Mayo, which was a century ago the first clinic in America to standardize the way it kept records in the first place, is also at the forefront in creative ways to use those records once they are in the system. You see Mayo doesn’t have six million patients, they have six million patient records — many of those being records of people long dead. But keeping extensive records of dead people creates a powerful database for statistical testing of possible treatments and even drug interactions. “Surely in those six million records there is something similar to this medical mystery we are trying to solve today.” And often there is.
Figuring out from an analysis of records that combining drugs A, B, and G sometimes kills people can be good to know.
Mayo is taking the process even further to include DNA data for many patients with the goal of being able to statistically identify genetic trends within the population through records analysis.
That’s the good side. The negative side of all this record keeping is that many people see it as a possible invasion of patient privacy. This is what led to the Health Insurance Portability and Accountability Act (HIPAA) of a few years ago which forced health providers to be more strict in how they managed health records, adding at the same time about $25 billion per year to the cost of keeping us all in the system.
Hey, isn’t Information Technology supposed to SAVE money?
Sometimes. Ideally, it should.
So medical records are an area where IT could make us healthier and, if done correctly, ought to save lots of money, too. What we need is some form of centralized medical record keeping that preserves patient privacy yet, at the same time, keeps us from shopping all over town for bogus Oxycontin prescriptions.
Here is an ideal opportunity for government to set a standard for medical records and possibly even to develop medical records software, though I don’t think it has to go that far. What’s required is a specification that would allow health care providers to interface with a medical database, knowing how to insert and retrieve data. It’s a specification, NOT a national database.
And here’s what we do with the specification. We establish that patients own their own records. Supposedly they already to but doctors and clinics do a darned good job of keeping us from moving by retaining those records. Under my system we’d take the records away from the health care providers entirely, at the same time relieving them of the need for records clerks and much of their current HIPAA responsibilities.
Then we’d let a thousand databases bloom. Organizations could establish health record databases compliant with the Federal standard but not otherwise subject to Federal control. These databases could be accessed by any authorized medical care provider — authorized by you.
Patients could decide where they’d like their health records to reside, with that service possibly becoming a perk for membership in certain organizations. So you could keep your health records at the National Rifle Association, for example, while I might keep mine at the American Civil Liberties Union (or at Pep Boys, whichever is cheaper). If you are worried about government snooping, trust your records to an organization mortally opposed to government ANYTHING.
Record access becomes a lot like an electronic funds transfer. Banks have spent a lot of money working-out the technical details of giving and denying access to databases with a variety of key systems. You give your doctor access to records of a certain kind for a certain period of time and that’s it. The system ought to work well for everyone.
And it even can be the basis of new types of business. I can see third-party outfits popping-up to parse your records (at YOUR request) to look for likely genetic problems or for past and present medical mistakes concerning multiple prescriptions, bad drug interactions, etc. Here $10 per year could save hundreds — maybe thousands — of not just dollars, but lives.
And what does this record system look like, when you come down to it? It’s the World Wide Web — medical records as a web app. And one thing we know about web apps, as opposed to any kind of medical technology — the price only drops over time.
More to come.
Two points that you might want to ponder.
Perhaps the health care records could follow the same model as that of credit records. There are privately owned credit reporting agencies – not government run, but somewhat regulated. By law, you have access to your credit reports. You can also restrict access to them, or at least know who is looking at them. And those companies are liable for any “lost” records or failure to protect privacy. It seems to work, if not perfectly, then well enough to do business. Similar problems, similar solutions?
Second point: you should be getting your record of health care from your insurance company, not your doctor. Your insurer keeps vast and detailed records of every little transaction. Sure your doctor may have lots of good stuff, but the insurance company can tell you exactly what information each health care provider has. What happened to that x-ray of your arm? The insurance company knows who took it, what specialist examined it and when you had the appointment for your doctor to explain the result to you. Of course, it’ll take an actual act of congress to pry that information out of their hands.
Looking forward to more columns on this subject.
You may want to adjust your microphone & or recording settings, the sound quality in the audio edition of this column is deplorable. Just go back to whatever you were using in past columns. The audio in those are great.
Compare with XBRL
Health care costs have exploded as government has taken over healthcare. I don’t think the perscription for fixing the problem is more of the disease.
This was obvious to economists decades ago, and since the government has intruded even further.
http://mises.org/story/3586
You say that the Mayo Clinic considers its patient records as an asset to mine for information on how best to treat patients as a way to further their world class reputation. But then you propose that a patients medical record be owned by them and access to that information should be limited/controlled by the patient.
Do you think that health care organizations like mayo will willingly relinquish patient record information entered by their nurses, doctors and lab techs? Not likely.
How does the emergency room get access to your medical information if you are unconscious? Will everyone need to wear a medical id badge everywhere they go?
You know that electronic information is easy/cheap to copy so if you let one organization have access to your records one time they will keep a copy on file for all time in order to “serve you better”. Government regulation to create a system like you propose would cost more than HIPAA but your privacy would likely be compromised anyway. Last week you complained that orbitz’s poor data management might compromise your frequent flier numbers, but you think that medical records can be safely and securely shuffled around the internet?
How much privacy do other nations such as Canada happen?
The Web is not the right place for health records, at least, the type you’re suggesting. Firstly, can you be sure the information will still be available in ten years time? Twenty? A hundred? Your recent article about Orbitz highlights the main problem – in the effort to cut costs, data loss will undoubtedly happen. You also need to protect against phishing and malicious attacks. Don’t forget that your average user doesn’t understand the technology of the Web and that these are problems that banks have not solved – they can shout about phising scams as loud as they can but people still fall for them. Malicious attacks could also come from pharmaceutical companies looking to promote their products by falsifying theie effectiveness. Your health record needs to be available at all times – you never know when you’re going to be in A&E! The Web suffers from intermittent connections, ISPs suffer power failures and cut cables!
Also, what do people do if they can’t afford to pay a health care record provider? Would the government provide a free version with the downside being that, hey, it’s the government and they, at least here in the UK, are really good at losing your data!
Perhaps the best, most secure place for this information is on a RFID that’s implanted in your body somewhere. (That’s a joke.)
I see two main problems. Firstly, technology is a long way off being capable of addressing all the issues (and there are lots of them – security, reliability, interoperability, etc). Secondly, there just isn’t enough quality programmers around to build these system (but that’s just a general problem).
Nice strawman. Because, of course, Goldman Sachs stands in for the whole idea of free markets. Evil, greedy, and maybe even vaguely Jewish.
Except when all those government run systems from other countries fail, our current health care system is the go-to place.
Heaven help us when the same people that bring us public schools, the post office, the IRS, and the VA, take over health care.
As for the medical records idea, all I see is that my current medical costs would stay the same, but you’ve now added a monthly medical record storage cost.
I do like the idea that doctors would be forced to turn over copies of all records as they create them. Some do now. I was given a copy of my last MRI without even needing to ask.
One thing I would like government to agree on is to require that hospitals and doctors give you a complete and final bill right when you check out. Currently, if you go in even for some kind of minor surgery, you’re still getting inexplicable new charges a year later. There oughta be a law.
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I have taught computer operating systems and database technology around the world and have developed some expertise. I am in the process of designing the ideal medical records system and here are some features I think it should have:
1. All medical records should be on one database universally available through internet. My medical practitioner, not matter where I am, should have the best medical information possible — with my permission.
2. The database should be under government control.
3. All records should have the same format.
4. The medical record should begin sometime after conception.
5. It should employ the latest technology in encryption and control access.
6. All medical input should be recorded: shots, vaccinations, doctors reports, prescriptions, tests, everything necessary to provide good medical information for future medical practitioners to make the best assessment of treatment that they can.
7. Technology should make it possible to input information directly into the database. Doctors should be able to easily voice input directly into the records; testing equipment should be able to send results directly to the medical database.
8. The database should be accessible in almost every language; if I am in China or Japan, I want the medical practitioner to see the information, is possible, in his/her language.
9. Each medical consumer should have complete access to his/her records and be able to make comments and, perhaps, some edits to the record.
10. There should be enormous cost savings with this system and, unfortunately, some obsolescence in the field of medical records.
11. Having had 9 hospilizations in the last 7 years, I have noticed that doctors and medical staff spend a lot of time at computers and with record keeping. There is also terrible redundancy of record collection. Why should any medical practitioner anywhere have to ask me for a list of my medications? These have all been prescribed somewhere and filled somewhere.
I would appreciate any features and suggestions for improvements as well as caveats (although I am somewhat prejudiced in believing that carefully implemented technology can be bullet proof.)
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Great article covering the fact that there are other things wrong with the health care service in America. With creating a better computerised health care record and the health care reform could make the health care that everybody wants to have and have the ground work for a reliable service for generations to come. But with creating a computerised service will be the time to input all the millions and millions of records out there which will take some time but when completed will aid in so many ways to benefit the system.
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Patients could decide where they’d like their health records to reside, with that service possibly becoming a perk for membership in certain organizations. So you could keep your health records at the National Rifle Association, for example, while I might keep mine at the American Civil Liberties Union (or at Pep Boys, whichever is cheaper). If you are worried about government snooping, trust your records to an organization mortally opposed to government ANYTHING.
Record access becomes a lot like an electronic funds transfer. Banks have spent a lot of money working-out the technical details of giving and denying access to databases with a variety of key systems. You give your doctor access to records of a certain kind for a certain period of time and that’s it. The system ought to work well for everyone.cheap VPS
And it even can be the basis of new types of business. I can see third-party outfits popping-up to parse your records (at YOUR request) to look for likely genetic problems or for past and present medical mistakes concerning multiple prescriptions, bad drug interactions, etc. Here $10 per year could save hundreds — maybe thousands — of not just dollars, but lives.
And what does this record system look like, when you come down to it? It’s the World Wide Web — medical records as a web app. And one thing we know about web apps, as opposed to any kind of medical technology — the price only drops over time.
I hope you have a good day! Very good article, well written and very thought out. I am looking forward to reading more of your posts in the future.
You should really considering moderating the comments here….
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