Stupid IT Tricks: Medical Records
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A reader asked me to write tonight about the Health Information Technology for Economic and Clinical Health Act, which is about as far from something I would like to write about as I can imagine, but this is a full service blog so what the heck. The idea behind the law is laudable — standardized and accessible electronic health records to allow any doctor to know what they need to know in order to treat you. There’s even money to pay for it — $30 billion from the 2009 economic stimulus that you’d think would have been spent back in 2009, right? Silly us. Now here’s the problem: we’re going to go through that $30 billion and end up with nothing useful. There has to be a better way. And I’m going to tell you what it is.
But first a word from my reader:
“My number one annoyance is that hospitals are still extremely dumb,” he writes. “My wife has Lupus (and other disorders) and every single freaking time we go in they always have to know the same information and fill out the same damn paper forms. I expect more, a lot more from my doctors and the systems that support them. Why are we still dealing with paper and paying people to just duplicate that effort by typing it in? Wouldn’t it be much easier to say, ‘Here’s what we have on file for you (hands the patient a tablet computer). Please review it, update any medications with dosing as well as any allergies.’ Boom, you make the changes directly in their system, you’re not repeating that effort every time and this system would be completely standards based with every other system in production. Problem is, we have no standard and it should have been laid out before any of these EHR systems were built. I’m not talking about creating another FBI virtual case file waste of taxpayer cash, but these professionals know exactly what kind of information they gather and how it’s used. There is no excuse for today’s hospitals.”
So we passed a law, appropriated a lot of money, and are now implementing a medical records system that the National Academy of Sciences says in a recent 273-page report isn’t going to do the job.
This is not the first such negative report, either.
Yet still the project moves forward because, well, there’s that $30 billion we should have spent back in 2009 and if we don’t spend it, heck, Congress might just take it back.
Use it or lose it is not the proper motivation for this or any IT project.
Remember that more than 50 percent of major IT projects fail outright producing nothing, so the chances going into this were that it would fail. From what I have read that is already happening since the whole concept of interoperability — the basic purpose of the system — seems to have been lost.
It’s not like there aren’t any good medical record systems. Back in 2007 I visited the Mayo Clinic in Rochester, Minnesota specifically to learn about their medical records system that had already been in development for more than a century. Mayo built the first standardized medical records system anywhere on Earth using lots and lots of paper and had over decades refined it into an amazingly useful bit of analog technology. When I visited, the clinic was rapidly turning six million paper patient records into electrons in a way they were sure would quickly lead to saving lives simply because they’d finally be able to correlate treatments and outcomes over thousands of similar patients over many decades. Computers were everywhere and caregivers could instantly find any data they needed including X-ray images. Mayo had a good system and they were making it even better. Problem solved, right?
Maybe if we could first kill all the administrators.
Every hospital administrator has his or her own idea about how medical records should be kept. This has resulted in many different systems being developed with something less than 50 percent of those actually working successfully. But no matter how many systems failed they didn’t all fail and some are probably pretty darned good. I was certainly impressed with what I saw at Mayo.
So here’s what we do. First we stop. Whatever we have so far is crap, believe me, so let’s throw it away. It was insanity to start building a whole new records system when there were already systems in operation that were close to the objective.
We do this really stupid thing over and over in IT, which is we find something pretty good and say, “Let‘s build something like that.” Which means, if you think about it, “let’s take this functional model and attempt to emulate it with what has historically been less than a 50 percent success rate.”
I’m with stupid.
So we stop; we throw away the work we’ve already done; then we take a look at all the electronic medical records systems that are already up and running at scale. I’m sure there are at least a dozen of them running in various places around America. Our goal here is to pick the best of these systems. We don’t even have to be good at selecting because if we were to make a mistake and choose the second best or the third best system it would still be better than the disaster we’d likely build from scratch.
We figure out which is the best presently operating system in terms of functionality, reliability, ease of use, and any other criteria you’d like to add. Then we do something that is never done in IT. We take this off-the-shelf product, spend a little of that $30 billion to buy it outright, then give it to every hospital, clinic, and doctors’ office in America.
And that’s it. No R&D, no development — just pick the best and give it to everyone for free. And if there are problems here and there, well it is easier to fix a problem than it is to build a system.
Now for a really radical idea: just point Google at the problem and let them buy the system and run it.
They’ll make it ad-supported and therefore totally free to doctors and patients alike.
This isn’t brain surgery you know.
The 2 man Austin TX internal medicine practice I go to has been using electronic prescription records for 4+ years and electronic medical records for over 2 years. The only problems were at the beginning and were MEDCO and then Caremarks electronic incompetence with electronic prescriptions. My MD can do everything from generate written instructions for me, schedule followup and make referrals and show me charts of the changes in medical tests. Saves a lot of time. Also when he makes a referral the consulting MD gets all my current medical info electronically and all I have to do is sign in. As do most hospitals and minor care clinics. And my dentist. Oh, and insurance claims are as instantaneous are a debt card transaction.
Whats not to like.? And you’re right. Why are we paying for R&D when we have 5 year old system that works.
The EMR/EHR need not necessarily be one monolithic system.
The records can be geographically distributed and maintained by the healthcare providers (similar to current data on the Internet), and accessible to the healthcare professionals via a secure and restricted medical network (similar to the Internet).
This is what I want them to do. I don’t care what EHR system they run, if it fits their needs fine. But ALL of their data on the patient, X-Ray/CT/CAT images need to be able to be exchanged/synchronized/accessed with the hospital/clinic requesting it. Much like how the airlines have a messaging system for exchanging passenger records (PNRs) with other airlines. It’s how your checked bag gets from A to B when you switch planes and airlines.
Some of the objections being voiced here are very puzzling. Of course it would be expensive and complex to convert every hospital and medical office to EMR, but it was also horrendously expensive to switch from traditional film X-ray cameras to CAT, MRI and digital X-rays. It’s proving to be hugely expensive to switch from traditional surgery to computer-assisted robotic surgery. But all of these switchovers pay huge dividends in the end which erase the upfront costs.
Did you read what the doctor from Halifax said about the transition to EMR in Belize? A standardized, universal, open source EMR has had an impact greater than the introduction of antibiotics on national health in that country. It’s saving money and, more importantly, it’s saving lives. Lots of lives. What else matters? It’s time to knock some heads in our countries. Canadian and American lives are just as important as the lives of people in Belize.
You say, “switchovers pay huge dividends in the end which erase the upfront costs”. I’m not in any way opposed to advances in medical care but people have been talking for decades about how new techniques and technologies will save money, yet expenditure goes on increasing exponentially.
Here in the UK, the last government took the budget of the NHS (already one of the costliest departments in Whitehall) and in a few years DOUBLED it. Amongst the firestorm of spending was the “NHS National Programme for IT”, a centrally-mandated electronic care record for patients. In four years the cost exploded from $3.5bn to $20bn and the chairman of our government Public Accounts Committee concluded in a 2007 report that it was “unlikely that significant clinical benefits will be delivered by the end of the contract period.”
At the end of last year they canned it. You’ve got to wonder whether a return to quill pens and tallow candles might not be a good thing.
Lots to say in response to this comment. UK health expenditure is big http://en.wikipedia.org/wiki/United_Kingdom_budget but the important figure is per capita expenditure, which is modest actually http://en.wikipedia.org/wiki/File:International_Comparison_-_Healthcare_spending_as_%25_GDP.png With some notable exceptions, for example care of the elderly, people are pretty happy with the standards of care they receive in the UK. Some outcomes could improve, but in general terms people accept a trade-off which favours comprehensive care over heroic interventions.
The NPfIT hasn’t been canned, but it hasn’t been successful. For many reasons. But the approach in the UK was not the one Bob outlined. Which might have succeeded, at least in secondary care, had VistA been adopted.
per capita expenditure is here http://www.parliament.uk/briefing-papers/SN02584.pdf
The problem that the ARRA funding is trying to solve is generally with the smaller clinics and doctor’s offices. Most hospitals already have some kind of EHR – electronic health records system. They save money, decrease errors, improve efficiency and generally can cost justify the savings in a reasonable amount of time. The smaller medical clinics and doctor’s offices see no financial benefit to EHR to themselves, hence the $44,000 to $64,000 encouragement payments. The big money saved is with the Centers for Medicare and Medicaid Services (CMS), the government payer for Medicare, who works with the states on Medicaid and Hospitals and large medical groups.
With electronic records, CMS could much easier catch fraud. Safely and efficiency will increase with the required “meaningful use.”
Insurance companies don’t want to pay faster. Medical providers and hospitals want to receive faster payments, which electronic insurance submissions can provide.
Certification Commission for Health Information Technology (CCHIT) currently certifies 127 EHR systems and this number seems to be falling as big players buy out of the little fish and the smaller fish go belly up. While national system would be great, politically it won’t fly in a Republican blocked world.
A system that serves all the relativity simple needs of small clinicians and the complex needs of large hospitals doesn’t seem to exists. Most EHRs, even from the biggest software companies, focus on one or the other. The big software houses typical have at least a baby bear and a poppa bear offering. They often have even a momma bear (no relations to Sarah Palin) offering.
Yes, the Feds could go with the VA’s ViSTA, another open source EHR offering, or buy out someone like EPIC but it won’t help small (especially rural) clinics automate without training help and stick and carrot financial incentives.
SteveH has got it right, though I’ll elabroate a bit. Settling on a particular EMR is only part of the challenge – you’ve then got to install it, interface it, maintain it and upgrade it. Vista was the example that I thought of immediately – it’s barely moved out of the VA, despite the “license” cost heading to 0 – it’s all of the other costs that make Vista a real challenge.
Compare EMRs to Email systems….
One of the many problems with any EHR system is getting people to use it. Atul Gawande wrote about this in one of his columns or maybe one of his books (probably Better).
Um… “We” already have a healthcare records system that “we” paid for. The VA has been using it for several years. It’s currently got some seven or eight million people in it. Yes, it has a few issues. What massive IT/IS program doesn’t?
What we really need is universal health care, so record privacy isn’t the huge issue it currently is. If one can’t be denied coverage for anything, then keeping health care records private becomes a matter of personal privacy rather than a potential bankrupting or life destroying issue in job changes.
Don makes a lot of sense.
How about universal internet, universal power, and universal water. If no one can be denied these essentials, imagine how much better off we will all be. (Oh wait, I think the USSR tried that with toilet paper but no one would produce it for the affordable price so they had to ration it.)
@Ronc:
This is a straw man argument, and it seems to me to be based on whether one considers health care to be a basic human right, or whether one considers it to only be a privilege for those who can afford it.
To compare health care to universal water for all citizens is a bit ridiculous, since we essentially *have* universal water for all citizens. Yes, we have to pay for our water based upon a meter which measures our personal usage of the system, but the system is heavily funded and regulated, at least in the US. Water is pretty much affordable in the US. Health care is increasingly not affordable for far too many citizens.
My wife is a doctor, and it is simply incredible how much time she has to spend on billing issues and determining what kinds of things insurance companies will cover and how to recommend treatments (and code them) in such a way that both the office and the patient can be reimbursed by the insurance companies involved.
She provides health care for patients, but she spends an inordinate amount of time not in deciding the best way to treat the medical problem, but in deciding how to approach the situation so that the insurance company will cover the treatment. This simply cannot go on. It is fundamentally unsound and unsustainable.
So you agree that water meters are ok. Then health care metering is also ok. The question is whether the government will do a better job. In any case it won’t be free (or universal). Remember there is something called “government red tape”.
Or universal roads, or universal police, or universal education…
I really don’t understand the mentality of Americans [it's always Americans] that object to universal healthcare. Usually it seems to boil down to ‘the govt can never do anything right’ – well if something is broken – then instead of grouching about how broken it is – why don’t you FIX it? Americans are supposed to be good about fixing things right?
Also keep in mind that universal healthcare is not compulsory. If you really don’t like it, you’re free to pay your own way.
Next you’ll hear the argument that you don’t want to pay for it via your taxes. Strangely enough, the rest of the civilised world manages to provide universal healthcare, with VASTLY better outcomes than your private system, while paying taxes that are not too dissimilar to what you pay. Maybe that’s something else for you to fix.
You might have to spend a trillion or two less on military adventurism, but the rest of the world would thank you for that.
The problem with the government doing everything is that the individuals involved are ultimately being paid with taxpayer dollars without limit since the federal government can essentially print money until it’s worthless. Giving them more excuses to make our money worthless is undesirable. The money is being spent by people who got into office by promissing to give stuff for free to the voters not to people who must provide a service to get paid. That’s why ideally the government’s job is to keep criminals in line and that includes totalitarian governments that exist for themselves and not for their people, threatening the free world in the process.
Again you present an entirely solvable problem [Hint - how many countries with universal healthcare have resorted to printing money to cover their costs?], as if it was an insoluble dilemma.
When did Americans start giving up so easily?
“Printing money” is another way to describe “inflation”. Basically, it means providing government services without raising taxes to pay for them. They get elected by promising to do just that, leaving inflation as the only means left to pay. Alternatively, they could just outlaw higher priced services, which is why people living in countries that do that come to the US for treatment.
Point well made and taken into every consideration of coming nationwide, not-for-profit health service.
Yes! Its called VISTA and is freely available to the public already!
https://secure.wikimedia.org/wikipedia/en/wiki/VistA
Just take a look at the requirements for HITECH certification from the government (which is required for the practice to receive the stimulus funds): while its supposed purpose is to encourage medical professionals to adopt new high technology EHR/EMR solutions (hence the name), the requirements, fees, and approval process guarantee the opposite.
I have never been to the Mayo clinic however I was recently hospitalized. Now I am not a sickly person. Quite the oppisite. The only other time I have even been to a hospital was for a broken arm when I was 11.
In any event as is common I was not given a choice of where to go the ambulance simply took me to the closest ER, which was a Kaiser-Permanente HMO facility near my house. I am not currently a Kaiser member but I did have it at one point many years ago. I lost the insurance when I could no longer afford $12,000 a year to insure my family of 4 (a different subject entirely). Despite this they had my medical history on file and pulled it up on a terminal in the ER. The Nurse updated the info before the doctor got there.
Later when I was admitted in every room there was a terminal and the nurse could look up my lab results right in the room the moment the lab had entered them.
I know Kaiser has a bad rap for trying to cut corners from many folks but I got good care and was totally impressed by the IT records system.
I’m a recovering hospital administrator and medical practice administrator, and the author of two books on medical practice management. I’ve dealt with more than one IT guy who thinks it’s so simple to develop an EHR system.
Eventually, their eyes glaze over and they walk away – it is such a complex industry, and the day to day process, whether in a facility or a medical practice, is complex and involves parties both within the control of the entity running the EHR system as well as entities outside their orbit. And the docs – who are far, far from being technophobes – are worse than any administrator when it comes to control and how to organize their world.
Want to know who has a system, developed internally, that is widely viewed as working well? The Veteran’s Administration – the VA. I’m sure lots if IT jockeys will find all sorts of faults with it – but the thing has been installed and works. Today. Now. I understand the Johnson VA Center has it.
In healthcare, the IT systems CANNOT FAIL – EVER.
The systems are expensive, are fraught with problems and the “normal” disruption of an installation. Private practice docs are reluctant to take the hit of the losses when the install happens, and the time it takes to change and adapt how they work once the system is up. Google doesn’t seem to be tackling this one
Personally, I think EHR will become widespread. As more docs come through their residency using EMR systems, they will have developed habits that fit with how EHR systems work – or force the doc to work within the parameters of the system. There is so much which is already happening where the patient uses computers for their own data entry and communicating with physicians and clinicians, whether for telemedicine (the Charleston VA is using it for mental health patients in outlying areas, I understand) or to monitor patients more closely at home (Mass General has a program going using Intel equipment) – EHR is almost a distraction. There is a lot happening now.
As always, your posts are interesting, insightful and pointed. Thanks!
We switched to Kaiser Permanente Northern California from other paper-based providers in late 2009. We made sure that all of the older providers sent our past 10 years of records to Kaiser, which scanned them all in. Of course, all of our Kaiser doctors have access to all of our current and older records.
We’ve found that EMR makes an incredible difference in the patient experience.
Because we were new to Kaiser, we got new workups from our primary care and specialist doctors. One of them ordered a CT that found a kidney tumor in me. Three weeks later, it was surgically removed. Chances are very good that it would not have been found by my pre-Kaiser doctor until it was much further advanced.
Kaiser has an excellent internal email system that allows us to email our doctors; we get replies usually within hours. We can order prescription refills via their Web site, and choose to either pick them up at one of the 5 local pharmacies (one of which is open until 1 AM seven days a week), or have refills mailed to us. We can make doctor appointments on the Web site.
We pay the monthly bill (we’re a small group) and fixed doctor and pharmacy copays and that’s it. No niggling benefit forms, no pre-authorizations, WAY better care than we previously got. The kicker: in the first year, we paid $6,000 LESS in medical costs than in the previous year.
Compared to what we had before, it’s like living in the future. I won’t go back. In fact, when my wife recently got a new job that offered us different, traditional coverage, we turned it down.
I have a bad feeling about this, $30 billion sitting there is too big a temptation, and if it is business as usual in Washington, the best lobbyist will get the job. So the $30 billion will set back the establishment of a usable system by ten or more years (and a few billion more dollars.) If politicians can ever rid themselves of the notion that they can fix anything, and just do their best to stay out of the way we all might be better off.
On a political side note, since I am from Texas, if Rick Perry (currently Governor of Texas) ever runs for President as is rumored, PLEASE do not vote for this man. Donald Trump (or even Donald Duck) would be a better choice than Rick Perry.
Why don’t we give everything to the private enterprise to make a profit and run the nation – Goldman Sachs GM Enron all are good examples of well run companies!
In 80′s 90′s Microsoft ran whole enterprises for the government!
Germany had many Hitlers running the nation under their own fiefdoms.
Even Schindler ran his own empire.
We’re seeing security matters almost hourly WHY?
LACK OF PLANING for the needs of a App and additions in an ad hoc manner.
And you want Google to run it — just wait a year and see how porous Google is!
The UK is suffering from a 6-year late national healthcare database program – that is billions over budget and half the hospitals have pulled out.
Aren’t Google already half way there with Google Health?
http://www.google.com/intl/en-US/health/about/index.html
OK I give up, where do I find out what the doctor from halifax said about belize??
Click the “Older Comments” link and see my earlier comments. I quote him there.
The Dept. of Veterans’ Affairs has an excellent electronic medical records system up and running. It holds each vet’s complete history and other data such as graphics of x-rays, retinal diagnostic photographs, etc. The vet can access much of his information via a secure, encrypted, track his appointments, renew prescriptions, and insert personal information such as the types and amounts of supplements he takes. He can also send secure email to his primary care physician and get email in return.
Everyone involved with it seems to love it. If you want a best-practice model of medical record keeping in the IT age, check the VA’s. It is one reason why patient satisfaction with VA medical care is the highest of any provider in the country.
I always wondered how our Canadian government managed to screw up their gun registry so monstrously. Thank you for the insight.
@cringley
Your idea will never work because it has COMMON SENSE written all over it.
Yeah — that’s what I want! Google indexing all my health records for advertising purposes so I can have a shiny new “interoperable” (so long as it’s a google software) EHR app. Sweet.
Or not. I just can’t bring myself to trust Google or any other advertising agency to use such personal details in a responsible manner.
– I just can’t bring myself to trust Google or any other advertising agency to use such personal details in a responsible manner.
I would be much, much happier if people generally recognized that Google is an *advertising* company, with all the evil that Mad Men can inflict.
Does anyone else see the slogan “don’t be evil” as a textbook exercise in misdirection?
There are certainly lots of well-intentioned people working for Google (I would even go so far as to say the majority of them are). But they still report to the shareholders, and they are still obligated to turn a profit, by whatever means at their disposal.
They’re a one-trick horse until they can find revenue streams besides advertising. And when that trick wears thin, it will be “interesting” to see what other avenues they turn to.
Bob,
I worked on converting medical contraindications for use on a Web page for various medical conditions for a rather large medical outfit. One day I double-checked my results and found I made an error. I listed the treatment for one medical condition for another one. Ooops. Nothing was published, because one should always double-check their work, right?
So I casually asked my boss who was double-checking our results? Nobody. No doctor, nurse, anyone. Shortly after this, I found another position outside the company because I was scared I might actually make a mistake which could injure or kill someone.
So when you come up with a system for EMR, you might want to add in double-checking the conversion results. Because I can’t be the only person who has done conversion work like this.
How about carrying a copy of med records (yeah, standardized format would have to be devised) on a chip embedded in a credit card?
I went to fill a prescription for my wife. I gave all the insurance information (plastic cards, the written prescription) to the pharmacy clerk, and waited.
First, she copied all the numbers from the insurance card by hand and entered it all into a computer. (Never mind that magnetic stripes with all manner of data have been common for fifty years). After every entry she had to pass a bar code worn around her neck in front of a scanner, and sometimes she entered a different code of some kind into a different scanner. (Never mind that 2D barcodes, used since about 1995 and easily printed on plastic, with much more information than magnetic stripes could certainly be read by at least one of the scanners there).
I asked her whether she would return to a convenience store that had to copy numbers from a credit card by hand if whe were buying gas there. Never, she said, somewhat surprised and upset at the question.
Eventually, in about 20 minutes, it got done. I paid $35 for the prescription; the insurance later mailed me a four-page receipt for $1.50 that they paid! All together, it was a complete waste of time, and probably money because their cost had to be very close to what they actually paid.
The clerk was certainly not at fault; but the dumb programmers and executives that designed such a system were grossly incompetent.
John Lenihan
We have a history of this sort of thing in the UK; doesn’t matter whether it’s health records, or child protection information, or taxation information, the story always goes something like this …
Hmm, we have loads of data silos that don’t work together. I know, let’s put them into a BIG SINGLE DATABASE. But we’ll base the criteria for tendering to put that BIG SINGLE DATABASE together on the grounds of cost alone (got to show value for money you know).
But the people who need this information are too busy to use it, so we’ll grant access to the administrators. But the administrators are too busy administering so we’ll outsource to a private company to run it and add in access to all sort of people who *might* need the information, maybe, someday. But we’ll base the criteria for tendering for that outsourcing on the grounds of cost alone (still got to show value for money these days).
Next thing you know, the project is heaven knows how many millions over budget and goodness knows how many years late and there’s been leaks of confidential information in dumpsters and on USB memory sticks and finally the whole thing gets canned.
Here in the UK we’ve done this so many times. We don’t learn from experience.
Now re-read this and substitute database and information for “medical records”. Private medical records, which insurance companies would love to get their hands on to help calculate your cover and premiums. Scary thought isn’t it?
What always annoys me is how hard it is to get at my own medical records.
Seriously, we should be able to keep a copy for ourselves for free, without having to handwrite every little thing either, and not simply a copy of the bill. If they have to mail/whatever it to us at a later date (since most doctors just take a few notes and fill in the details later) that’s fine.
It would certainly help when going from one doctor to another – whether moving or simply changing b/c one is dis-satisfied with the service they were receiving.
I can honestly say there are some medical records for me that I’ll never get – as I last saw the only doctor to collect them almost 30 years ago; and yet, that’s one of the most interesting periods in my own medical history – along with another instance just under 20 years ago. Yet, if you don’t see the doctor often enough the records get archives and later buried so deep you’ll likely never find them if they weren’t destroyed first – information that could very well be pertinent to current doctors depending on your own issues.
So, standardize the stuff and give patients USB-sticks with the data too on every visit, or mail them an updated one shortly after the visit once the doctor has inputted the new information. And give patients the software they need to read it and update it so that when they arrive in, they can hand over the USB-stick, which then goes into a machine that first checks it for security and then synchronizes the records. (It’s not like patients need to update a whole lot.)
The old tried and true “sneaker” net
The bottom line with medical IT systems is the bottom line. They are not for doctors or patients but for the billing department.
BTW my wife had to “sneaker” net her original imaging data for her ACL, schlepping around a DVD. The ortho she selected to do the replacement was chosen partly upon his practices modern patient care IT system. All patient data including imaging was available online. The surgery was done in the practices own surgery center vs a hospital. They would have even let me observe the surgery but the whole bone tunnel procedure might have been a bit gruesome even though it is all scope work.
I need to preface my comment by stating that I AM IN NO WAY, SHAPE, OR FORM SOME TYPE OF MUSH LIMPBLOW REPUBLICAN WHO BELIEVES THAT INVISIBLE HAND OF THE MARKET HAS ALL THE SOLUTIONS FOR THE WORLD’S PROBLEMS.
With that out of the way, I have my doubts about any government solution regarding health care records. Take the most recent Census as an example.
Did any of you come into contact with any Census takers this time last year? They were filling out paper forms with pencils….just like the Census of 1910. One would think that they would have been supplied with hand-held computers in the year 2010, but no. Actually, hand-helds were purchased by the Census Bureau…..$700 million worth of them. Unfortunately the hand-helds didn’t work….one of the many problems was that the hand-helds were not water resistance, so they’d quit when they got wet….like in rain. Apparently it never occurred to anyone either at Census, or the supplier of the hand-helds, that Census workers going door to door might be caught up in a rain shower. The hand-helds spent 2010 gathering dust in some warehouse.
Not enough? After the paper forms were completed by field personnel, they were taken to local Census offices, AND KEYED IN BY HAND…..like it was 1960. The Census computer network was so unstable, that it was held together by duct tape and bailing wire. Census assignments to field crews were delayed because the Census computer network was dangerously unstable, and threaten to crash if run at full power.
So if our government is barely able to utilize modern IT resources to do something relatively simple…..like count how many people live in the US…….what makes anyone think they can be entrusted with sqillions of pages of medical records?
BTW, don’t ask me how I know what was going on at Census, I signed a form that stated: “The first rule of Census is, you do not talk about Census. The second rule of Census is, you DO NOT talk about Census.”
I’ve previously worked as a programmer for a large company that produces hospital network software and afterwards I’ve been involved and in touch with the industry. IMNSHO, the problem isn’t IT or software. It’s the stakeholders.
Every doctor, every doctor’s office, every lab, every hospital (even hospitals within the same network) has its own way of doing things. Procedures, filing methods, information flow, etc, is always different in every single location you visit. I have never seen a CIO or CTO who was powerful enough to force a culture change to fit what the software does out-of-the-box. Instead, at every site (EVERY SITE) the software must be massaged and customized to accommodate the existing staff and their peculiar ways.
Want to force a change anyway? You won’t get buy-in from the staff or doctors, who will drag their feet and hamstring the switchover at every step. Eventually the project will fail simply because the people won’t use the new system.
The cost of a EHR system is largely irrelevant (even if free), because every hospital/network has to hire an army of consultants for implementation and maintenance, who refuse to work for free. Consulting costs plus the cost of paying staff to attend training pushes the cost of the initial software/hardware purchase into insignificance (for the most part).
This is the exact same reason companies like Peoplesoft and SAP make so much money on consulting fees and most of their projects fail in the long run. The successful projects succeed for a different reason: business necessity.
If you really want the health industry to adopt a unified system, you can’t appeal to their sense of duty or or their desire to “better serve patients”. You have to appeal to their wallets instead. If Medicare or, better yet, Blue Cross/Blue Shield were to impose additional fees or delays on any institution that didn’t adhere to a specific EHR standard, you’d see immediate action. Start with loose standards and gradually tighten them until you arrive at your goal.
This is something private insurers could do more easily than the government, since they’re less vulnerable to pressure from lobbyists and they control the dollars anyway.
Check this out: http://wiki.chip.org/indivo/index.php/Indivo this is a great eHealth open source project from Harvard, MIT and Children’s Hospital:
http://indivohealth.org/developer-community
It’s amazing and even written in Django, so it’s even more cool
BTW https://uts.nlm.nih.gov doesn’t provide it’s codes publicly, perhaps part of the money could be used to pay for the rights from NIH.
“Now for a really radical idea: just point Google at the problem and let them buy the system and run it.”
funny. I would have make it open-source…
“… every single freaking time we go in they always have to know the same information and fill out the same damn paper forms”
Not that I disagree with the need for better IT systems… but for you, individually… you can take an extra copy home, fill it out, and make photocopies. It might be a more practical solution than waiting for your hospital to change their IT systems.
[...] I, Cringely » Blog Archive » Stupid IT Tricks: Medical Records – Cringely on technology via cringely.com [...]
I can’t begin to address how bad the suggestion is to hand health records over to Google. As an aside, Google just announced it’s shutting down Google Health.
http://googleblog.blogspot.com/2011/06/update-on-google-health-and-google.html
To follow Sam Yewell’s and Sam Brinton’s comments
And there are already government funded systems out there that have been storing moving and providing medical information for a few years out there. The VA has a medical records systems that is in USE for MILLIONS of Vets and seems to be a viable secure working product as opposed to a massive remake that will probably cost taxpayers billions of dollars to reinvent something that has been running quietly and successfully for a few years.
http://en.wikipedia.org/wiki/VistA
It’s in the public domain and has the potential to be exported to any hospital. The biggest hurdle to this is the big IT companies cannot make as much money from it. It’s not proprietary. There will be no sales reps coming to hospitals and taking Administrative staff out to dinner, to “educational” conferences in Las Vegas and other vacations spots (not kidding about this I saw this happen when a hospital I was working shifted to a “paperless” system) and presenting glossy brochures. It wont have staff coming in to help you set it up and customize it for you for a “reasonable” set of fees (that will recur for years) I am sure anyone who has gone to a HIMSS conference recently is well aware of how the large corporations are trying to grab their part of the billions of dollars converting hearth care to electronic medical records. And if the government in any way tries to promote it screams of “Big Brother” and other less savory statements will start up giving the news people more fodder to fill air time.
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