Reuters:New military electronic records to be model for US

[jpillian]

New military electronic records to be model for US

* Obama says existing system poses hardship for many vets

* Says new program would cut red tape, reduce mistakes

* Stimulus plan includes $19 billion for such technology

* Unclear whether private sector would help design system (Updates with comments from Obama)

By Jeff Mason

WASHINGTON, April 9 (Reuters) - President Barack Obama on Thursday said the government would create a national electronic medical records system for the military that will serve as a model for broad reform of U.S. healthcare administration.

The system, organized by the Department of Defense and the Department of Veterans Affairs, would follow military personnel from active duty through retirement, keeping records organized and complete.

Obama said the agencies were moving to create a system for military members "that will contain their administrative and medical information -- from the day they first enlist to the day that they are laid to rest."

"Currently, there is no comprehensive system in place that allows for a streamlined transition of health records between DOD and the VA," he said.

"That results in extraordinary hardship for an awful lot of veterans, who end up finding their records lost, unable to get their benefits processed in a timely fashion."

Obama has stressed the use of electronic medical records and e-prescribing -- which lets doctors send prescriptions directly to pharmacists via computer -- as part of his plan to transform the U.S. healthcare system and cut costs.

He said the new system would transform veteran care.

"This would represent a huge step towards modernizing the way healthcare is delivered and benefits are administered for our nation's veterans," he said. "It would cut through red tape and reduce the number of administrative mistakes."

DEARTH OF ELECTRONIC RECORDS

The economic stimulus bill signed by Obama in February includes $19 billion for healthcare information technology.

Fewer than 2 percent of U.S. hospitals have adopted fully functional electronic medical records, according to a study published last month in the New England Journal of Medicine, and just 17 percent of American doctors have switched from paper records to electronic health records.

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[jpillian]

I'm not quite understanding this. So you're telling me the most pressing need RE: Healthcare in America (which in my book is synonymous with the rising costs of healthcare in America) is the conversion of paper records to electronic records.

Really?

I've heard of lots of culprits mentioned as to why we have the most expensive healthcare in the world, but our means of record keeping have never been in the top 10.

I'd be interested in the opinions of those in the industry. Should this really be a $19 billion priority? :whoknows:

[Renegade7]

Making it all digital will be easier to organize, regulate, and keep track of. Making the system more efficient is the first step to stopping the wasting of money. I'm concerned like everyone else the idea of all our records being a click away from anyone who wants them. But if done correctly, it will work a helluva lot better then a bunch of papers flying every. I want to see how it works with the military first. The VA is in worse shape then the public system from what I've seen.

[armstrong001]

If the digital record keeping was going to streamline things that much, don't you think for-profit companies would jump at it? Even non-profits would, since less overhead means more money going to help those who need it. The lack of adoption by those who "need" it signals to me that it's a) not quite ready, not useful enough to merit the expense, or c) institutions are in the process of adopting it now. Either way, I have a hard time stomaching $19 billion put up by the Federal Government to push this.

[Larry]

If the digital record keeping was going to streamline things that much, don't you think for-profit companies would jump at it? Even non-profits would, since less overhead means more money going to help those who need it.

One electronic system can be vastly more efficient.

Having every hospital, every doctor's office, every insurance company, and every government agency that pays for health care each have their own, separate, custom-built (which is a fancy way of saying "this is the way it's kind of grown over the decades") system, not so much.

(Still, I also have to admit that my suspicion is that the main thing this system will be used for, is to allow insurers and employers to more efficiently deny coverage to people. As an example: Anybody really want to claim that the primary purpose of having your driving records computerized isn't so that insurance companies can more efficiently charge people?)

[jpillian]

One electronic system can be vastly more efficient.

Oh, I agree Larry. It just seems to be a curious first step. Not what I'd think of as identifying or addressing any of the reasons why healthcare costs are spiraling out of control.

Obviously, it was the fact that patients' records weren't in a universal electronic system that caused the cost structure to go kaput :doh:

My take: either 1) we can't identify why healthcare costs are becoming so insane; or 2) vested political interests require nothing be done to actually effect the problem. Either way, I see it as "low hanging fruit" and for all intents and purposes a smokescreen. :whoknows:

[Pwyl]

If the digital record keeping was going to streamline things that much, don't you think for-profit companies would jump at it? Even non-profits would, since less overhead means more money going to help those who need it. The lack of adoption by those who "need" it signals to me that it's a) not quite ready, not useful enough to merit the expense, or c) institutions are in the process of adopting it now. Either way, I have a hard time stomaching $19 billion put up by the Federal Government to push this.

http://www.bizjournals.com/nashville/stories/2008/10/27/story4.html

Hospital companies are moving towards digital records.

[Larry]

OTOH, from what I've seen, repairing computers in doctor's offices, I'd say that the average medical bill has a lot of overhead to cover the cost of non-medical things. Like shuffling paper, doing billing, arguing with the insurance companies, correcting mistakes, . . .

And to me, there's a lot to be said for the theory that if you want to improve health care, then if you can cut costs without affecting a single medical thing, then that's not a bad place to start.

(I've said the same thing for decades about welfare. From what I understand, for every dollar that the government actually pays out in Food Stamps or whatever, they spend almost another buck fifty paying bureaucrats to oversee the dollar they spent. That more than half of their budget goes to paper pushers. Seems to me, if you can figure out a way to cut the cost of pushing paper, then you can cut the amount we spend on welfare, without cutting the amount of welfare that people get.)

[armstrong001]

One electronic system can be vastly more efficient.

Having every hospital, every doctor's office, every insurance company, and every government agency that pays for health care each have their own, separate, custom-built (which is a fancy way of saying "this is the way it's kind of grown over the decades") system, not so much.

(Still, I also have to admit that my suspicion is that the main thing this system will be used for, is to allow insurers and employers to more efficiently deny coverage to people. As an example: Anybody really want to claim that the primary purpose of having your driving records computerized isn't so that insurance companies can more efficiently charge people?)

If one system were that much more efficient, the hospitals would be clamoring to do this on their own. If they aren't doing it now, it probably means the costs to install the system outweigh the costs of not installing it.

Maybe I just haven't had enough catastrophic incidents in my life. I don't see how electronic records are going to be so much more efficient if you go to see a general practice doctor on most occasions, then if you need to see a specialist your doctor forwards them a copy of your records. I've even moved across several states in the West, and have had to take my records with me from location to location to hand to my new doctor. Would pressing a button to send records be a little easier? Sure. But how much more "inefficient" is it to hand carry your records with you, really? And can that justify the $19 billion price tag?

[armstrong001]

http://www.bizjournals.com/nashville/stories/2008/10/27/story4.html

Hospital companies are moving towards digital records.

Great, then then the Government doesn't need to spend the $19 Billion.

[armstrong001]

OTOH, from what I've seen, repairing computers in doctor's offices, I'd say that the average medical bill has a lot of overhead to cover the cost of non-medical things. Like shuffling paper, doing billing, arguing with the insurance companies, correcting mistakes, . . .

And to me, there's a lot to be said for the theory that if you want to improve health care, then if you can cut costs without affecting a single medical thing, then that's not a bad place to start.

(I've said the same thing for decades about welfare. From what I understand, for every dollar that the government actually pays out in Food Stamps or whatever, they spend almost another buck fifty paying bureaucrats to oversee the dollar they spent. That more than half of their budget goes to paper pushers. Seems to me, if you can figure out a way to cut the cost of pushing paper, then you can cut the amount we spend on welfare, without cutting the amount of welfare that people get.)

There is an easier, more cost effective way. Local charities. But the Government likes to keep its hand in things so I doubt they'd let others do this work.

[Larry]

If one system were that much more efficient, the hospitals would be clamoring to do this on their own. If they aren't doing it now, it probably means the costs to install the system outweigh the costs of not installing it.

You've never seen two IT departments, each of which is in charge of a large collection of systems which have incrementally evolved over the course of decades, discussing the possibility of merging their information, have you?

[SkinsHokieFan]

The credit sharing system run by TransUnion and Expieron can be the foundation of an electronic medical database

Reducing the sheer amount of paper and errors caused by paper will be HUGE for the medical industry

[Larry]

The credit sharing system run by TransUnion and Expieron can be the foundation of an electronic medical database

Reducing the sheer amount of paper and errors caused by paper will be HUGE for the medical industry

I've never understood why the insurance companies didn't get together and simply impose a system like that, to handle medical billing.

I assume that the reason is that every insurance company is stuck on "why doesn't everybody else simply redesign their system to be the same as mine?" mode.

[armstrong001]

You've never seen two IT departments, each of which is in charge of a large collection of systems which have incrementally evolved over the course of decades, discussing the possibility of merging their information, have you?

So, in your mind, it's more efficient to merge hundreds if not thousands of IT departments? Look, if my insurance company/hospital/doctor want to set up an electronic system, I'm not sure I see a problem with that. All I'm saying is that the impetus should come from those that are trying to make the profit, not from the Government. How many times have you seen $19 Billion dollar projects turn out to be $190 Billion? The Federal Government is NOT the solution, private industry is. You don't think that they have just as much if not more riding on getting a system going?

If a single system is indeed worth the time and effort, private industry will make it happen, because I'm reminded all the time that private industry is a bunch of greedy ****s. Well, in some cases that greed IS good (Thank you Michael Douglas). If private industry doesn't get a system up and running, it probably isn't worth it and we shouldn't want the Government throwing money at it.

[Larry]

So, in your mind, it's more efficient to merge hundreds if not thousands of IT departments?

No, I'm saying it's well-nigh impossible to merge two IT departments. (And if government rules get involved, then the cost squares.)

It's far, far cheaper, and much more efficient, to create a system from scratch and impose it.

Ask any IT guy on this board about the difference between designing a system from scratch, vs patching systems by adding another several layers of software atop several existing layers of software.

Look, if my insurance company/hospital/doctor want to set up an electronic system, I'm not sure I see a problem with that. All I'm saying is that the impetus should come from those that are trying to make the profit, not from the Government. How many times have you seen $19 Billion dollar projects turn out to be $190 Billion? The Federal Government is NOT the solution, private industry is. You don't think that they have just as much if not more riding on getting a system going?

Now, if you want to argue the comparative efficiency of private IT initiatives vs. government, then I'd say you've at least got a case.

(Although I'll point out that, to pick some example, that one of the biggest advances in IT standardization, the creation of hardware-independent programming languages, was created by the government and imposed on private industry. (When Grace Hopper imposed COBOL on anybody who wanted to sell or rent computers or programs to the DoD.) Private industry didn't create the standards that became the Internet, government did. Private industry created VHS and Beta at the same time, and did the same thing with HD-DVD and Blu-Ray. In short, I'd point out that the debate about government vs. private may not be as clear cut as you might think.)

If a single system is indeed worth the time and effort, private industry will make it happen, . . .

Not when the landscape consists of thousands of little kingdoms, every one of which thinks that they're important enough that they can simply, by fiat, compel the world to revolve around them.

Why should Blue Cross spend millions of dollars designing a system that BCBS can share with AvMed, when BCBS can simply issue a memo that says "any doctor that wants to accept BCBS can darned well do whatever it costs to make his operation fit our existing system, without us changing a thing"?

From where they're sitting, they don't have to change. They're a big company, and big companies don't change to fit themselves to other companies, big companies tell other people to change.

From where they're sitting, they aren't paying the costs of Joe Doctor having to fit his computers to 40 different insurance companies. Joe Doctor is paying that.