US HealthCare - Digitalising Record

Discussion in 'Politics' started by liberalcynic, Sep 6, 2009.

  1. liberalcynic

    Verified Gold Member

    Joined:
    Mar 23, 2007
    Messages:
    239
    Albums:
    2
    Likes Received:
    12
    Gender:
    Male
    Location:
    Sydney (NSW, AU)
    Verified:
    Photo
    Evidently with the stupid arguments the Republicans are putting forward to oppose any sort of reform for health care in the US, would it be possible to some how get a small amount of legisative motivation by passing a bill which would atleast have a potencially good economic impact. The digitalising of health records.
    At current, health records are all on individual computers, or on paper in offices not linked whatsoever, and when someone arrives at a hospital emergency room doctor are working from scratch with no medical history or knowledge of drugs being taken by those admitted.

    meh... your opinions?
     
  2. B_VinylBoy

    B_VinylBoy New Member

    Joined:
    Nov 30, 2007
    Messages:
    10,516
    Likes Received:
    7
    Gender:
    Male
    Location:
    Boston, MA / New York, NY
    There's absolutely no reasonable excuse as to why medical records are not digitized. Not ONE.
     
  3. HazelGod

    Gold Member

    Joined:
    Dec 11, 2006
    Messages:
    7,531
    Albums:
    1
    Likes Received:
    9
    Gender:
    Male
    Location:
    The Other Side of the Pillow
    It's an interesting conundrum, and one that I'm intimately familiar with in my line of work.

    The largest obstacles are presented by data ownership and the privacy thereof. With the enacting of HIPAA, any provider in the healthcare industry can face hefty fines and even criminal sanctions for failing to adequately protect the privacy of patients' data. It's not even sufficient any longer to define who can access your data...they must be authorized to do so within a specific context.

    This is further complicated by a lack of any standards in data storage and transmission. Literally hundreds of applications and solutions exist for storing medical records, and nearly all of them are proprietary...meaning it's prohibitively expensive to integrate one with another, when it's even possible at all.

    I agree that the industry as a whole would benefit tremendously from both digitization and standardization. However, our healthcare system operates on a for-profit basis...and most competitive corporate types aren't willing to take the short term hit required to put the appropriate time and infrastructure in place to ensure success, even though it would save them a shitload of money over the long term.
     
  4. B_VinylBoy

    B_VinylBoy New Member

    Joined:
    Nov 30, 2007
    Messages:
    10,516
    Likes Received:
    7
    Gender:
    Male
    Location:
    Boston, MA / New York, NY
    I really don't think that would be a problem.
    If the issue is just standardized forms and not anything that requires the maintenance of any fluctuating statistical data, then it only makes sense that a simple scan to PDF solution would do best. Most computers can create a basic one without any additional software needed (A Mac can save any file in PDF format from any application using the print menu), and these files be viewed on practically any application. File sizes are also very minimal as well, making it very easy to store hundreds of thousands of files on a standard Hard Drive, especially since we now have 2TB Drives coming into the consumer market. This provides a quick, "dummy proof" solution since basic PDF files cannot be edited without tools like Photoshop & Illustrator because all items in a standard PDF file are treated as objects and not editable text. So, with proper water marks throughout the document it would be very difficult to duplicate and spoof. One would actually need Acrobat Pro and create a PDF with editable & searchable features in order for someone else to be able to change the data on the file easily. Of course, to prevent this even further you could also set passwords & encryption for these particular files as well.

    It's a preliminary thought that would need more work due to the fact that it would need some level of an agreed standard as you suggested, but going this route wouldn't really cost much to implement. Plus it would create jobs since you could imagine how many files out there would have to be converted. :wink:
     
  5. HazelGod

    Gold Member

    Joined:
    Dec 11, 2006
    Messages:
    7,531
    Albums:
    1
    Likes Received:
    9
    Gender:
    Male
    Location:
    The Other Side of the Pillow
    You're thinking about it from the patient-facing side. Information on the massive scale of a country's medical records doesn't get stored as documents...it's all done with relational databases on the backend. Trying to manage entire documents for such purposes would be impracticably cumbersome, inefficient, and insecure.

    It's much more sensible to define a standard information schema and use dynamic service calls to access and manipulate specific information attributes as needed; and it's much easier to link multiple datasets to a common key, e.g. linking a patient's prescription to both a physician and a diagnosis, or even just linking all of one person's visits to any number of providers to his own identity.

    The other point of using open standards for both the information schema and the transmission mechanisms is to avoid proprietary vendor lock-in. Nobody is interested in using a format that requires any particular vendor's application in order to work.
     
  6. Ericsson1228d

    Ericsson1228d Member

    Joined:
    May 22, 2005
    Messages:
    582
    Likes Received:
    0
    Gender:
    Male
    Location:
    MI, USA
    I agree with Vinylboy in that there is no good argument against it.

    However, Hazel is absolutely correct about the logistical challenges, costs, and privacy issues. HIPAA is one of the few laws that actually grants privacy in this country.

    I personally wish we had secure, private medical records that were digitized, then again, I also wish we had zero emission cars that ran on only water. Everyone would agree those are a good idea, but the implementation is the problem.

    Sometimes the logistics and reality of implementation have to be considered. I hate to beat the dead horse, but it is kind of the same argument with socialized medicine. An altruistic idea with no way to make it happen or pay for it is nice, but not realistic.
     
  7. vince

    Gold Member

    Joined:
    May 13, 2007
    Messages:
    14,785
    Albums:
    1
    Likes Received:
    538
    Gender:
    Male
    Location:
    Asia
    Why couldn't health records be stored on an electronic card in the possession of each individual? Every time you interact with a hospital or doctor or dentist, they swipe updated information onto the card. When they need to see your health records they just read the info on the card. The cards could be backed up to a central database.

    Maybe they shouldn't try to digitize old records. If it started from now with a new system, it would only take 10 or 20 years to have a completely useful data record for 99% of people.
     
  8. HazelGod

    Gold Member

    Joined:
    Dec 11, 2006
    Messages:
    7,531
    Albums:
    1
    Likes Received:
    9
    Gender:
    Male
    Location:
    The Other Side of the Pillow

    If the data resides in a central database, then what purpose do the cards serve? And as for that database, who owns and maintains it?



    I don't think there's any plan to do so...at least not as part of Phase 1.
     
  9. midlifebear

    Gold Member

    Joined:
    Dec 21, 2007
    Messages:
    5,908
    Likes Received:
    11
    Gender:
    Male
    Location:
    Nevada, Buenos Aires, and Barçelona
    Hazelgod brings up some very good points. Long ago in a galaxy far away I worked for the USA's third largest medical informatics company (companies that design software to track labwork in a hospital or hospitals, as well as software that tracks ALL patient care). The largest company that tracks patient care and the patient's lab work is the USA's Veteran's Hospital Group. the Second largest is Siemens, from their health care software mother ship in Salt Lake City. Many public hospitals use Sunquest Information System's lab software, which is rather good considering it's third in the USA and the cheapest.

    HIPAA is one of the things that really gummed up the works, but it is possible to create an encrypted health card for every patient which allows only that patient to provide access to his or her private medical records. But even that's still not perfect. However, there are database softwares that are ready to go, if the HIPAA issue can be resolved and other privacy issues with regard to private insurance companies using the information to discriminate against patients because of pre-existing conditions, age, or how many years one might be cancer-free after initial treatment. There's a ton of other stuff too. But the BiG THREE each have their own patient care tracking software ready and waiting to implement when given the green light to do so.

    But the next problem is what platform those giant databases are written in. It may surprise many to know that good old FOTRAN is STILL used for saving and retrieval of medical information in a huge database. COBOL (normally used by large businesses) is also stil used. There are others. Imagine a city hospital's entire patient medical database rendered in BASIC. Well, I may not have seen a UFO, but I've seen a city hospital's entire medical database rendered in BASIC, including their lab and billing software. (It was the only software language their IT guy knew!) FORTRAN is sort of like programming with rocks and sticks compared to even the early versions of C++. So, there is the problem of not only keeping everything private, but retrieving and converting information from what any 30 year-old would consider an archaic programming language then converting and saving it in seamlessly retrievable world standard program language format that could be the NEW universal code standardized all over the world -- and not make any mistakes in converting the original information. That's kind of like saying, "I want you to copy the entire dictionary by hand and not make an error in your hand writing. However, this, too, is not insurmountable, but it requires programmers who are the cream of the crop, can be trusted and authorized by all governments to not divulge personal information, and continue to work hand-in-hand with whatever new 22nd century database language is used and continuously in development for the repository of so much information. Currently, insurance companies do not even agree on what computer language they maintain the exact same information for all of their client patients.

    There are "patches" which amount to little more than a customized UNIX kernel or a GUI rendered in C++ that looks and feels like Uncle Bill's Microsoft software. But then Microsoft is the most hackable, poorly designed stuff (well, ONE of the most poorly designed) sets of interactive software for the end users of the world to understand and use.

    A final problem, (but not the only one left) are physicians. Physicians, in general, regard themselves as "above average intelligence." Granted, many of them are. But there is still a feeling among physicians in the USA that they cannot be bothered with attending to their patients even with a hand-held wireless computer device with which they can write on that will be deciphered by a special software and that they then can dock at the nurses station in a hospital. No, they are more touchy-feely (and for good reasons) and persist upon clinging to clipboards of tattered papers and insist that "all that paperwork" is something a medical transcriber is best at -- not them. Ever try to read a prescription? Enough said. Medical transcribers are the slaves of the medical world who end up being thrown under buses when .50 millligrams shows up on a patient's chart when it should have been .05 milligrams. Medical transcribers, therefore must not only be clairvoyant but above making mistakes -- even though the physician actually wrote .50 milligrams for a medication instead of .05 milligrams. Physicians, especially in the USA, don't have enough time to stop and really practice medicine (yes, I know, that's a very big and broad characterization); especially those in a communal practice where they pool their fees to pay overhead such as malpractice insurance, rent, lease x-ray machines (it's absolutely amazing how expensive and x-ray machine set up is in the USA -- even though they've been in use since approximately 1900).

    Yes, the dream of some day having a credit card with a chip in it that has your life's medical record is not impossible to make a reality. It's getting humans, insurance companies, lawyers, and a bunch of other idiots to agree simply to do it.
     
    #9 midlifebear, Sep 6, 2009
    Last edited: Sep 6, 2009
  10. vince

    Gold Member

    Joined:
    May 13, 2007
    Messages:
    14,785
    Albums:
    1
    Likes Received:
    538
    Gender:
    Male
    Location:
    Asia


    The database would only be a back up for lost cards. The cards make the data portable. No one could access your data without permission or knowing security codes. The government would "own" the database. It could be operated and maintained by a contractor(s) working for the govt.

    Or maybe the whole thing could be webbased. You enter some pin codes and the doctor can access your file. Just like a banking website.

    Of course there are technical problems to be resolved. But it need not be any more complex than other large systems such as those in the financial sector.

    Again, the main impediment to reform is not technical, it's lost profits and legislative fear.
     
  11. HazelGod

    Gold Member

    Joined:
    Dec 11, 2006
    Messages:
    7,531
    Albums:
    1
    Likes Received:
    9
    Gender:
    Male
    Location:
    The Other Side of the Pillow

    That was my point with the first question. If the data are centrally stored, then the cards become superfluous...an unnecessary expense.

    Web Services would be a sensible approach for data accessibility, as the SOA model uses open standards and provides for the complete range of usability, data privacy, and security.




    I could not agree more. If American Express can manage hundreds of millions of financial transaction records for its millions of customers the world over, we the people can certainly establish a medical records clearinghouse for our citizens.
     
Draft saved Draft deleted