Bush Promotes Computerized Medical Records

[rodeodance]

advances in technology are fine--but right now we need a more equitable health care delivery system!!


http://story.news.yahoo.com/news?tmpl=story&cid=544&ncid=716&e=7&u=/ap/20050127/ap_on_go_pr_wh/bush

Bush Promotes Computerized Medical Records

Thu Jan 27, 2:21 AM ET


By NEDRA PICKLER, Associated Press Writer

WASHINGTON - President Bush (news - web sites) is using the first trip of his new term to highlight what he hopes will be the wave of the future in medicine — computerized records to reduce cost and errors.



Doctors have all manner of new technology to diagnose illness, but they are still likely to write patient records and prescriptions by hand.


"We've got 21st-century medical practices but 19th-century paperwork system," Bush said Wednesday during a visit to the National Institutes of Health (news - web sites).


"Most doctors can't write clearly anyway," he said, drawing laughter from his supporters and physicians in the audience. "So there's a better way to enable our health care system to wring out inefficiencies and to protect our patients." ......

[Gman]

1. Check the contributor list

who has money to make on this one?

[rodeodance]

3. The information technology industry will make megabucks from his one!!

Industry--score one, Patients-score ZIPPO

[dweller]

14. yeah, in India......n/t

dp

[The Backlash Cometh]

16. It will just be easier to find your opponent's medical file through

a Carnivore type program.

[Drifter]

17. Me ...

I design high speed document scanners. Any push to go paperless is good for me. That means that they will undoubtedly need to scan history.

Cheers
Drifters

[papau]

33. Indeed a standard form that reduces to bar code makes sense

But Bush's idea is just more jobs for India.

[annabanana]

2. checking for overprescription of Plan B maybe.........n/t

[rodeodance]

4. PLan B decision was delayed by the FDA--report was suspose to

be last Friday, but none yet that I know of

[Clark2008]

5. Wes Clark advocated this

However, I somehow doubt the bidding would be closed to only his friends.
I'm all for this, I just don't trust Bush to implement it properly because he's such a monumental screw up.

[rogerashton]

6. Well, look, we need both.

In my own recent medical adventures, I have had to fill out the same damn forms multiple times, try to remember for 4 or 5 docs what drugs other docs have prescribed for me. (My problem is a brain injury that could impair memory! Fortunately my wife helps out -- she had a way better memory than I had even when I was uninjured.) And so on and so on -- we are still not sure who prescribed dilantin! Which symptoms are relevant to which specialists? and so on.

What is crooked about *'s line is the claim that this will cut costs and contribute to solving the problem of rising costs that cut more and more out of health care. (My boss recently announced that no employees hired after 1 January will be eligible for retirement health insurance.) Here are the facts -- cruel to someone like Bush, but certainly not all bad. Medical progress has the potential of assuring all of us longer lives with less pain and disability, but only on the condition that we have guts enough to raise taxes to pay for it. Otherwise, this potential will not be realized. Certainly it will not be realized for the poor and middle class. The rich probably have the illusion that they can escape the trap, probably by travelling to some medical resort in a cheap-labor third world country. But they will be swindled and die anyway, because fraud is a way of maximizing profits.

[rodeodance]

9. thanks for your comments--yes, I agree with you

[moondust]

7. Doctors virtually NEVER write out records.

And they haven't for many years. They keep their own notes but they normally dictate patient records verbally into a Dictaphone machine which are then transcribed.

When medical records are computerized they can easily be sent to India for (cheap labor) processing. Some places have been doing this for years.

Bush is so far out in the right field weeds that the one cute little reason he gives for doing this is not even an issue.

[Enraged_Ape]

8. That's not entirely true

Although doctors farm out a lot of transcription when they can, they still issue a lot of written orders, prescriptions, and SOAP-note-type summaries, particularly in hospitals that don't have and/or can't afford electronic charting. And I can assure you that there are many of those; I am a physical therapist who works in them.

I personally think Bush is on the right track with this. Even a broken clock is right twice a day.

[moondust]

13. Deleted.

[Enraged_Ape]

18. Hardly. Is Albuquerque, NM, out in the woods?

And Dallas, TX, before that?

That's how it happens in hospitals. There's indeed no time to send everything off for transcription. Things like detailed op notes can be (and often are) transcribed, and physicians' orders are transmitted by the unit secretaries (although the physician writes them out and signs them), but the doctors' daily progress notes are still written out BY HAND and kept in the medical record that way.

I have also been involved with the medical review process for a health plan, and I can assure you that the charts they look at around the state are overwhelmingly handwritten. They pay the nurses that perform the AMR good money to decipher them.

Again, I think Bush is on entirely on track with this, and I applaud him for it. Now, whether the financial benefits of a widely-used and standardized EMR will trickle down to the health care consumer is another question entirely. My guess is, based on past Republican performance, absolutely not.

[moondust]

28. The minute-by-minute details

of patient care that are now handwritten may never end up in an EMR anyway. There's too much of it and, as you say, too little time. And who really needs all those details in real-time besides the immediate caregivers?

EMR isn't a bad idea but I don't understand why Bush would try to sell it based on bad handwriting. It tells me he doesn't understand the issue.

[Enraged_Ape]

38. Bad handwriting is at Bush's maximum level of complexity

We should be thankful he didn't tie it to tax cuts or the war on terror.

[Bridget Burke]

19. Much of the transcription is now done in India.

A friend was working part time, transcribing records for several physicians. But all the work dried up, since physicians are now having that work done in India.

[WildClarySage]

10. The idea isn't necessarily a bad one

(though I'm a tad concerned about privacy--- but after HIPPA, what privacy do we have left anyway?) but the implementation is what concerns me most.

Like NCLB- yes, improving schools by introducing accountability is good- the actual NCLB program is a worse fix than the schools were in to begin with.

[katinmn]

11. It's easy to tell physicians to adopt EMR

but the reality is that there are a gazillion different systems out there with little standardization. A clinic system has to be able to dovetail with those of one or many hospitals, labs and pharmacies.

Most docs are starting off with very basic systems for prescriptions because they know the feds will invariably make changes to reporting requirements, as in HIPAA. They're also waiting for the bugs to get worked out and for some basic standardization in the electronic medical records field. As with a lot of software companies, you might invest in a system, train your people, get your data entered, and then the software company goes out of business. Then you are left with system that no one on staff can fix when it goes down.

[Enraged_Ape]

21. They are working on standards

Health Level Seven (HL7) is an ANSI-approved body that is involved in the specs for storage and transmission of health data across the spectrum of care.

But you're right about the lack of standards now. There have been a lot of companies involved in this from an early time to try to "get in ahead" of everyone else, each offering their own solution and none of it compatible with its competitors. Every company's product runs the risk of being the next Betamax or even, with the popularity of DVD, VHS.

What this enterprise definitely requires is money, organization, and management of Apollo-project-like proportions, but I think the benefits will be well worth it in the end.

[katinmn]

25. Yes, it's moving in the right direction

however, with * now speaking out for it, it may be doomed for the next four years.

He has this knack for screwing up everything single thing he attaches himself to.

[Demit]

12. One Bush cousin will probably benefit. Jonathan Bush--a "live wire

of energy in a blue suit and cowboy boots", the Boston Globe called him in a story on 4/28/2003. Sorry, no URL for that, but here's this:

"Athenahealth plans to offer clinical applications
Athenahealth Inc., a Waltham, Mass.-based company that provides revenue and claims management services for provider organizations, expects to offer clinical information services for physician practices by 2005, said Jonathon Bush, the company's CEO. Bush said he hopes the company can build off its current business model and provide clinical applications, such as electronic medical records, on a subscription basis."

-- http://www.healthcareitnews.com/NewsArticleView.aspx?ContentID=711&ContentTypeID=3&IssueID=4

The Bushies are everywhere.

[OzarkDem]

15. Why is he visiting Cleveland Clinic?

Rather surprising that he's making a trip right now, when there's no particular campaign going on. He never travels unless there's a reason.

Keep in mind, Cleveland Clinic is the top heart center in the US. Dole was here a couple of years ago for heart surgery. This trip coming up so suddenly and without a real purpose, with a last minute change to include the VA hospital seems odd.

[FuzzyDicePHL]

20. Been done for a couple of years

My doctor has been computerized for a few years now. Since I am in IT support, I asked him questions about how it worked out for him and his partners, and he really liked it. I can see how it would make things much easier for billing, tracking, health trends, prescriptions, etc. The biggest drawback, he told me, was that the old records weren't online, and that created a huge inconvenience while they were all being put into the system.

I agree with several other folks here who find this to be a not entirely bad idea. For my partner and me, it's a positive thing, since his job is as a QA tester for a company that makes the software used in hospitals and doctors' offices.

FD

[underpants]

22. Wasn't this proposed oh 12 years ago and soundly rejected?

Oh wait that's right that was when Bill and Hillary were trying to update American medicine.

[cap]

23. in and of itself, this is not a bad idea, but.....

the devil is in the details.

These people never do anything for the general good...so, I am waiting for the other shoe to drop.

First, how much of this computerization and record keeping will be offshored?

What will be the privacy on offshored data? Not only on offshored data but what about insurance companies access to your records. A lot of people pay for psychiatric treatment out of pocket because they dont want other people to know about them. Will the draft boards have access to this data?

The medical community has fought computerization especially doctors. Why is Bush trying to do something that they dont want.

Computerization has not been the panacea for keeping down costs on medical record keeping. Ask any doctor about Medicare/Medicaid reimbursement.(EDS computerized these programs a long time ago). It can be really hard to get the government to pay up.

My gut instinct is that this is going to cover up something really nasty. I think I want to see the fine print on this before I get on board.

[TahitiNut]

26. Actually, it is ... a VERY bad idea.

Patient records are already extensively computerized. Patient workups, examinations, orders, care logs (e.g. bathroom, bedsores) are kept handwritten for a very good reason - they show tampering. Computerized records don't show tampering ... or SnoPake ... unless they're carefully designed to do so. (Show me the last time that any corporation paid for a design that could show they committed fraud.)

Primary caregiver personnel (doctors, nurses, therapists, etc.) already spend enormous amounts of time in defensive foxholes hidden away from the patient doing "billable" hours maintaining the alternative reality on the computer. The last thing a patient needs is more foxhole time and less hands-on care.

Handwritten paper records have a number of very important advantages. They're very portable and can be kept and maintained wherever the patient needs care ... thus not drawing the caregiver away from the patient and into some administrative foxhole. The caregiver can scrawl anything on them ... even those things not foreseen by the forms designer. There're abundant telltales about when and who wrote on the paper record; color of ink, handwriting, etc. Ad hoc discussions can be held over paper records, even including the patient, and copies can be easily made - possibly by a family member with a concern, maybe even a legal concern.

There's a place for computerized records and a place for handwritten records ... and sometimes i makes sense to have both for the same information. The key concerns are whether the patient is receiving the lion's share of the caregiver's time and whether the care is honest. We're already losing sight of that.

[LosinIt]

29. A system can be designed that once a doc is scanned it can't be changed

Changes are made as overlays or notes attached, things can be highlighted etc. The original doc can never be replaced, another one may be added, but you don't lose the original. This is the design of the product that I support.

[TahitiNut]

30. Such systems and their use is my professional area of expertise.

I can absofuckinguarantee you that systems design is driven by cost minimization and cover-your-ass considerations. Putting waste, fraud, and abuse detection into a systems design (and associated procedures) is pragmatically impossible. No enterprise will pay for or support any system that can be used against them!


My 35-year career began in applications programming, moved to systems software (operating systems, telecommunications, and database internals) design and implementation, and then moved to Audit and Operational Analysis. I became one of those internal "white hat" seekers of waste, fraud, and abuse in business operations. Sometimes called "management auditing," I've worked both as an employee and as a consultant (usually reporting to the Board of Directors), examining business practices, procedures, and systems, identifying both opportunities and instances of waste, fraud, and abuse. Along the way, I had the unfortunate "success" of finding it at the executive levels in three major corporations. Needless to say, those were career-limiting "successes."

[yellowcanine]

31. But the point is, it is nowhere as simple as Bush makes it out to be.

If it were simple - believe me, hospitals and doctors would have jumped on this a long time ago. There are all kinds of issues with electronic signatures and computer security that just have not been all worked out yet. As usual Bush acts as if he just had a great idea that the experts in the field were too hide bound to think of. He fancies himself to be a visionary thinker which is just....well, laughable.

[Stuckinthebush]

24. Wow...a good idea from Bush!

Actually, this is not really a unique idea, just something for him to attach his name to.

But, it is needed.

[neweurope]

27. Next step is a central place to store all those data - and government

access to them, of course. Your authorities generally seem to be very interested in medical records. Didn't FBI agents want to see the medical records of somebody who has anti bush signs in her front yard?


-------------------

Remember Fallujah

Bush to The Hague!

[Algorem]

32. can watch jackass speak at Cleveland Clinic live at 11:30am:

http://www.cleveland.com/politics/ President expected to talk at Cleveland Clinic today about benefits of computerized records

• Watch live video at 11:30 a.m.

• Details: President in town

• Politics Forum: Talk healthcare policy Maybe he'll screw up comically,though we know how rare that is.
video link: http://www.cleveland.com/wkyc/ or: http://www.newsnet5.com/video/4134681/detail.html "Bush Visit to Push Medical Changes":...Last May, President Bush told an audience at Vanderbilt University Medical Center that the VA does a "fabulous job" using health information technology.

The president is expected at the Cleveland Clinic today to talk about the benefits of such technology. Dr. C. Martin Harris, the Clinic's chief information officer, serves on two commissions related to Bush's goal of ensuring that most Americans have electronic health records within 10 years.

Such records would make a patient's medical information available to doctors anywhere, no matter where that information is stored. At the same time, patient privacy would be protected. Bush has established the position of national health information technology coordinator - currently held by Dr. David Brailer - to achieve his goal.

Hospitals in Northeast Ohio, including MetroHealth Medical Center and the University Hospitals and Cleveland Clinic health systems, have some electronic record-keeping in place, but there's room for improvemen http://www.cleveland.com/politics/plaindealer/index.ssf?/base/news/1106825416114980.xml

[ElsewheresDaughter]

34. $170 million taxpayers $$$ spent on new FBI terror computers have to .....

be used somewhere and make another miserable failure the bush* MO http://www.cbsnews.com/stories/2005/01/13/terror/main666644.shtml


FBI Terror Technology Flops

As envisioned, Virtual Case File would have allowed agents throughout the country to have instant access to extensive background on suspects: history, contacts, fingerprints, travel patterns.



(CBS/AP) A $170 million computer overhaul intended to give FBI agents and analysts an instantaneous and paperless way to manage criminal and terrorism cases is headed back to the drawing board, probably at a much steeper cost to taxpayers.

CBS News Correspondent Bob Orr reports the system, labeled Virtual Case File is still not ready, but it's already obsolete.

Orr reports an Inspector General's report about to be released says the centerpiece of the FBI's half billion dollar technological overhaul is a bust.

The system, labeled the "Virtual Case File," is still not ready -- but already obsolete. One official calls it 2001 software ... with "a number of deficiencies" and security flaws.

The FBI is hoping to salvage some parts of the project, known as Virtual Case File. But officials acknowledged Thursday that it is possible the entire system, designed by Science Applications International Corp. of San Diego, is so inadequate and outdated that one will have to be built from scratch.

[hunter]

35. Electronic votes, electronic medical records, what next?

Electronic voting machines might be made to work, in the same way that electronic medical record systems might be made to work, but that's not the purpose of Bush's proposal...

In Bush's world, things go much easier for his friends in big business when accounting records, medical records, and votes are entirely vaporous. Electronic bits are easily modified or disposed of. Paper ballots, charts, and other records are much more troublesome to deal with when you are doing something unethical and fraudulant.

But it could be worse... Imagine a world where a single economic entity counts your votes and keeps your medical records. If you get uppity, as demonstrated by your voting pattern, maybe your medical record begins to reflect that, and your daily medications are adjusted...

I actually think Bush lives in that sort of world now. Whenever he becomes erratic and unmanagable his medications are adjusted. If that doesn't work, he takes a vacation. His medical records are almost certainly electronic.

[genieroze]

36. Wow, we all know how much computers have helped voting. eom

[happynewyear]

37. oh yeah great idea!

I had surgery a little over a year ago. The office/doctor uses computerized records. However, doctors are rather notorious for not knowing the "hows" of computers to say the least IMO.

Anyway, to make a long story short, I recently called to make a follow-up appt. and guess what? They have NO RECORD of ever having seen me! Gee that is like $10,000.00 later!

Computerized records - time savers? Yes they are being complete records and files of patients are being "lost"!

:kick:

[WannaJumpMyScooter]

39. What ** relative has ties to this boondogle? or is this Rudy G's

new gig?

[deacon2]

40. Data is neutral

It is what it is. It is impossible to argue against the improved (not absolute) efficiency of storing data electronically and disseminating it neurally. HOWEVER - in the hands of crypto-nazis, or simply in the hands of data miners beyond the reach of any U.S. safeguards (as laughably flimsy as they are) - it is potentially DEVASTATING to the privacy and security of American citizens. Or citizens of any nation foolish enough to hand off its sensitive information to a competing nation. Not to mention how easy it would be for insurers to abuse this data pool and deny coverage to individuals. Or for blackmail to be applied. Or just create your own John Le Carre' scenario of nefarious activity. Data is neutral... but these amoral sons of bitches are not. Everything they propose is subject to absolute suspicion. There is always another goal.