Medical Obama Idiocy.

Yes, besides ramming a faulty stimulus plan down the throat of Americans, helping to destroy the automotive sector by letting states define their own CAFE standards, we have even more monumental stupidity from the Obama Administration.

What is it?  Computerized health records.

Now you might be saying to yourself, “this guy has finally gone off the rocker!  Why would anyone object to computerizing health records?!?”

Well, lets take a look at a recent CNNMoneyonline article

Obama’s big idea: Digital health records

President-elect wants to computerize the nation’s health care records in five years. But the plan comes with a hefty price tag, and specialized labor is scarce.

NEW YORK (CNNMoney.com) — President-elect Barack Obama, as part of the effort to revive the economy, has proposed a massive effort to modernize health care by making all health records standardized and electronic.

Here’s the audacious plan: Computerize all health records within five years. The quality of health care for all Americans gets a big boost, and costs decline.

Sounds good. But it won’t be easy.

In fact, many hurdles stand in the way. Only about 8% of the nation’s 5,000 hospitals and 17% of its 800,000 physicians currently use the kind of common computerized record-keeping systems that Obama envisions for the whole nation. And some experts say that serious concerns about patient privacy must be addressed first. Finally, the country suffers a dearth of skilled workers necessary to build and implement the necessary technology.

“The hard part of this is that we can’t just drop a computer on every doctor’s desk,” said Dr. David Brailer, former National Coordinator for Health Information Technology, who served as President Bush’s health information czar from 2004 to 2006. “Getting electronic records up and running is a very technical task.”

It also won’t come cheap. Independent studies from Harvard, RAND and the Commonwealth Fund have shown that such a plan could cost at least $75 billion to $100 billion over the ten years they think the hospitals would need to implement program.

That’s a huge amount of money — since the total cost of the stimulus plan is estimated to cost about $800 billion, the health care initiative would be one of the priciest parts to the plan.

The biggest cost will be paying and training the labor force needed to create the network. Luis Castillo, senior vice president of Siemens Healthcare, a company that designs health care technology, said the laborers will have the extremely difficult task of designing a a system that “thinks like a physician.”

“Doctors cannot spend hours and hours learning a new system,” said Castillo. “It needs to be a ubiquitous, ‘anytime, anywhere’ solution that has easily accessible data in a simple-to-use Web-based application.”

But highly skilled health information technology professionals are as rare as they come, and many IT workers will need to be trained as health technology experts.

Early government estimates showed about 212,000 jobs could be created from this program, but Brailer said there simply aren’t that many Americans who are qualified.

Furthermore, ensuring the privacy of patients’ records in a nationalized computer network will be tricky. There are obvious concerns about hackers and system failures. And new online health record systems, such as Google Health are not currently subject to the Health Insurance Portability and Accountability Act, the national health privacy law.

“HIPAA was never intended for the digital age, because the laws never anticipated the emergence of Web-based records,” said Brailer. “Congress can pass one of numerous policy proposals for change, it’s just a question if they have the will to do that.”

Jobs and savings for the future

The Obama transition operation declined a request to elaborate on Obama’s proposal. The president-elect said Thursday in a speech on the economy that the benefits of a modernized national health record system go beyond just cost savings.

“This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests,” said Obama. “It just won’t save billions of dollars and thousands of jobs — it will save lives by reducing the deadly but preventable medical errors that pervade our health care system,” he added.

Still, compared to the $2 trillion a year that the industry spends, the $100 billion experts say it may cost to implement Obama’s plan is a drop in the bucket.

“We must reduce waste to become more efficient” said Brailer.

The savings of such a plan could be substantial. Brailer estimates that a fully computerized health record system could save the industry $200 billion to $300 billion a year.

That could ultimately slow the rapid rise of health care premiums, which have cut into Americans’ paychecks. While wages are rising at a rate of around 3% a year, health care costs are growing at about three times that rate.

“Obama’s support for electronic medical records is one of the key efforts of health reform that actually will deliver lower costs for hard-working American families,” said Larry McNeely, a health care advocate at U.S. Public Interest Research Group. “Long-term savings can’t happen unless we have 21st century health information technology.”

Massachusetts has developed a plan to fully computerize records at its 14,000 physicians’ offices by 2012 and its 63 hospitals by 2014. After a pilot program, the state legislature estimates it will cost about $340 million to build the statewide computer system, with a cost of about $2 million per hospital.

“[Obama’s] timeframe is very ambitious, but there is a need to be able to track data on patients and talk across providers and health care systems,” said Dr. JudyAnn Bigby, Secretary of Health and Human Services for Massachusetts. “The program will allow for greater patient safety.”

Some say some of the hard work has begun. The Bush administration laid much of the groundwork for the program, leading to several pilot programs in a handful of states, as well as a standardization of medical records.

“The whole structure has already been developed,” said Stephen Schoenbaum, executive director of The Commonwealth Fund’s commission on a high performance health system. “It’s feasible to at least make a lot of progress on this in the next five years.”

The few readers out there who actually know me, and know me well, also know that I have quite a bit of experience in this area.  I’ve got nearly two decades of software development experience, and quite a bit of that time was spent in the medical and dental office management field.  I probably know more about this, especially from a business standpoint, than the morons that were cited for the aforementioned article.

This is not – in any frickin’ way, shape, or form – Obama’s big idea.  It has been around for nearly two-frickin’-decades.  It has been tried.  It has been, to some extent, a failure.

Why?

I’ll give you a GLARING example of what a absolute, frickin’ dimwit Barack Obama is when it comes to this issue.  In a recent town hall meeting, The Nazarine went off about the first thing that happens when you walk into an emergency room is that someone hands you a clipboard with paper that needs to be filled out.  The implication here is that the paper on the clipboard is somehow kept and filed by the hospital somewhere, and this is how the hospital keeps information.

The point of the clipboard is so that the information gathered at the front desk CAN BE ENTERED INTO A FRICKIN’ COMPUTER SYSTEM!  What that numb-skull who calls himself President obviously doesn’t understand is that virtually every Emergency Room, doctor’s office, dentist’s office,  and hospital across the United States has an extensive billing and financial management system.  They also have systems for recording of laboratory results, provider scheduling, room scheduling, and so on, and so on.

Moreover, every time they hand you a clipboard to detail your medical history, they do this so that what’s on their system can be verified with what the patient specifies.  In some instances, they require that you, or the person making your medical decisions, sign a piece of paper that specifies the patient’s medical history.  That way, there is no confusion if you, say, have no allergies to a certain medication one year, and now have recently developed an allergy to the same medication recently.  This is to prevent killing you when they prescribe a specific kind of medication to fix your medical dilemma.

I might point out that this is the guy who everyone says is so stinkin’ smart because he has an Ivory League education.  He said something completely stupid, and no one (as far as I can tell) is calling him on it.  Then again, this is nothing new.

Nowadays most of your medical billing – if not virtually ALL medical billing – is done through computer systems.  It’s all online.  There is a vast infrastructure already built-up recording all of the procedures you’ve had done, how much you paid, how much was billed to the government, and so on.  There is no need to infuse more money into a system that already exists, and does a pretty good job as is.  If you doubt me, take a look at how most state agencies handle things like Medicare and Medicaid billing: they often hand it off to private-sector or semi-private-sector companies as a money-saving method of claims processing.

Computerized claim processing, office management, and hospital management has become a de facto requirement of doing business WITHOUT ANY STINKIN’ NEED FOR GOVERNMENT INTERVENTION!

But there is more…

On the flip-side of this equation are “computerized health records.”  Basically, this encompasses diagnosis, treatment, tests, and care notes taken by a provider, and kept by some entity somewhere.  This, again, is something that has been discussed for nearly twenty-years now.  There have been LOTS of attempts at bringing this online in some fashion, but for the most part, attempts to digitize this have been slow.

Again, you may ask, “why?”

First, let me highlight probably one of the most stupid comments in the article cited above:

The biggest cost will be paying and training the labor force needed to create the network. Luis Castillo, senior vice president of Siemens Healthcare, a company that designs health care technology, said the laborers will have the extremely difficult task of designing a a system that “thinks like a physician.”

There is a reason why Luis Castillo is a senior VP at Siemens Healthcare, and not someone actually working on a medical records solution: he hasn’t a clue as to what in the hell he’s talking about.  People do not design computer systems that think like the person using them.  They design solutions to aid that individual by eliminating redundant and tedious tasks that free that individual to do their job better, and more efficiently.  This essentially means streamlining data entry, eliminating simple tasks (like calculating stuff like sales tax), and guiding data entry.  In the end, all the computer does is collect information.  Thinking has nothing to do with software, nor should it.

This way, the person who uses the software can spend more time in the decision-making process.  If you go off designing systems that start telling doctors what meds to prescribe, and you’re going to run into problems really, really fast.  Doctors will refuse to use the system, or will demand so many overrides to the “automated decision-making process” that it’ll eliminate the need for the computer to do “thinking” in the first place.

Go to your average doctor’s office, and ask to see your medical history.  What you’ll undoubtedly see a big ole file with lots of notes, charts, and scribbles in it.  Despite what people may think, doctors are practical businessmen.  Their aim – after spending tens-of-thousands of dollars on an education, and years upon years in training – is to make a decent living.  They do this by charging fees for their services, and making a profit off of those fees.  So, they tend to be cheap.  Now, with the prevalence of computers these days, you’d think that doctors would jump to computerizing medical records.  After all, most businesses have gone that route for cost-savings.  Well, that’s all nice and fine, but one needs to remember the following truths about paper-and-pen systems:

1) Paper is cheap.  So are pens and clipboards.

2) Paper is reliable.

3) Paper doesn’t get viruses that either destroy or expose medical records, of which the doctor is liable for losing.

4) Paper doesn’t crash and destroy some or all of your medical records in the process of grinding to a halt.

5) Paper can be backed-up easily with a standard office copy machine (which is hanging around the office anyways).

6) Paper can be held almost indefinitely, or at least until the time the patient finally expires.

7) Paper doesn’t need to be upgraded every five- to ten-years, nor does it have to deal with buggy 64-bit operating systems.

8) Paper doesn’t need a dedicated IT staff or a solutions provider to do maintenance.

9) Few people these days “hack” into a doctor’s office to steal your medical records, which are printed on paper.

So, you see, there are some clear-cut incentives to continue with a paper-based system.  The transition to a digital system is slow, but it is happening.  However, when you start justifying the costs of an all-digital medical office system against the costs of doing business, keeping paper records is far more attractive than going with “gee wiz” gadgets and gizmos that put the office on the bleeding edge of technology.

That’s because most doctors prefer to keep costs as low as they can, make a decent living for themselves, and provide better care for their patients (I know that many liberals think that doctors are the source of all evil, so this will obviously be disputed).  One of the reason why Americans have one of the best systems of healthcare in the world is because the focus is on technology for diagnosis and treatment…not online medical records.

One of the areas where most of the patient information is held in computer systems is in your average dental office.  I, for example, go to a dentist who holds all my X-Rays (bitewings and full mouth), tooth charting (records fillings, chips, cracks, and bleeding in teeth), as well as all previous procedures done on my mouth in a very extensive and flexible dental management system.  I go from the hygienist to the billing area all within the same system, on each visit.  There is hardly any paper used in the process, with the exception of my receipt and checkup reminders.  In fact, this has become more commonplace over the last ten years in dental offices.

Why has this taken hold with dentists, and not physicians?

Well, dentists are often not affiliated with large hospitals – they are independent small businesses all on their own.  Most physicians practices are affiliated with a hospital of some sort.  The hospital provides a lot of services that physicians need – such as software.  Dentists, in this regard, are on their own.  So, they need a comprehensive solution.

Moreover, people don’t go around suing their dentists for seven-digit sums because they capped the wrong tooth.  Nowadays, if your doctor doesn’t treat your hemorrhoids properly, you’re entitled to the Good Life at the doctor’s expense.

A doctor can decide to move from one health system to another.  The physician business model is that physicians generally take their patients from one health system / hospital to another should they change over.  Usually, because dentists are mostly independent entities, patients stay within that office or groups of offices.  If a dentist leaves and starts their own practice, he or she may take their patients with them.  However, they will also need their own software to manage the office.  And, dental records can be easily updated by a one- to to-hour exam and charting session.  Not true with physicians, who often retain a decade or more of health history.

Dentists, despite being notoriously cheap, they have the money and the business model to invest in what Obama claims they don’t have.  Some physicians have gone this route already, but most keep their records on paper.

This is the other dirty little secret that The Nazarine isn’t mentioning: software to hold and manage medical records has been on the market for some time now.  It has been on the market, to my knowledge, for at least a decade.  That metal defective and his drooling, wide-eyed followers act like such a thing doesn’t exist.

There is another reason why medical records are not so quickly moved to online storage.  Your average dentist has a limited number of diagnostic tools by which he is able to diagnose problems in your mouth.  There’s the visual inspection (known as “charting”), things like periodontal checks (also part of charting), X-Rays, and miniature video cameras.  That’s about it.  A doctor, however, can have EKG printouts, CAT scan picture, PET scan pictures, X-Rays, lab results (and there are literally hundreds of these), ultrasound videos, and so on, and so on, and so on.  A vast majority of these diagnostic machines are older pieces of equipment that do not generate output that is compatible with any medical management package.  So, the end result is that if the doctor wants this information stored in his system, he generally has to buy a specialized scanner that will convert “paper”-based images like old X-Rays into digitized bitmaps with a fairly high resolution.  Such resolutions did not exist even a decade ago without the outlay of a HUGE amount of cash from the doctor’s own pocket.

Plus, hospitals tend to keep things like outdated CAT scan machines around because they’re already paid-off, and actually generate revenue for the hospital at that point.  I know that hospitals making a profit tends to make most socialists shudder.

Finally, and this is probably the biggest obstacle to Obama’s Utopian goals, there is the question as to what to do with medical records that already exist in paper form.  Scanning old X-Rays and CAT scans is just the tip of the iceberg.  No, anyone who regularly goes to the doctor has a file that looks like the rough draft of War and Peace.  So, assuming that all of the technological issues are somehow resolved when it comes to importing things like test results and whatnot, you still have to somehow import the doctor’s notes.  Despite the commonly held notion that doctors are on the golf course for most of their professional careers, a VAST majority of doctors spend a good portion of their personal and professional life doing their job.  On average, a decent doctor spends well over 40-hours a week at his job.  They are frequently on call, and are not going to be available to transcribe their notes.  Nurses and most office staff are not data-entry people, and they tend to be pretty busy as well.  Thus, it requires someone to hand-enter pages, and pages of notes for each patient, past and present.  It costs money.  It takes time.  These two things alone make digitizing medical records cost-prohibitive to your average medical practice, regardless of whether software exists that will do this (and, as mentioned before, there is software that already exists on the market today to computerize your medical records).

If you’ve got the notion that you can just scan in a document filled with the doctor’s notes, and have the wonder of modern technology transform this into clearly understandable medical notes, you’re deluding yourself.  First, your average doctor’s handwriting is notoriously bad, and illegible to most people.  Secondly, most (if not all) image translation software is terribly inaccurate, for lots of functional reasons.  So, the end result is that it is often times cheaper to just hand-enter the data into the system, as opposed to scanning and correcting automated entry processes. 

I’m not even going to touch the hardware costs for some of the stuff that will literally be required for soup-to-nuts implementation of an online medical records system with computer tablets for physician entry, redundant and secure backups, system security, and 24×7 reliability.

Despite modern technology being able to meet the demands of the medical records market, there’s a reason why physicians and some hospitals have not rushed towards digitizing medical records.  The market has been slow to embrace this concept for some very good reasons.  It’s easy for a numb-skull with an Ivy League education to think that by throwing money at the problem, it will somehow spur the economy, and create jobs, and fix all these problems we supposedly have.  And it may do just that in the short-term future.

It also might put doctors and hospitals out of business too, via litigation and long-term support costs.

But after eight years in office, Obama won’t have to actually worry about that.  He’ll be giving speeches for half-a-million a pop.

It sucks to be us, I guess.

But the most comical of the comments (if not the most infuriating) in the aforementioned article probably has to be the following:

The Obama transition operation declined a request to elaborate on Obama’s proposal. The president-elect said Thursday in a speech on the economy that the benefits of a modernized national health record system go beyond just cost savings.

“This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests,” said Obama. “It just won’t save billions of dollars and thousands of jobs — it will save lives by reducing the deadly but preventable medical errors that pervade our health care system,” he added.

Still, compared to the $2 trillion a year that the industry spends, the $100 billion experts say it may cost to implement Obama’s plan is a drop in the bucket.

“We must reduce waste to become more efficient” said Brailer.

This is coming from the representatives of the same government whose tax laws can be counted in bound volumes, provides redundant social services to fix the same problem, continually runs a deficit, and pays $500.00 for a $23.00 hammer.

Physician, heal thy self.

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