Stimulus Avoids Serious Solutions For Health IT 184
ivaldes3 writes in to note his post up on Linux Medical News, pointing out the severe shortcomings of the Health IT provisions of the just-passed stimulus bill. "The government has authorized enough money to purchase EMR freedom for the nation. Instead the government appears set to double down on proprietary lock-down. The government currently appears poised to purchase serfdom instead of freedom and performance for patients, practitioners and the nation. An intellectual and financial servitude to proprietary EMR companies for little or no gain. A truly bad bargain."
Criticisms and a Better plan (Score:5, Interesting)
I read the article.
The guy's central point is that corporate systems are bad, and open, federally funded systems are good, with the further implication that government is good, and corporations are bad.
Now, the reason, though, that he gives for this is that a private corporation owns his data in the present system, but if the government owned, then, somehow, he'd own it more.
That's the crazy thing. There's no such thing as "public ownership". You own as much of something that is public as you do a car by walking past a Ford factory. Ownership at its most practical is, who controls it, and you really don't have any control over the daily disposition of property managed by the government. In effect, when you argue for publicly owned health care, or publicly owned anything, what you are really arguing for is to pay your own taxes to buy something for some administrator either elected or appointed or a lifelong civil servant. In any case, its not you.
There's a lot of good reasons to adopt open source in health care. For one, the creation of a single standard document for representing a medical history would go a long way towards enabling applications across the medical spectrum to coexist.
This will be easier said than done.
A good example is that there were some efforts to do this in insuring property for catastrophic losses - a build is remarkably complex for insurance purposes, but that specification has essentially died by its own complexity. The industry largely and thankfully essentially resorted to using SQL Server copies of the leading vendor of property and casualty software for CAT. Is it proprietary? Yes. But, it allows all the insurers to exchange books in a way that is relatively practical and easy to use.
The moral here is that its not good enough to say that a standard is open for data interoperability. Ease of use and ease of transportability becomes paramount and if open source wants to drive health insurance, it stands to reason that there needs to be a pervasive application that goes along with it.
Re:Why Is Health Care even in the Stimulus (Score:2, Interesting)
Health care is big business. Moves(washes) lots of money. Government and big business always help each other. The insurance companies are the democrats' "Halliburton".
All seriousness aside, the truth is that health care is as much part of our infrastructure as the the lights and roads are. Perfectly within the government's interests to see that everybody has access. Handing it over to private interests has proven disastrous for everybody not involved the business. Most of all the patients. But, like everything else...
Not entirely true (Score:4, Interesting)
At least down here in Texas, any grant money funded through DSHS [state.tx.us] as well as HRSA [state.tx.us] at the federal level have specific sections that state that any system proposed that makes use of the VistA [va.gov] system will receive higher consideration to getting funded above any proprietary solution. Unfortunately the available solutions are still very high risk and many hospitals and other healthcare entities really don't like the look and feel when compared against proprietary browser-based systems.
Health care reform and payment is the real issue. (Score:2, Interesting)
Medical care, on the other hand, has an obfuscated price structure. Do you want to know how much something will cost? You can't find out. There's a price for the insurance company which is a trade secret [salon.com], a cost for cash paying customers, and another cost for government. What really pisses me off is that there's a price to pay in cash, assuming the doctor won't cut you a discount, is MORE than the insurance price! The insurer will take their sweet ass time to pay the doc (I've seen over a year!) and yet, if I pay NOW, it costs more! I tell you doctors are pretty stupid when it comes to business!
Do you know who the true customer is? The one who pays. That's right! The insurance company is the REAL customer! They're the ones that the docs answer to: not us. That's why health care is so over the top! And the other thing is keeping folks alive for another month or so. My wife had an 89 year old patient who had a heart valve replaced. The doc who did it said that the patient will be gone in a couple of months because he was too old to handle the surgery - at a cost of tens of thousands of dollars to the tax payer. Why are we spending so much money keeping people who should be dead alive for a couple of more months? I'm not suggesting a Soylent Green scenario, but we have to face the facts of life that we can't live forever. Sure the doc could be wrong and that old guy could live to 100, but the odds are, he'll be gone and our health care costs continue to spiral out of control. I'm sorry for being callous, but I have a real problem with spending thousands and thousands of dollars on people who should be dead: they're too old, they lived hard (smoked, drank, fucked everything in sight, etc...)
Nope, IT is not going to help anything. We, as a society really need to reevaluate our priorities and and how we pay for our care.
Re:Why Is Health Care even in the Stimulus (Score:3, Interesting)
On top of all the other crap that certainly won't really stimulat the economy.
In the short term, paying people to hop up and down on one foot would stimulate the economy - as long as the people were going to spend the money rather than stuff it in their mattress.
Here's the bottom line. The problem with the economic crisis today lies with the financial and banking system. Health care wasn't the reason for the collapse, and fixing health care isn't the core issue here.
Ah, but why do we care about the financial crisis at all? Because some CEO might not be able to afford to buy his second mistress a third vacation home? Not so much.
Rather, because ordinary people end up out of work and can't afford basic necessities like health care. Fixing health might not help people this time around (just like the GWOT didn't go back in time and prevent 9/11) but it might help next time around.
Its funny how liberals were complaining that invading Iraq had nothing to do the GWOT. This is the liberals version of 9/11, using the crisis as a pretext to remake the US economy and set their agenda.
The only reason that makes sense as to why Bush invaded Iraq is that he was doing a favor for his associates in the war, oil, and religion industries (plus his friends in Saudi Arabia).
On the other hand, I get the sense that Obama really does care about helping poor people. I may turn out to be wrong about Obama's motives and, even if I'm not, Obama's only guy (up against a sea of simple-minded people like yourself).
But, at the end of the day, I feel better about helping poor people than Bush's associates (plus, Obama's methods don't involve killing so many people).
Re:Opinionated much? (Score:5, Interesting)
I use the proprietary systems and had attempts at open systems (there are always "shoot outs" at the medical conferences) and I can say that the proprietary systems suck much less.
It's all about workflow. The open systems fail to understand this concept.
Re:Criticisms and a Better plan (Score:1, Interesting)
Now, the reason, though, that he gives for this is that a private corporation owns his data in the present system, but if the government owned, then, somehow, he'd own it more.
That's the crazy thing. There's no such thing as "public ownership".
I took my kid to a public park the other day. We showed up, played on the play structures for while and left.
Would that have been possible if the land had been owned by a private corporation? Sort of. It's possible the corporation would have set up some kind of pay-to-play situation. Some of the cost would probably go to maintaining the play structures but some of the cost would also go the owners (or management) of the corporation as "profits".
The essence of capitalism is that some people get paid for doing work and other people get paid for owning "capital" - that's right, some people get paid for doing nothing other than being rich. So, who gets paid for owning the land the park is on? If the land is owned privately, then whoever owns the land gets paid for doing nothing other than owning the land. If the land is owned publicly then no one really gets paid, per se, but people who use the park don't have to pay some rich person for doing nothing other than owing the land.
In effect, when you argue for publicly owned health care, or publicly owned anything, what you are really arguing for is to pay your own taxes to buy something for some administrator either elected or appointed or a lifelong civil servant.
That depends on whether you think government officials can be compelled to act in the public interest.
The recent business with Bush invading Iraq for the benefit of his friends in the oil (and war) industries does suggest that there is a strong tendency for government leaders to spend tax dollars for their own benefit.
On the other hand, getting back to the public park example, the land the park was on was very clearly not being used exclusively for the benefit of a government official (for example, as a private residence).
Bottom line. It's not quite as black and white as you claim.
Open Source medical software in Canada (Score:3, Interesting)
I recently got delayed in an airport, and sat next to a Canadian doctor.
The discussion led to what I work with and hence Open Source. He said that doctors in Canada use open source software. So I looked it up and found OSCAR [oscarcanada.org] which is indeed open source.
No proprietary lock-in for formats, no vendor lock in, and minimal costs.
Re:Healthcare is full of closed apps (Score:2, Interesting)
You are right on the money that there is currently no demand for an open EMR spec. If customers were asking for it, believe me they would get it, but that's honestly the last thing on their minds. They want more features to reduce the amount of resources (people, time, materials) that they need, thereby saving them money.
Not to mention the fact that forcing all EMR software companies to support a completely new spec in addition to their existing one would cost these companies a lot of money. That's time that could be spent improving the functionality of the existing software.
Meanwhile, WalMart plans to sell MS-based EMR (Score:1, Interesting)
I thought TFA was a bit rabid, like a lot of you.
Then I saw this NYTimes article [nytimes.com] about how WalMart will be feeding at the stimulus trough by selling a Microsoft-based EMR system.
That's both scary and ironic. The ironic part is how WalMart will continue to not provide health insurance coverage for the poor minions it pays minimum wage to install this stuff.
Re:Criticisms and a Better plan (Score:3, Interesting)