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Medicine Politics

Stimulus Avoids Serious Solutions For Health IT 184

Posted by kdawson
from the add-just-one-sentence dept.
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."
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Stimulus Avoids Serious Solutions For Health IT

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  • Opinionated much? (Score:4, Insightful)

    by religious freak (1005821) on Tuesday March 10, 2009 @05:34PM (#27141291)
    A little too opinionated in TFS. What news is this post actually trying to tell us?
    • by Nethead (1563) <joe@nethead.com> on Tuesday March 10, 2009 @05:39PM (#27141359) Homepage Journal

      What news is this post actually trying to tell us?

      They didn't get the money sent to them so they are calling the others bad names and getting all pissy about it.

    • by sleigher (961421)
      I think what they are trying to say is that United States Health Information Technology is exactly that. United S.H.I.T.

      Maybe that depends on who you ask. I am sure many companies will love this.
      • Re:Opinionated much? (Score:5, Interesting)

        by glueball (232492) on Tuesday March 10, 2009 @06:17PM (#27141931)

        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.

        • by conureman (748753) on Tuesday March 10, 2009 @07:29PM (#27142803)

          With some extra cash, maybe the proprietary system vendors could widen that gap. Or at least hire some lobbyists to explain why they'll need more money next year. Failure seems to be our new economic engine.

          • I see the humour in your post but who says these campanies are failing? Just because car makers are getting a free ride so that auto-workers do not become angry pennyless voters doesn't mean that government infrastructure investment falls into the "rewarding failure" category.
            • Spasmodic cynicism. I'm sure none of the IT providers benefitting from this are having any trouble at all. And I doubt this will buy us a standardised, open, or interoperable system. I reckon we should just be glad they hustled this through so fast only a scant 8 billion extra went to buy local votes. The failure of which I speak is the overall system inefficiency, which seems to be designed around cash-extraction rather than service. I, for one, would like to move away from systems that have already demons

              • I'm not from the US but I understand what the US euphemisticaly calls a health "system" is farked. Your sig seems to describe the overall situation very succinctly.
        • by rtb61 (674572)

          Let's just think about that. A patient EHR electronic health record system, so no one is capable of creating a open free system with 17 billion dollars. The government is not capable of putting to tender the creation of an open source system where the vendor or vendors have to surrender copyright as part of a lump sum payment for that system. So instead they are committing to a closed source, data locked up, per seat, perpetual licence fee upgrade cost.

          All with no public review of patient confidentiality

    • by tverbeek (457094) on Tuesday March 10, 2009 @06:23PM (#27142021) Homepage
      This article is a poorly written, useless rant. It contains little information about what pisses the writer off, and even less about what should be done instead. I'd love to read a thoughtful, informative article about the subject, since I've recently started an IT job in the health care field, but this isn't it. Any suggestions?
      • Re:Opinionated much? (Score:4, Informative)

        by Anonymous Coward on Tuesday March 10, 2009 @06:33PM (#27142161)

        He has the same rant about proprietary applications without interchangeable data formats in the medical field that people have with MS Office. Health Systems are just as bad if not worse than the other closed proprietary systems that people here constantly rail about. It's very likely that you'll have to buy a special program to read the medical information that you get from your doctor. It's a closed silo system that won't get any better based on the new funding.

      • by Ironica (124657)

        If you find one, send me the link, too. We're using OpenMRS as a cross-agency TB registry, but it's sooooo not a full-featured EMR compared to the proprietary solutions. The stuff that our agency is willing to look at isn't even web-based, so you're locked into Windows (or maybe emulation; no idea if that works) for your desktop machines too. One of the systems runs only on Windows servers with MSSQL. Gack.

  • by Anonymous Coward on Tuesday March 10, 2009 @05:38PM (#27141345)

    On top of all the other crap that certainly won't really stimulat the economy.

    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.

    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.

    • This is the liberals version of 9/11, using the crisis as a pretext to remake the US economy and set their agenda.

      It's tempting to think that, but the truth is McCain would've done pretty much the same thing. Except he would have cried more.
      • Re: (Score:3, Insightful)

        by ravenshrike (808508)
        Of course, McCain also joined in McCain-Feingold, so clearly he's not a conservative barometer.
        • Of course, McCain also joined in McCain-Feingold, so clearly he's not a conservative barometer.

          As I recall McCain helped with that in 2002, before opposing it while running for president in 2008. So a more accurate statement might be:

          McCain joined in McCain-Feingold in 2002, before making himself a conservative barometer and opposing it in 2008

          • by sumdumass (711423)

            Perhpas McCain doesn't support it because some of the provisions were struck down in court as unconstitutional and it's ineffective and doesn't make sense now. Then he not even pretending to be a conservative barometer. BTW, that is what Palin was supposed to have been.

    • Re: (Score:2, Interesting)

      by iminplaya (723125)

      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 everyth

      • It was never "handed over to private interests" in the US, because it was always in private hands and hasn't been forcibly taken away. Yet. Partially.

        There's no legal authority for the US federal government to be providing, funding, or controlling medical care, so any debate about expanding its role ought to focus on whether to amend the Constitution to allow it.
    • Re: (Score:3, Interesting)

      by Anonymous Coward

      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

    • by cgenman (325138) on Tuesday March 10, 2009 @07:24PM (#27142731) Homepage

      Our economy is broken in more ways than just the financial system. Our Car companies have been mismanaged for years, our healthcare system is derided worldwide for being incredibly expensive and backwater, our education system is a joke.

      What we need to get out of any economic downturn is higher per-capita productivity. Health Care has been a big drain on our economy for years, and a distributed automated health records system is long overdue. My Mechanic has better records of the work done on my car than My Doctor. I've seen doctors prescribe to my grandmother treatments that had serious interactions with drugs she was already taking, and treatments that she was simply allergic to.

      We need growth and efficiencies, and this is one area where a little expenditure would save a lot of lives. And I hate to sound this crass, but saving lives cheaply is good for the economy.

      • by MBGMorden (803437)

        our healthcare system is derided worldwide for being incredibly expensive and backwater

        Not really. Our healthcare IS expensive, and that's annoying mostly to people who live here, but the QUALITY of US healthcare is pretty much the best in the world. Certainly not "backwater" at all. You pay through your nose for that quality (and many of the ricer people of the world will visit the US just for healthcare - ironically some of our poorer people are starting to visit places like India though simply due to the cost), but it IS quality.

        Whether or not that's viable long term, or best for the pe

    • by DragonWriter (970822) on Tuesday March 10, 2009 @07:31PM (#27142829)

      The problem with the economic crisis today lies with the financial and banking system.

      No, the problem lies with the lack of availability of credit and the lack of consumer demand. The primary direct cause of that may have been actions in and affecting the financial services industry including the banks, but that doesn't mean that the most effective way of dealing with it is exclusively with policies directed at that industry, in the same way that bad diet and inadequate exercise may be the principal cause of a heart attack, but the best response to a heart attack may not be limited to diet and exercise changes.

      Its funny how liberals were complaining that invading Iraq had nothing to do the GWOT.

      Liberals, in fact, were not generally complaining about that. Liberals were complaining that Iraq (not "invading Iraq") had nothing to do with 9/11 (not "the war on terror") and that invading Iraq was directly counterproductive in (not "had nothing to do with") the war against the people who had actually attacked the United States on 9/11, and that contributed to producing more people who would be more easily recruitable by groups wanting to attack the United States through terrorism.

      The first half relates to the justification, the second to utility. Confusing different parts of two distinct-though-related criticisms of the invasion of Iraq misses the point of both criticisms rather completely.

      This is the liberals version of 9/11, using the crisis as a pretext to remake the US economy and set their agenda.

      That doesn't make sense. The economy is broken. Liberals are proposing a particular way of fixing it that, they argue, apply both to the immediate problem and the longer-term structural problems that make problems like the immediate one both more likely to occur and more damaging to individual citizens when they occur. As you note, what they are doing is directed at the economy, which is where you admit the problem is, not at some unrelated thing. Now, you might argue that the proposals are not directed well to fix the problems in the economy, which would be a legitimate point to debate, but you fail to make that argument, instead making an argument by analogy (though, as noted, a poorly-crafted analogy that reveals poor understanding both of the immediate situation and the one to which an analogy is drawn) that seems to rely on the idea that it is not directed at principal immediate cause of the problem, rather than arguing that it is ineffective at solving the problem. But being effective at addressing a set of undesirable conditions is logically orthogonal to being directed at the events and conditions which contributed to the development of those conditions.

    • What nitwit modded that comment insightful?

      And now, the top two reasons why healthcare spending is economic stimulus...

      drumroll

      • A healthy population is more productive than a sick population
      • Economic resources wasted on inefficiencies in the health system hurt the economy. That waste is not economically productive.

      cymbal splash

      • by Ironica (124657)

        What nitwit modded that comment insightful?

        And now, the top two reasons why healthcare spending is economic stimulus...

        Both true, and very valid.

        But there's also the way in which *most* spending is economic stimulus. Yesterday, our organization (a non-profit healthcare provider with Section 330 funding, so we're a Federally Qualified Health Center (FQHC)) learned that we'll be eligible to apply for a skosh over $400k in ARRA funding in the next couple of weeks. These funds are to be disbursed in two payments, the first of them by the end of the month. This is LIGHTNING speed for government funding; the typical RFP comes

  • by tjstork (137384) <todd@bandrowsky.gmail@com> on Tuesday March 10, 2009 @05:40PM (#27141389) Homepage Journal

    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.

    • by Nethead (1563) <joe@nethead.com> on Tuesday March 10, 2009 @05:49PM (#27141537) Homepage Journal

      I think it was Heinlein that said something like: You only truly own that which you can carry in both arms at a dead run.

    • by be0wulfe (252432) on Tuesday March 10, 2009 @06:17PM (#27141933)

      You're only half right. The problem is that HIT vendors are generally well behind the times, slow to innovate and closed and proprietary as all get out. You think MS is bad? You haven't seen highyway robbery until you've seen the shit in a box most HIT vendors push. The technical implementation is lacking and the SOLE focus, the SOLE focus of every sale is simply to further ensare the particular customer still deeper into more from the same proprietary stack. Integration is a joke, made challenging by intention rather than accident.

      This is a HIGHLY lucrative market. Any given vendor has ZERO interest in open systems and will push to make sure you buy their entire stack.

      Thankfully, there are exceptions to the rule and there are many CIOs and CEOs that are wising up to their antics.

      This stimulus plan, unfortunately, only makes things WORSE backing proprietary vendors and closed systems over open standards - real standards, not the recommendations AKA HL7.

      • by jerdenn (86993)

        You're only half right. The problem is that HIT vendors are generally well behind the times, slow to innovate and closed and proprietary as all get out. You think MS is bad? You haven't seen highyway robbery until you've seen the shit in a box most HIT vendors push.

        While there is certainly long history behind this statement (and some truth), it's not so black and white. Innovation works great when you are landing new client deals - flashy and shiny sells.

        However, many clinicians (and dare I say physicians in particular) while normally highly intelligent, are actually very "challenged" users of technology. Changes that are straightforward in the business world are a complete no-go in HIT. Many large healthcare entities will actually draw into contractual language th

      • You forgot the BEST part.

        YES, Your LIFE does depend on it !!

        Millions of lives depend the crap software(as you say) that is being pushed. They are far too many articles describing the multitudes of failures with EMR, and hospital software. Yet the majority of dumbasses really believe this will work. Try this at home. Try to get a copy of your credit report. Is it wrong...super. Now try to FIX it!. Think a credit report applies only to getting a loan? Think again, try to get a new job.

        Now think of the

        • by Ironica (124657)

          And yet, EMRs also *save* lives, by reducing medical errors.

          As with nearly all technology implementations, there are multiple dimensions in which things change. When examining security issues with EMRs, people get frightened about the fact that if someone just broke into the system at ONE point, they could get access to EVERYONE's records... which is true. However, that's no different from now, where someone could slip into the chart room (which is usually locked, but doors have to open sometime) and have

    • by tverbeek (457094)
      When it comes to what's done by the government, I have only one vote. But that's one more vote than I have when it comes to what's done by private businesses, and it guarantees me a right to participate in the process.
    • by jeko (179919) on Tuesday March 10, 2009 @06:33PM (#27142159)

      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 visited Washington DC a while back. I stood on the Mall. I stood on the Lincoln Memorial. I own a piece of it. So do you. I ran my fingers down the names on the black Wall, and I knew that my family had bought a piece of it at the cost of blood. I looked up at the top of that giant obelisk and knew that Washington had given me a piece of it. I walked through Arlington. I for damn sure own a piece of that.

      Yes, if the government owns it, you absolutely own it more. You own it more because there's a huge difference between being a citizen and being a customer. I own it more because generations of my kin have stood in uniform and fought and bled for it.

      If there's truly no such thing as "public ownership," then why is my family pulling on uniforms and strapping on guns to fight for it?

      • by HornWumpus (783565) on Tuesday March 10, 2009 @06:45PM (#27142305)

        You don't own any of it.

        If you own something then you can sell it.

        Try and sell 'your share' of the Washington memorial.

        You family protected the nation. The nation government used to mind its own business (courts, national defense, some infrastructure...nothing else) and mostly leave us alone.

        You can say you have a stake in the commons, but that is nothing like ownership.

        With businesses you can choose which company you deal with. Government pretty much always grants itself a monopoly.

        • by vyrus128 (747164) <gwillen@nerdnet.org> on Wednesday March 11, 2009 @12:23AM (#27145807) Homepage

          If you own something then you can sell it.

          This right here, ladies and gentlemen. This is the cancer that's killing /b/^H^H^H America.

        • by perrin (891)

          "If you own something then you can sell it."

          There are lots of things you can own, but not sell. Some things you can only sell under certain very limited circumstances, other things not at all. There is an infinite variety of property arrangements, and trying to define property to be just one, simple (ideologically loaded I guess) concept is meaningless. Try reading a book about the philosophy of law and property one day. You might learn something.

      • I visited Washington DC a while back. I stood on the Mall. I stood on the Lincoln Memorial. I own a piece of it.

        Do you? Really? Can you sell your piece of it, or give it away? Can you take your piece somewhere else, or destroy it if you feel like it? If not, you sure have a funny definition of "own".

    • 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 is exactly right, and a bit wrong. We don't need open SOURCE code, we need STANDARDS and DATA STRUCTURES. I don't care if GE writes the database and front end using FORTRAN or Visual Basic. But we do need commonality in the record so that the GE system can ta

      • by falsified (638041)
        You mean HL7?
        • by imamac (1083405)
          That's great for a data/transmission standard, but another big problem is proprietary databases. Every application has it's own "under-the-hood" storage structure. Imagine if there was a standardized database structure, don't you think that would go a long way towards better interoperability and communication?
          • by jerdenn (86993)

            That's great for a data/transmission standard, but another big problem is proprietary databases. Every application has it's own "under-the-hood" storage structure. Imagine if there was a standardized database structure, don't you think that would go a long way towards better interoperability and communication?

            No, I don't think a common data storage schema would promote better interoperability. I think a correct data exchange standard will promote this, and vendors will implement data storage and business logic independently.

            The problem is that HL7 v 2.x is too "loose" of a standard. It's not particularly descriptive, and both vendors and healthcare organizations have had to stretch the HL7 protocol in order to make it useful.

            HL7 3.0 and the RIM have gone a long way towards fixing many of the problems with 2.x. However, 3.0 is not ratified, and there is not straightforward mapping between 2.x and 3.0. This makes it a challenge for vendors and healthcare organizations to leverage 3.0.

            HIT is a conservative, slow moving vertical. We'll see gradual movement towards better interop on the wire, and we'll go from there. The RDBMS (or, in some cases OODBMS) is not the place to tackle this issue.

            -jd

      • by ninjagin (631183)
        The BPEL standard languished, there have been a host of other standards that have languished... firewire, USB,XML? It's too long a time to spend on arguing over common ground at the structure level, I think.

        I heard the idea of a seperate internet proposed, especially for healthcare traffic, optimized for images and wild DB queries for genes and records and disease information content and pharmacy data... a whole new cloud.

        Fantasy? Maybe, but I think bigger companies have a better sense of what's working

    • by Asic Eng (193332)
      I think a stimulus bill should be an investment bill. Initially there is extra spending which causes economic activity of some kind, and that helps in the short-term. However the spending needs to be directed, so that long-term public costs are reduced. If that doesn't happen your debt may get out of control. One way of investing in that way, could be to pay for software to be written so you own it, rather than owning a license to use it.

      If you buy e.g. an installation of MS Office, then you own merely th

      • by Ironica (124657)

        Similar for medical software - you could direct the spending so that you'll get extra features in the short-term and keep paying for them in the long-term. Alternatively you could pay to have it created under GPL license, and in the future you could always get competing bids when it comes to add features to the software, and you could add additional installations without further licensing costs.

        Exactly. For our non-profit organization, which operates six clinics and two mobile units, EMR/PM bids are coming in at half a million for the first year and $200k and up each year after. The costs scale with our size, too; if we start seeing more patients or hire more doctors, we pay more for our EMR. This means we can't even *think* about switching to electronic records until we've secured funding for at least a few years, while we build that into the budget and our indirect cost agreements.

        If instead,

        • Re: (Score:3, Interesting)

          by bittmann (118697)
          I feel your pain. We are a closely-held corporation (it's for-profit, but the docs own the place so they set the priorities), and we're now looking at commercial EMR software costs in the neighborhood of $12,000/physician to license a system, $2400/physician annual maintenance, plus all of the necessary hardware, etc. The hardware cost is a gimme (obviously), as is the implementation effort, but paying a couple million for software plus 400k/year maintenance stings a bit. Especially when you consider tha
    • by jerdenn (86993)

      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 document type does exist. Please review the emerging HL7 v3 documentation. Pay particular attention to CDA/CCD.

      The bottom line is that once there is convergence around interoperability, which proprietary EMR solution a Healthcare Organization utilizes matter much less less. Prior to CCHIT and changes in STARK, vendors had little incentive to develop interoperable solutions - vendor lock-in is part of the HIT business model.

      For once, the government is actually driving positive change into an industry

      • Have you ever seen a medical record from one vendor successfully brought into to another vendor's EHR? I'd like to believe that it's really being done at this point in time, but I've never actually seen this behavior in the wild....
        • by jerdenn (86993)

          I've seen PHR to EMR interoperability, but very little EMR to EMR. The Social Security Administration is also doing an enormous amount of work to leverage the NHIN to pass CDA content for disability eligibility, but that's a payor/eligibility type relationship, kinda sorta.

          RHIOs were supposed to be the "grass roots" mechanism to get this going, but while there have been some marginally successful RHIOs, most of them are funded by grant money. Without a mechanism to monetize this data exchange, there's lit

    • by tyrr (306852)

      The problem with your response is that you have no knowledge of the economic and legal concept called public goods [wikipedia.org]. Look it up. Public ownership and public property in fact exists in order to provide benefits that are non-rivaled and non-excludable.

      Health services should be just that non-rivaled and non-excludable. If you turn health care, or heath insurance for that matter, into a profit-seeking growth industry you get just what you have in the United States - expensive and tremendously inefficient system

  • The people building health information sharing networks have taken this into consideration and have designed "translators" for all the health record formats.

    I'm peripherally attached to the team working on the first state-wide health information network (in Maryland), so I can tell you a lot of these problems have already been solved long ago

    • Re: (Score:3, Insightful)

      by DamnStupidElf (649844)

      Quick, what's the proper race code to send in PID-10? What about PID-17 (that was a fun one to standardize)? Not to mention the mess with PID-18, PID-2 and PID-3 across disparate systems, and every mind-boggling combination of ways that different systems treat persons, encounters, orders, results, reports, and images.

      Basically, the government will have to throw out or severely limit the use of most medical software, and enforce its replacement with something standard if they want to make health informatio

      • by VP (32928)

        PID-2 has been deprecated for ages.

        • by Qzukk (229616)

          So in other words, it's required in every system older than 5 years, and an error in any system newer?

      • Basically, the government will have to throw out or severely limit the use of most medical software, and enforce its replacement with something standard if they want to make health information electronically available to any provider.

        Which is what the government has done (more than once) with existing billing software, by specifying (and then updating) standards for electronic health care claims and related transactions under the HIPAA Transactions and Code Sets rule. (These standards aren't open, but they

    • wouldn't the government then do better to define a "Lingua Franca" for all medical records. ie, one central standard to which all insurance companies' individual crap should be translatable by, say 2011. And mandate that the insurance companies must handle the translation themselves.
      • by Ironica (124657)

        ie, one central standard to which all insurance companies' individual crap should be translatable by, say 2011.

        And mandate that the insurance companies must handle the translation themselves.

        Why do people keep talking about insurance companies? Their stuff has been computerized forever. TFA and most of the discussion is about medical records in the clinic or hospital setting.

        It has to do with insurance only peripherally, in that one of the driving forces behind digitization of medical records is to ease the billing process through better coding of medical procedures and reducing after-the-fact data entry, but being able to do billing from your system in an integrated fashion is a standard fea

  • ... I thought for a second that Slashdot had again updated its interface. Then I realized that this is a random internet rant. Really, not much different from a NYT or WSJ rant, but those at least pretend to have outside expert sources.

    Yes, I would like Medical institutions to use GPL'ed software. Yes, I'm disappointed that the government still doesn't think that software freedom and dumb pipes are the keys to a networked future. But am I surprised? No, not really.

    • I really don't care who makes/manages the software, as long as the file format, and method's of talking to it are standardized, public, and open.

  • by joeflies (529536) on Tuesday March 10, 2009 @05:43PM (#27141437)

    Healthcare is dominated by application vendors who each make their own megaplatform for healthcare records. Cerner, Meditech, Siemens, et al. are all trying to keep as much of their system closed as possible, and aren't particularly interested in opening it up to third party systems. They don't particularly want open interfaces, their goal is to keep their customer locked in as much as possible.

    So the healthcare IT companies get what they want, i.e. a bigger push for electronic records, selling the software they already have.

    The stimulas package isn't going to add an open spec for EMR because nobody in the healthcare industry is bringing it up that they want one.

    • Re: (Score:2, Interesting)

      I work for an EMR company and we have been working towards giving customers more freedom of choice, at the customer's request. For example, previously the customer had to purchase software AND hardware from us, now they can purchase the software standalone and bring their own hardware to use. Also, a lot of medical information is available for transfer or synchronization from one system to the next using HL7 interfaces. You can use a third party system to schedule exams and use our system to perform the
    • by Yvanhoe (564877)
      The government does not need to pay money for this. It just need to mandate openess (of standards, for a start). It will save money in the long run.
    • by bittmann (118697)

      Healthcare is dominated by application vendors who each make their own megaplatform for healthcare records. Cerner, Meditech, Siemens, et al. are all trying to keep as much of their system closed as possible, and aren't particularly interested in opening it up to third party systems. They don't particularly want open interfaces, their goal is to keep their customer locked in as much as possible.

      So the healthcare IT companies get what they want, i.e. a bigger push for electronic records, selling the softwa

  • by damn_registrars (1103043) * <damn.registrars@gmail.com> on Tuesday March 10, 2009 @05:47PM (#27141505) Homepage Journal
    The National Institutes of Health [nih.gov] just announced the NIH Challenge Grants [nih.gov] that is used for doling out stimulus money to small projects. In it they identified several high-priority topics [nih.gov], which if you look through, you will find includes Information Technology for Processing Health Care Data [nih.gov].

    So there certainly is money available for this type of work. And for those not familiar with grant funding by the US government, the NIH is the single largest grant provider for the life science in the US.
  • Not entirely true (Score:4, Interesting)

    by Dishwasha (125561) on Tuesday March 10, 2009 @05:57PM (#27141657)

    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.

  • Unemployment would quadruple overnight if 90% of the "Medical" staff at a hospital were no longer needed to do paperwork for the insurance companies.

    Hell no, make more paperwork not less, the country needs jobs.

    • :)

      I know you're only half serious. But in the short term, the number of people employed by the changeover to the new records systems is going to dramatically outweigh the number of people that the new systems make unnecessary. It's only once the systems start coming online that the carnage begins.

  • He brought up some interesting points. But the real problem with health care in this country has to do with the payment system. Here's an example on how to do it well: I don't know about your dentist, but mine informs me about costs upfront. I know how much something will cost and I can make the decision, based on his or another dentist's advice, on what to do and how to spend my money - which includes what my dental insurance eventually pays because I am the one paying the premiums after all and I am the o
    • by MBGMorden (803437)

      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!

      While I have no idea if the practice is universal, my mother works as an insurance coder for a doctor's office and I know for a fact that in all the practices she's ever worked in (3 over the last 15 years), the exact opposite of this has been true. If you have insurance, they'll bill at a higher rate because they know that the insurance will pay up (and sometimes they'll even bill the insurance company for what they can get and so long as they get back a reasonable amount they drop the remaining unpaid po

  • It sounds like you're being ignored because you're coming off as bombastic and shrill.

    I have no doubt that you feel passionately about patient care, open source software, open standards, EMR and the range of other issues that come into play, but I also get the sense that you're unlikely to change your position or find a middle path, given that large healthcare companies already occupy a lot of the thought-space. As I listen to you, I get the sense that you see the pool as having already been peed in, and ma

  • by Ironica (124657) <[pixel] [at] [boondock.org]> on Tuesday March 10, 2009 @07:25PM (#27142767) Journal

    Page 488 of the ARRA [loc.gov]:

    (b) STUDY AND REPORT ON AVAILABILITY OF OPEN SOURCE HEALTH INFORMATION TECHNOLOGY SYSTEMS.
    (1) STUDY.
    (A) IN GENERAL. - The Secretary of Health and Human Services shall, in consultation with the Under Secretary for Health of the Veterans Health Administration, the Director of the Indian Health Service, the Secretary of Defense, the Director of the Agency for Healthcare Research and Quality, the Administrator of the Health Resources and Services Administration, and the Chairman of the Federal Communications Commission, conduct a study on -
    (i) the current availability of open source health information technology systems to Federal safety net providers (including small, rural providers);
    (ii) the total cost of ownership of such systems in comparison to the cost of proprietary commercial products available;
    (iii) the ability of such systems to respond to the needs of, and be applied to, various populations (including children and disabled individuals); and
    (iv) the capacity of such systems to facilitate interoperability.
    (B) CONSIDERATIONS. - In conducting the study under subparagraph (A), the Secretary of Health and Human Services shall take into account the circumstances of smaller health care providers, health care providers located in rural or other medically underserved areas, and safety net providers that deliver a significant level of health care to uninsured individuals, Medicaid beneficiaries, SCHIP beneficiaries, and other vulnerable individuals.
    (2) REPORT. - Not later than October 1, 2010, the Secretary of Health and Human Services shall submit to Congress a report on the findings and the conclusions of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.

    I'm planning on using this to justify why we're applying for ARHQ research funding for implementation of a non-CCHIT certified product... we're just trying to help them research open source options. ;-)

  • This article is not in any dialect of english that I know of. Can anyone out there translate this for us?

  • by kbahey (102895) on Tuesday March 10, 2009 @08:49PM (#27143725) Homepage

    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.

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