HEALTH CARE: Bureaucrats Gone Insane
Tom aka Rusty Rustbelt
HEALTH CARE: BUREAUCRATS GONE INSANE (topic update)
President Obama wants health care provider to invest in electronic medical records networked in electronic health records systems.
President Obama put funds in the the stimulus bill to subsidize providers’ large capital outlays.
President Obama wanted “meaningful” EHR utilization, and only providers meeting the “meaningful use” definition will receive subsidies.
Today the feds published the final “meaningful use” rules – all 864 pages.
Tomorrow I write a piece for a national audience telling most of them to forget the program, and wait-and-see what develops next.
This does not portend well for the rest of the health care program.
Tom aka Rusty Rustbelt
Rusty,
Insane is not the term that comes to mind here, unless it is insane to manage the health care industry.
Hope is not a plan and you cannot build anything IT without requirements and handshakes.
One industry bid received 9 July 2010 for the no mission, too soon, too unspecified Air Force Refueler replacement boondoogle was 8800 pages long, another over 8000. The specification for the tanker, is unbounded, and when you fill in the blanks it fills a few thumb drives. I don’t know how big the bid to sell the Russian Antonov airplane might be.
864 pages from inside the beltway is a primmer.
There have been very few disjointed attempts to bring “health” system into the IT age. They have not been very successful, any more successful than the same evolutions in banking and security exchanges.
There is technology and there is infrastructure.
A word of perspective, a users’ manual for a military system at 864 pages would be a very small simple node of that system. I have seen “node” manuals larger than that.
There is hope that a foundation be laid for IT in health, that the AMA or insurance companies are not going there reflects their market power to pass huge inefficiencies with good margins on to the taxpayer.
Gotta agree with islm. This trick of counting up pages of regulation and, when the page count gets to somewhere between “Goblet of Fire” and “Gone Wtih the Wind”, to declare that government has run amok, is getting pretty tired. Page counts don’t tell you much. Once regulation is institutionalized, page counts tell you almost nothing, because the reality of the regulation becomes routine – only change requires reference to the pages.
And the fact that some guy intends to advise his audience to do nothing does not, in itself, portend any particular way for any particular thing.
Substance?
864 pages may seem like a lot. I know nothing of this particular document, but very, very frequently such works have very large sections of industry standards, previous government regulations, standard – but lengthy – definitions lists and the like. Organizations and firms that may be interested in working in this field probably could take the document at 8 AM and hold a pretty useful review of what it all means later in the day, since Sally, Henry, Nalin, etc. all participated in industry groups where the requirements were developed/negotiated.
I should point out this is only Stage 1, two more stages to come.
This is not for the military or a large organization, the average physician group has five docs and a staff of 15, none of whom have any significant IT skills.
The geeks will love this stuff, the people who on the tip of the spear have no clue, no time and are already overworked.
My task for the rest of the summer is to write a 40 page +/- “how to make this work” paper.
Plenty of substance there.
Many of the groups in my audience will be merged into integrated provider groups (due to economic necessity) within three years so the wait and see strategy makes perfect sense for now.
If you want to ignore page counts thats fine, so ask this “do the people who have to make this work have the capabilities to make this work?” Right no, nowhere close.
There many reasons for failed IT deployments, the most certain predicter of failure is to go into a design with no standards. Standards are needed so that everyone can talk on the same sheet.
Standards come from policies which may include using common data dictionaries or using a common messaging language with standard formats.
These things are not stated in a few word or pages.
A lot of the standards are already codified for example in industry associations GEIA and SAE, but need to be translated for health.
The MEDICARE, VA and the DoD medical systems could be flag ships for health IT.
This is not bureaucracy. Standards are not made by bureaucrats.
A more optimisitic view by administration officials in the NEJM.
http://healthcarereform.nejm.org/?p=3732&query=home
I observe an awful lot of time in ICU’s spent on the workstation.
The “already overworked” are so because of IT deficiencies.
The geeks…………………….. are saving the world.
When I started being an ‘ilsm’ on military IT systems there were 80/80 column/punch card data bases. We evolved to relational DB, and then to object oriented, and this was before Al Gore started the www (tongue in cheek).
If implemented properly this thing will look like the way you go in to pay your credit card.
Or the way we teach young soldiers to operate a work station in a command and control node.
If we all are not geeks we will fade away.
Even the Doc needs to use the laptop!!
We are all geeks.
***This is not for the military or a large organization, the average physician group has five docs and a staff of 15, none of whom have any significant IT skills. ***
But surely, that Average Physician Group is going to buy a “packaged IT solution” (PIS) from someone. They aren’t going to develop their own. What they buy will largely determine what they do in practice.
Which doesn’t mean that the folks who produce the PIS are going to comply with — or even read — 864 pages of regulation if it isn’t 98% tabulated working data (e.g. long lists of drug names to be used and the synonyms in general use that will have to be translated). What they’ll most likely do, is scan the regulation, extract what seem the most salient points, and tweak their current product to try to comply with as much of the regulation as they can cope with.
I assume that in a saner world, the regulation would consist of six pages of regulation, definition of 8 or 12 standard forms and the associated data base files, and maybe 50-100 pages of appendices defining things like standardized nomenclature, medical procedure codes, etc.
My business email this morning is full of vendor emails, each promising an IT solution to solve every physician’s problems.
Physicians have 25+ years of sub-functional IT billing systems, so count me skeptical.
Unified command-and-control helps a lot.
We need to connect a couple of hundred thousand providers on some sort of conherent standard.
Y’all–I see Rusty’s point. There are still a lot of small medical providers out there. Solo shops or small group practices with computers that are used solely for billing invoices and some accounting functions. Gigs and gigs of memory these systems don’t have. Maybe only a two or three PC’s working off the same server in a simple LAN. Nothing big here at all and you have to look at the practicality of it all from the doctors’ standpoint. They have enough trouble making ends meet now in general practice or as internists. More money out the door they don’t want to spend.
If I were an affected provider, I wouldn’t do a thing until I had a lot more information. In a lot of systems changes SSA instituted during the 80’s and 90’s, the program changes never got made, were never completed, or have subsequently been abandoned. I’m not buying the idea this is all that great an idea anyhow. But, whenever big things were promised, I didn’t do anything until I absolutely had to. Which strategy saved me a lot of wasted time. Rusty has something to say we should hear. I’ll be interested to hear it. Nancy Ortiz
If bringing technology to medical data is going to be helpful, and if doing so means change for medical care providers, then the fact that medical care providers will have to change is good news. There is a tendency to look at what you know, see that some force is working to change it, and declare that change to be a bad thing. Experience suggests that older folk are more attached to what they already have than the young, though that is clearly not an iron rule.
Point being, the current structure of the medical care industry is not necessarily something we should want to preserve, nor is the fact that new regs will lead to change in that structure points against the regs. In fact, new regs are pretty much always aimed at affecting change. Doesn’t mean the change that is planned will necessarily bring benefits. It is that question – does this make things better? – that should drive the discussion. Change in the medical care industry is a given.
Oh, and, since the current structure of the US medical care industry is associated with high costs for mediocre results, we have a strong reason not to let the prospect of change deter us.
My dentist has an integrated IT system, and knowing that I’m an IT guy, they let me look at it while they are working on me and occasionally even make suggestions. (Ever try to explain to someone how to get an unwanted window out of the way while your mouth is full of hardware and your lips and gums are numb?). It actually seems to work quite well and they’re happy with it..
My doctor also has an integrated system, and he’s not so pleased. Slow response, confusing menus, all the usual stuff. The big plus. The support staff, pharmacists, etc can read his typing a hell of a lot better than they can his handwriting which is truly abominable. A lot fewer “Hey Doc, what does this say?” phone calls. The downside, way too much time spent dealing with user interface issues rather than medical issues. Haven’t talked to their billing people who may or may not be happy with it. But I will say that their bills look to be bills for what they actually did and to reflect payments properly — which is not always the case with physicians and hospitals.
The new Obama jobs program??!?? Might be.
Well, as I understand it the IRS still has multiple IT systems which cannot communicate with each other.
Why not sub this out to Google or Cisco and get some pros on this.
To be clear I think this ‘health care…’ from OBama and posse is a scam and a hype but as long as we are spending cash why not hire someone who knows how to do something, eh?
If any project should be open sourced, built by regualr folks, maintained by regualr folks, without 864 pages of BS, and politicians handing money to companies in their districts that will not use open standards – it is this one. It will get developed faster, and with more transparency.
The money for this should go to these efforts not hospitals or Doctor’s parctices, who probably have no idea where to start.
Ohhh look things like this are happening:
http://www.oemr.org/
Y’all–You can sub it out to any outfit you can name. It’ll only be funded for X amount of time and you have to bid out every new phase of the install and budget for it. And, you have to deal with any equipment issues the same way, and it’s all competitive procurement, and so on and so on. This is not a military buy where you can give it all to Haliburton and everyone just looks in the other direction. And, inevitably contractors will fail to perform. Or their contracts will run out and they’ll disappear taking their programmers etc with them. And, the whole thing has to be designed to allow limited access…..etc etc etc. But, cheer up. Lots of private contractors will get lots of money and hire lots of people and get absolutely nothing done. What can go wrong??? Nancy Ortiz
CoRev,
I can tell the “health” of Petraeus’ airplane but there is no standard way to tell the health of a human citizen.
There is immense opportunity to standardize medical record keeping, record forms, transaction tracking, information sharing/security and procedures baselines/application sort of like the things we loggies do with ERP’s.
Put it on the www makes it useful to the one nurse Doc in Montana.
If that is a jobs program then better that which will makes the consumption of health services more efficient than the war machine jobs programs which deliver only deficits plundering the productive base.
So do you have a link to this 864 page manual, or are you just blowing it out your ass without having read it?
A 900 page manual specifying IT standards does not seem excessive to me. Why do you think it is?