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."
Opinionated much? (Score:4, Insightful)
Re:Opinionated much? (Score:4, Insightful)
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.
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Maybe that depends on who you ask. I am sure many companies will love this.
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:Opinionated much? (Score:5, Funny)
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.
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Re:Rewarding Failure (Score:2)
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
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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
Re:Opinionated much? (Score:5, Insightful)
Re:Opinionated much? (Score:4, Informative)
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.
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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.
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Wow. To put all that effort into coding your own solution but to choose that platform... ugh.
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I mean, the whole fiasco of a spending bill was ram-rodded through congress, no one really read it....etc.
YOu have to guess nothing in it was well thought out...and it is a shame, especially with items concerning a very important topic, our private health records.
Why Is Health Care even in the Stimulus (Score:3, Insightful)
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.
Re:Why Is Health Care even in the Stimulus (Score:5, Insightful)
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.
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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
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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.
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They would've gained more ground by propping up Buckley's corpse.
They've done frighteningly well with puppet presidents in recent memory (Reagan, Bush II, in particular). One would have expected that after turning John Sidney McCain III into a marionette that they would have done quite well there as well. Really, what could have possibly gone wrong with that iron-clad plan?
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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
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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:Why Is Health Care even in the Stimulus (Score:4, Insightful)
This also goes to show that Republicans aren't really the party of small business.
Neither party is the party of small business. They're the party of the party, for the party, by the party.
It's not a democrats versus republican thing, it's an US versus Politicians thing.
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It's people. Politicans are PEEEEOPPPLEEEE!!! They're using people to make decisions. Next thing you know they'll create a democracy and make us vote!
Republicans always talk up the small business. (Score:3, Insightful)
See: Joe the Plumber. Republicans often campaign on small business issues.
Democrats? Not so much.
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Not taking away his choice of health care...
I've never once seen anyone suggest we should take away health care choices... just that we should better fund health care, so that those who have no choices now actually can get some.
I have trouble believing you could prohibit the system of private health care that currently exists. However, if we devise some sort of national insurance program, and the government therefore stops compelling employers to provide benefits to their employees, people will have the choice of the government plan or paying out of
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Small businesses who become members of the chamber of commerce or other quasi politico enti
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My health insurance (family, employer pays half of my premium) through blue cross blue shield is closer to $3,800/month. Single person is well over $1000. So yeah, your figures are wildly out of date. But yes I realize there are ways for a small business to pay fees in order to pool their resources to get better rates. You can call it the chamber of commerce, but you're still describing an ad hoc form of government.
I do acknowledge where this money is coming from. Higher taxes. Our taxes are ridiculously lo
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That's the dumbest idea ever besides using hydrogen in the Hindenburg. I own a small business, nationalising healthcare would do nothing but raise our taxes for ALL, thats bad.
Um.
Children dying from asthma attacks is bad, too.
As a small business owner, national health care would free you from any expectation of providing health benefits to your employees. You may not have employees, but you probably hope to be that big someday if you don't. You may currently use some sort of workaround (such as hiring people "on contract" or "part time") to avoid providing benefits, but that makes your listing less competitive, so you have to pay higher salaries. Also, if we had a government i
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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
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Would you like to lay out your alternative theory in detail?
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Obama likes power.
He knows which side his bread is buttered on and will serve his masters (none are poor) in order to be re-elected.
Same as all politicians.
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Re:Why Is Health Care even in the Stimulus (Score:4, Insightful)
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.
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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
Re:Why Is Health Care even in the Stimulus (Score:5, Insightful)
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.
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.
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.
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What nitwit modded that comment insightful?
And now, the top two reasons why healthcare spending is economic stimulus...
drumroll
cymbal splash
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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
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:Criticisms and a Better plan (Score:5, Insightful)
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.
Re:Criticisms and a Better plan (Score:4, Insightful)
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.
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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
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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
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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
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Thomas Jefferson disagrees with you (Score:5, Insightful)
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?
Re:Thomas Jefferson disagrees with you (Score:5, Insightful)
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.
Re:Thomas Jefferson disagrees with you (Score:4, Insightful)
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.
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"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.
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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".
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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
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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
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Meh. That's why people should just go enterprise. =)
"Just going enterprise" doesn't cut it. Sure, you can buy your PM and EMR from the same vendor, and in most cases, that's your best option (even though the PM from one vendor and the EMR from another may meet your needs better, neither company is going to play very nicely, so you'll end up wasting the increased efficiency in mediating the tussle over your data). But your pharmacy is going to be using a different system, and the hospital you have privileges at will be on another system, and your labs have
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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
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If you buy e.g. an installation of MS Office, then you own merely th
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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,
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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
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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
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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
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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.
I stopped at McDonalds with my niece a couple weeks ago... if you haven't heard of them, they're a huge multi-national corporation (and I happen to own no stock in them, so I have no ownership claim). Get this, they had a play area complete with slides, video games, etc and I didn't have to pay a thing for my neice to use it. There wasn't even an evil overlord there demanding that I buy some food to use it.
Private ownership doesn't mean you have to pay some evil capitalist to use their property. Some of
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Under the current state of things, I have the freedom to decide what type of coverage I want, who my doctor will be, etc. Under a government run system, there is a monopoly and that freedom is
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My understanding was that the play areas at fast food restaurants were only for paying customers: if you didn't buy food, technically you were trespassing on private property. But maybe I'm misinformed; do you have a link to the McDonalds website where they indicate that their play areas are available to the general public (who don't buy food)?
We had breakfast, so I did pay... but there wasn't anyone there demanding to see proof of payment to use them. In fact, in the hour that she spent playing on there, no staff came in to check to see if anyone had bought anything. In fact, there were people in there that didn't buy anything.
In McDonald's case, at least this one, the policy is to generate good will and hope that good will translates into increased sales... kinda like advertising, though without going out of their way to annoy you. Other big
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You do realize that in certain (urban) areas, the vast majority of people can't afford houses with yards? Are you seriously proposing a society where the only places children have to play are (sneaking into) McDonald's play areas?
The premise of your original post was that only the government can provide "free" parks. I pointed out that there are privately owned parks which are also free, and that you're forced to pay for those "free" government parks whether or not you want them and regardless if you intend to use them.
The key difference is, we're all forced to pay for your park. Nobody is forced to pay for the park run by the generosity of another individiual. That's something the big government types like you don't grasp unless
Not as big of a deal as you might think (Score:2)
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
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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
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PID-2 has been deprecated for ages.
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So in other words, it's required in every system older than 5 years, and an error in any system newer?
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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
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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
While reading the blogpost... (Score:2)
... 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.
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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.
Healthcare is full of closed apps (Score:5, Insightful)
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.
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Try A Different Pot Of Money (Score:5, Informative)
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)
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.
What, are you nuts (Score:2)
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.
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:)
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.
Health care reform and payment is the real issue. (Score:2, Interesting)
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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
Dr. Valdes, ... (Score:2)
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
The TFA doesn't seem to have noticed... (Score:3, Informative)
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. ;-)
Translation Please? (Score:2)
This article is not in any dialect of english that I know of. Can anyone out there translate this for us?
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.
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Not that I'm particularly a fan of Democrats, and in fact prefer the Repubs on almost (not quite) every issue, but I suspect that if you just scratch "Democrat" from both occurrences in your post, you'd probably still be right.
Re:Please, get the government OUT of healthcare (Score:4, Insightful)
Isn't it the other way round? Don't Americans by the thousand drive across the border to get their drugs from Canadian pharmacies?
The bureaucracy of the American system is much, much higher than that of the UK NHS (which is no model of streamlined elegance). Just looking at the messaging protocols for the IT systems will tell you that. We don't have to implement half the messages because they relate to billing.
On top of that, the US system is treated as a for-profit endeavour. I'm told that a 15% profit margin is considered to be at the low end.
In the UK we spend only 40% per head what the US does, yet we have universal coverage, flat-rate prescription costs, and no co-pay. Access to treament is based on what is cost effective within the NHS budget, not which loophole your policy manager can use to yank the rug out from under you.
I'd much rather be ill here in the UK, especially if I was poor, than in the USA.
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Frugal Americans buy their meds from Canada. The Canadian system got very good prices by threatening to steal the drugs (ignore the patents) unless they got them at cost. Same as your national health system did. 'It's good to be a sovereign nation.'
Rich Canadians get health care in the US as they avoid the wait and/or denial that comes from government funded care. (You have that too, Your super rich come to the USA as well.)
One question: Where would you like to be if you were a 60+ year old that needed
Re:Please, get the government OUT of healthcare (Score:4, Insightful)
Rich, anywhere. If you are not rich then the UK is better than the US.
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Unless you fall into one of the categories that the English national health has decided is not worth treating. (like over 60 needing a kidney)
If you are employed and/or insured then the US is better then the UK.
Granting it can be hard to get treatment from the insurance company, it is impossible to get from the government once they decide the answer is no.
If insurance companies went too far everybody would take their business elsewhere.
What did you do when the nation health went too far?
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