Jan

10

 One of the most highly-regarded components of the proposed stimulus package is the computerizing of medical records. Pres-elect Obama says this will save the government $80 billion dollars a year and will in effect pay for covering the uninsured.

Let's analyze this a little, especially since we have many readers owning (or working at) financial firms who know something about computerizing and securing sensitive records, and paying for developing, maintaining and continually updating the IT departments, hardware and software that will be necessary for every doctor's office, clinic, hospital and pharmacy. Computerized medical records may be a good idea, but anyone who thinks this elaborate nationwide IT set-up will cost less than the extremely cheap file folders currently found in most doctors' offices has never had much to do with IT.

Does anyone remember the computer systems development of certain other entities which took years of — and still could not work?

Now let's make the heroic assumption this time it will be different and the Gov will get a national computerized record system to operate within a reasonable number of years, within budget, and properly protecting from unauthorized disclosure everyone's very sensitive personal medical information. Let's think in a slightly sophisticated way about the effect on costs.

Doctors get paid these day (by Medicare, Medicaid and insurance companies) by listing all the diagnostic and therapeutic procedures they carry out for which reimbursement is permissible. When each doctor is computerized and can have his computer instantaneously search through thousands of possibly-applicable reimbursement codes, does anyone think there will not be more codes checked and listed by the computer? Would an average medical bill 20% higher be a reasonable projection?

And how about all the vaunted enhancements provided by a computerized record system such as alerting the doctor to alert each patient when to return for a further test or procedure or for adjustment of the patient's medication? Assuming doctors' offices will be competent enough to comply with such computer alerts, how many more doctor visits and additional charges will this generate, to be paid for by the Gov or private insurance?

And these are just two of the more obvious cost consequences, with more subtle cost consequences sure to emerge as health practitioners learn to game the system. Computerized medical records may be a great idea but anyone who thinks they will cost less, $80 billion less, is smoking dope.

Let's consider the analogy of your financial records — income records, expenses, receipts, stock purchase and sale records, purchase dates and cost-basis records extending over many years — that you keep for calculation of your income tax each year. Some handwritten, some computerized, but from various different, incompatible, software systems.

How inefficient! Why doesn't the Gov develop a uniform computerized financial record system, securely protected from unauthorized access or disclosure, which your tax preparer, or the Gov itself, could use to calculate your yearly income tax? According to the, uh, Brookings Institute, such a national computerized system could save the country $80 billion a year.

Or should we rely on people to keep their own financial records? But wait, the average person is not medically — I mean financially — trained. These records are too important to each person's medical — I mean financial — health to leave to chance. And some people don't even have computers. Or filing cabinets. Nah, let's not rely on relatives or volunteers to help those few; we need a computerized financial record system to take care of everyone.

Okay, okay, enough. It's clear from this reasonably close analogy what the solution is — people should keep their own computerized medical records. And, amazingly, the way to do this already exists on the Internet, for free, without waiting years for an elaborate, confidential, Gov system to be developed.

Take a look at myhealthfolders.com (and I'm sure there are others). For free, you can in a few minutes set up for each family member an online medical record file, protected by a password (which you can change after you have given anyone temporary access). Or an employer, again for free, can set up a medical record file for each employee. And each time you go to a doctor, or to the hospital, or to the emergency room, you (or, if you are unconscious, your medical emergency bracelet or emergency card in your wallet) can reveal the website and password so your medical records can be immediately accessed.

And each time you visit a doctor or hospital, you can ask them to update your online medical file. Or if they are too obstinate or inefficient to do so, you can ask for a copy of your new medical record (which you have the right to by law) and update your online file yourself.

Would some politician please suggest this instead of appropriating billions on it in the stimulus package? And then be forced to wait to see how many years, at what cost overrun, and at what compromise in protected confidentiality, the Gov computerized record system takes?

This is not just a theoretical discussion. Collect your last blood test results, the prescription and otc drugs you take, and go here to begin setting up your computerized medical record file.

Alan Millhone comments:

There will always be millions who remain uninsured in the US unless you are on welfare and get a free medical card that comes along with your welfare payment each month. Also if you are on some kind of disability thru SSI, etc. you get a free medical card with your monthly payment.

On another post I see mention of computerizing medical records. Some years back the government came out with a 'paper reduction act', another farce.

Also any kind of public works project related to schools, bridges, roads, etc. will fall under Davis-Bacon, prevailing wage, Union wages and the money in the project will be eaten alive due to the exorbitant labor costs associated and just the 'big boys' will be able to bid who can secure enormous bonds for the various projects. All this TARP and stimulus money is like pounding sand into a big rat hole. I am just a realist and not a dreamer. 


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2 Comments so far

  1. Russell Pierce on January 12, 2009 12:41 pm

    I find an analogy between medical records in a file folder and library cards. The “old” library cards often contained hand-written notes and annotations that were very useful to the researcher. When the old cards were computerized in my local public library, the hand-written comments were lost forever. A doctor will frequently make notes on a patient’s file regarding his observations, some of which may never make sense but frequently lead to diagnostic insights in the future. The doctor’s notes will be lost in the government’s computerized system, but the savings of such “efficiency” may be lost with many patients.

  2. Maggie Liu on January 17, 2009 12:26 am

    The author is concerned that the upfront cost of implementing the program might too high; the software may not work; and patients may have to pay more for the same service.

    First of all, a budget overrun does not necessarily mean the program itself won’t bring about the benefits and savings it promised.

    As for the software itself, there are commercially available software on the market already. What the government needs to do is to advocate for a common standard for basic features and for sharing patients’ records.

    When the program initially gets implemented, patients might have to pay higher fee but as times goes on, the savings will certainly trickle down, just as what happened to stock trading, the cost of which has come down dramatically because of information technology.

    Another point, I certainly don’t want to keep track of my own medical record or my family’s records since I don’t know the medical terms. Besides, if the doctors know how to take electronic notes, it will be much easier for me to review records when I don’t have to deal with different hand-writings.

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