I like the idea, that maybe, foresakes, maybe, it would stop the doctors and pharmacists from issuing drugs like candy. I remember when I was a member of Kaiser years ago, everytime I went to the doctor I left with a prescription - sinus, headache...then when I was diagnosed with hyperthyroidism, it was hard to get medication - they wanted to operate.

On the other hand, I don't like being in every computer system in this country. As it is, people can look up your name and find you on a computer, whether it be for credit, or pull up all your personal information. The fact that no one seems to care about identity theft- I kinda have a problem with this.

***when I say you are on every computers database, I can go to a private investigator and give just an address, the p.i. can pull up data for everyone that receives mail at the address, in addition to, every person that have ever used that address.

Companies sell data, and tend to have more data on citizens than the government. For example, there are companies that keep information on all checking accounts opened under your name DOB & SS#. Anytime you use an ATM, it is printed exactly on your bank statements. Use a cellphone, every telephone number you called is there and can be subject to subpoena.

I think it's just too much information, and in the hands of the wrong people, it's not good.

There is no savings to computerize medical records. It can makes things more efficient and add capabilities but it costs a lot. The underlying hardware and software have to be updated every few years. The medical records is connected to imaging, pathology, diagnostic, billings, scheduling, ordering, and even meals. It is a very complicated system and would basically require every hospital and doctors office to work the same way. All medical providers would have to adjust their processes to match the computer systems and that is probably not going to happen.

Here's an interesting tidbit -

The Former Prime Minister of Belize - Mr. Said Musa (as I said in a post last week, Palestian)
was criminally charged with theft of $10 million USD grant from Venezuela to pay for Universal Health.

www.belizefirst.com/News.html *click on 2004-2009

**it talks about Randall Tobias - head of Bush Adm. Foreign Aid program, that resigned over the DC Madame - said he specifically used Central American women.

***it talks about 10 Taiwanese paid $15k to invest in Belize and immediately got residency cards although they haven't yet stepped foot in the country.

****it talks about Americans & other expats being killed, home invasions, robberies - must see

*****I need to see if Michael Feinstein is related to Dianne. This guy is spending alot of money there! hmmm

Would it be too much to ask to find SOMEONE somewhere who is actually informed about the complications of health care reform rather than just continue the back and forth with entrenched OPINIONS that have little backing in FACT???? The biggest problem Obama has is the mentality of far too many in 'merica who need everything QUICK and SIMPLE!!!

I worked in the Healthcare IT industry for eight years, and had contact with Children's in Pittsburgh . . . and the article misses the point. Software is necessary -- open source means each hospital has to staff up IT resources to build and maintain, closed source means the hospital pays someone else (I prefer the latter). The real issue is that hospitals do not design their workflows, processes, and policies to work with the software -- they throw it all together and then expect the care givers to figure it out -- it is rarely the software's fault. Doing it right means changing work practices -- few hospitals want to make that commitment.

B:

You and I both know that Cerner's software is a bugly mess. It is only a matter of time before someone finally takes Neal Patterson and his crew to court over it.

Personally, I think the reverse is better. IT working in the hospital is more likely to responsive to the needs, workflows, and deliverables of the various departments.

"Done right, digitized health care could help save the nation from insolvency while improving and extending millions of lives at the same time. Done wrong, it could reconfirm Americans' deepest suspicions of government and set back the cause of health care reform for yet another generation."

Possibly. So which system do you think the government program will pick? If the NHS in Britain is any guide, the more expensive, proprietary one.

They looked at the open source system and rejected it and now the system they're building from scratch is 4 years late and costs are rising through $15 billion.

It isn't that if governments always took the right decisions they might make us better off: it's how few decisions taken by government are the right ones....

Open-source vs proprietary: I have worked with LaTeX for years (open-source document formatting language). I use cygwin and xemacs. I like open-source.

HOWEVER, when you compare the two, remember that with open-source, no one is paid to maintain the code. That means that changes occur VERY slowly, and sometimes do not occur. No one is responsible for addressing questions. No one is responsible for .... anything. That being said, proprietary is a better approach here. After all, if you are retaining records about life-threatening conditions, do you REALLY want to depend on the willingness of some teenager in Pokipsee to fix the code? I didn't think so.

What we need are STANDARDS which all must adhere to. This STARTS with OPEN-SOURCE DATA FILES, so that all can work with the files. XHTML is the way to go here.

Open source does not mean that nobody is going to maintain it, or even that nobody will be paid to maintain it. Linux is open source, but there are scads of people who maintain it, courtesy of IBM, Oracle, etc.

I'd prefer open source because it means that *I* can know what is being done with my data. If I can't know what's happening, then I'm going to have less trust in the system.

As to the point of having to hire people to maintain hospital IT systems: those people are going to have to be hired anyway. It's not like Microsoft sends a system administrator free of charge to your location to fix your problems. With the admins having access to the source, however, they will be able *to fix their own problems* and not have to shrug and say "the vendor's been notified..."

I say this as a 10-year veteran of the Windows server/desktop support wars, and as one of those dirty hippies who works on open a major open source project.

the only way that EMR will work is if it allows wide access to patient information-for example, if I see someone in my hospital who has been to a different institution, I would be able to access the results of all tests that person has had, even if they were done at different facilities. I should also be able to access pharmacy records. this is the price of entry to a true single payer system, IMO. but I really really doubt we will ever get there-not because of privacy concerns, because those can be addressed-but because the multiple EMR products all compete with one another and are unable to communicate with one another.

done properly, an open source EMR system with multiple access points for different heirarchies-registration, pharmacy, radiology, lab, nurse, physician-would facilitate efficient and high quality care, allow tracking of outcomes, generate data to create best-practice programs, and reduce duplication and excessive testing.

"Done right, digitized health care could help save the nation from insolvency ..."

Hyperbolize much Steve? And if the above IS the case shouldn't the "Done wrong ..." part of the equation end with an all caps screed about the ground opening up and swallowing North America?

Gimme a break.

People should be able to have their info put on a zip drive that they can carry.

I totally agree with Drew. As a nurse who's hospital just started with computerized charting -- I spend more time on the computer hunting around for a place to put the information than I do with the patient.

The outside IT people just made my job more complicated. Inside IT people could have taken what we already used, automated it, THEN tweaked it.

It sounds like the VA hospital system - which is not so small - already has a good open source system. That is, it is not something that could one day be a good solution, it is here now. Why not let the VA market their system? They could even charge for support and help pay for new development.
I am a computer guy and a big fan of open source. Stuff that is written by or with the cooperation of the people who use the software is usually better.

Roger,

Are you talking about the OpenVista system? A quick search seems to indicate that's what the VA is using, and that it's an open source solution. Do you have any good resources for learning more about it? The articles I found were light on details.

I've seen three doctors in the past three weeks, and they are using the eClinical program to collect patient information.

Medical record-keeping software could be a good thing for medicine, but it will be a GREAT thing for health insurance companies.

Think about it: All the underwriter has to do is click a mouse and he will be able to see your entire history laid out in front of him. Every unverified doctor's hunch can now be classified as a "Preexisting condition". Rescission will be exceedingly easy, as any stuff the doctor wrote down, even if he didn't tell you about it, is now grounds to deny payment or coverage.

This is not a hypothetical point. I was recently denied coverage for a preexisting back condition that I never knew I had and had never been to a doctor to treat. It was in my records somewhere, but insignificant enough so a doctor didn't bother to mention it to me. Of course...by the age of 62, there is nobody alive that does not have a history of "preexisting conditions".

The EMR change-over is likely to do great harm to sick people by making it easy to deny them coverage. The only way it will do what is claimed is if basic anti-discrimination law is applied to insurance companies. Every other business in the US is required to serve you if you show up in their establishment except insurance companies. If they are required to sell you coverage at a reasonable price, then the system will work. Otherwise, no.

Medical Markup Language.
see:
http://www.medxml.net/worldwide/What_is_MML.htm

I don't work with it, but if you get Medicare and Medicaid to adopt it, presuming it works, you can start to force proprietary systems to talk to each other in the same language--and build from there.

Various responses: there are a lot of misunderstandings of open source going around this thread:

Software is necessary -- open source means each hospital has to staff up IT resources to build and maintain, closed source means the hospital pays someone else (I prefer the latter).

This is false. Open source isn't incompatible with support contracts (in fact, for-profit makers and distributors of open-source software often make all their money from support contracts, since, by nature, license fees aren't really a viable option.) The difference between open source and closed source software is that open source means that a user of the software can (either themselves or by some third party), given the resources, get software modified or supported when the original maker isn't interested in the modifications or has decided to terminate support.

The real issue is that hospitals do not design their workflows, processes, and policies to work with the software

Which they shouldn't; an IT solution should be designed to work with the workflow, not vice-versa. This is a problem with closed-source software, where each purchaser is likely to be faced with the choice of choosing off the shelf, or paying for a ground-up custom solution, whereas open sources solutions and components better support remix components to build customized solutions for different environments without limiting the pool of components to what one particular vendor has built in the past (particularly if you have open-source components and strong standards for interoperability.)

HOWEVER, when you compare the two, remember that with open-source, no one is paid to maintain the code.

This is false. While many small open-source projects are supported only by hobbyists and volunteers, many large ones have many people being paid to maintain the code, and indeed there are companies that do very little besides develop, maintain, and support particular open-source code bases. And with open source, any user, or group of users, that is concerned with the resources being applied to maintain a piece of software can, themselves, pay people to maintain it; that's a natural result of the rights that are given under open-source licenses (and why many of the people that are being paid to maintain many open source projects aren't being paid by the same people that distribute the code.)

That means that changes occur VERY slowly, and sometimes do not occur. No one is responsible for addressing questions. No one is responsible for .... anything.

This, again, is not true. Most open source projects (particularly major ones with important use in industry) have defined governance structures and identification of responsibility. Some are governed essentially like typical closed-source corporate developed software but released under open source licenses, others have different governance structures that are only possible because they are open source, but it is simply not the case that change is universally slow with open source and that no one is responsible for anything in open source projects in general.

Various responses: there are a lot of misunderstandings of open source going around this thread:

Software is necessary -- open source means each hospital has to staff up IT resources to build and maintain, closed source means the hospital pays someone else (I prefer the latter).

This is false. Open source isn't incompatible with support contracts (in fact, for-profit makers and distributors of open-source software often make all their money from support contracts, since, by nature, license fees aren't really a viable option.) The difference between open source and closed source software is that open source means that a user of the software can (either themselves or by some third party), given the resources, get software modified or supported when the original maker isn't interested in the modifications or has decided to terminate support.

The real issue is that hospitals do not design their workflows, processes, and policies to work with the software

Which they shouldn't; an IT solution should be designed to work with the workflow, not vice-versa. This is a problem with closed-source software, where each purchaser is likely to be faced with the choice of choosing off the shelf, or paying for a ground-up custom solution, whereas open sources solutions and components better support remix components to build customized solutions for different environments without limiting the pool of components to what one particular vendor has built in the past (particularly if you have open-source components and strong standards for interoperability.)

HOWEVER, when you compare the two, remember that with open-source, no one is paid to maintain the code.

This is false. While many small open-source projects are supported only by hobbyists and volunteers, many large ones have many people being paid to maintain the code, and indeed there are companies that do very little besides develop, maintain, and support particular open-source code bases. And with open source, any user, or group of users, that is concerned with the resources being applied to maintain a piece of software can, themselves, pay people to maintain it; that's a natural result of the rights that are given under open-source licenses (and why many of the people that are being paid to maintain many open source projects aren't being paid by the same people that distribute the code.)

That means that changes occur VERY slowly, and sometimes do not occur. No one is responsible for addressing questions. No one is responsible for .... anything.

This, again, is not true. Most open source projects (particularly major ones with important use in industry) have defined governance structures and identification of responsibility. Some are governed essentially like typical closed-source corporate developed software but released under open source licenses, others have different governance structures that are only possible because they are open source, but it is simply not the case that change is universally slow with open source and that no one is responsible for anything in open source projects in general.

In particular, one person who could support an open source health record software effort would be...the government. Lay down a standard for interoperability, give some grants to start projects, maybe offer some kind of usage-based compensation. It can be done.

I am a patient in the VA medical system. Previous to that my Primary care doc belongs to a practice that computerized within the last 5 years.

THIS NEEDS TO BE DONE, AND WE SHOULD NOT REINVENT THE WHEEL JUST TO MAKE SOFTWARE DEVELOPERS RICH.

The VA's OPENVISTA works very well, I am very impressed by it. The Feds have spent a lot of money developing it, it works, a patient can walk into any VA hospital or clinic in the country and his entire record is available instantly. My brother is a VA Critical Care Nurse and really likes the system.

Why not spend the IT money in the health care plan to export and put Openvista into the civilian health care system, instead of wasting money reinventing the wheel??

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