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Advances in Health IT - No Government Needed
Health and Human Services Department Secretary Mike Leavitt has taken a special interest in Health IT (health information technology). He advocates requiring Medicare providers to use e-prescribing and e-records.
The national government has already set a deadline for implementing electronic records by 2014. Leavitt and others suggest the government should take the lead in Health IT, set the standards, and drive the market and movement toward full electronic implementation in the health care industry.
Leavitt and his colleagues are wrong about the need for government to drive the Health IT market. More legislation and major government initiatives are not needed to push Health IT forward. Private industry has made significant progress on its own and will continue to improve its response to consumer demand for personal health records (PHRs) and electronic health records (EHRs).
As Diana Ernst, public policy fellow in health care studies at the Pacific Research Institute, argues, “Thriving incentives for voluntary enterprise in Health IT are already expanding outside of government edict, and are likely to operate more effectively than blanket, government-issued programs, including heavy-handed national legislation on the private sector. We must allow Health IT to materialize freely from innovative entrepreneurship, and preserve competition in the health care industry, for the maximum protection of privacy, and the best quality of care for all Americans.”
Ernst makes four main points in her article, “America’s Consumers Will Beat Government to (Health) IT:”
In 2003, President George W. Bush created a Health IT initiative to turn paper-managed health care records into a more transparent and efficient system using computers. Since then, government has spent more than $1 billion to expand health information technology. Not only wasteful, the government’s involvement in Health IT creates expensive and hindering mandates on private industry. Twelve different national agencies overlap on Health IT research.
The private sector, meanwhile, has taken dramatic strides to streamline Health IT on its own. While government spends more money, America’s private companies and employers move forward without government mandates, responding to consumer demand. IT companies involved in providing hospitals and insurance companies with the technology to convert paper records into e-records already comply with government regulations in place (such as HIPAA).
They also go beyond meeting those standards and set strict, ever-improving standards of their own--as result of competition. Government does not need to intercede anymore. Adding more mandates raises costs and sets static standards for companies to follow rather than allowing companies to compete dynamically with each other and adapt to consumer demand, while improving service and products.
Many tech companies have taken promising steps in Health IT. Girish Kumar, president of eClinicalWorks, “continues to see more and more business every quarter, that tells him that the market is moving forward rather than backwards or sideways.” (See “TECH: Conversation with Girish Kumar, eClinicalWorks,” The Health Care Blog). Other companies taking similar approaches and making themselves into brand names in Health IT include NextGen Healthcare, Secure Services Corp., Epic, Allscripts, and GE Centricity.
Too many people begin with the premise that government creates the standard, drives what private industry does, and deems something as good for others if it’s good enough for the government. Some have applied this faulty reasoning to the health industry as well.
Instead, as Ernst vividly demonstrates in her article, government does not need to drive the Health IT market with more useless legislation. Craig Barrett, chairman of Intel, describes Dossia’s role in health care reform as “forward-looking vision,” not “punitive action.”
Advances in Health IT should facilitate more consumer involvement in personal health care, not more government involvement.
Private industry continues to make strides on its own and respond to consumer demand for Health IT, including personal health records and electronic health records. Government should stay out of the way and allow private industry to continue this progress.
Are you sure that it wasn't Ayn Rand that wrote this? To make a counterpoint, gov't intervention is an option when citizens/industry need to be coerced into looking past their own self-interests to the interests of society at large. Is this the case with Health IT? Docs and Pts have a limited interest/ability in documentation and vendors won't build more into their systems than their customers need/want. But this limited documentation falls short of the kinds of information needed for important (but less profiitable) concerns such as biosurveillance. So could it be that rather than being an evil empire, the "interference" mentioned is actually benevolence?
Ron Rudnicki
www.org.buffalo.edu/RTU
RonRud9: Are you sure that it wasn't Ayn Rand that wrote this? To make a counterpoint, gov't intervention is an option when citizens/industry need to be coerced into looking past their own self-interests to the interests of society at large. Is this the case with Health IT? Docs and Pts have a limited interest/ability in documentation and vendors won't build more into their systems than their customers need/want. But this limited documentation falls short of the kinds of information needed for important (but less profiitable) concerns such as biosurveillance. So could it be that rather than being an evil empire, the "interference" mentioned is actually benevolence?
Really the point of why I posted this - hoping to engender some discussion. Just because we are mentioned in the article doesn't mean that is an exact representation of what I believe is good for the market. It is really a subject that we have touched on in several threads which then unfortunately have deteriorated into - well you know.
It is a valid question with no clear-cut answers. As EMRs mature, who determines direction, content, development, standards, etc? Regulation is always necessary but when does it stifle innovation? Are the ten scariest words you can hear really "I'm from the government and I am here to help"? Government often does have as part of its mandate the "society at large", but often well intentioned motivation ends with the the government mostly promoting its own self interests, rather than that of greater needs of society (to make the above mentioned Ayn Rand point).
If we say that C-CHIT is the wrong way to go, what are the alternatives? No standards? Government standards? As I have mentioned before, there are over 300 companies who sell something they call an EMR. Most of those vendors are honest and above board. Some are not. Doctors are not IT specialists and their expertise in looking at these systems is limited. Who helps to protect them and how?
I used to be quite pro consumer. However, we recently looked at the retail market and my opinion was altered. I think that if a consumer is educated and informed then they will make good health care decisions. But there in lies the problem. How many consumers have enough medical background to choose wisely vs. how many will choose based on price?
However, a person has the right to make less than good decisions.
Lowell Kleinman, MD www.drkleinman.com www.old-fashionedhousecalls.com
Real world scenario on consumers:
1. Cat scratch of arm in US of Ecuador Manager for big bank in Miami. In US he gets scratched he calls for appointment, they say go to ER because his hand is blown up. He goes and then is given medication for antibiotic some 24 hours plus after on-set.
2. Ecuador, he gets scratched and everyone knows that if cat scratches you you go to the Pharmacy (farmacia) and get a Antibiotic.
I am not saying Ecuador is better then US,but the cost to go to the Pharmacy and get your own Antibiotic has to be better. Patients truly can if educated or are required learn more about themselves.
Often a patient will know more then a Physician about there own body.
The time I've spent "lurking" (unfortunate term, but I have no better) on emrupdate has given me a better appreciation of a physicians needs in the use of an EMR, trouble is I'm beginning to believe that those needs will never drive commercial vendors to offer the kinds of possible uses that could be made of EMRs. And that will really be a lost opportunity. Maybe Fred and Greg are right after all and the solution is to join an open source effort. Dunno.
And this is why, when you get anything more serious than a catscratch in Ecuador, the antibiotics no longer work. Because every drug has been used for 2 days against every strain of germ, and they all are now resistant.
Heaven help you if you get TB there, or in Mexico.
Reddy
Brendon: Real world scenario on consumers: 1. Cat scratch of arm in US of Ecuador Manager for big bank in Miami. In US he gets scratched he calls for appointment, they say go to ER because his hand is blown up. He goes and then is given medication for antibiotic some 24 hours plus after on-set. 2. Ecuador, he gets scratched and everyone knows that if cat scratches you you go to the Pharmacy (farmacia) and get a Antibiotic. I am not saying Ecuador is better then US,but the cost to go to the Pharmacy and get your own Antibiotic has to be better. Patients truly can if educated or are required learn more about themselves. Often a patient will know more then a Physician about there own body.
William "Reddy" Biggs, MD
Managing Partner, 23 physician Internal Medicine group
"Live on eClinicalWorks since 2/1/2007" http://tinyurl.com/reddybiggs
Reddy,
Agreed, and they fly here for any surgery and back there for long term care. Ironic isn't it. It is better to have a surgery here and then hire a nurse for 10K there to treat you for an entire year. In our country how much in home nursing can you get for 10K?
My point was that as much as we value Physicians to make the right choices for us, as less and less physicians are available compared to the number of patients, they simply will not have the time. Therefore, like in Ecuador, we will need more self help and be better informed. Maybe there will be askdoc.com that will allow you to use home testing kits and diagnosis over the phone.
Who knows how this ends, surely not the way it is going. EMR software designed to make data collection clerks out of Physicians, Insurance Companies increasing demands on reporting, Patients that can't get physicians on the phone and wait extended time to see a Doctor. I have several sites that Physicians cannot even get other Physicians on the Phone.
I just had a 5 physician cardiology group visit to go over our Dragon Product to a existing site and there was two many Heart Problems this AM in Boca therefore they cancelled. They valued this meeting ery much but on the other hand they had other unforseen obligations.
If I have learned anything from my time in this industry it is that Physician Time is to limited as it is and it is getting worse by the year. The stress on the Health Care System is to much.
I am going to start a new thread from something I heard on NPR Science Friday from the Government on the future of healthcare that had me rolling my eyes.
Regards,Brendon
The interplay between patient, provider, and vendor has already produced extraordinary HealthIT applications that satisfy the needs of those three roles. There are other roles, medical research comes to mind, that have no money on the table and consequently have unmet needs. I am not saying that providers and vendors should sacrifice their practices/businesses to satisfy someone else's agenda, but to the extent that that agenda has a societal benefit, an agency with clout has to make certain that it is addressed or at least heard.
LOL. Nice analogy, even worse is that all of my car's maintenance and repair records are digital whereas my health records are on paper. But don't mistake my intent here, the original article and my posts have been directed at the topic of regulation of HealthIT, not Health.