Electronic medical records: what’s it really about?


Richard Moore

Obama has stressed the use of electronic medical records and e-prescribing — which lets doctors send prescriptions directly to pharmacists via computer — as part of his plan to transform the U.S. healthcare system and cut costs. … The economic stimulus bill signed by Obama in February includes $19 billion for healthcare information technology.

They use terms like send prescriptions but if you think about it, what does that really mean? I can tell you, as someone from the industry, that what we’re actually talking about is a Federally-managed central database, where all this information will be maintained. Your doctor and hospital will have access to the records, but the records will actually exist in the database, not in the hospital. Any other approach would be technically foolish, a nightmare to coordinate, and inherently unreliable and inconsistent.
The goal here is about efficiency, and with this kind of system, there is a lot that can be gained. For example, instead of typing in the name of a prescribed medicine, wouldn’t it be a lot quicker to have a drop-down menu to choose from? Of course it would. That’s how such systems always work. A doctor won’t store a prescription in the system, or send it to anyone, rather a prescription will be a transaction carried out on the database, like the Add To Cart button on Amazon.
The potential of such a system to micro-manage health care is of course obvious. The doctor chooses a diagnosis from a drop-down menu, and then he gets a menu of prescription or treatment choices, based on ‘the best scientific knowledge’ — which will be provided by the new National Coordinator of Health Information Technology. If your doctor wants to prescribe something else, or a different treatment, he won’t hear Hal saying, “I’m sorry Doc, I can’t do that”, rather the desired menu item will simply be missing. I imagine there will also be flashing ads from pharmaceutical companies on the page, Prescribe now! instant rebates! win a Caribbean Holiday!
And when it comes to efficiency, the real gains won’t be in medical information per se, but rather in the area of accounting and management. It’s not the efficiency of data access which is really important, but rather the efficiency of care-provider operations generally — and ‘efficiency’ is just a code word for cost minimization. Controlling allowed procedures for identified ailments, as mentioned above, is one way to minimize costs. And of course lots of clerical people in hospitals and clinics will become redundant with the new system, greatly reducing overhead costs.
Perhaps the greatest opportunity for controlling costs, and micro-managing operations, has to do with money itself. If a health provider wants to get their insurance reimbursement for a visit or a treatment, the transaction will need to be approved by the system at the time of delivery. So a patient shows up at the clinic, their medical card is swiped as the very first thing, and up comes the message, insurance premium overdue — no services can be reimbursed. Or perhaps the patient can’t even get into the building if their card swipe won’t open the door. Or the nurse enters the data for an office visit, and up comes the message, excessive visit time, reimbursement reduced
These may be fanciful examples, but you can see how tightly and easily the whole industry can be controlled, and services micro-supervised, all from one little central control office, occupied by some administrator, selected by the pharmaceutical and insurance industries. It is easy to see why this is all worth $19 billion (of taxpayer money), and who it it is that will be benefitting. The actual goal of the system is to maximize the revenue that flows into into Big Pharma and Big Insurance, by minimizing both administrative overhead and medical care itself.

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UPDATE 1-New military electronic records to be model for US

Thu Apr 9, 2009 3:07pm EDT

* Obama says existing system poses hardship for many vets

* Says new program would cut red tape, reduce mistakes

* Stimulus plan includes $19 billion for such technology

* Unclear whether private sector would help design system (Updates with comments from Obama)

By Jeff Mason

WASHINGTON, April 9 (Reuters) – President Barack Obama on Thursday said the government would create a national electronic medical records system for the military that will serve as a model for broad reform of U.S. healthcare administration.

The system, organized by the Department of Defense and the Department of Veterans Affairs, would follow military personnel from active duty through retirement, keeping records organized and complete.

Obama said the agencies were moving to create a system for military members “that will contain their administrative and medical information — from the day they first enlist to the day that they are laid to rest.”

“Currently, there is no comprehensive system in place that allows for a streamlined transition of health records between DOD and the VA,” he said.

“That results in extraordinary hardship for an awful lot of veterans, who end up finding their records lost, unable to get their benefits processed in a timely fashion.”

Obama has stressed the use of electronic medical records and e-prescribing — which lets doctors send prescriptions directly to pharmacists via computer — as part of his plan to transform the U.S. healthcare system and cut costs.

He said the new system would transform veteran care.

“This would represent a huge step towards modernizing the way healthcare is delivered and benefits are administered for our nation’s veterans,” he said. “It would cut through red tape and reduce the number of administrative mistakes.”


The economic stimulus bill signed by Obama in February includes $19 billion for healthcare information technology.

Fewer than 2 percent of U.S. hospitals have adopted fully functional electronic medical records, according to a study published last month in the New England Journal of Medicine, and just 17 percent of American doctors have switched from paper records to electronic health records. [ID:nN25412831]

This compares to 98 percent of doctors in the Netherlands and 89 percent in Britain.

The White House said in a statement the military program would serve as a template for the rest of the country.

“The creation of this Joint Virtual Lifetime Record by the two organizations would take the next leap to delivering seamless, high-quality care, and serve as a model for the nation,” it said.

The White House did not say whether a commercial company would help design the electronic medical record system.

There are many that design such systems, including Cerner Corp (CERN.O:QuoteProfileResearchStock Buzz), Eclipsys Corp (ECLP.O: Quote,ProfileResearchStock Buzz), Global Med Technologies Inc (GLOB.OB:QuoteProfileResearchStock Buzz), Quality Systems Inc (QSII.O:QuoteProfileResearchStock Buzz) and Allscripts-Misys Healthcare Solutions Inc (MDRX.O: QuoteProfileResearchStock Buzz), IBM (IBM.N: QuoteProfileResearchStock Buzz), General Electric Co (GE.N:QuoteProfileResearchStock Buzz), Siemens AG (SIEGn.DE: Quote,ProfileResearchStock Buzz) and McKesson Corp (MCK.N: QuoteProfile,ResearchStock Buzz).

Wal-Mart Inc’s (WMT.N: QuoteProfileResearchStock Buzz), Sam’s Club unit is offering individual doctors a package including software and Dell (DELL.O: QuoteProfileResearchStock Buzz) computers.

Experts say any national system would have to connect easily to other systems while protecting privacy. (Additional reporting by Maggie Fox and David Alexander; Editing by Xavier Briand)

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