Brent Nyitray
Fairlington Blade
Let the mutherfuker burn!
jnc4p
Kevin S. Willis
Michigoose
lmsinca
markinaustin
Arcanaut
novahockey
quarterback
ScottC
yellojktJust a couple of quick links from the NEJM about electronic medical records and the difficulty doctors are having with implementation. Perhaps NoVA can help out and give a his perspective as well.
Even as consumer IT — word-processing programs, search engines, social networks, e-mail systems, mobile phones and apps, music players, gaming platforms — has become deeply integrated into the fabric of modern life, physicians find themselves locked into pre–Internet-era electronic health records (EHRs) that aspire to provide complete and specialized environments for diverse tasks. The federal push for health IT, spearheaded by the Office of the National Coordinator for Health Information Technology (ONC), establishes an information backbone for accountable care, patient safety, and health care reform. But we now need to take the next step: fitting EHRs into a dynamic, state-of-the-art, rapidly evolving information infrastructure — rather than jamming all health care processes and workflows into constrained EHR operating environments.
Escaping the EHR Trap — The Future of Health IT
Debates about the productivity yield of IT are new to health care but not to other sectors of the economy. During the 1970s and 1980s, the computing capacity of the U.S. economy increased more than a hundredfold while the rate of productivity growth fell dramatically to less than half the rate of the preceding 25 years.1 The relationship between the rapid increase in IT use and the simultaneous slowdown in productivity became widely known as the “IT productivity paradox,” and economists debated whether investing billions of dollars in IT was worthwhile. The Nobel laureate economist Robert Solow observed in 1987 that “you can see the computer age everywhere but in the productivity statistics.”
That earlier IT debate and its resolution carry important messages for today’s health IT debate. Solow’s famous observation launched more than two decades of research on IT’s effect on productivity, and that research revealed numerous explanations for the paradox — as well as evidence that earlier conclusions about the relationship between IT and productivity were incorrect and that under the right conditions, IT could indeed yield significant productivity gains.
Unraveling the IT Productivity Paradox — Lessons for Health Care
Filed under: healthcare |
All Things in Moderation 
The move to computers was harrowing for my 5 lawyer firm in the early 80s. We hired an IT person who was a former CIA analyst. We did not see productivity gains, literally, for years.
However, this current move is not merely about updating data entry [essentially, EHRs, in this field]. It may ultimately require a nationwide network for information exchange, secure from non-privileged users. It certainly is ambitious. But it may take years before we see productivity gains. Those gains, however, are possible.
The second article points up the favorables: health care is an information rich environment used by highly educated and skilled professionals. This is where IT gains are greatest in business, generally. It also points up the scaling problem. Many integrated clinics use their own proprietary IT and software to achieve the advantages of integrated clinic care. How will those systems be accommodated and how will their strengths be emulated across non-integrated care facilities?
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OT, but health care and SCOTUS related.
No other group of Americans faces higher stakes in the impending Supreme Court ruling on the Affordable Care Act than those with pre-existing conditions. The law, once its major provisions take effect, would prohibit insurance companies from turning people away or charging them more because they are sick. In exchange, most Americans would be required to have insurance, broadening the base of paying customers with an infusion of healthy people. Those who did not buy insurance would be subject to financial penalties.
The Government Accountability Office estimates that 36 million to 122 million adults under 65 have a pre-existing condition. As many as 17 million do not have insurance. Many try to buy coverage on the individual market, but in most states that is either impossible or too costly.
Experts are divided on what the ruling will bring for this group of Americans. If the mandate that everyone buy coverage is struck down, the Obama administration and the insurance industry say that the protections for people with pre-existing conditions should be, too. If the ailing pile in without the larger pool of healthy people, premiums would skyrocket, insurers say.
This is a perfect description how those of us with loved ones, or in the predicament ourselves, feel. Personally, I don’t have much confidence that SCOTUS will rule favorably for us.
With the law’s fate uncertain, participants in the plan are worried, like Maryann Kaine, 52, a music store owner in Fredricksburg, Va., who signed up for the program after she was shut out of her family’s policy because she had had surgery on her back.
“I can’t imagine that they’ll just dump all of us back out into the world of no coverage,” she said.
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One of the things i’m hearing regarding EHR (or EMR) adoption is the time needed to recover the investment. And if you’ve got retirement in sight — and most of our docs do — why spend the $$ and go through the inevitable implementation hiccups if you’re not going to be around the benefit from it. Going off memory here, but I think it’s close to 1/2 of our docs are going to be 65 by 2020.
Re: PCIP, I don’t want to get anyone’s hopes up, but there’s talk of legislation that would address that if the court strikes it down. don’t have any details unfortunately.
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Generally, projects like this tend to be top-heavy with academicians, theorists, managers, leadership experts, etc, etc. and “IT People” who are, again, more managerial and academic rather than nuts-and-bolts folks. So you have a whole lot of Homer Simpsons designing cars—a task they are, in fact, entirely unsuited for.
Big IT projects run by committee (usually, run by a project management committee overseen by a planning committee in cooperation with some other committee that has to inject it’s 2 cents) tend to be awfully executed, insanely expensive, and bring very little, if any, improvement in productivity.
Not that it can’t happen. But it needs to be It experts who actually are experts (lots of field work) managing small autonomous teams of folks who are actually doing and implementing, rather than talking about implementation. While I understand the need for consensus and standards, and the complexity of IT systems than have to serve large numbers of interested parties, the way such things are approached usually amount to Death by Committee. The end product has 1000 cooks, no master chef, and tastes horrible. But everybody agreed to it, so the bureaucracy is satisfied.
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nova
Re: PCIP, I don’t want to get anyone’s hopes up, but there’s talk of legislation that would address that if the court strikes it down. don’t have any details unfortunately.
We’ll take hope. Thanks
re IT, the group of doctors, hospital, specialists and lab etc. that we belong to through our insurance have a very effective electronic records system that I’m assuming is specific to our group. Why does it have to be a national system, or does it?
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I am guessing that until we are all in the inclusive clinic model the only real efficiency comes when your internist can look at his file and see the latest eye exam your optometrist gave you and the latest extraction your dentist did and the long history from your proctologist and the long history from your allergist, and the surgery you had in 1994.
EDIT: AND YOUR HISTORY AT THE PHARMACIES!
For most Americans, the doc is working off the inaccurate history the patient just gave her. Lots of costly pseudo-malpractice results.
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mark:
For most Americans, the doc is working off the inaccurate history the patient just gave her.
Not me. My doc is a him.
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re: HIT, standardization would help share data across systems and payers. also useful for data mining for comparative effectiveness and fraud prevention. i can easily see a spike in claims/orders for example very expensive and rarely used power wheelchairs and see it’s its just an outlier or if something else is going on.
can also help public health goals — you can ping a doc if the patient meets the right criteria. kind of “i see you’re treating s 65-year-old women with diabetes. have you considered X?” … or “did this patient receive her flu shot? she doesn’t know, but his local pharmacy entered into the database, so know we know”
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mark and nova, I’m sure it will eventually help lower costs and promote more responsible behavior on the part of patients, doctors, pharmacists and hospitals, but it all sounds a little creepy to me.
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yeah, it has an air of big brother to it — no reason it can’t be linked into other systems.
“citizen nova. you did not complete your calisthenics and your glucose levels are sub-optimal. soda purchase denied. this information has been posted to facebook. prepare for public shaming.”
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“Not me. My doc is a him”
She’s a man, baby!
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NoVA:
The flip side of the coin of the docs getting older is that all the residents going through the system right now are being trained on EMR, so it might become more of a standard practice. Or at least the younger docs will be used to it.
The impetus for my post is hearing the MD fellow in my lab complain about the different EMR systems he has to deal with. The main training hospital for USF is Tampa General, which has its own EMR system. But he sees patients in the USF clinic and at the VA, which both have their own EMR systems. They’re all somewhat different and don’t talk to each other all that well. It is reminiscent, to me, of the word-processing/social network competition in consumer IT, except that there isn’t the same sort of competitive market for HIT.
It might be that the large HMOs and VA have to be the drivers of what style of EMR will become the industry standard, then all the private docs will be more ready to adopt EMR for their offices.
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Completely OT, but an interesting graph of median net worth by age group, from the ’80’s to the oughts.
http://www.epi.org/m/?src=http://www.epi.org/files/2012/snapshot-retirement-savings.png&w=608
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McWing, that’s depressing. Looks like the 45 to 64 took the hardest hits percentage wise. That’s most of us here I think. Nova and ash are younger and maybe Dave. They’re also the least likely age groups to be able to recoup.
Edit: re recouping, I was referring to the 45 to 64, especially the 55 to 64 age group.
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lms:
Actually, it looks like the 35-44 group took the biggest loss percentage-wise — >50%. 55-64 took the greatest dollar loss (>$100K). But your point about recouping is well taken.
BTW, I was in the 35-44 group in 2010.
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I suppose the under 35 crowd didn’t lose much b/c it didn’t have anything to lose.
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Thanks Mike, I didn’t run the numbers just looked at the graph. And gosh, you’re much younger than I thought. 😉 I don’t think the under 35 crowd has had much of a chance yet to establish net worth nova. It’s an interesting dynamic to watch. Doesn’t a lot of it reflect home equity and retirement funds?
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This is our only thread for today, so excuse me for OT
Have you seen Greg’s thread today about Bain? Man how can anybody be so clueless? (except Axelrod)
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“I don’t think the under 35 crowd has had much of a chance yet to establish net worth nova”
that’s one of my biggest objections to how our current systems are set up.
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I wonder what Bain’s name recognition is. low double digits at best?
If you have to explain your talking point, it’s too late.
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Nova, yes I know. Do you honestly think you could do better while buying a home, raising children and probably paying off student loans, to save for retirement and health care in your later years? And what percentage of the people, excluding you, do you think would be able to? We’re pretty good savers around here and paid our first home off in 12 years but we had to cash out two separate IRA accounts when we were younger to pay medical and other emergency bills. Besides the penalties we also had to pay income tax on those. Most people find themselves in that situation at one point in their lives………….at least in my experience.
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Me personally? absolutely. but i understand not everyone is a DC lobbyist who’s married to someone in a similar role. I get that. but there’s something seriously wrong by taxing those with no/few assets who have the big expenses — like you mention — and transferring up the income and wealth ladder.
If even a little bit of the payroll tax when to an individual account, i’d lose a lot of my objections. give people a stake — a balance they can see grow over time. something they can pass down. no wonder people can’t move up the ladder — we tax their wages and limit their ability to save.
sure, I’ve got the ideological objections to the program. but that aside, i just don’t see it as helping like it could. it’s keep people out of poverty. that’s a success? that seems like barely above failing to me.
what i want for everyone is what the rich have — inherited wealth built over lifetimes. simple transfers don’t do that — but i think we could change the system so that it meets bot of our goals — protection from poverty for our elderly and a nest egg for the next generation.
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“citizen nova. you did not complete your calisthenics and your glucose levels are sub-optimal. soda purchase denied. this information has been posted to facebook. prepare for public shaming.”
Doesn’t this happen already? 🙂
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no wonder people can’t move up the ladder — we tax their wages and limit their ability to save.
Or ability to spend. If I had that money, I’d probably spend it (I know this because I spend it even though I don’t have the money, though I’d have few consumer debts if I had the money I pay in taxes) . . . still, no small part how much we are taxed is due to public expectations of what should be provided for and what level of security they want in their lives. If we could all just suck it up and die if it’s going to cost too damn much to save our lives, and skip the health insurance altogether, we’d all have a lot more money. If we could live without Internet, cell phones, and cable TV—something we all lived without 30 years ago—most of us would have an extra $200-$500 (assuming your paying a family cell phone bill) per month. If we’d ease up on the air conditioning and sweat a little during the summer and shiver in the winter, we’d probably have another $50-$100 a month. Some folks do without, but most do not, and most won’t.
Similarly, most voters want enough federal programs and other government expenditures to keep going that there’s not going to be significant cuts in spending. Arguably, the human race survived before the advent of Social Security or Lyndon Johnson’s Great Society, and there were many great people doing great things and leading great lives and making great contributions, all without the existence of Medicare, SS, and ten-thousand other government programs that did not exist before 1960. But there aren’t going to be enough voters, or enough leaders in government, looking to either (a) dismantle such programs or (b) take away their own power of the purse by turning taxes into mandated individual investment accounts.
It’s human nature at work, I suspect. We could have a lot more money to save, if ww never went out to eat, if we skipped health insurance, if we scaled down our lifestyles in a hundred small ways. But we don’t. When it comes to government programs, we may not be happy about what we pay, but we certainly don’t want to forgo the benefits, even if they are merely theoretical. So we’ll keep our SS and cell phone plan just the way it is, thank you.
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$500 per month = $6000 per year. at 18 years = $108000 and a kid who doesn’t care what the interest rate is on student loans.
or the $200 = $2400. 18 years = $43,200. still a good start.
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For us the only real chance we’ve had to save for retirement came from paying off our first house and having it as rental income during retirement and the last 10 to 12 years after the kids finished their college degrees. We put 5 through though so our experience may be different than others here…………………we’re crazy anyway. We had money saved for the first two, the boys, then for our niece we had some insurance money we’d saved from her Dad’s life insurance and we managed to save some of their SS survivor benefits over the years and we paid the rest as she went in month by month payments.
When it came to our girls, we had to borrow. Luckily they both had some academic scholarship money and since we had three in college at the same time for three years they both got a little work study. For the four with advanced degrees we helped where we could but they borrowed most of it that wasn’t covered by scholarships. The youngest lucked out and Chevron ended up spending a couple hundred thousand on her Masters.
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Kevin
It’s human nature at work, I suspect. We could have a lot more money to save, if ww never went out to eat, if we skipped health insurance, if we scaled down our lifestyles in a hundred small ways
There’s something wrong I think if we expect people to live like paupers, without health insurance, cell phones, minimal entertainment etc. their entire lives, and expect them to use whatever little bit of spare change they have, to save up for medical bills that are 25-40 years away.
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lms:
There’s something wrong I think if we expect people to live like paupers, without health insurance, cell phones, minimal entertainment etc. their entire lives, and expect them to use whatever little bit of spare change they have, to save up for medical bills that are 25-40 years away.
What is the alternative? To expect some stranger(s) to have to pay their medical bills 25-40 years from now?
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I think your example kind of gets what i’m getting at. let’s talk more later. have a good weekend!
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Okay, we always come back to this don’t we? But if you’re going to say that if we had a little more of our paychecks we could have saved earlier for retirement, my answer will be that it never would have made it into a retirement account. Somebody always needed something and we already went without a lot. We only had one income for quite awhile. I challenge anyone to raise five kids and work full time without family to help or a nanny………. 🙂
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Scott
What is the alternative?
Isn’t that the question of the decade? I’m not sure, but I do know that most of the money I’ve paid in insurance premiums over the last 40 years has been money down the drain as I almost never get sick. If that money had gone into a single payer type kitty of cradle to grave coverage, no one else would have to pay my medical bills ever. The majority of the population would be the same I’d wager. There will always be some people who can’t or won’t support themselves but I’m sure there’s a better system than the one we’re using now. And now, when I need the coverage, I have the worst coverage of my life which is a little more than just frustrating, although you can rest assured I won’t burden anyone else with my bills. I’m not trying to be snotty btw, just honest, even if it does sound a little angry. I’ll apologize in advance.
It’s Friday………………….I need to lighten up.
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lms:
Isn’t that the question of the decade?
Actually I think it’s perpetually the question. And the answer never changes.
It is a fact of reality that, we, collectively, cannot consume more than we produce. That means that, individually, we either consume no more than we produce as individuals, or we consume more than we produce individually, therefore depending on others to produce the excess for us, while expecting them to consume less than they produce as individuals. These are the only two alternatives available to us.
I’m not sure, but I do know that most of the money I’ve paid in insurance premiums over the last 40 years has been money down the drain as I almost never get sick. If that money had gone into a single payer type kitty of cradle to grave coverage, no one else would have to pay my medical bills ever. The majority of the population would be the same I’d wager.
It is the nature of insurance that most people involved in the program pay more in premiums than they ultimately get out. If that weren’t the case, it wouldn’t work. Insurance is not meant to be a savings plan for future expenses. It is meant to be protection against a catastrophic event that one hopes will never happen. You buy it for peace of mind in the face of the unknown.
If it is true that your premium payments over your lifetime would have been be enough to cover all your lifetime medical expenses, then what you needed was not a single payer kitty. A simple savings account would have sufficed.
Edit: I think that may not have sounded as intended. I’m not commenting on anything you did personally. I’m just making the point that your justification of a single payer system is really just a justification for an individual savings account dedicated to healthncare costs.
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Scott
Your first answer barely makes sense to me. Health care is not like other consumer products in my opinion. If you’re referring to the fact that medicare is running a deficit then it makes a little sense but generally I don’t think people intentionally over consume health care and wait for someone else to produce the money to pay for it. Obviously the money we’ve all put into medicare hasn’t kept up with the costs and so we need to do something about it. The question of the decade I was referring to was what exactly do we do.
Also, I understand how insurance works and I think my solution of a single payer format is much better than your idea of a simple savings account. We have become immersed in a system of referrals, reimbursements, cost controls etc, etc that would not be easy to unwind. Hence, medicare for all would be a much better solution. Obviously, pooling the risk and benefit is still an essential part of health care dollars, to me anyway.
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lms:
Health care is not like other consumer products in my opinion.
Economically speaking it is, but we’ve been round and round on this before, so there’s probably no point in doing it again.
If you’re referring to the fact that medicare is running a deficit…
No, I was referring to what you you said we should “expect”. My point is that you can either expect people to provide for their own wants and needs or you can expect someone else to provide for them. Those are your only two choices. To use an already overused – but nonetheless true – phrase, there ain’t no free lunch.
I think my solution of a single payer format is much better than your idea of a simple savings account.
I wasn’t offering a solution. I was just responding to your justification of a single payer system, ie the notion that most people will pay enough in premiums over a lifetime to cover their lifetime medical costs. I’m not at all sure that is true, but if it is then a simple savings account rather than insurance would suffice to take care of most people.
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I’m doing some canning this weekend so I’ll be out for the most part. Here’s a very dramatic account of the Sandusky verdict that came in last night.
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My son just a job with a major EMR software firm so I’m glad he’s in a growth industry.
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scott
I’m not commenting on anything you did personally
I didn’t take it personal at all btw. I’m just frustrated with the way the health care debate is going. And also, while we personally are able to pay our co-pays and deductibles, a lot of people simply are not and they may be the exact same people who wouldn’t have been able to save up hundreds of thousands of dollars for some future event………………..just sayin’. It seems to me we’re all in this predicament together rather than individually as the future is unpredictable no matter how much money we have or save.
yello
Congrats on your son’s job, didn’t he just graduate from college? He definitely picked a lucrative industry. Looks like health care and/or energy are it for now, unless you’re into finance I guess.
Have a great day everyone!!!!!!!!!!!!
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Scott
My point is that you can either expect people to provide for their own wants and needs or you can expect someone else to provide for them. Those are your only two choices. To use an already overused – but nonetheless true – phrase, there ain’t no free lunch.
I see now. You threw me off with the word produce. Basically, you’re describing an insurance pool and that’s generally the way they work. Obviously, some will benefit more than others.
Third point re savings account is unrealistic I think. You can’t force people to save money, especially if they’re struggling to begin with, but I think you can get the money through a payroll tax. Otherwise we’d be left with a lot of people needing health care that hadn’t saved the money for it. Of course that will only be feasible if employers, having been freed from health care, raise the wages and salaries of middle class workers. Income disparity being what it is, that would be essential I think.
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