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Obamacare: Separating Politics From Practicalities
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David F. Carr
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David F. Carr,
User Rank: Author
1/10/2014 | 10:21:21 AM
Obamacare part of a coherent policy?
One of the questions I keep asking is whether all the bits of law and regulation promoting use of EHRs, new payment models, and access to health insurance add up to a coherent policy for improving healthcare quality and cost effectiveness.

What do you think?
Whoopty
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Whoopty,
User Rank: Ninja
1/10/2014 | 11:10:24 AM
Surprise
Obamacare stories tend to surprise me more than anything. Did the US really not have digitised medical records before this? 
SteveF984
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SteveF984,
User Rank: Apprentice
1/10/2014 | 11:30:46 AM
Re: Obamacare part of a coherent policy?
Yes, I think it is part of a coherent policy. Not perfect though, and I agree that it will be hard to improve the law with Republicans not only fighting it, but making it their sole issue for the 2014 elections. Most people are not aware that the individual mandate and healthcare exchanges were both originally Republican ideas. Right now I think the biggest challenge is getting people to have a better understanding of the ACA, and this aricle helps. As much as I have read about ACA, I was not familiar with ACO's.

And I think it's about time for EHR. I was just in to my doctor's office for my yearly physical. Behind the receptionist are floor to ceiling racks of patient folders. It emphasizes your point that they needed to be pushed to improve. Good article David.

Regards,

Steve Fraebel

 
David F. Carr
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David F. Carr,
User Rank: Author
1/10/2014 | 11:40:19 AM
Re: Surprise
Heatlh IT boosters often talk about healthcare being behind the rest of the economy in digitization of processes. That said, building an electronic health records system that tracks clinical and claims data effectively, while maintaining usability despite the complexity of the data, turns out to be a hard problem. Once you have something in place, getting doctors and nurses to use it effectively is also not trivial. That's part of the reason for the system of incentives -- to get people and organizations over the hump.

EHR use was already growing, but slowly, prior to the government programs. There are a lot of hospital systems in use today and the government incentives have made usage in individual doctor's practices more common. Whether they're the ideal systems is another question.
RobPreston
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RobPreston,
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1/10/2014 | 12:15:26 PM
Re: Obamacare part of a coherent policy?
I think Dr. Ketcherside raises a good point. To the extent that digitized healthcare practices are tied to the highly politicized Obamacare, we need to divorce the two. The healthcare industry needed and still needs to go digital regardless of the Affordable Care Act.
SilenceD518
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SilenceD518,
User Rank: Strategist
1/10/2014 | 2:12:22 PM
Cost Structure
An explanation of the ACA cost structure. Any commentary would be appreciated. Good luck my friends.



https://www.youtube.com/watch?v=j7Y-5rjsaJY&list=TLAUBoyiVDhjhlV9kO-835n7ZD_Qk5bUvF
moarsauce123
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moarsauce123,
User Rank: Ninja
1/11/2014 | 11:03:04 AM
Re: Obamacare part of a coherent policy?
I agree and there are places like Germany where health care went digital over a decade ago. Why not look at their experiences? What worked or did not work? Yes, the health care and insurance industry is structured differently over there having mandatory health insurance for everyone since ages, but in the end it is providing services based on a fee schedule to be paid by an insurance and distributing patient data while keeping it secure.

I am sure it also did not help that the US has a convoluted mish mash of state based rules and regulations that had to be massaged into one gargantuan system. Honestly, the health care industry is more broken than healthcare.gov ever was.
Gary_EL
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Gary_EL,
User Rank: Ninja
1/11/2014 | 2:59:49 PM
Re: Surprise
From my standpoint, that of the patient, EHR is the greatest thing since sliced bread. Once you get into middle age, you are seeing a variety of doctors for a plethora of problems. I used to have to waste a good portion of the doctor visit explaining what all the other docs were doing. No longer, because all the info is there for him or her to peruse without me and my unprofessional knowledge and interpretations getting in the way.
David F. Carr
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David F. Carr,
User Rank: Author
1/13/2014 | 9:34:09 AM
Re: Surprise
Good to hear that you perceive a real time savings for the patient. Interesting, because usually the discussion is whether it makes doctors more productive (generally, they say documenting notes electronically is more time consuming), but everyone says the end goal should be a payoff for the patient. If your doctors having EHR gets you in and out of the office quicker, that's a payoff that shouldn't be discounted.

Presumably, you would see even more benefit with good health information exchange between providers and between hospitals and practices. If everyone you are seeing is on the same EHR system, great, but often that's not true.
UberGoober
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UberGoober,
User Rank: Strategist
1/13/2014 | 11:23:51 AM
Re: Surprise
Given that there is very little EHR data interchanged between health organizations, you must be seeing docs within a single organization.  The chance of the unaffiliated doc on the corner being able to get your EHR from, say, your hospital is very near zilch.

 

Health Information Exchanges are supposed to be the answer, but in practice there are lots of little ones that don't necessarily talk among themselves.  The whole thing is a mess.
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