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Healthcare IT: Savior Or Sinkhole?
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User Rank: Apprentice
1/21/2013 | 12:37:40 PM
re: Healthcare IT: Savior Or Sinkhole?
I do not believe it is possible to draw a conclusion from a RAND forecast that is 7 years old. It is a highly questionable approach, and has no scientific merit.

This is once again a demonstration of the 'Luddites in medical practice.' In no other domain, be it biomedical research, finance. law or law enforcement, would anyone be questioning the value of converting from a paper-based system to an electronic record. I just hope that other members of my generation of physicians retires as quickly as possible.

Using an analogy in radiology, it took a decade from the time that DICOM standards of inter-operability were introduced, to adoption of a single interoperable system. Much of that lag can be explained by vendors using their own 'flavor' of DICOM, that could only be used to exchange data to devices and computers on their own systems.

You see a similar phenomenon today - EPIC does not permit health data to be transmitted other EHR systems unless they are EPIC systems.

I would argue that the problem can be attributed to the conservative nature of medical practice, and to vendors that exploit this feature of medical practice for their own benefit.

As an aside- does anyone here know what the fastest growing diagnostic test in the history of medicine might be? It has taken place over the past year, but most clinicians are clueless.

Kind regards - Gerry Higgins, M.D., Ph.D.
User Rank: Apprentice
1/16/2013 | 7:01:46 PM
re: Healthcare IT: Savior Or Sinkhole?
As one who has worked as a health provider CFO and CIO, systems developer/vendor, and health care consultant for over forty years I am not surprised Rand came to its current conclusion. I was really surprised when they said in 2005 we could save $80bill a year.

In all my years of health care experience I have never seen a capital investment in healthcare/medicine actually save dollars when you take a total health system view.

Think about it. Back in the 60G«÷s most lab procedures were done manually. So for better quality and efficiency we invented lab auto analyzers, they could do 2 to 4 chemistry tests all at once. In the 70G«÷s it went up to 20 tests, in the 90G«÷s it went up to 50 and it could be G«ˇdiscreetG«÷ meaning you could pick and choose which test to run. Was all this more efficient? You bet it was. Was it better quality health care? Of course it was, and better quality (and quantity) generated far more information and as such identified many previously hidden patient medical problems. And finding more medical problems meant more health care was needed.

The same can be said for Radiology, first simple Xrays, then CAT scans, PET scans,then NMR, and so on. More efficient, yes, better health care, yes, and more medical problems identified. In short, better diagnoses tools means you will always find more patient problems, which in turn demands more therapies, and more protocols, more specialists, and even more sophisticated tools.
Then add to that an aging patient population, more chronic illnesses, and societal issues such as obesity.

What we seem to forget (or ignore) is that health and medical care is not a zero sum game. We have absolutely no idea how many medical problems are out there. The human body is far too complex. Youare not born with with a maintenance manual or a trouble shooting guide. For over a thousand years, using trial and error, we have been trying to G«ˇreverse engineerG«÷ the human body, trying to identify all these possible problems. Yet it seems for every one we do identify we find three more. All these wonderful medical devices have taken us deep into human biology and we still could fill an ocean with what we do not know.

Looking at overall health expenditures and expecting EMRs to reduce them is like believing that the new screw driver set you just bought is all youG«÷ll need to fix your car. EMRs are no more than tool and a relatively simple one at that.
Frank Poggio
The Kelzon Group

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