About Me 0076: Making Money Program

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That's not all.
by Menlo

Charade is the perfect name for it too...nt
by AceInTX

I've been through Israeli security several times
by wennejunk

Why increase it?
by froster

Do you listen to John King for John King or when Erick is on?
by froster

Turns out that my Sen. Chambliss voted NO because it didn't apply to less than $500K! so conservatives don't even have 25
by Mike gamecock DeVine

ladyimpactohio- That statement is key
by Scope

Gamecock is on hold for Erick...nt
by Mike gamecock DeVine

Although the words "cap and trade" were never mentioned..
by ladyimpactohio

Vassar, "not one of us." "This is the dance of elitist."
by penguin2

Senator Dodd and his farewell speech
by npaul

and call the senators that voted for this thing and warn them
by Mike gamecock DeVine

thx guy - nt
by Mike gamecock DeVine

Ohio can claim all kinds of good things
by npaul

Not so sure about that NYTimes article
by aesthete

Some history of Chanukah in America
by ashland_avenue

Speaking of Sherrod Brown...
by redtillimdead

Put down your pitchforks and think, people...
by thejaykob

You'll have to start one in the diaries
by Erick Erickson

Do your research
by azmar

I beg to differ
by Brian Darling

It could be bait placed by the Obama
by Warrior

Republicans were wrong in 2005
by Brian Darling

I would beg to differ on the election assessment
by ceili_dancer

I am in favor of a 67 vote threshold on the filibuster
by Brian Darling

mirac777- The tactic that I will only listen to those in my district
by Scope

Forum
by BigGator5

But for the filibuster, government would be even bigger.
by Brian Darling

I wasn't going to post in this thread
by Finrod

I said then, and say now
by cwilson

RedState
by Erick Erickson

Pretty AWESOME diary you got there Vassar....
by JadedByPolitics

I opposed the Constitutional Option
by Brian Darling

You can email me.
by Erick Erickson

Conservative Forum?
by BigGator5

Can we send you questions?
by Brian Darling

Abuse of the filibuster
by cwilson

and on to the next userpation of the liberties of Americans...nt
by AceInTX

boiling the frog my friend...one degree at a time
by AceInTX

no...but I know enough...I didn't think that through before I posted it
by AceInTX

Fueled by the economic stimulus passed by Congress in 2008, the federal government has embarked on a controversial $30 billion program to induce doctors throughout the country to adopt electronic health records (EHRs) by 2014. The purpose is to create an interconnected system of electronic health records to improve safety and reduce medical costs.

But the United Kingdom has spent the last 6 years working on the same idea, and it's proven to be a colossal failure -- so much so that the government is drastically cutting its program. What happened to their plan? Should we be paying attention before rushing ahead with our own?

In 2005 the United Kingdom embarked on the largest investment ($18 billion) in health information technology in the world. Yet despite expectations that the system would increase efficiency and reduce medical errors, their efforts neither improved health nor saved money -- in fact in some cases, they may have led to patient harm.

Britain's government-run medical system is obviously different from our complex public-private insurance system. However, its electronic health record project bears an uncanny resemblance to the program President Obama is starting. Here are the mistakes the British committed that we are now repeating:

Too large and ambitious: The UK project tried to accomplish too much, too fast, attempting to digitize health records for the whole population in a period of four years. This massive undertaking is years behind schedule and has delivered only a fraction of what it promised. Despite all the money poured into the system, the vast majority of hospitals in the UK still don't have integrated electronic health records. Because non-clinicians developed the system, the electronic forms they designed have little to do with how doctors treat patients -- making it unworkable for many physicians. As the Chair of the British House of Commons Public Accounts Committee recently stated, "This is the biggest IT [Information Technology] project in the world and it is turning into the biggest disaster."

Too dependent on commercial, proprietary companies: Rather than create one system and beta-test it, the UK government depended on four companies to build the system, two of which quit or were fired for missing deadlines. So the health records were never developed in the south of England. The computer software was secret and proprietary. There was no accountability to the public, and the vendors did not provide enough technical support to clinicians having trouble using the records.

The resulting software errors and crashes caused missing or incorrect clinical information and sometimes threatened patient safety, for example by causing surgical delays and the cancellation of hundreds of operations.

If a country like Britain -- which already has a national health system and is a fraction of the size of the US -- had so many problems with electronic health records, imagine the problems America would face. Here, instead of four companies competing for contracts, we have dozens of vendors -- most with proprietary software -- vying for billions in stimulus funds. It will be virtually impossible to make their products compatible, therefore not allowing all doctors in different offices to see the same patient's health information.

Even our partial adaption of electronic health records is causing problems. Over the last couple of years, doctors and hospitals have reported to the FDA dozens of medical injuries -- including six deaths and preventable heart attacks -- caused by problems related to computerized health records such as software errors and unreadable computer screens. Some errors resulted in drug doses that were 10 times higher than intended. FDA officials called this the "tip of the iceberg".

More than 50 medical organizations, including the AMA, have called on the Secretary of Health and Human Services to delay the program. In response, the administration delayed some of the required health IT functions, but kept the same 2014 deadline.

How do we avoid the UK's failure? The administration or Congress should slow down the program and delete those parts of the legislation that fine doctors for not using this technology. There's no need to have this system in place by 2014. Instead, we should conduct rigorous studies of the cost-effectiveness of electronic health records systems before mandating their use. Rather than force doctors to choose from dozens of commercial software products developed in secret, we should take a hint from the non-commercial sector, such as the Veterans Administration, which uses "open-source" coding so people can work collaboratively to continuously improve the system.

The Obama administration wants government programs to be based on evidence of effectiveness. Simply following the lead of "IT believers" and salesmen without the requisite evidence will repeat the UK's failures. Now is the time to proceed carefully, consider existing research and the British experience, and chart a more rational course into the digital age of medicine.

Stephen B. Soumerai is Professor of Population Medicine at Harvard Medical School. Anthony Avery is Professor of Primary Care at the University of Nottingham Medical School, UK.

eric seiger do

Wednesday, December 1, 2010

Making Money Program

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