Federal Deadline Hobbling eHealth IT Rollout 99
Lucas123 writes "A federal deadline that begins next year and requires hospitals to prove they're meaningfully using electronic health records will lead to technical problems and data errors affecting patient care, say politicians and top IT professionals responsible for the deployments. Physicians and hospitals have until the end of 2011 to receive the maximum federal incentive monies to deploy the technology. If not deployed by 2015, they face penalties through cuts in Medicare reimbursements. 'I think we have nontechnology people making decisions about technology,' said Gregg Veltri, CIO at Denver Health. 'I wonder if anybody understands the reality of IT systems and how complex they are, especially when they're integrated together. You're going to sacrifice quality if you increase the speed [of the rollout].'"
Fast, Good, Cheap, pick 2... (Score:4, Insightful)
Slow, Bad, Expensive, pick 1...
-Rick
Re:Fast, Good, Cheap, pick 2... (Score:4, Insightful)
We're talking about the US Federal Government here. In particular, the CMMS (Center for Medicare and Medicaid Security)
You get all three.
Re:Fast, Good, Cheap, pick 2... (Score:5, Insightful)
We're talking about the US Federal Government here. In particular, the CMMS (Center for Medicare and Medicaid Security). You get all three.
"Ggovernment is bad" sock puppet, we're talking about private-sector insurance here. CMMS has a fraction of the administrative costs of the private sector. I've worked at private insurance companies: the business processes and technology is frequently appalling.
Stop chanting the "privatization is good" mantra--some of those who grew up in the Reagan era (such as myself) and were diehard conservatives (such as myself) understand that sometimes, private industry is NOT the answer.
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In my experience the private sector can be just as awful as any government department. /and are "too big to fail")
There is a certain amount of selection bias since companies which are really really really bad choke on their own incompetence and fail.(unless they have political connections
Government departments are just less inclined to die when they're insanely inefficient and unproductive due to a money supply not based on productivity.
When it comes to government contracts there's little difference since a
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The private sector when working for the government can be every bit as bad if not worse than the government doing it in house.
I'm completely in agreement with you here (*cough* KBR *cough*). However, my point was specifically toward comparing and contrasting the performance of CMMS vs. private insurance (i.e., Blue Cross, United Healthcare, etc.).
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Fine and well, somebody has to do it and, as you point out, per patient administration costs are lower than most (but not all) private companies.
But if you have ever worked with anyone from the CMMS or their minions, the Third
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Rules that are are logically inconsistent, randomly applied and so voluminous that changing one thing requires ten committees, 4 years and numerous sacrifices of goats, virgins and cases of Diet Coke.
This is no different than private sector, with their "clinical edits" and other tactics to hope that someone simply doesn't resubmit the claim.
That said, it's only fair to mention that to try to reduce the claims process to a flowchart would be folly: this would assume that there's one right treatment path for
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"A federal deadline that begins next year and requires hospitals to prove they're meaningfully using electronic health records will lead to technical problems and data errors affecting patient care, say politicians and top IT professionals responsible for the deployments. Physicians
Re:Fast, Good, Cheap, pick 2... (Score:5, Insightful)
Because it's the private sector receiving that money to build an infrastructure that meets the government requirements.
Or to put it more simply:
* Government give money to hospital.
* Hospital supposed to use money to build computing infrastruture that makes medical records / insurance easier to process.
* Hospital say "five year deadline too fast; we too stupid/bureaucratic to build infrastructure. We need more time so that money can be hidden / wasted / embezzled."
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Actually, hospitals don't get the money until AFTER they show that they're using electronic records.
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In sort it works like every other giant IT project and we're still in phase 1.
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The problem with privatization is that it puts corporate profits ahead of the mission.
And unfortunately people have proven that if they can get away with cheating, they will do it. Look at all the money swallowed by the telecom industry.
That's one thing I like about government. It might be bureaucracy, but it's about as close to "interest in the common good" as we're ever going to get, seeing as the bureaucrats, at least in theory, still have to answer to the voters that put them in office. With corporat
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Stop chanting the "privatization is good" mantra--some of those who grew up in the Reagan era (such as myself) and were diehard conservatives (such as myself) understand that sometimes, private industry is NOT the answer.
While on the face your statement makes sense, are these organizations truly private in a classic sense? --> No, these organizations have exceptions from anti-trust law and are also highly regulated. Further, the barriers to entry in this market are huge.
Contrary to the propaganda spewed by republicans, other first world countries with "socialized" medicine are considerably more "privatized" than our backwards country.
After all, why is it that in many of these countries, individuals have more cho
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Medicare has lower administrative costs than private insurers when you compare percentages.
However, Medicare spends an awful lot per each insured. When you compare the amount of money spent per insured person,
Medicare doesn't look so great. If you really want to compare, you'd have to break down administrative costs into
buckets based on whether the costs scale with the number of insured and then compare those.
I'd also note that many of the costs that a private entity would incur show up on another departm
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Medicare has lower administrative costs than private insurers when you compare percentages.
However, Medicare spends an awful lot per each insured. When you compare the amount of money spent per insured person,
Medicare doesn't look so great. If you really want to compare, you'd have to break down administrative costs into
buckets based on whether the costs scale with the number of insured and then compare those.
Of note: when assessments of per-person costs are performed, it's critical to ensure that similar d
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Stop chanting the "privatization is good" mantra--some of those who grew up in the Reagan era (such as myself) and were diehard conservatives (such as myself) understand that sometimes, private industry is NOT the answer.
Then obviously you are NOT a diehard conservative. In fact, you're like most Republicans that get elected these days - you tell everyone you're a diehard conservative, but your vote betrays your words.
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It's "CMS". Somehow the Ms overlap or something.
http://www.cms.hhs.gov/ [hhs.gov]
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Slow, Bad, Expensive, pick 1...
-Rick
Why? I know lots of companies that do all three very well.
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Fast, Good, Cheap, pick 2...
We’re the government. We don’t need any of those. ;)
qip-pro-quo Re:Fast, Good, Cheap, pick 2... (Score:1)
Slow, Bad, Expensive, pick 1..., You get all three.
WooWoo, qip-pro-quo and more zombie-land dogma for US.
Excuses are all bullshit for US. "Slow, Bad, Expensive" and no insurance company wants to do the job for US without far more "Slow, Bad, Expensive" bullshit. .... How many more bullshit excuses for doing nothing, before we save US "The People" from more bullshit excuses.
"It is all to complicated," "It is all wrong," "It is too expensive," "It is bad,"
If bullshit excuses were around 65 years ago, German w
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Does hospital IT work pay well enough? (Score:2)
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For some uses yes it's choke full of niche medical equipment and other lucrative business. But if you start talking about standardization and using common tools, then you have to start herding cats. If you ask a doctor to draw the organization chart they are often the senior medical expertize on this area with them on top and the management hierarchy is just the overhead coordinating the medical units. Even with the exchange of skills they aren't working on any true collaboration, most of the time it's one
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Keep in mind that the developers are not generally working for the hospitals, they are working for the software vendors. The vendors are where the real time and resources crunch is. It takes months (sometimes years) to convert a hospital over to a completely new system, and they are likely limited by staff and other resources as to how many hospitals they can bring up at one time. Any individual hospital has plenty of time, but from the vendors perspective it's dozens, possibly hundreds of hospitals they
Politicians playing the King! (Score:1, Insightful)
This is the same as the political push for the CFL light bulbs. Non technology people dictating the technology sector. Obama does not have an ounce of knowledge about health care systems, yet thinks he knows everything that should be done. It's a farce.
Side note: Jesus told the people they absolutly did not want a King, yet the people wanted to blindly follow and appointed a King anyway. So, here is your King Obama, shortly to dictate Intel manfucaturing numbers because it effects "the environme
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One of those know-nothing politicians challenged the US to get to the moon in 10 years. The job got done. Of course, insisting that a hospital somehow manage to make the necessary change to electronic record-keeping in 5 years (when anybody with an ounce of sense has known the change was coming for at least that long already) is impossible.
Give me a break!
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Good analysis. I hope you don't mind if I make a couple of observations. First, it should be pretty easy to come up with a basic list of things that need to be tracked at EVERY hospital, then gradually extend the list over time. There's some Palm software for nurses that has the concept on a very simple level.
For the sake of argument, put blood work first. There's a pretty standard set of tests that are run everywhere when somebody presents with certain symptoms. A second possibility would be standa
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You are right! The president of the united states actually writes all these rules and bills. Unlike every president before him, that relied on advisers and people with intimate knowledge of subjects, this president does everything himself. Hell, this president even goes one step further, and skips the whole legislative branch of government, and writes, votes, and enacts legislation and policies on his own!
Seriously, your a trolling idiot.
Take a basic civics class. Please. I beg you! Or at least do ever
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shortly to dictate Intel manfucaturing numbers because it effects "the environment".
I'm waiting with baited breath. Mr. AC do you know nothing about business, politics, organizations or societies? Ideas guide work, rarely do the people who come up with the ideas, or even the ones that push them get work done. Even more rare is when they do the work themselves. The only idea-men in our economy that actually know how to get work done and come up with the work that needs to be done are the entrepreneurs. The financial incentives (did I forget to mention economics) mentioned in TFA provi
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Urban Health Initiative [suntimes.com]
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Side note: Jesus told the people they absolutly did not want a King, yet the people wanted to blindly follow and appointed a King anyway.
Side note: Nobody on Slashdot cares about your invisible friends.
Bah... (Score:4, Funny)
It's not like anything bad's ever happened when critical systems are rolled-out untested [zdnet.com], unprepared [itdisasters.com], or irresposibly [baselinemag.com].
I mean it's not like someone's life [novinite.com] is ever put in jeaopardy by minor software glitches, especially in hospitals [drexel.edu]. ...on a side note, Googling "IT disasters" leads to some very interesting results.
-Matt
On the flip side (Score:5, Insightful)
On the other hand, look at the digital TV transition debacle.
If you don't set a deadline and enforce it, difficult technology implementations tend to drag on forever.
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Yeah, but it's not like people were going by pushing out digital television faster. There are already a substantial number of reports indicating drugs are being incorrectly dosed due to system errors related to EHRs.
It's not like we don't have tons of human error and problems with lost or incorrect paperwork anyway. Maybe we replace one set of problems with another, but the new tech has the ability to be improved upon constantly, which is how very complex systems tend to be done anyway.
That said, from what I've read about these EMR systems, they range from pretty horrible to decently good. They take years of work to get the most serious bugs out. How much they actually do to improve patient care varies dramaticall
The clear solution... (Score:4, Insightful)
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Or maybe the government should just let healthcare professionals decide how much IT can improve the care they give. Why do we need this government mandated health database?
This is really a nonsequitur to my original point. The fact is the mandate has been given. It doesnt matter if it came from the Government or the CEO. The CIO here is still responsible for making it happen. His claim that it won't be ready may be true, but why not? what fall-back functionality CAN be provided?
Maybe the CIO should just accept that he's not going to get the MAXIMUM incentive payment the Government is willing to hand out in order to get this done.
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Because if I have a medical problem in New York at night there's almost zero chance of a doctor there knowing that I'm allergic to penicillin-based drugs because that information is only on paper files in my doctor in California's office and he is only available 9-4:30 PST. No, I don't have a Medic-Alert bracelet - I shouldn't need one. That information should be available to emergency personnel anywhere I am at any time and a goverment-mandated dat
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That information should be available to emergency personnel anywhere I am at any time and a goverment-mandated database is the only way this is likely to happen.
So, we should all give up our medical privacy so that you don't have to be inconvenienced by wearing a Medic-Alert bracelet?
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In my experience it's usually management that demands the impossible (with often very vague ideas about what the final product should be), and IT that tells them it won't happen, but are forced to do it anyway.
This guy is the CIO. He is management.
A lot of hospitals already have e-records (Score:4, Insightful)
i know people that work in the medical field and a lot of hospitals already have electronic charts. people i know have worked with them for years. going back to 2005 or earlier as far as i can remember.
I bet this is another case of the leftovers crying about investing money in infrastructure that will save them money in the long run but they see it as an expense and fight it. just like the genius MBA's at Dell and HP who concentrated on volume and tight margins while Apple went the opposite direction. Now Mac sales are growing by double digits, profits are rolling in from boring things like computer sales, the prices compared to higher end Dell/HP computers are comparable on the same specs most of the time, and Apple has a much better brand name. And they don't have Asus and Acer taking away their market share
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It might also be some of these organizations that have part of their records done electronically, but not all that the government requires or that don't have proper linkages between their clinical and billing systems. There are often separate (and, in merged organizations, several) vendors for scheduling, EMR, lab, prescribing, and billing all working "together" with different amounts of integration.
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Intermountain Healthcare had electronic medical records in the 1980s, used the data gathered from the system to improve their medical practices, improve patient outcomes and reduce costs.
http://www.longwoods.com/product.php?productid=20146&cat=571&page=1 [longwoods.com]
Their system was chosen as one of 5 to be studied by a Canadian Quality by Design process improvement team, and one of the 'few small exceptions' in the Congressional Budget Office report that eHealth records don't reduce healthcare costs. The others
The Flip Side (Score:5, Interesting)
Clearly there are a lot of people here posting about how the government should not be getting involved and that seems to be the bias of both the article and summary. Allow me to go into some personal experience here though. As someone who has been very ill, lack of standardized medical records and the inability of various hospitals to transfer digital copies of video and images resulted in my spending another month or so of my life in a state I would not wish upon anyone. Right now a very good friend of mine works in healthcare and they have been (I shit you not) writing down patient information on recipe cards as the one and only method of storing drug prescription info. This resulted in, by her count, several hundred patients not getting needed insulin, antipsychotics, and other drugs as a result of numerous ordering errors that were never caught and were impossible to search for. So when people say digitizing medical records in a standard fashion is going to result in problems for patients... well not doing it is resulting in the very same.
I'm not big on government interference with many parts of our lives, but they are addressing a very real problem and they're doing it with kid gloves. They did not pass regulations requiring hospitals to comply, they just tied federal funding to that compliance and gave the hospitals many years in which to get their shit together. If medical providers have not done so and are rushing about now, that is absolutely not the fault of the feds.
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Congress doesn't have the Constitutional authority to directly require this of local hospitals and physicians...
How is it any different that HIPA from constitutional standpoint?
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I work in healthcare and my opinion here doesn't necessarily reflect my employer's. That disclaimer aside, I feel for you. I sincerely hope your situation has improved. I will offer one counterpoint, though. If your friend's practice couldn't get it together well enough to store prescriptions in Word, Excel, Access, or even Notepad, should we have any hope that they will be able to participate meaningfully in a fully transactionalized data transfer system without error or confusion?
I don't advocate doin
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If your friend's practice couldn't get it together well enough to store prescriptions in Word, Excel, Access, or even Notepad, should we have any hope that they will be able to participate meaningfully in a fully transactionalized data transfer system without error or confusion?
Yes, because while the employees will never change without being motivated, the corporate headquarters will mandate change and hire some experts to implement a system if they see both a chunk of change from the feds to more than pay for it and they see a threat to their medicare payment revenue if they don't make the change in the long term. A bunch of aged secretarial types will never upgrade anything on their own. They will, in fact, resist change. When management tells them a new system is being put in,
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Actually...one of the dirty little secrets here is that the final r
Upgrading in the middle of a recession (Score:2)
It's the Fed's money, they don't have to take it. (Score:2, Insightful)
Is there something I'm missing? It seems like the deadline is for applying to receive "federal incentive monies" to roll out the new technology. If they're not rolling out the new technology, then they shouldn't be applying for the money. If they are rolling out the technology, then send in the application for free money.
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Of course your missing something - you're posting on Slashdot...
The issues within the issue is something like this:
- Systemic EHR's (ones that do something potentially useful) are very
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It's more than a carrot, there is also quite a large stick attached to this.
All ER/EDs treat any patient that comes in, regardless of insurance. They report to and receive money from Medicare based on treatment of these uninsured patients. If you do not meet the new standards set forth, the money you receive from Medicare will be drastically cut. For large city hospitals this is simply not an option.
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Along comes Uncle Sugar dangling a carrot. A nice sweet carrot. But Uncle has lots of sticks, thorns, belts and various other nasty gizmos hidden under the blanket. And he moves the toys randomly. Your job is to get the carrot without getting the various shafts. That's hard because of many reasons. For one, they are pushing a very aggressive timeline. For another it's not really clear what the carrot actually consists of or how strong the string is.
That's an impressive way of not saying anything meaningful. Why is the timeline considered so aggressive? WTF does any of the rest of that even mean in reality? If some hospital systems are making it and others aren't, why is that? Why aren't smaller hospitals and hospital groups working together on this or working with bigger hospitals? This stuff has been coming for a long time now. What exactly is unclear about the incentives or penalties or the requ
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Sorry, take two Pintos and call me in the morning.
Thank you. I'm running for office in November. I consider this a compliment.
The government is in a bit of a bind. You can't let these things go on forever or nothing will happen. In the current political climate, rationale thinking and long range planning just don't seem feasible. We can't even set p
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Many are, but there are numerous small hospitals that for one reason or another are left out. Perhaps 30-50% (number made up on the spot, likely to be fairly close). Why they can't work amongst themselves is another question, but it hasn't happened.
I'd like to know why that is. Seems like they should be working together at the very least to ensure that data could be exchanged in some openly defined formats.
Actually if you RTFA you get a pretty good idea of the big picture. I understand your reluctance in this issue, but trust me. The CIO of Denver Health is pretty sharp and actually Denver Health is one of the more functional entities in this game.
Yeah, I read it. Seems to me that a lot of the hospitals and doctors that got started on this ahead of others will have the best shot at the earlier, larger amounts of money for compliance. I don't see a problem with that. The others have several years still to get their systems in place. I don't think we can expect the government to pick up th
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That doesn't really seem to be the problem. The data set is there for small hospitals as much as it is for the big boys. The big problem for little places is that apparently there isn't any money in it. There are few vendors that deal in the small hospital space and the ones that do are pretty anemic. Since there are so many smaller institutions
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The whole thing is ridiculous. (Score:1, Insightful)
First off, only in the health care industry - which is insulated from almost any market pressure - would you have to have the government fund such a basic infrastructural system. All these companies/doctors have to do is sit back, rake in the profits, and wait for the government to improve their basic tools of business for them. It's bullshit - why should I have to pay for this as a taxpayer? Banks seem to have figured out how to do monetary transactions just fine on their own, why couldn't there be a visa
Interoperability (Score:2, Informative)
That's the biggest problem I've seen.
There's no real e-standard for e-medical records.
This is mainly from friends with knowledge of Meditech and Epic, some of them from HIMSS level 6 institutions (it only goes to 7).
The systems might be able to talk to others of the same type (maybe, sometimes they don't), but so far, there's no real "medical record standard" that everyone can read.
Another added problem is actually DOING the e-record...
History, documentation, orders, verifying meds,,,
I've heard of widely va
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In my experience as a healthcare interface (hl7) guy at a small hospital, there are. According to a link in TFA that points to a summary on healthit.hhs.gov :
The adopted standards rely heavily on existing standards for the interoperability of health information technologies, including those established and/or promoted by Health Level 7, Inc. (HL7), the National Institute of Standards and Technology (NIST), and Integrating the Healthcare Enterprise (IHE). The standards also rely on existing classification
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Mod this guy up, VERY informative.
The systems named are indeed standards, it's usually the implementation that leaves much to be desired (vendor's fault most of the time).
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This is mainly from friends with knowledge of Meditech and Epic, some of them from HIMSS level 6 institutions (it only goes to 7).
There's your problem. Make it go to 11, and it'll kick ass.
EMR Integration and Developer Pay (Score:4, Informative)
After reading the posts here I felt compelled to respond to several points raised:
1. "Great software developers entering the field today aspire to work on pop culture technology like Facebook, Google, and CG animated film production. Who does that leave to work on hospital IT? Does hospital IT pay well enough to compete with the sexy IT jobs?"
Yes. It pays quite well and with federal dollars flowing there is a HUGE push to implement and integrate EMR technology. There are development gigs that pay more, but not a lot more (in either number of open positions or dollars).
2. "Non technology people dictating the technology sector. Obama does not have an ounce of knowledge about health care systems, yet thinks he knows everything that should be done. It's a farce."
True - Obama doesn't know about health care systems - Nor does he need to. "He" is not dictating the "how" just the "what". That seems appropriate for the Federal Government. In terms of actual Federal input - it's pretty minimal - maybe even more minimal than desired. They are certainly driving the industry in a good way (towards integrated health records) - but have not even specified format or protocol - much less the "single repository" that so many are afraid of. The private sector - rightly or wrongly - has standardized on HL7 (v2 mostly from what I've seen - too bad really - v3 is XML while v2 is a bit arcane - pipe ("|") and carat ("^") delimited).
3. Deadline : Plain and simple, without a deadline the industry would easily take another 20 years to get fully automated.
4. "I bet this is another case of the leftovers crying about investing money in infrastructure that will save them money in the long run but they see it as an expense and fight it."
Because of the stimulus package no one is fighting it. On the contrary - any given EMR is now reporting a six month backlog to integrate.
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Working in Healthcare IT and actually on an EMR project for a fairly prominent hospital I'd like to comment on a few of your points:
1) There is HUGE need for developers but budget concerns are a real problem, the stimulus money is years away but the cost of implementation is immediate. This creates a real problem, the need is there but the budget isn't and the timeframe for implementation doesn't leave much room to adjust the budget to open new positions without cutting into development time.
2) I'm going t
1 Billion Dollars (Score:1)
WASHINGTON, DC - Health and Human Services Secretary Kathleen Sebelius and Labor Secretary Hilda Solis today announced a total of nearly $1 billion in Recovery Act awards to help health care providers advance the adoption and meaningful use of health information technology (IT) and train workers for the health care jobs of the future. The awards will help make health IT available to over 100,000 hospitals and primary care physicians by 2014 and train thousands of people for careers in health care and information technology. This Recovery Act investment will help grow the emerging health IT industry which is expected to support tens of thousands of jobs ranging from nurses and pharmacy techs to IT technicians and trainers.
http://www.hhs.gov/news/press/2010pres/02/20100212a.html [hhs.gov]
Seems to me that regardless of any deadline, the Feds are making every effort to provide the financial assistance necessary to all types of health care providers so that Health Information Exchanges can be stood up and make electronic health records more available and their use more efficient.
"No duh!" moment (Score:2)
Yes. Yes, we do. Frequently.