nielsennewswire

March 2009

 Babylonian Lessons: Healthy Information Technology and The ARRA

There has been a lot of attention in the media recently regarding the passage of the ARRA stimulus plan in regards to two major cost items, Health Information Technology (HIT) and Comparative Effectiveness Research (CER) 

The Senate Finance Committee released for public use a number of Qs & A’s which were inadequate to deal with these issues. Those who simply brush off the very real problem of the government overseeing the development and implementation of HIT is a gross error in my opinion. So lets’ look at the HIT issue first and deal with Comparative Effectiveness Research in a separate commentary. 

There is a lesson in the Old Testament in regards to the building of the tower of Babel. In so much as God was angry with the people of Babylonia, he caused them all to speak different languages during the building of their monument. Consequently the tower couldn’t be built. Confusion and disarray resulted from the language mess.  A poor analogy to today’s HIT status, but in many ways, not that far off. 

CONFLICTING PRIORITIES

Today’s equivalent are the many technologies and more specifically, programs that make up HIT. Each provider of HIT uses a proprietary system, so a perfectly workable program for a chain of 15 hospitals may not be compatible with the Center for Medicare/Medicaid Services CMS for billing purposes, or with physicians’ offices for the exchange of critical patient information. Everyone is on their own system. There are conflicting proprietary interests and billions of dollars at stake. Everyone thinks they have the best answer. Everyone is speaking a different language and using different computer systems in their own worlds.

The result, according to authors Carol Diamond and Clay Shirky writing in Health Affairs in the August 18th 2008 issue…Health Information Technology…A few years of magical thinking..is that health planners must stop the magical thinking that HIT is going to improve health care.  There is simply no evidence to support that by pouring Billions of dollars into this field the US will save any money, let alone improve care.

REFORM HEALTH CARE FIRST

What seems like an intuitively good idea, i.e. computerizing records and data, is only part of the solution to our health care problems. What is needed of course is a major reform in the way health care is delivered and how it is financed. Simply working on IT does nothing to solve the underlying problems with our health care system.

One of the most critical errors made by many is that they seem willing to accept that the government as a perfectly harmless entity to carry out the mission of building and implementing HIT.  Nothing could be further from the truth.  What if the government developed the Internet?  Would it be as free and open as it is today?  I am sure politicians would have figured out a way to put a fee on each e-mail or web visit as is often the subject of unsubstantiated web folk lore.

OPEN SOURCE SOFTWARE

The HIT system that we do need and can benefit from must come from private enterprise working on open source software that is free to all wish to use it.  The second consideration must involve control of key standards by a non-profit board comprised of HIT specialists, physicians, hospitals, the pharmacy industry, government representatives, and most importantly, CONSUMERS.  Consumers should be the focus of the entire system and have complete ownership and control of all their Electronic Medical Records (EMR) or what is often referred to as Personal Health Information or PHI.  Without the strictest of systems built by a non-governmental agency, people will be reluctant to engage new government sponsored technologies that post and track personal information.

The nature of a government designed HIT system seem clearly nothing more than a method to pursue ownership of the entire health care delivery and payment system.  Once the Federal Government has forced all the medical providers into their system of HIT, it is only a matter of time before they will control what doctors and hospitals do, or put more clearly, they will control what health care you and I receive.

I hope that those who support the Obama administrations’ incursion into this arena  will step back from the precipice on this issue and get into the problems that are related to health care first such as how to serve more people at a lower cost, how to keep access to health care open and fluid, and how to keep Americans covered by the private insurance plan of their choice.

Kirby V. Nielsen, M.A. CLU

Delaware, Ohio

knielsen@insight.rr.com