Why We Will Not See Widespread Electronic Medical Records Soon

There are many reasons why use of electronic medical records remains rare in small physician practices. Many are buggy and do not meaningfully correspond to how physicians work. Another problem is communication between programs. It defeats the purpose if I purchase a system for medical records which does not interface well with my billing program, the equipment in my lab, or with systems in use by others.  The biggest problem is the cost. I saw a hopeful headline at The Wall Street Journal on Sam’s Club planning to offer a “low cost” system for small physician groups. My interest dropped as I read the article:

The system, expected to be available at the clubs in the spring, will cost $25,000 for the first installed system, and $10,000 for each additional system, plus $4,000 to $5,000 a year in maintenance costs.

The more complex systems cost about $40,000 for the first installation in a small physician group, said Kent Gale, founder of Klas Enterprises LLC, a research company for health-care technology.

They also note the difficulties in establishing such systems:

Adaptation of these systems hasn’t been widespread because of their cost and complexity, said Mr. Gale. “The easiest part is picking the hardware, loading the software, and walking the staff through training,” Mr. Gale added. “The hard part is connecting electronically to labs, pharmacies and image centers. It so complex, it is hard to imagine.”

This is the inexpensive alternative to what we have now?!!  The hardest part will be getting doctors to spend this much money when reimbursements are already dropping. Some components are actually in place at present, but each is separate from the others. I can obtain lab results electronically from the two labs I use the most for lab not run in my office. I can view x-rays on line from the hospital where the majority of the x-rays I order are performed. I can send in prescriptions on line. The problem is that each of these systems is totally independent and does not communicate with the other systems. I also have a totally separate system for billing, and another system set up in WordPerfect to handle  office notes and consults.

On top of all of this, there’s yet another computer system which is used to track information for incentive payments from insurance companies. This has limited communication with some of the other systems (but nothing in my office) and winds up generating tons of inaccurate information. At present I’m holding off on adding information into the system as, besides other flaws in the system, the staff time involved in correcting all the bad data and entering new data will cost me far more than any incentive payments for reporting the information. This doesn’t include data for Medicare incentive payments which I submitted through yet another system.

Hopefully readers are totally confused and bewildered by all of this. If so, you will have a feeling for where we now stand with regards to medical information systems.

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Seymour Hersh Accuses Dick Cheney Of Running Assassination Ring

Raw Story reports that Seymour Hersh has accused Dick Cheney of running an assassination ring:

Investigative reporter Seymour Hersh dropped a bombshell on Tuesday when he told an audience at the University of Minnesota that the military was running an “executive assassination ring” throughout the Bush years which reported directly to former Vice President Dick Cheney.

The remark came out seemingly inadvertently when Hersh was asked by the moderator of a public discussion of “America’s Constitutional Crisis” whether abuses of executive power, like those which occurred under Richard Nixon, continue to this day.

Hersh replied, “After 9/11, I haven’t written about this yet, but the Central Intelligence Agency was very deeply involved in domestic activities against people they thought to be enemies of the state. Without any legal authority for it. They haven’t been called on it yet.”

Hersh then went on to describe a second area of extra-legal operations: the Joint Special Operations Command. “It is a special wing of our special operations community that is set up independently,” he explained. “They do not report to anybody, except in the Bush-Cheney days, they reported directly to the Cheney office. … Congress has no oversight of it.”

“It’s an executive assassination ring essentially, and it’s been going on and on and on,” Hersh stated. “Under President Bush’s authority, they’ve been going into countries, not talking to the ambassador or the CIA station chief, and finding people on a list and executing them and leaving. That’s been going on, in the name of all of us.”

Lex Luthor Requests Bailout

The above video shows Jon Hamm of Madmen (and recently with a guest role on 30 Rock) portraying Lex Luthor requesting a government bailout.

Bristol Palin and Levi Johnston Break Up

If you were waiting for the big wedding this summer, I have bad news. In the least surprising news of the year to date, E! Online reports that Bristol Palin and Levi Johnston have broken up:

Bristol Palin and Levi Johnston are both single parents now.

The young couple, who welcomed son Tripp Easton Mitchell Johnston two months ago, have gone their separate ways.

Rumors had been swirling, and Johnston, 19, finally confirmed Wednesday that they have been broken up for a while.

After being thrust into the national spotlight last summer, Johnston and Palin, the eldest daughter of former vice presidential candidate Sarah Palin, had said they were planning to marry this summer after she finished high school.

They have been broken up for a while? I wonder if the break up date was November 5, 2008, once they no longer needed to stick together for the sake appearances before the election.

Update: Radar on Line has more:

Sarah Palin‘s 18-year-old daughter Bristol has reportedly broken off her engagement with Levi Johnston, the father of her 2-month-old son Tripp. It’s surprising because in an interview just last month with FOX’s Gretta Van Susteren, Bristol said the 19-year-old Levi is a hands-on dad and that they planned on marrying after finishing their education.

But in a new interview with Star Magazine, Levi’s sister Mercede Johnston says Bristol actually broke up with Levi more than a month ago, is not attending school and rarely lets her baby daddy see their young son. Mercede also says Bristol even told him that she hates him and, when she learned she was pregnant, wished the baby wasn’t his.

Mercede told Star: “Bristol’s just crazy. That’s the nicest way I can put it. She and Levi actually broke up a while ago!”

Apparently, Levi is also far from being a hands-on dad. Said Mercede: “Levi tries to visit Tripp every single day, but Bristol makes it nearly impossible for him. She tells him he can’t take the baby to our house because she doesn’t want him around ‘white trash.’ She treats him so badly!”

Star Magazine adds:

The worst part, Mercede continues, is that the former vice presidential candidate supports Bristol’s treatment of Levi, 19. “I used to love Sarah,” Mercede says sadly. “But I’ve lost lots of respect for her.”

Ross Douthat To Replace Kristol On NY Times Op Ed Page

The New York Times has picked Ross Douthat to replace Bill Kristol as a weekly columnist. I previously noted that his name was one being mentioned, even if I did prefer someone more from the libertarian portion of the right.

Douthat is a considerable improvement over Kristol, even if I frequently disagree with his views. Douthat has noted that the Republicans are in trouble due to failure to address today’s issues. On the other hand his advice for the GOP would perpetuate their problems by continuing to embrace the archaic views of the social conservatives. At times he even managed to be as irrational as Kristol, such as when writing about eugenics.

I have commented on Douthat’s writing several times in the past and anticipate doing so even more in the future when writing for the opinion page of the nation’s premier newspaper. I expect that Douthat will provide far more material worthy of discussion. Even if I disagree with him, this will be a welcome change from Bill Kristol whose columns were often both factually inaccurate and composed of poorly reasoned arguments. There was little point in commenting on his material very often as simply pointing out the incoherence of his work would become tedious. At least I expect that Douthat will write material which is worthy of rebuttal (and hopefully there will sometimes be areas of agreement).

More Conservative Scare Tactics on Health Care Reform

When conservatives rewrite history, as they frequently seem to do, we will go directly from Clinton to Obama, with the two being responsible for all our problems. As I’ve noted previously, during the Bush years everything was Clinton’s fault. No matter what the problem, to conservatives it was inherited from Clinton and not Bush’s fault. Now conservatives are beginning to ignore the Republican domination of government the past several years, along with both programs and problems beginning in the Bush years, and blaming everything on Obama. This includes imaginary problems from improving health information technology.

There is little doubt that we will see expansion of government in certain areas during the Obama years (along as declines in government action in other areas). Conservatives are certain to ignore the fact that this is in response to problems which developed when the Republicans were in power, and that many of the examples of increased government they oppose began during the Bush years.

I’ve previously noted the scare tactics conservatives are using with regards to health information technology. Ezra Klein has another example from a highly inaccurate column by Amity Shlaes on the topic:

The administration seems almost to relish the sinister aspect of government-run health care. Otherwise it wouldn’t have created a position called “National Coordinator of Health Information Technology.” That’s a title worthy of Rhineheart, Neo’s boss, who tells him, “This company is one of the top software companies in the world because every single employee understands that they are part of a whole.”

Ezra responds:

This idea that the stimulus bill “created a position” called “National Coordinator of Health Information Technology” got its start in another Bloomberg column written by Betsy McCaughey. She called the National Coordinator of Health Information Technology a “new bureaucracy.”

But this just isn’t true. It’s not sort of true or arguably true or caught in arguments about the nature of truth. George W. Bush created the position of National Coordinator of Health Information Technology in 2004. Five years ago. The current director of the office is a Bush appointee by the name of Robert Kolodner. He has served there since 2006.

Shales’ column is packed with distortions. She began her column  by trying to compare health care reform to The Matrix. The comparison does not hold up at all, as Steve Benen discussed.

There are certainly arguments which might be raised against Obama’s proposals on health care reform. Medical information technology is not the panacea to increased costs, but it is also not a horror out of The Matrix. If only conservatives such as Shales could stick to the real issues as opposed to resorting to these scare tactics.

National Enquirer Reports John Edwards Confessed Paternity to Elizabeth

The National  Enquirer writes that John Edwards has confessed to Elizabeth that he is the father of Rielle Hunter’s baby. This was widely assumed after the affair was revealed but Edwards had denied paternity. The article states that Edwards made the admission under pressure from Hunter.

I hate to base a post on a single source, especially the Enquirer, but the paper did turn out to be right about their initial allegations regarding the affair.