Monday, March 08, 2010
For My Sins...
After much research, which I am now writing up, I must sorrowfully return tomorrow to discuss the very penitential situation with him. The Chief had suggested that I not spoil SuperDoc's weekend by giving him the bad news on Saturday, since the weather had turned.
ARRA (stimulus bill last year) mandated stuff to do with electronic health records. The theory is that doctors and hospitals will get payments based on meaningful use of EHRs meeting the standard. It all sounds so wonderful, as in this industry coverage of a speech:
Dr. David Blumenthal introduced himself to the IT community yesterday in a talk in which he told the story of his first experiences using health IT and shared his convictions about its future.It was at that point that I cracked and started hurling epithets at the screen. There is nothing patienty-North Star-ish about what is going on, and in fact, one of the main problems is that the regs governing this "complicated", "difficult", "diverse" "unprecedented ambition" which is also an "experiment" have not in fact been written yet.
Speaking to a crowd of thousands for a keynote address at the Health Information and Management Systems Society annual conference, he had the tone of a gracious outsider in the IT community.
“As long we keep the patient as our North Star we will not go astray,” he said.
In giving the history of this first 10 months in the job, Blumenthal reminded the crowd they were involved an experiment that had no equal in the history of healthcare, “or any other industry,” he said.
“It’s a huge and unprecedented ambition,” he said. “No one in the history of healthcare has tried to do something as complicated and difficult and in such a large diverse country with the kind of independence of spirit and professional autonomy that we have."
Of the “meaningful use” plan, he was as positive: “This is the first time I believe anyone has laid out in black and white what it should expect of a modern electronic health care system.”
Any of you who have been involved with this sort of thing realize that conforming to a standard which has not yet been explicated is extraordinarily difficult and promises to be extraordinarily expensive. After a lot of time and money, failure is almost guaranteed. That is why anyone who has a successful track record in IT flees from such projects as if harpies were devouring their entrails. Those of you who have no background in such matters and wish an independent opinion might do well to ask Snarky Mark, who does have this background, and can think. Also see this excellent post at Photon Courier reviewing another grand governmental initiative based on "radical ambitiousness" that just did not work.
This experiment is all the more worrisome because no one has worried about the inherent RISKS of these systems. But they exist. Anybody who gave this half a thought would realize that a hasty adoption of such systems would magnify those risks. But that is our plan.
Word has it that Joseph Heller's "Catch 22" was heavily consulted by those who have been hired by the government to write the regulations and, well, just supervise and makes speeches in a leisurely fashion while collecting healthy and satisfying salaries with excellent health benefits. Dr. David Blumenthal was hired as the National Coordinator for Health Information Technology by President Obama. Bio.He has all the qualifications - including a complete lack of understanding of actual IT, costs, etc. In short, no idea of what is achievable, and the glorious academically accumulated indifference to believe that practical limitations don't matter.
I will later post some of what I am writing up for SuperDoc. I can embed the links and it will be a useful resource later for me, since I am probably going to be spending many gloomy hours hanging out at the health regulatory websites over the next few months.
This wouldn't be so bad if it were possible to conform to the law itself through common-sense best practices, but the law appears to prohibit said common-sense best practices. It's just good d**n luck that no camera-hound District Attorney has decided to make an "example" of some random small-business operator.
I really, truly, don't think they care anymore what effect their laws have outside the DC cocktail party circuit. To the extent they do care, I think they welcome the chaos for the power it brings them. And note that this law was a bi-partisan effort, hardly anybody voted against it. This kind of stuff is why there's Tea Parties, and why the Tea Partiers don't care which party attends their concerns, just that at least one does.
Any of you who have been involved with this sort of thing realize that conforming to a standard which has not yet been explicated is extraordinarily difficult and promises to be extraordinarily expensive. After a lot of time and money, failure is almost guaranteed. That is why anyone who has a successful track record in IT flees from such projects as if harpies were devouring their entrails.
I nearly posted a very long rant here about the importance of standards. It became so long that I put it on my blog instead.
"Advanced Automation System"
Oh my. I'm reminded of yet another story. One programmer managed to convince management to let him work on "Generic AI". He had them convinced that artificial intelligence could be black boxed and all our products could use it.
I just wanted to know the answer to one question. Would it be smart enough to snipe me with a sniper rifle AND beat me at chess? If so, maybe I was obsolete. Maybe it could program games instead of me, lol.
I can imagine that there might be some *core* AI functions which would be useful both for sniping and for chess IF there was a lot of domain-specific software wrapped around them. But it sounds like the guy you mention had something much more galactic in mind...
Congress is a decent Generic AI simulator in my opinion.
1. Every decision takes a really long time.
Can you imagine what it would be like to play Congress in a game of chess?
"We're getting nothing done. Let's try a new approach. First we'll vote on which piece to move and then we'll vote on where to move it. And no more filibusters!"
Later that day...
"I would be willing to move your state's horse out of harm's way this turn if we could later move my state's bishop out of harm's way next turn."
So Congress passed this bold wonderful new law and patted themselves on the back for how bold and wonderful they were in leading the country into a new era of safety. Oh, and they gave the CPSC and the entire nation six months to work out all the details and implement them (which as everyone knows is a far shorter length of time than the retail cycle). At the same time as retail was in a slump. Oh, and a court decision made it retroactively illegal to sell any soft plastic stuff that hadn't been tested for phthalates, four days before the deadline. And by the way, Congress also passed two other major laws (one of which required some ungodly proportion of the nation's swimming pools to be inspected by the CPSC) that were also to be implemented by CPSC in the same six month time window. Which CPSC also had to work out all the details of. Based on "peer-reviewed science" of course. 'Cause that stuff just grows on trees! Oh, and they promised CPSC a budget increase, but it wasn't going to happen just yet. In a recession, natch.
Result: nobody knew what the hell was going on with CPSIA compliance. Some people went out of business because they couldn't afford what they thought they'd have to do to comply. Others did stuff that turned out later to be a waste of money. People argued about whether CPSC would require permanent tracking labels to be affixed to children's post earrings and how to properly label a set of marbles and whether clothes with rhinestones could be resold at thrift shops. I kid you not. Children's boutiques and resale shops were being very cautious about what they bought, which meant that those of us who supply these things were getting very poor. Some retailers (Burlington Coat Factory, I'm looking at YOU) were asking for retroactive proof of lead testing on everything their vendors had sold to them for years before the law was even conceived and threatening to charge them if such proof was not forthcoming. Many of my friends went out of business entirely because they couldn't survive the chaos this law unnecessarily imposed with its short time frame. Vintage children's books, whose inks stand a remote chance of containing enough lead to be dangerous should a child decide to eat his entire bookshelf, were thrown out by the boxful lest their sale bring the wrath of government down upon them.
I don't like this new trend of Congress waving their magic wands around and declaring It Shall Be So, All You Peons Work Out The Details.
What winds up happening is people who take pride in doing a good job abandon these projects as fast as they can. That leaves the project staffed with nothing but people who really don't give a damn.
Way better than the others
Honestly, that's what propelled me into the Tea Party movement. You can't have a system of representative government that's designed to completely ignore the voice of the people.
I can just see how much the general public is going to love to be standing at the doctors office waiting on a computer to respond because of all of the overhead of the unknown regulations that have to be applied to their medical information. That is going to be one pissed of North Star. It's already bad enough waiting on the doc at the office let alone their computer system.
And, what docs office can afford to properly set up servers and network and staff to support this ambitious experiment? Can you imagine what would happen if the app that hold the EHR's breaks or is broken into? You have no idea how open some medical records are because vendors do not think about what they are doing. And making something like that secure??...you must be kidding!!!! Who at a doc's office is going to maintain security and make sure that their data is not stolen? How about proper backups and redundancy of these systems?
Just thinking about this makes me want to break out the Jack Daniels to dull the madness. These kinds of projects\experiments with no direction are the kiss of death. No IT person worth anything wants to be a part of one.
-- Army Mom
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