Monday, July 28, 2008

With HIPAA, why don't doctors automate their records? Would generate jobs

Back in August 2002, eight months after my layoff, I got a call about a job in Richmond with a PPO that I think was called First Health. It was supposed to be a contract bringing their systems up to standard for HIPAA (Health Insurance Portability and Accountability Act of 1996, text here), for a phase which at the time was to start going into effect in 2003. I didn’t hear anything until almost Thanksgiving, when I had a phone screening, did not do particularly well, and did not get the job (as I had move on to something else and lost interest). But the episode sticks in my mind.

I also had an interview for a contract at a pharmacy information services company, Express Scripts, in Bloomington MN, on Sept. 11, 2002 (yes, an ironic day). Again, the company didn’t quite have the authorization to hire, and it fell through. But the need that the project could have addressed was keeping track of prescription complex medication schedules for many patients at home.

Today, I was in a doctor’s office, and watched the doctor go through paper charts about eight inches thick, to follow treatment and prescriptions back for a number of years. I wondered, why doesn’t he go to a computer screen and pull it up. Hospitals do.

Then I though about what happened when I moved back to Arlington from Minnesota in 2003. In 2004, I had interviewed for a job as a letter carrier at the USPS and was about to be hired. There were concerns about the acetabular hip fracture that I had incurred in a convenience store in Minneapolis in 1998. After a year of requests, the records from the surgery had never arrived and been placed in the chart. It was impossible to be hired.

Now, I wonder, twelve years after HIPAA, why are doctors working this way? And why do patients under Medicare go to multiple specialists with no automated system for checking for medication conflicts? This is crazy. How much is this lack of automation, here in 2008 costing? It should be a closed application, mainframe centered, fully secured, not available to the Internet. But doctors should have a system like this.

Oddly, the best effort around seems to come from a leading Internet company. Google Health has started its “preseason” at the Cleveland Clinic, according to a New York Time story by Steve Lohr on Feb. 18, 2008, link here. Doctors that I talk to seem to know nothing about

Curiously, the classic IMS mainframe textbook by Dan Kapp and Joseph F. Leben, "IMS Programming Techniques: A Guide to Using DL/I" (1978, Van Nostrand)uses a hospital database as its sample application. And from 1979-1981, I worked for a Blue Cross and Blue Shield Consortium in Dallas (CABCO) that was supposed to come up with the state of the art Medicare processing system. The project failed because of turf protection and political infighting among the plans. (No, "it wasn't my fault." Some of the plans would run back to EDS as fast as "their little legs would take them.") In my next job, a coworker actually piddled with the idea of a medical system on his home Radio Shack, pre-Internet by many years. It doesn't seem that we've progressed much in 25 years.

Welcome to the health care reform debate, McCain and Obama.

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