[dahlek]

I'm for it in many aspects, but worry about the whole 'monitoring' aspects. Good reading anyhow tho:
http://healthcarereform.nejm.org/?p=2669&query=TOC
While I realize that this mite be viewed as 'political'? I think the aspect of who views computerized records {IF that actually happens} is key to some of us and our problems with doctors at times.
I just wonder IF we have any 'input' as to what's being put IN this stuff?
This seemed a somewhat balanced and professional source for comment. Ergo... IF it's zapped? So be it. Thanks all - j

[darlindeb25]

I disagree...this is just another way for govt to get their fingers into areas they do not belong. The cost of this is astronomical, and many small practices will be forced to close their doors. The business will have to hire an outside service to enter all this info onto computers, this has already been explained to them. If you have 25,000 charts, there is no way a small office can do this on their own. This is just one more step to taking over, and it will only hurt us, not help. This will cause more job losses, and will not improve the health industry.

[glenntaj]

I don't think that expanding the connectivity of physician's practices is inherently evil--certainly, there can be benefits in the sharing of info among specialists/facilities and the resultant collegiality and fresh points of view for difficult cases, and in trcking treatments and medications so that fewer potential cross-purpose prescriptions and downright medical errors are made.

The trick will be in who gets to see this stuff, what mechanisms are in place to correct errors, which have a habit of getting inexorably perpetuated in computerized systems, and perhaps most importantly, HOW CLOSELY these are perused. All the info in the world is useless if medical professionals, pressed for time and not institutionally pressured to consult it before making decisions, do not look at it closely in all treatment circumstances.

I'm not too worried about medical practices knowing the ins and outs of my conditions--I tend to tell them anyway. I do recognize the problems with insurance companies and employers getting a hold of this info in some circumstances, but I don't think the solution is not to have the info acccessible--I think it's to create regulation with real teeth in them to keep discriminatory decisions from being made based on the info. The current US health care bill provisions that would strike down existing condition clauses in policy granting are a step in the right direction in this realm, but there's a lot of other things that could be done, including passing a spate of individual protection/correction laws on the state level, and rigorously enforcing the ADA.

In the end, the objections to this that are couched in other language generally come down to money--how much does this cost to implement, how much does this cost to keep up accurately, how much does this cost to litigate when errors are there and mistakes are made. AND--will implementing this hurt the ability of doctors and insurance companies to make larger profits (which I think is the fundamental question behind ALL the rhetoric in our health care system).

People are well aware of my bias here--I think capitalism is the worst economic system, except for all the others, but that capitalism needs stringent regulation at its edges to keep people from gaming the market system and distorting its function. To that end, I have always thought there are two areas that should not be left entirely to the market--education and health care. (We've already decided that primary, but not secondary, education, and civil protection--police, sanitation, fire protection, military protection--should not be left entirely to the market, and it's instructive to remember that there was a time when that was argued, too, and cities would have different private fire companies, police companies, etc., in different neighborhoods.) We will continue to argue this as long as there is not a consensus as to whether education and health care are a fundamental right of citizenship or services that must be personally earned and paid for.

It may be ture that the reason we continue to have widely divergent opinions on this in the US has much to do with our Calvinist "show you are a member of the elite by earning" and our social darwinist origins; other nations do not have such an ethos in their histories and therefore more consensus.

[dahlek]

One aspect I find truly amusing is that most docs react to it as a 'demotion'! They have to actually RECORD info themselves and not mumble dictation or scribble crib notes to have an actual 'secretary' write it down. This way the 'garbage in' is all their responsibility! That's an aspect I like, makes docs think twice before committing opinions to 'the system'. On the other hand, computer systems are vulnerable - just ask the security systems of this country...either defensive or financial. All too often things are 'viewed' by others who either have a purient curiousity or some other alternative agenda...,such as insurance companies and all.
All in all? How the info is gathered, classified then summarized could be useful for emergency situations. However the privacy and access controls aren't particularly clearly stated. Further, unlike credit reports? The actual patient doesn't seem to be 'included' to ascertain the validity of any information in that 'system' or 'systems'. Thus, when errors occur-or mis-statements? IT's Deep HECK to pay by the patient!
Somehow, to me, at least? it seems that this has been developed and discussed ad-nauseum by medical, hospital and insurance professionals, BUT little consideration about, for or BY the patients..other than 'privacy aspects'.
I mean, after all, shouldn't WE be included in this mess in other ways?
For example... why not a feature that triggers notification either by e-mail or by letter[snail mail] that 'someone' has 'viewed' my 'history. Ideally, a method of e-notification followed by written one. That way, should someone 'unauthorized' view your records, it could be cut off.
I am also taking into consideration that there are still a number of people out there who do not have computers, nor know really-how to use them.
As things are proposed and implemented now? WE have little to no access nor control! That all worries me!
Happy new year to one and all! May we all have a much better year to come!
's a plenty! -j