Healthcare IT - Mission Impossible

National Healthcare Records
"Mission Impossible"

Executive Summary
The Obama administration’s plan to spend $19.2 billion on electronic medical records as the sole path to achieve health care automation is the equivalent of Kennedy dictating to NASA the use of bear claws and stone knives to get Neil Armstrong to the moon. Health care automation is the new national project for good reasons. Americans spent $2.7 trillion on health care in 2007, or $7,900 per person.

The electronic health record concept has been around for a very long time, but the adoption rate in the U.S. is only 1.5 percent, according to The New England Journal of Medicine.
The failure of these systems to catch on is not uniquely American. It is the failure of static software architectures that continues to drive the price of software beyond time/cost feasibility. The simple truth is that without a "national XML standard" there can be no electronic healthcare information sharing. Even with a metadata, process standard the cost for re-writing and interfacing existing software will still be prohibitive.

By Example
The British government initiated a 10-year, multibillion-dollar project to implement a national patient record system in 2002.The British House of Commons published a report in September 2007 and described in painful detail the data collection challenges, budget and schedule overruns. The irony is despite the single-payer system in Britain, which should make electronic patient records easier to achieve, the British government is learning the hard way that it might be mission impossible.

By Comparison
An American multi-payer system if it is delivering health care through 500,000 office-based physicians, 5,000 community hospitals, 16,000 nursing facilities and hundreds of insurance companies, with a full spectrum of ownership, different pricing systems and data formats, IS SIMPLY NOT FEASIBLE.....not with $19B or even $190B.

Health Care software fragmentation in America creates a exponentially higher degree of challenge, as compared to the British attempt/failure.

The electronic health record concept is easy to describe, but the difficulty in achieving such a system is enormous because it is fundamentally not a technical problem, it is a systemic problem of no-standards. What if all US HealthCare records were standardized like the Department Of Justice XLM STANDARD. (google it)

A Dynamic Standards Based Solution
With a national XML Healthcare standard, imagine a new class of Self Organizing Eaas Framework (everything as a service) software that becomes your operational software as your visually define the workflow of your clinic.  Since the visual modeler consumes the XML standard, information sharing cannot be simpler. As worflow takes place, a local SOA gateway passes information to a "system of record database" & through common emal.  Collaboration, business process tracking and information visability become a dot product of the common use.

A Potential Problem
Under the current law, medical records belong to the patient. But each individual patient’s information actually resides in dozens of different places, such as the family practitioner’s office, the lab, the hospital, the drugstore and so on. As one solution....Patients could carry medical records within an GOV encrypted 8 GIG biometric USB. At ANY location, import/export is versioned by date/time/facility. Lose it ? By another and go back the last place you were updated. That would be money well spent.


Conclusion
Today, to create a system of electronic patient records, an individual must have the will to track down —- and collect —- the scattered data from both different sources and in vastly different formats. The individual then has to have the access, the know-how and time to enter all this data —- error-free —- in a single system. The significant challenge is to keep national data consistent, independent of content (up-to-date as new procedures, medications, referrals, etc. are added). With the establishment of a National Healthcare XML Standard the use of advanced Self-Organizing Eaas Frameworks could single handedly save the tax payers 10's of billions over any other solution approach being discussed today.


Blane Land
blaneland.com