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Written by Eugene Borukhovich
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Sunday, 08 February 2009 16:21 |
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On January 14th, I decided to completely take control of my health. This is not about lack of trust in my PCP, its about the one-to-one (me & me) vs. one-to-many relationship (doc to many patients) for my health experience. I still highly rely on my PCP and love the guy!!! So last week I picked up a copy of all the notes and test results. This only goes back to 2000 but that is more then enough to get started with. Boy will I need some help!!! Since I don't have any direct clinical background I am having a hard time comprehending the short-hand. I am able to make out a lot, such as my jumps in weight and A1C test results from year to year as well as words "diet and exercise" during each of my visits. While I am fighting my way through pages and pages of medical history, it spurred yet another thought on Obama's aggressive plan. The goal is to create jobs and cut long-term costs as a result of conversion to EMR. This obviously makes my record (1) readable, (2) theoretically portable, (3) hopefully secure and hence my treatment (1) enhanced, (2) more accurate, (3) with a tint of consumerism. Having said that, how many man hours will it take to convert each doctor's unique handwriting either via ICR/OCR + human capital? If you have done EMR conversion of your office, I would love to hear what it took! I am curious on the $$ amount, number of man hours, percent of automation vs. human workforce. Stay tuned for Part III |
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Last Updated on Sunday, 08 February 2009 20:46 |
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Written by Eugene Borukhovich
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Thursday, 15 January 2009 23:47 |
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This is my third post now that mentions Obama and the healthcare IT stimulus. I just cant stop thinking about the macroeconomic impact this will have and a potential of a contagion that will spread outside of United States. At this moment, my only justification of continuous coverage of this topic on a healthcare blog is the fact that this $50B will be spent on HIT. I recently picked up "The Wealth of Nations" by none other than Adam Smith. He states: "Every individual necessarily labors to render the annual revenue of the society as great as he can. He generally indeed neither intends to promote the public interest, not knows how much he is promoting it. He intends only his own gain, and he is in this, as in many other cases, led by an invisible hand to promote an end which was no part of his intention. By pursuing his own interest he frequently promotes that of the society more effectually than when he really intends to promote it. I have never known much good done by those who affected to trade for the public good. It is not from the benevolence of the butcher, the brewer, or the baker, that we expect our dinner, but from their regard to their own interests." Now I will explain how this paragrpah actually struck me. Basically, each physician's office is only concerned with their own efficiencies and obviously the bottom line (ofcourse, dont forget about the well being of the patient). He or she now converted their office to an EMR system or at least a stand alone e-prescribing system. These forward thinking doctors, may or may not have realized that they are actually promoting the "public interest". Now this is were the views of a free-market economist will difffer from what Obama's administration is suggesting. So is our healthcare system better served by doctor offices acting in their own selfish best interest and hence contributing to the overall good of the society, or is it our government that is the "invisible hand" (very visible actually) that is leading these individuals to "an end whcih was no part of his intention" - i.e $77B in savings!!! |
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Last Updated on Friday, 16 January 2009 01:13 |
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Written by Eugene Borukhovich
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Wednesday, 14 January 2009 22:23 |
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Obama's administration wants “to ensure that within five years, all of America’s medical records are computerized.” It is obvious at this point, that a good portion of the spend will be in a form of subsidies to physician practices and hence I decided to alleviate my primary care physician of converting one additional record. I am starting a quest on digitizing my health. As an advocate of Healthcare technology I am actually embarrassed that I do not have an encrypted XML file with all my data in it. I want it portable, transportable and secure. I want my lab test results charted year to year like my quickbooks tracks my checking account. Step 1, request my paper records. Sent an email to my PCP Step 2, find a provider or a clinical scribe to transcribe all that data (any ICR/OCR software that can help here :). If anyone has any suggestions contact me info at nyhto.org Step 3, contact my PCP again to find out if he is participating in the Quest Diagnostics and Google Health program (here) Step 4, anyone willing to sponsor my genetic test on 23andme? Step 5, I already have a Google Health account but it is pretty useless at the moment Step 6, Get a list of medication that I got at retail form my pbm - hopefully import it into Google Health And the journey to the nucleus of my health begins. |
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Last Updated on Wednesday, 14 January 2009 22:58 |
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Written by Eugene Borukhovich
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Wednesday, 07 January 2009 23:45 |
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I finally had a chance to sit down and actually read Obama's Health Plan in more detail. I will leave the detailed analysis aside and concentrate on the paragraph for EHR's as well as look at a very highlevel macroeconomic impacts of this statement: "(1) INVEST IN ELECTRONIC HEALTH INFORMATION TECHNOLOGY SYSTEMS. Most medical records are still stored on paper, which makes them difficult to use to coordinate care, measure quality, or reduce medical errors. Processing paper claims also costs twice as much as processing electronic claims.13 Barack Obama and Joe Biden will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records. They will also phase in requirements for full implementation of health IT and commit the necessary federal resources to make it happen. Barack Obama and Joe Biden will ensure that these systems are developed in coordination with providers and frontline workers, including those in rural and underserved areas. Barack Obama and Joe Biden will ensure that patients’ privacy is protected. A study by the Rand Corporation found that if most hospitals and doctors offices adopted electronic health records, up to $77 billion of savings would be realized each year through improvements such as reduced hospital stays, avoidance of duplicative and unnecessary testing, more appropriate drug utilization, and other efficiencies." So $50B (inflation adjusted $10B/year?) will be spent on Health IT and Electronic Health Records and the supporting systems. Just like with any massive Government spending (G), the macroeconomic theory is that a multiplier effect will take over and hence aside form the $77B in direct savings there will be additional dollars generated. Lets follow this hypothetical "healthy America" scenario... * Governement spends $50B in the next 5 years. These dollars may consist of subsidies to hospitals, doctors, nursing homes, etc as well as direct payments to technology companies to improve standards, design systems, etc. * Hospitals, Doctors and other Healthcare organizations will now start suffering a learning curve effect and their efficiencies and workflows will degrade, therefore they now pay consultants and yet more technology companies to enhance their process in this new electronic world. Training their staff is yet another expense. New and innovative educational services are launched for the healthcare industry. * Given these new and imporved electronic records, some people will loose their jobs and will need to be retrained to now fill the void in shortage of experts in EMR's * Employers are now saving money on the health plans since the patients are much more educated, given the fact they have a copy of their EHR (PHR) in the cloud and it is completely portable form provider to provider (we can only hope). This is yet another outcome of the initial $50B spending * By moving up the healthcare stack, the medical billing assitant is now an electronic health record expert and due to higher disposable income the whole aggregate demand curve shift in our favor * Healthcare gets cheaper and patients ride the healthcare indifference curve to demand enhanced total care management services I can continue walking down this fictional yellow brick road, but please note that the multiplier effect is argued by non-Keynsians and is looked at as a very short-term measure. So will the government injection into health IT spur innovation or will it be too slow and beurocratic and the free market forces will win?
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Last Updated on Sunday, 11 January 2009 23:08 |
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