<article>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#article09_06_25_0228217</id>
	<title>IT and Health Care</title>
	<author>samzenpus</author>
	<datestamp>1245954960000</datestamp>
	<htmltext>Punk CPA writes <i>"Technology Review has some thoughts about <a href="http://www.technologyreview.com/computing/22852/">why the health care industry has been so slow to adopt IT</a>, while quick to embrace high technology in care and diagnosis.  Hypothesis: making medical records available for data analysis might expose redundancy, over-testing, and other methods of extracting profits from the fee-for-service model.  My take is that it might also make it much easier to gather and evaluate quality of care information.  That would be chum in the water for malpractice suits."</i></htmltext>
<tokenext>Punk CPA writes " Technology Review has some thoughts about why the health care industry has been so slow to adopt IT , while quick to embrace high technology in care and diagnosis .
Hypothesis : making medical records available for data analysis might expose redundancy , over-testing , and other methods of extracting profits from the fee-for-service model .
My take is that it might also make it much easier to gather and evaluate quality of care information .
That would be chum in the water for malpractice suits .
"</tokentext>
<sentencetext>Punk CPA writes "Technology Review has some thoughts about why the health care industry has been so slow to adopt IT, while quick to embrace high technology in care and diagnosis.
Hypothesis: making medical records available for data analysis might expose redundancy, over-testing, and other methods of extracting profits from the fee-for-service model.
My take is that it might also make it much easier to gather and evaluate quality of care information.
That would be chum in the water for malpractice suits.
"</sentencetext>
</article>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464561</id>
	<title>Re:lots of work for very little gain</title>
	<author>Anonymous</author>
	<datestamp>1245930480000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>Would you rather have your doctor spend 10 minutes explaining to you why he is doing what he is or typing your chart into a database? Doctors job is to save lives, not spend his valuable time typing stuff into a computer.</p></htmltext>
<tokenext>Would you rather have your doctor spend 10 minutes explaining to you why he is doing what he is or typing your chart into a database ?
Doctors job is to save lives , not spend his valuable time typing stuff into a computer .</tokentext>
<sentencetext>Would you rather have your doctor spend 10 minutes explaining to you why he is doing what he is or typing your chart into a database?
Doctors job is to save lives, not spend his valuable time typing stuff into a computer.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463663</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465029</id>
	<title>Re:Medical IT sucks</title>
	<author>Anonymous</author>
	<datestamp>1245937020000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>I'm a hospital based IT tech, and this:<br>The thing is, few of the doctors and even fewer of the nurses are interested in computers. They're interested in medicine, and computers are a pain in the neck even *before* they break down. They can't tell when the computer is behaving unpredictably, because as far as they're concerned, the computer always behaves unpredictably.</p><p>is exactly how it is. I support 3 full hospitals and about 20 small sites, and it's the same everywhere. to compound the problem, we're just now starting to reign in purchasing. For years, any department could partner with any vendor and buy any system they wanted, leading to a horrible interconnected mess of hacks to make everything talk to each other. IT here didn't get to set down app guidelines, we just had to "make it work".</p><p>for us to switch over to some kind of new, single application system for intake/treatment/records would be a blessing for us folks in the trenches, but to do so would require department heads, executives, and doctors to piss off their vendor contacts, give up the free golf trips and vacations, and burn through a pile of cash in penalties for breach of contract. Even as a non-profit, it's still all about the money</p></htmltext>
<tokenext>I 'm a hospital based IT tech , and this : The thing is , few of the doctors and even fewer of the nurses are interested in computers .
They 're interested in medicine , and computers are a pain in the neck even * before * they break down .
They ca n't tell when the computer is behaving unpredictably , because as far as they 're concerned , the computer always behaves unpredictably.is exactly how it is .
I support 3 full hospitals and about 20 small sites , and it 's the same everywhere .
to compound the problem , we 're just now starting to reign in purchasing .
For years , any department could partner with any vendor and buy any system they wanted , leading to a horrible interconnected mess of hacks to make everything talk to each other .
IT here did n't get to set down app guidelines , we just had to " make it work " .for us to switch over to some kind of new , single application system for intake/treatment/records would be a blessing for us folks in the trenches , but to do so would require department heads , executives , and doctors to piss off their vendor contacts , give up the free golf trips and vacations , and burn through a pile of cash in penalties for breach of contract .
Even as a non-profit , it 's still all about the money</tokentext>
<sentencetext>I'm a hospital based IT tech, and this:The thing is, few of the doctors and even fewer of the nurses are interested in computers.
They're interested in medicine, and computers are a pain in the neck even *before* they break down.
They can't tell when the computer is behaving unpredictably, because as far as they're concerned, the computer always behaves unpredictably.is exactly how it is.
I support 3 full hospitals and about 20 small sites, and it's the same everywhere.
to compound the problem, we're just now starting to reign in purchasing.
For years, any department could partner with any vendor and buy any system they wanted, leading to a horrible interconnected mess of hacks to make everything talk to each other.
IT here didn't get to set down app guidelines, we just had to "make it work".for us to switch over to some kind of new, single application system for intake/treatment/records would be a blessing for us folks in the trenches, but to do so would require department heads, executives, and doctors to piss off their vendor contacts, give up the free golf trips and vacations, and burn through a pile of cash in penalties for breach of contract.
Even as a non-profit, it's still all about the money</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464231</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464889</id>
	<title>Re:As someone who has worked on it...</title>
	<author>Niartov</author>
	<datestamp>1245935640000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext>Number 1 seems way off.

Caring for health quicker mean more efficiency and hopefully less mistakes. That leads to more patients maybe even more patients satisfied with their quality of care. This leads to better Ranking in US new which leads to more patients.  This all leads to greater profits.</htmltext>
<tokenext>Number 1 seems way off .
Caring for health quicker mean more efficiency and hopefully less mistakes .
That leads to more patients maybe even more patients satisfied with their quality of care .
This leads to better Ranking in US new which leads to more patients .
This all leads to greater profits .</tokentext>
<sentencetext>Number 1 seems way off.
Caring for health quicker mean more efficiency and hopefully less mistakes.
That leads to more patients maybe even more patients satisfied with their quality of care.
This leads to better Ranking in US new which leads to more patients.
This all leads to greater profits.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463883</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465565</id>
	<title>IT and Medicine are a Bad Fit</title>
	<author>Anonymous</author>
	<datestamp>1245940500000</datestamp>
	<modclass>Informativ</modclass>
	<modscore>5</modscore>
	<htmltext><p>One thing everyone seems to be missing here (including the author of the article) is that medical data is an <i>odd duck</i> that just doesn't fit easily into a digital record. (I'm an MD, a medical informatics guy and CTO at a medical software company)</p><p>If you're running a McDonalds you can easily computerize everything: You have a fixed menu your customers can choose from, and every purchase can easily be stuffed into a relational table. Medicine isn't like that.</p><p>Trying to enter a patient encounter into a contemporary medical record system is an extremely unsatisfying experience: Humans are just weird and idiosyncratic and every time you treat someone there will be parts of the patient visit you can't represent symbolically in a piece of software. This is still largely an unsolved problem- If you read the literature on Description Logics you'll see that even PhD logicians have a hard time symbolically storing this kind of abstract data into a piece of software, let alone a doc with little computer training.</p><p>Because of this, most current record systems use a lot of "free text" for storing medical info, which is a pretty ugly hack and everyone realizes this.</p><p>I think this is a major reason for the problems people have with digital records: <b>They don't work very well right now</b> for fully capturing a patient encounter in a rigorous, symbolic fashion.</p></htmltext>
<tokenext>One thing everyone seems to be missing here ( including the author of the article ) is that medical data is an odd duck that just does n't fit easily into a digital record .
( I 'm an MD , a medical informatics guy and CTO at a medical software company ) If you 're running a McDonalds you can easily computerize everything : You have a fixed menu your customers can choose from , and every purchase can easily be stuffed into a relational table .
Medicine is n't like that.Trying to enter a patient encounter into a contemporary medical record system is an extremely unsatisfying experience : Humans are just weird and idiosyncratic and every time you treat someone there will be parts of the patient visit you ca n't represent symbolically in a piece of software .
This is still largely an unsolved problem- If you read the literature on Description Logics you 'll see that even PhD logicians have a hard time symbolically storing this kind of abstract data into a piece of software , let alone a doc with little computer training.Because of this , most current record systems use a lot of " free text " for storing medical info , which is a pretty ugly hack and everyone realizes this.I think this is a major reason for the problems people have with digital records : They do n't work very well right now for fully capturing a patient encounter in a rigorous , symbolic fashion .</tokentext>
<sentencetext>One thing everyone seems to be missing here (including the author of the article) is that medical data is an odd duck that just doesn't fit easily into a digital record.
(I'm an MD, a medical informatics guy and CTO at a medical software company)If you're running a McDonalds you can easily computerize everything: You have a fixed menu your customers can choose from, and every purchase can easily be stuffed into a relational table.
Medicine isn't like that.Trying to enter a patient encounter into a contemporary medical record system is an extremely unsatisfying experience: Humans are just weird and idiosyncratic and every time you treat someone there will be parts of the patient visit you can't represent symbolically in a piece of software.
This is still largely an unsolved problem- If you read the literature on Description Logics you'll see that even PhD logicians have a hard time symbolically storing this kind of abstract data into a piece of software, let alone a doc with little computer training.Because of this, most current record systems use a lot of "free text" for storing medical info, which is a pretty ugly hack and everyone realizes this.I think this is a major reason for the problems people have with digital records: They don't work very well right now for fully capturing a patient encounter in a rigorous, symbolic fashion.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464179</id>
	<title>Re:Doctors</title>
	<author>Anonymous</author>
	<datestamp>1245924420000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>You are the closest to right. I don't think badly of doctors, but I have seen enough offices and hospitals (which are making forward thinking IT decisions quicker then private or small community practices) to know that doctors are uninspired to learn anything new. Same with nurses and assistants. Everyone has spent so much time memorizing books of symptoms and and insurance codes that learning an actual new process of communication is beyond the average practice to justify.</p><p>Also, some patients are the same way, they want an old office thats like the first office they ever visited, with a clipboard and the same 4 pages to fill out every time. The customers don't want (or simply just fear) change and the doctors agree and abide.</p></htmltext>
<tokenext>You are the closest to right .
I do n't think badly of doctors , but I have seen enough offices and hospitals ( which are making forward thinking IT decisions quicker then private or small community practices ) to know that doctors are uninspired to learn anything new .
Same with nurses and assistants .
Everyone has spent so much time memorizing books of symptoms and and insurance codes that learning an actual new process of communication is beyond the average practice to justify.Also , some patients are the same way , they want an old office thats like the first office they ever visited , with a clipboard and the same 4 pages to fill out every time .
The customers do n't want ( or simply just fear ) change and the doctors agree and abide .</tokentext>
<sentencetext>You are the closest to right.
I don't think badly of doctors, but I have seen enough offices and hospitals (which are making forward thinking IT decisions quicker then private or small community practices) to know that doctors are uninspired to learn anything new.
Same with nurses and assistants.
Everyone has spent so much time memorizing books of symptoms and and insurance codes that learning an actual new process of communication is beyond the average practice to justify.Also, some patients are the same way, they want an old office thats like the first office they ever visited, with a clipboard and the same 4 pages to fill out every time.
The customers don't want (or simply just fear) change and the doctors agree and abide.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463887</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28474141</id>
	<title>Re:Who keeps the records?</title>
	<author>dmr001</author>
	<datestamp>1245931680000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext>I had an interesting experience, volunteering in a clinic in a slum in Kampala Uganda a few years ago. Medical records were kept on 5 x 8 index cards the patients would bring in with them. Unless, of course, the records fell in a pile of goat crap on the way there, or the arthritic patient with homemade crutches slipped and the card landed in the open sewer, or the card was simply lost altogether in the chaos of the patient's life.
<br>This was troublesome enough in Uganda where blood pressure management consisted of prescribing enough Valium to use for headaches as needed when the patient's blood pressure exceeded 200 systolic or so, but imaging this model in use with, say, USB keys or even patient-passworded files living in a cloud somewhere gives me tremors. Emergency call in the middle of the night from someone bleeding profusely from some orifice? Patient temporarily psychotic when they mess up their thyroid meds? Patient is 4 years old with the third foster parent of the week?
<br>Thank you, but I guess this is one instance where I prefer my overpriced, non-interopable, mediocre centralized EMR.</htmltext>
<tokenext>I had an interesting experience , volunteering in a clinic in a slum in Kampala Uganda a few years ago .
Medical records were kept on 5 x 8 index cards the patients would bring in with them .
Unless , of course , the records fell in a pile of goat crap on the way there , or the arthritic patient with homemade crutches slipped and the card landed in the open sewer , or the card was simply lost altogether in the chaos of the patient 's life .
This was troublesome enough in Uganda where blood pressure management consisted of prescribing enough Valium to use for headaches as needed when the patient 's blood pressure exceeded 200 systolic or so , but imaging this model in use with , say , USB keys or even patient-passworded files living in a cloud somewhere gives me tremors .
Emergency call in the middle of the night from someone bleeding profusely from some orifice ?
Patient temporarily psychotic when they mess up their thyroid meds ?
Patient is 4 years old with the third foster parent of the week ?
Thank you , but I guess this is one instance where I prefer my overpriced , non-interopable , mediocre centralized EMR .</tokentext>
<sentencetext>I had an interesting experience, volunteering in a clinic in a slum in Kampala Uganda a few years ago.
Medical records were kept on 5 x 8 index cards the patients would bring in with them.
Unless, of course, the records fell in a pile of goat crap on the way there, or the arthritic patient with homemade crutches slipped and the card landed in the open sewer, or the card was simply lost altogether in the chaos of the patient's life.
This was troublesome enough in Uganda where blood pressure management consisted of prescribing enough Valium to use for headaches as needed when the patient's blood pressure exceeded 200 systolic or so, but imaging this model in use with, say, USB keys or even patient-passworded files living in a cloud somewhere gives me tremors.
Emergency call in the middle of the night from someone bleeding profusely from some orifice?
Patient temporarily psychotic when they mess up their thyroid meds?
Patient is 4 years old with the third foster parent of the week?
Thank you, but I guess this is one instance where I prefer my overpriced, non-interopable, mediocre centralized EMR.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463939</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465721</id>
	<title>Small Office With EMR</title>
	<author>Ikonoclasm</author>
	<datestamp>1245941400000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>I'm currently working in an office that primarily serves elderly Hispanic patients. There's one doctor and the support staff. The doctor happens to be a technophile and converted the office to an EMR back in Nov. of 2007. There were a LOT of bumps along the way, but 18 months later, we have other doctors tour our office to see the way we've successfully integrated the EMR into the office workflow.</p><p>I started working here a year after the conversion, but I was the first IT-competent person hired since then (I wasn't even hired for IT purposes). As such, I've been able to significantly streamline office practices to the point where lab results are directly inserted into progress notes from Quest, the doctor gets real-time indications of patient insurance drug coverage while prescribing, ePrescribe capabilities which allow the doctor to send the Rx to the pharmacy while noting the medication in the progress note, fax records and progress notes directly from patient charts, etc. Pretty much any piece of paper that passes through the office (billing aside) gets scanned into the patient's chart. We do this both for ease of reference (easier to just pull up the high-quality TIFF than typing in a summary of a consult or diagnostic image) and for legal purposes. The doctor, contrary to some of the other comments, feels much safer legally having everything scanned, titled, timestamped and easily accessible. Oh, not to mention how much time is saved when we're subpoenaed for records and it takes the better part of 30 seconds to do a multi-doc fax.</p><p>The only real complaint I have with our EMR is its lack of ability to share records. We still have to fax records (certainly not snailmail!) and burn through reams of paper receiving records from other offices. I would love to see a connectivity standard between EMRs. That may be putting the buggy before the horse, though, with the lack of adoption we've been seeing in our area. Medicare's office a lot of incentive bonuses for using the EMR and ePrescribe, which are a lot more beneficial for early adopters, but still doctors seem to be dragging their feet. Maybe that'll change when they start seeing a 2\% penalty tacked onto their Medicare payments in 2014?</p></htmltext>
<tokenext>I 'm currently working in an office that primarily serves elderly Hispanic patients .
There 's one doctor and the support staff .
The doctor happens to be a technophile and converted the office to an EMR back in Nov. of 2007 .
There were a LOT of bumps along the way , but 18 months later , we have other doctors tour our office to see the way we 've successfully integrated the EMR into the office workflow.I started working here a year after the conversion , but I was the first IT-competent person hired since then ( I was n't even hired for IT purposes ) .
As such , I 've been able to significantly streamline office practices to the point where lab results are directly inserted into progress notes from Quest , the doctor gets real-time indications of patient insurance drug coverage while prescribing , ePrescribe capabilities which allow the doctor to send the Rx to the pharmacy while noting the medication in the progress note , fax records and progress notes directly from patient charts , etc .
Pretty much any piece of paper that passes through the office ( billing aside ) gets scanned into the patient 's chart .
We do this both for ease of reference ( easier to just pull up the high-quality TIFF than typing in a summary of a consult or diagnostic image ) and for legal purposes .
The doctor , contrary to some of the other comments , feels much safer legally having everything scanned , titled , timestamped and easily accessible .
Oh , not to mention how much time is saved when we 're subpoenaed for records and it takes the better part of 30 seconds to do a multi-doc fax.The only real complaint I have with our EMR is its lack of ability to share records .
We still have to fax records ( certainly not snailmail !
) and burn through reams of paper receiving records from other offices .
I would love to see a connectivity standard between EMRs .
That may be putting the buggy before the horse , though , with the lack of adoption we 've been seeing in our area .
Medicare 's office a lot of incentive bonuses for using the EMR and ePrescribe , which are a lot more beneficial for early adopters , but still doctors seem to be dragging their feet .
Maybe that 'll change when they start seeing a 2 \ % penalty tacked onto their Medicare payments in 2014 ?</tokentext>
<sentencetext>I'm currently working in an office that primarily serves elderly Hispanic patients.
There's one doctor and the support staff.
The doctor happens to be a technophile and converted the office to an EMR back in Nov. of 2007.
There were a LOT of bumps along the way, but 18 months later, we have other doctors tour our office to see the way we've successfully integrated the EMR into the office workflow.I started working here a year after the conversion, but I was the first IT-competent person hired since then (I wasn't even hired for IT purposes).
As such, I've been able to significantly streamline office practices to the point where lab results are directly inserted into progress notes from Quest, the doctor gets real-time indications of patient insurance drug coverage while prescribing, ePrescribe capabilities which allow the doctor to send the Rx to the pharmacy while noting the medication in the progress note, fax records and progress notes directly from patient charts, etc.
Pretty much any piece of paper that passes through the office (billing aside) gets scanned into the patient's chart.
We do this both for ease of reference (easier to just pull up the high-quality TIFF than typing in a summary of a consult or diagnostic image) and for legal purposes.
The doctor, contrary to some of the other comments, feels much safer legally having everything scanned, titled, timestamped and easily accessible.
Oh, not to mention how much time is saved when we're subpoenaed for records and it takes the better part of 30 seconds to do a multi-doc fax.The only real complaint I have with our EMR is its lack of ability to share records.
We still have to fax records (certainly not snailmail!
) and burn through reams of paper receiving records from other offices.
I would love to see a connectivity standard between EMRs.
That may be putting the buggy before the horse, though, with the lack of adoption we've been seeing in our area.
Medicare's office a lot of incentive bonuses for using the EMR and ePrescribe, which are a lot more beneficial for early adopters, but still doctors seem to be dragging their feet.
Maybe that'll change when they start seeing a 2\% penalty tacked onto their Medicare payments in 2014?</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28470111</id>
	<title>Re:Too few computers, too little bandwidth</title>
	<author>ldrydenb</author>
	<datestamp>1245959700000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>I've no idea about the real costs of servers and their maintenance, but as for re-purposing old computers: last time I saw someone (our department secretary) have their computer replaced before it died - or was stolen - was 2001!</p><p>As you say, all that's really required is a dumb terminal that can run XP with IE6 (or even IE5!)<nobr> <wbr></nobr>... but that just reduces the cost of replacements for dead machines. There's no incentive to upgrade from existing machines, so few older models to repurpose.</p></htmltext>
<tokenext>I 've no idea about the real costs of servers and their maintenance , but as for re-purposing old computers : last time I saw someone ( our department secretary ) have their computer replaced before it died - or was stolen - was 2001 ! As you say , all that 's really required is a dumb terminal that can run XP with IE6 ( or even IE5 !
) ... but that just reduces the cost of replacements for dead machines .
There 's no incentive to upgrade from existing machines , so few older models to repurpose .</tokentext>
<sentencetext>I've no idea about the real costs of servers and their maintenance, but as for re-purposing old computers: last time I saw someone (our department secretary) have their computer replaced before it died - or was stolen - was 2001!As you say, all that's really required is a dumb terminal that can run XP with IE6 (or even IE5!
) ... but that just reduces the cost of replacements for dead machines.
There's no incentive to upgrade from existing machines, so few older models to repurpose.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464735</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463789</id>
	<title>Too much testing required</title>
	<author>Gribflex</author>
	<datestamp>1245962700000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>There's another good reason.</p><p>In the IT Healthcare Sector, teams have to perform intense amounts of testing on all aspects of the system (right from the specs, to the product, to the docs, to the training - the whole deal). Some of the testing can be done in house, some has to be signed off on by external bodies.</p><p>This kind of process is expensive, long and inflexible. None of these things is conducive to rapid development or innovation.</p></htmltext>
<tokenext>There 's another good reason.In the IT Healthcare Sector , teams have to perform intense amounts of testing on all aspects of the system ( right from the specs , to the product , to the docs , to the training - the whole deal ) .
Some of the testing can be done in house , some has to be signed off on by external bodies.This kind of process is expensive , long and inflexible .
None of these things is conducive to rapid development or innovation .</tokentext>
<sentencetext>There's another good reason.In the IT Healthcare Sector, teams have to perform intense amounts of testing on all aspects of the system (right from the specs, to the product, to the docs, to the training - the whole deal).
Some of the testing can be done in house, some has to be signed off on by external bodies.This kind of process is expensive, long and inflexible.
None of these things is conducive to rapid development or innovation.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28466737</id>
	<title>Re:one word: protectionism</title>
	<author>cpufrier37075</author>
	<datestamp>1245946620000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p><div class="quote"><p>Parent either is full of it or lives in a parallel universe.



1. Cost is not a barrier? Our EMR costs each physician many tens of thousands a dollar a year in application support, licensing, databases, and for a phalanx of IS personnel in various departments (local, regional, EMR, hospital IS).

2. MD's have a monopoly? What planet are you on? DO's have had precisely equivalent standing for decades in medical practice in the United States, and NP's are far from being "wiggled in." As a primary care physician, when I send a patient to the cardiologist or pulmonologist, half the time the entire consult is done by a PA or NP.

3. Please direct me to the land you describe where I can have control over my care environment and take home most of the money. I can't get a contracting pregnant lady into labor and delivery without asking for permission from two nurses, and I'm not aware that the balance of power in any health system I've worked in has been any different before and after transition from paper records. Medical care in most locales in the US has long been collaborative, team-based system, even if you've met a few physicians who are jerks or drive nice cars. (I am looking forward to upgrading my '94 Corolla by 2014.)



EMR systems have poor market penetration, in my direct experience over the last 9 years, because:

1. Many, if not most, suck in a medium to large way;

2. They are incredibly expensive;

3. They can often be hard to use, and are typically more labor-intensive than paper charts for most physicians in the US;

4. They don't inter-operate. (When I request old records from other physicians with electronic charts, I enter the pertinent data into my electronic chart by typing it in.)


If any skilled group of software engineers were to write a decent, usable EMR that was extensible, and didn't cost an arm and a leg, with an eye to being excellent first and profitable as a consequence, they could be up for a Nobel prize.

TFA refers to cardiac CT to prevent heart attacks. The author, too, lives in a dream world - contrary to her thesis, this test has been shown to help with the boat payments of radiologists and equipment manufacturers, but there is no evidence it helps prevent heart attacks.</p></div><p>Ok, You wrote my comment for me. But I'll  add my bit. My background is Chemical Engineer, Internal Medicine (because they were easy and fun to study), then Emergency Medicine (because it was fun to do) for the past 30 years. During that time I was mostly in direct patient care but did have various administrative duties. Naturally, as a Slashdotter I had a continual involvement with computers. After evaluating numerous awful EMR systems for our hospital I checked to see why. Generally there was little clinical input at the levels that mattered, but I agree it is harder than it looks to do it right.

Getting long in the tooth for the ER, I thought to apply to some of the software companies for employment. The response was, "We only have openings in marketing."

I second all the comments here regarding lack of any conspiracy. None of us are that good.</p></div>
	</htmltext>
<tokenext>Parent either is full of it or lives in a parallel universe .
1. Cost is not a barrier ?
Our EMR costs each physician many tens of thousands a dollar a year in application support , licensing , databases , and for a phalanx of IS personnel in various departments ( local , regional , EMR , hospital IS ) .
2. MD 's have a monopoly ?
What planet are you on ?
DO 's have had precisely equivalent standing for decades in medical practice in the United States , and NP 's are far from being " wiggled in .
" As a primary care physician , when I send a patient to the cardiologist or pulmonologist , half the time the entire consult is done by a PA or NP .
3. Please direct me to the land you describe where I can have control over my care environment and take home most of the money .
I ca n't get a contracting pregnant lady into labor and delivery without asking for permission from two nurses , and I 'm not aware that the balance of power in any health system I 've worked in has been any different before and after transition from paper records .
Medical care in most locales in the US has long been collaborative , team-based system , even if you 've met a few physicians who are jerks or drive nice cars .
( I am looking forward to upgrading my '94 Corolla by 2014 .
) EMR systems have poor market penetration , in my direct experience over the last 9 years , because : 1 .
Many , if not most , suck in a medium to large way ; 2 .
They are incredibly expensive ; 3 .
They can often be hard to use , and are typically more labor-intensive than paper charts for most physicians in the US ; 4 .
They do n't inter-operate .
( When I request old records from other physicians with electronic charts , I enter the pertinent data into my electronic chart by typing it in .
) If any skilled group of software engineers were to write a decent , usable EMR that was extensible , and did n't cost an arm and a leg , with an eye to being excellent first and profitable as a consequence , they could be up for a Nobel prize .
TFA refers to cardiac CT to prevent heart attacks .
The author , too , lives in a dream world - contrary to her thesis , this test has been shown to help with the boat payments of radiologists and equipment manufacturers , but there is no evidence it helps prevent heart attacks.Ok , You wrote my comment for me .
But I 'll add my bit .
My background is Chemical Engineer , Internal Medicine ( because they were easy and fun to study ) , then Emergency Medicine ( because it was fun to do ) for the past 30 years .
During that time I was mostly in direct patient care but did have various administrative duties .
Naturally , as a Slashdotter I had a continual involvement with computers .
After evaluating numerous awful EMR systems for our hospital I checked to see why .
Generally there was little clinical input at the levels that mattered , but I agree it is harder than it looks to do it right .
Getting long in the tooth for the ER , I thought to apply to some of the software companies for employment .
The response was , " We only have openings in marketing .
" I second all the comments here regarding lack of any conspiracy .
None of us are that good .</tokentext>
<sentencetext>Parent either is full of it or lives in a parallel universe.
1. Cost is not a barrier?
Our EMR costs each physician many tens of thousands a dollar a year in application support, licensing, databases, and for a phalanx of IS personnel in various departments (local, regional, EMR, hospital IS).
2. MD's have a monopoly?
What planet are you on?
DO's have had precisely equivalent standing for decades in medical practice in the United States, and NP's are far from being "wiggled in.
" As a primary care physician, when I send a patient to the cardiologist or pulmonologist, half the time the entire consult is done by a PA or NP.
3. Please direct me to the land you describe where I can have control over my care environment and take home most of the money.
I can't get a contracting pregnant lady into labor and delivery without asking for permission from two nurses, and I'm not aware that the balance of power in any health system I've worked in has been any different before and after transition from paper records.
Medical care in most locales in the US has long been collaborative, team-based system, even if you've met a few physicians who are jerks or drive nice cars.
(I am looking forward to upgrading my '94 Corolla by 2014.
)



EMR systems have poor market penetration, in my direct experience over the last 9 years, because:

1.
Many, if not most, suck in a medium to large way;

2.
They are incredibly expensive;

3.
They can often be hard to use, and are typically more labor-intensive than paper charts for most physicians in the US;

4.
They don't inter-operate.
(When I request old records from other physicians with electronic charts, I enter the pertinent data into my electronic chart by typing it in.
)


If any skilled group of software engineers were to write a decent, usable EMR that was extensible, and didn't cost an arm and a leg, with an eye to being excellent first and profitable as a consequence, they could be up for a Nobel prize.
TFA refers to cardiac CT to prevent heart attacks.
The author, too, lives in a dream world - contrary to her thesis, this test has been shown to help with the boat payments of radiologists and equipment manufacturers, but there is no evidence it helps prevent heart attacks.Ok, You wrote my comment for me.
But I'll  add my bit.
My background is Chemical Engineer, Internal Medicine (because they were easy and fun to study), then Emergency Medicine (because it was fun to do) for the past 30 years.
During that time I was mostly in direct patient care but did have various administrative duties.
Naturally, as a Slashdotter I had a continual involvement with computers.
After evaluating numerous awful EMR systems for our hospital I checked to see why.
Generally there was little clinical input at the levels that mattered, but I agree it is harder than it looks to do it right.
Getting long in the tooth for the ER, I thought to apply to some of the software companies for employment.
The response was, "We only have openings in marketing.
"

I second all the comments here regarding lack of any conspiracy.
None of us are that good.
	</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463733</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463929</id>
	<title>Conspiracy?</title>
	<author>jandersen</author>
	<datestamp>1245921480000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>3</modscore>
	<htmltext><p>There's ample room for conspiracy in the murky world of health care, but I don't think it is in IT - instead, look at medical companies and the way medicine is prescribed and used, if you are looking fopr conspiracies.</p><p>There are many good reasons why computers aren't used universally in health care. Two of the biggest are education and resources - doctors and nurses aren't really taught to use computers in their work. And while having a well designed computer system can be a huge advantage in any line of work, that is actually only true once everybody is fully trained; until that has been done, it is actually less efficient. And the situation in most countries is that there are too few medical staff anywhere, so where would one find the resources to make it happen?</p><p>On top of that comes concerns with incompatible, existing systems, privacy issues etc. Not to mention the fact that nearly all public IT projects so far have been hugely over budget and behind schedule. I think that perhaps the only realistic way this can be solved is by creating a good, open source health care system and let it mature and grow into general use from the grassroot up.</p></htmltext>
<tokenext>There 's ample room for conspiracy in the murky world of health care , but I do n't think it is in IT - instead , look at medical companies and the way medicine is prescribed and used , if you are looking fopr conspiracies.There are many good reasons why computers are n't used universally in health care .
Two of the biggest are education and resources - doctors and nurses are n't really taught to use computers in their work .
And while having a well designed computer system can be a huge advantage in any line of work , that is actually only true once everybody is fully trained ; until that has been done , it is actually less efficient .
And the situation in most countries is that there are too few medical staff anywhere , so where would one find the resources to make it happen ? On top of that comes concerns with incompatible , existing systems , privacy issues etc .
Not to mention the fact that nearly all public IT projects so far have been hugely over budget and behind schedule .
I think that perhaps the only realistic way this can be solved is by creating a good , open source health care system and let it mature and grow into general use from the grassroot up .</tokentext>
<sentencetext>There's ample room for conspiracy in the murky world of health care, but I don't think it is in IT - instead, look at medical companies and the way medicine is prescribed and used, if you are looking fopr conspiracies.There are many good reasons why computers aren't used universally in health care.
Two of the biggest are education and resources - doctors and nurses aren't really taught to use computers in their work.
And while having a well designed computer system can be a huge advantage in any line of work, that is actually only true once everybody is fully trained; until that has been done, it is actually less efficient.
And the situation in most countries is that there are too few medical staff anywhere, so where would one find the resources to make it happen?On top of that comes concerns with incompatible, existing systems, privacy issues etc.
Not to mention the fact that nearly all public IT projects so far have been hugely over budget and behind schedule.
I think that perhaps the only realistic way this can be solved is by creating a good, open source health care system and let it mature and grow into general use from the grassroot up.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28467045</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>dokebi</author>
	<datestamp>1245948240000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>I have talked to a doctor friend recently about this. He's used various EHR systems, and his favorite is the VA Hospital's system, unfortunately named (VistA). He says it's pretty nice and easy to use. Looking at its wikipedia entry, apparently it is *public domain*, available to everyone. So it boggles my mind why other hospitals just don't adopt it, instead of spending billions developing their own.</p></htmltext>
<tokenext>I have talked to a doctor friend recently about this .
He 's used various EHR systems , and his favorite is the VA Hospital 's system , unfortunately named ( VistA ) .
He says it 's pretty nice and easy to use .
Looking at its wikipedia entry , apparently it is * public domain * , available to everyone .
So it boggles my mind why other hospitals just do n't adopt it , instead of spending billions developing their own .</tokentext>
<sentencetext>I have talked to a doctor friend recently about this.
He's used various EHR systems, and his favorite is the VA Hospital's system, unfortunately named (VistA).
He says it's pretty nice and easy to use.
Looking at its wikipedia entry, apparently it is *public domain*, available to everyone.
So it boggles my mind why other hospitals just don't adopt it, instead of spending billions developing their own.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463467</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464593</id>
	<title>Re:one word: protectionism</title>
	<author>Anonymous</author>
	<datestamp>1245931020000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>The reason these systems suck and are expensive is because they are the result of "design by committee".  What would be a good approach is that there is an existing system (home-grown perhaps) which gets transferred to another hospital, where a representative group gets together and says "This and that needs to be changed, the rest is OK."</p><p>What happens instead is that a committee is formed out of hospital representatives who don't know much about IT, and IT managers who don't know much about hospitals (and, frankly, not about IT either).  Since every hospital is absolutely unique and works completely differently from every other hospital (sarcasm intended), a new system needs to be designed from scratch.  The hospital representatives list requirements they don't \_really\_ understand, the IT managers perform CYA tactics because they don't oversee the implications or the \_real\_ requirements (and they don't actually mind - if the hospital asks for a five-nines system they are more than happy to comply since they can raise the cost tremendously).</p><p>Then, there are patient representation groups who interfere because they have privacy concerns, insisting on physically separate ADSL lines going from MD offices to chemists and hospital IT lines because "the internet can be eavesdropped" (I'm not making this up), restrictions get built in so that some kind of card reading device is needed at every desk which the doctor has to sign in on to send prescriptions out (what happens now is that the doctor has more pressing things to do than sign the prescriptions, so their assistants send them out and he signs them in bulk in the evening - what will happen after the card reading devices are installed is that the doctor will simply leave his card in the machine and move on to the more pressing work), etcetera.</p><p>Result: The system gets more and more expensive, more and more bloated, and in the end doesn't get implemented.</p></htmltext>
<tokenext>The reason these systems suck and are expensive is because they are the result of " design by committee " .
What would be a good approach is that there is an existing system ( home-grown perhaps ) which gets transferred to another hospital , where a representative group gets together and says " This and that needs to be changed , the rest is OK. " What happens instead is that a committee is formed out of hospital representatives who do n't know much about IT , and IT managers who do n't know much about hospitals ( and , frankly , not about IT either ) .
Since every hospital is absolutely unique and works completely differently from every other hospital ( sarcasm intended ) , a new system needs to be designed from scratch .
The hospital representatives list requirements they do n't \ _really \ _ understand , the IT managers perform CYA tactics because they do n't oversee the implications or the \ _real \ _ requirements ( and they do n't actually mind - if the hospital asks for a five-nines system they are more than happy to comply since they can raise the cost tremendously ) .Then , there are patient representation groups who interfere because they have privacy concerns , insisting on physically separate ADSL lines going from MD offices to chemists and hospital IT lines because " the internet can be eavesdropped " ( I 'm not making this up ) , restrictions get built in so that some kind of card reading device is needed at every desk which the doctor has to sign in on to send prescriptions out ( what happens now is that the doctor has more pressing things to do than sign the prescriptions , so their assistants send them out and he signs them in bulk in the evening - what will happen after the card reading devices are installed is that the doctor will simply leave his card in the machine and move on to the more pressing work ) , etcetera.Result : The system gets more and more expensive , more and more bloated , and in the end does n't get implemented .</tokentext>
<sentencetext>The reason these systems suck and are expensive is because they are the result of "design by committee".
What would be a good approach is that there is an existing system (home-grown perhaps) which gets transferred to another hospital, where a representative group gets together and says "This and that needs to be changed, the rest is OK."What happens instead is that a committee is formed out of hospital representatives who don't know much about IT, and IT managers who don't know much about hospitals (and, frankly, not about IT either).
Since every hospital is absolutely unique and works completely differently from every other hospital (sarcasm intended), a new system needs to be designed from scratch.
The hospital representatives list requirements they don't \_really\_ understand, the IT managers perform CYA tactics because they don't oversee the implications or the \_real\_ requirements (and they don't actually mind - if the hospital asks for a five-nines system they are more than happy to comply since they can raise the cost tremendously).Then, there are patient representation groups who interfere because they have privacy concerns, insisting on physically separate ADSL lines going from MD offices to chemists and hospital IT lines because "the internet can be eavesdropped" (I'm not making this up), restrictions get built in so that some kind of card reading device is needed at every desk which the doctor has to sign in on to send prescriptions out (what happens now is that the doctor has more pressing things to do than sign the prescriptions, so their assistants send them out and he signs them in bulk in the evening - what will happen after the card reading devices are installed is that the doctor will simply leave his card in the machine and move on to the more pressing work), etcetera.Result: The system gets more and more expensive, more and more bloated, and in the end doesn't get implemented.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463733</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28468127</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>illumin8</author>
	<datestamp>1245952440000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><blockquote><div><p>I, too, spent many years working as a developer and IT administrator. While there are certainly some technical problems--security, privacy, and especially finding a sufficiently expressive standardized vocabulary--the primary issue in implementing computer systems in hospitals is cultural and behavioral. Doctors are accustomed to a great deal of autonomy, and many do not care for the structure that systems impose. The VA has been more successful than most organizations because they can impose systems by fiat. Doctors are often subject to intense time pressure and will resist anything that slows them down. In the short term, it is much faster to scribble a prescription on a piece of paper than to navigate the widgets of any order entry system. Many don't care about the long-term problems that this creates. While administrators are more likely to be aware of the long-term benefits, there is generally little they can do when doctors threaten that babies will die if doctors have to change their ways.</p></div></blockquote><p>You hit the nail right on the head.  I work in Healthcare IT as well and I found that the biggest barrier to adoption of new EMR systems is usually the nurses and doctors.  To give you an example, one of our largest products is a dictionary of medical codes that is shipped in huge, hardbound volumes.  The nurses and doctors love this product, have used it for decades, and they write all kinds of notes in the margins of their books, dog-ear pages, etc.  We discussed turning the product into an electronic book, or electronically formatted online resource, and met great resistance.  People get accustomed to using the hardbound book to look up everything, and they DO NOT WANT to change.</p><p>I think that over the next few decades as doctors and nurses that grew up using the web and electronic media enter the field, this will change, but for now, we're stuck with the doctors and nurses that we have.  And there is a pretty good argument to be made for the hardbound book.  After all, it will never fail, have to be rebooted, or crash.  Your data will never be lost unless there is a fire, and those little notes you scrawled in the margins while working at 3:00 am won't be lost the next day...</p></div>
	</htmltext>
<tokenext>I , too , spent many years working as a developer and IT administrator .
While there are certainly some technical problems--security , privacy , and especially finding a sufficiently expressive standardized vocabulary--the primary issue in implementing computer systems in hospitals is cultural and behavioral .
Doctors are accustomed to a great deal of autonomy , and many do not care for the structure that systems impose .
The VA has been more successful than most organizations because they can impose systems by fiat .
Doctors are often subject to intense time pressure and will resist anything that slows them down .
In the short term , it is much faster to scribble a prescription on a piece of paper than to navigate the widgets of any order entry system .
Many do n't care about the long-term problems that this creates .
While administrators are more likely to be aware of the long-term benefits , there is generally little they can do when doctors threaten that babies will die if doctors have to change their ways.You hit the nail right on the head .
I work in Healthcare IT as well and I found that the biggest barrier to adoption of new EMR systems is usually the nurses and doctors .
To give you an example , one of our largest products is a dictionary of medical codes that is shipped in huge , hardbound volumes .
The nurses and doctors love this product , have used it for decades , and they write all kinds of notes in the margins of their books , dog-ear pages , etc .
We discussed turning the product into an electronic book , or electronically formatted online resource , and met great resistance .
People get accustomed to using the hardbound book to look up everything , and they DO NOT WANT to change.I think that over the next few decades as doctors and nurses that grew up using the web and electronic media enter the field , this will change , but for now , we 're stuck with the doctors and nurses that we have .
And there is a pretty good argument to be made for the hardbound book .
After all , it will never fail , have to be rebooted , or crash .
Your data will never be lost unless there is a fire , and those little notes you scrawled in the margins while working at 3 : 00 am wo n't be lost the next day.. .</tokentext>
<sentencetext>I, too, spent many years working as a developer and IT administrator.
While there are certainly some technical problems--security, privacy, and especially finding a sufficiently expressive standardized vocabulary--the primary issue in implementing computer systems in hospitals is cultural and behavioral.
Doctors are accustomed to a great deal of autonomy, and many do not care for the structure that systems impose.
The VA has been more successful than most organizations because they can impose systems by fiat.
Doctors are often subject to intense time pressure and will resist anything that slows them down.
In the short term, it is much faster to scribble a prescription on a piece of paper than to navigate the widgets of any order entry system.
Many don't care about the long-term problems that this creates.
While administrators are more likely to be aware of the long-term benefits, there is generally little they can do when doctors threaten that babies will die if doctors have to change their ways.You hit the nail right on the head.
I work in Healthcare IT as well and I found that the biggest barrier to adoption of new EMR systems is usually the nurses and doctors.
To give you an example, one of our largest products is a dictionary of medical codes that is shipped in huge, hardbound volumes.
The nurses and doctors love this product, have used it for decades, and they write all kinds of notes in the margins of their books, dog-ear pages, etc.
We discussed turning the product into an electronic book, or electronically formatted online resource, and met great resistance.
People get accustomed to using the hardbound book to look up everything, and they DO NOT WANT to change.I think that over the next few decades as doctors and nurses that grew up using the web and electronic media enter the field, this will change, but for now, we're stuck with the doctors and nurses that we have.
And there is a pretty good argument to be made for the hardbound book.
After all, it will never fail, have to be rebooted, or crash.
Your data will never be lost unless there is a fire, and those little notes you scrawled in the margins while working at 3:00 am won't be lost the next day...
	</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464281</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28479345</id>
	<title>Re:NHS IT: last year's hardware at next year's pri</title>
	<author>Dr\_Barnowl</author>
	<datestamp>1246011600000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>Indeed. I work for the NHS IT programme, and in a meeting yesterday I remarked that system designers want to make trains, when what users want is helicopters.</p><p>Trains must follow a particular route and pass through a particular set of stations for that route.</p><p>Helicopters can fly where they need to and land wherever they want to.</p><p>One of the major problems is that government is stuck in the dark ages of software process, where the requirements have to be carved in stone by as many meetings as possible before implementation begins in earnest. The only successful projects I've worked on are the ones that followed a more agile pattern and delivered software early and often to clients for feedback loops to occur.</p><p>Hell, the UK government invented the abomination that is <a href="http://en.wikipedia.org/wiki/PRINCE2" title="wikipedia.org">PRINCE2</a> [wikipedia.org]</p></htmltext>
<tokenext>Indeed .
I work for the NHS IT programme , and in a meeting yesterday I remarked that system designers want to make trains , when what users want is helicopters.Trains must follow a particular route and pass through a particular set of stations for that route.Helicopters can fly where they need to and land wherever they want to.One of the major problems is that government is stuck in the dark ages of software process , where the requirements have to be carved in stone by as many meetings as possible before implementation begins in earnest .
The only successful projects I 've worked on are the ones that followed a more agile pattern and delivered software early and often to clients for feedback loops to occur.Hell , the UK government invented the abomination that is PRINCE2 [ wikipedia.org ]</tokentext>
<sentencetext>Indeed.
I work for the NHS IT programme, and in a meeting yesterday I remarked that system designers want to make trains, when what users want is helicopters.Trains must follow a particular route and pass through a particular set of stations for that route.Helicopters can fly where they need to and land wherever they want to.One of the major problems is that government is stuck in the dark ages of software process, where the requirements have to be carved in stone by as many meetings as possible before implementation begins in earnest.
The only successful projects I've worked on are the ones that followed a more agile pattern and delivered software early and often to clients for feedback loops to occur.Hell, the UK government invented the abomination that is PRINCE2 [wikipedia.org]</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464535</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463479</id>
	<title>I have a different theory</title>
	<author>Anonymous</author>
	<datestamp>1245873000000</datestamp>
	<modclass>Informativ</modclass>
	<modscore>3</modscore>
	<htmltext>Hold the conspiracy theories.  It's relatively easy to install a stand-alone diagnostic device.  It's a thousand times harder to migrate a system that's ingrained into how everybody does their work from moment to moment throughout the day.  It requires conformity, and that means resistance (sometimes well justified!)</htmltext>
<tokenext>Hold the conspiracy theories .
It 's relatively easy to install a stand-alone diagnostic device .
It 's a thousand times harder to migrate a system that 's ingrained into how everybody does their work from moment to moment throughout the day .
It requires conformity , and that means resistance ( sometimes well justified !
)</tokentext>
<sentencetext>Hold the conspiracy theories.
It's relatively easy to install a stand-alone diagnostic device.
It's a thousand times harder to migrate a system that's ingrained into how everybody does their work from moment to moment throughout the day.
It requires conformity, and that means resistance (sometimes well justified!
)</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464281</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>lurker412</author>
	<datestamp>1245925860000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>5</modscore>
	<htmltext>I, too, spent many years working as a developer and IT administrator.  While there are certainly some technical problems--security, privacy, and especially finding a sufficiently expressive standardized vocabulary--the primary issue in implementing computer systems in hospitals is cultural and behavioral.  Doctors are accustomed to a great deal of autonomy, and many do not care for the structure that systems impose.  The VA has been more successful than most organizations because they can impose systems by fiat. Doctors are often subject to intense time pressure and will resist anything that slows them down.  In the short term, it is much faster to scribble a prescription on a piece of paper than to navigate the widgets of any order entry system.  Many don't care about the long-term problems that this creates.  While administrators are more likely to be aware of the long-term benefits, there is generally little they can do when doctors threaten that babies will die if doctors have to change their ways.<br> <br>The premise of the the original article appeals to conspiracy theorists, but I have to say I have never seen any evidence that supports it.  The author also fails to provide any. Rather than look to greed, it makes more sense to look at the UI failures of most commercial systems and the inadequate attention given to training and support during implementation.</htmltext>
<tokenext>I , too , spent many years working as a developer and IT administrator .
While there are certainly some technical problems--security , privacy , and especially finding a sufficiently expressive standardized vocabulary--the primary issue in implementing computer systems in hospitals is cultural and behavioral .
Doctors are accustomed to a great deal of autonomy , and many do not care for the structure that systems impose .
The VA has been more successful than most organizations because they can impose systems by fiat .
Doctors are often subject to intense time pressure and will resist anything that slows them down .
In the short term , it is much faster to scribble a prescription on a piece of paper than to navigate the widgets of any order entry system .
Many do n't care about the long-term problems that this creates .
While administrators are more likely to be aware of the long-term benefits , there is generally little they can do when doctors threaten that babies will die if doctors have to change their ways .
The premise of the the original article appeals to conspiracy theorists , but I have to say I have never seen any evidence that supports it .
The author also fails to provide any .
Rather than look to greed , it makes more sense to look at the UI failures of most commercial systems and the inadequate attention given to training and support during implementation .</tokentext>
<sentencetext>I, too, spent many years working as a developer and IT administrator.
While there are certainly some technical problems--security, privacy, and especially finding a sufficiently expressive standardized vocabulary--the primary issue in implementing computer systems in hospitals is cultural and behavioral.
Doctors are accustomed to a great deal of autonomy, and many do not care for the structure that systems impose.
The VA has been more successful than most organizations because they can impose systems by fiat.
Doctors are often subject to intense time pressure and will resist anything that slows them down.
In the short term, it is much faster to scribble a prescription on a piece of paper than to navigate the widgets of any order entry system.
Many don't care about the long-term problems that this creates.
While administrators are more likely to be aware of the long-term benefits, there is generally little they can do when doctors threaten that babies will die if doctors have to change their ways.
The premise of the the original article appeals to conspiracy theorists, but I have to say I have never seen any evidence that supports it.
The author also fails to provide any.
Rather than look to greed, it makes more sense to look at the UI failures of most commercial systems and the inadequate attention given to training and support during implementation.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463467</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464359</id>
	<title>time...</title>
	<author>hh4m</author>
	<datestamp>1245926700000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext>this is a very touchy subject as medical records are very sensitive information... im sure most would agree that there is no room for sub par implementations in this case. so all in all, they have to get it right, any small mistakes made on the IT level could prove quite disastrous...

<br>
<br>

as the world has become globalised, the only right way of doing this will be an international database... formed by an international consortium... which can regulate standards, credentials etc...

<br>
<br>


there is no room for mistakes...</htmltext>
<tokenext>this is a very touchy subject as medical records are very sensitive information... im sure most would agree that there is no room for sub par implementations in this case .
so all in all , they have to get it right , any small mistakes made on the IT level could prove quite disastrous.. . as the world has become globalised , the only right way of doing this will be an international database... formed by an international consortium... which can regulate standards , credentials etc.. . there is no room for mistakes.. .</tokentext>
<sentencetext>this is a very touchy subject as medical records are very sensitive information... im sure most would agree that there is no room for sub par implementations in this case.
so all in all, they have to get it right, any small mistakes made on the IT level could prove quite disastrous...




as the world has become globalised, the only right way of doing this will be an international database... formed by an international consortium... which can regulate standards, credentials etc...





there is no room for mistakes...</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463703</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>Anonymous</author>
	<datestamp>1245961680000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>3</modscore>
	<htmltext><p><i>A very large HMO has spent Billions on an EMR, with major IT consulting involved, and little to show for it.</i> <br>I assume you are talking about Kaiser Permanente's HealthConnect here?  I think the key is that the groundwork has been laid.  It takes a long time and a lot of money sometimes to be a pioneer in the healthecare industry.  Ultimately it will likely benefit KP, as it will takes years for other systems to catch up if it's even possible for them to (most lack the integrated delivery system that made this possible for KP).</p></htmltext>
<tokenext>A very large HMO has spent Billions on an EMR , with major IT consulting involved , and little to show for it .
I assume you are talking about Kaiser Permanente 's HealthConnect here ?
I think the key is that the groundwork has been laid .
It takes a long time and a lot of money sometimes to be a pioneer in the healthecare industry .
Ultimately it will likely benefit KP , as it will takes years for other systems to catch up if it 's even possible for them to ( most lack the integrated delivery system that made this possible for KP ) .</tokentext>
<sentencetext>A very large HMO has spent Billions on an EMR, with major IT consulting involved, and little to show for it.
I assume you are talking about Kaiser Permanente's HealthConnect here?
I think the key is that the groundwork has been laid.
It takes a long time and a lot of money sometimes to be a pioneer in the healthecare industry.
Ultimately it will likely benefit KP, as it will takes years for other systems to catch up if it's even possible for them to (most lack the integrated delivery system that made this possible for KP).</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463467</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463509</id>
	<title>Some insight perhaps?</title>
	<author>Anonymous</author>
	<datestamp>1245873180000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext>I work for a company that makes ophthalmic ultrasound machines.<br>1. They cost roughly $30000USD per system, plus a couple grand for training. Most large hospitals and HMOs are run by bean counters who refuse to spend any more than they absolutely have to, and they could care less if everything is still paper records. Smaller organizations are just so cash-strapped that they CAN'T spend money on non-essentials. Government hospitals (like VA hospitals) have NO money to even fix aging equipment, let alone buy new or have fancy things like IT.<br>2. Quite a few medical people are, frankly, pretty average intelligence, <i>if that</i>. Some are complete doorknobs and barely know how to use a PC let alone deal with using a network. Almost all of them are so damned busy that they don't have the TIME to learn non-essential skills like computer and network use, let alone having time during the day to actually USE the stuff, unless it's absolutely necessary to do their jobs.</htmltext>
<tokenext>I work for a company that makes ophthalmic ultrasound machines.1 .
They cost roughly $ 30000USD per system , plus a couple grand for training .
Most large hospitals and HMOs are run by bean counters who refuse to spend any more than they absolutely have to , and they could care less if everything is still paper records .
Smaller organizations are just so cash-strapped that they CA N'T spend money on non-essentials .
Government hospitals ( like VA hospitals ) have NO money to even fix aging equipment , let alone buy new or have fancy things like IT.2 .
Quite a few medical people are , frankly , pretty average intelligence , if that .
Some are complete doorknobs and barely know how to use a PC let alone deal with using a network .
Almost all of them are so damned busy that they do n't have the TIME to learn non-essential skills like computer and network use , let alone having time during the day to actually USE the stuff , unless it 's absolutely necessary to do their jobs .</tokentext>
<sentencetext>I work for a company that makes ophthalmic ultrasound machines.1.
They cost roughly $30000USD per system, plus a couple grand for training.
Most large hospitals and HMOs are run by bean counters who refuse to spend any more than they absolutely have to, and they could care less if everything is still paper records.
Smaller organizations are just so cash-strapped that they CAN'T spend money on non-essentials.
Government hospitals (like VA hospitals) have NO money to even fix aging equipment, let alone buy new or have fancy things like IT.2.
Quite a few medical people are, frankly, pretty average intelligence, if that.
Some are complete doorknobs and barely know how to use a PC let alone deal with using a network.
Almost all of them are so damned busy that they don't have the TIME to learn non-essential skills like computer and network use, let alone having time during the day to actually USE the stuff, unless it's absolutely necessary to do their jobs.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465113</id>
	<title>IT can cripple Dr's office visits</title>
	<author>Anonymous</author>
	<datestamp>1245937620000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>IT can have a terrible effect on Dr's office patient visits (especially primary care).<br>Reason is that Dr's time is generally very limited, especially since most primary care docs now have to be employees and generally operate under some kind of quota system.<br>Paper records do have the advantage of being able to be reviewed very quickly - a great deal of info can be scanned for the relevant data, and notes may be present within the records exactly at the appropriate places.<br>Reviewing electronic records can be much slower (click click page scroll click page scroll mouse around some more wait for next page click wait for next page etc etc etc etc).  (Paper can also be used much less intrusively while interacting with a patient.)<br>As an IT guy, I see the advantages of electronic records (access from different points, patient reminders, interdepartmental / interorganization coordination, outcomes analysis, etc etc) are overwhelming.<br>But for my wife the primary care doc, the time lost to her may have to be time taken from each patient encounter, and also be a threat to seeing enough patients in a day to pay the bills.<br>"Ease of use" is more than just "nice to have" in this case.  Seems to me that IT is just barely becoming adequate for this task, and that IT types who automatically condemn docs for their resistance may be guilty of that arrogance and ignorance that IT is occasionally famous for.<br>Seen both sides -</p></htmltext>
<tokenext>IT can have a terrible effect on Dr 's office patient visits ( especially primary care ) .Reason is that Dr 's time is generally very limited , especially since most primary care docs now have to be employees and generally operate under some kind of quota system.Paper records do have the advantage of being able to be reviewed very quickly - a great deal of info can be scanned for the relevant data , and notes may be present within the records exactly at the appropriate places.Reviewing electronic records can be much slower ( click click page scroll click page scroll mouse around some more wait for next page click wait for next page etc etc etc etc ) .
( Paper can also be used much less intrusively while interacting with a patient .
) As an IT guy , I see the advantages of electronic records ( access from different points , patient reminders , interdepartmental / interorganization coordination , outcomes analysis , etc etc ) are overwhelming.But for my wife the primary care doc , the time lost to her may have to be time taken from each patient encounter , and also be a threat to seeing enough patients in a day to pay the bills .
" Ease of use " is more than just " nice to have " in this case .
Seems to me that IT is just barely becoming adequate for this task , and that IT types who automatically condemn docs for their resistance may be guilty of that arrogance and ignorance that IT is occasionally famous for.Seen both sides -</tokentext>
<sentencetext>IT can have a terrible effect on Dr's office patient visits (especially primary care).Reason is that Dr's time is generally very limited, especially since most primary care docs now have to be employees and generally operate under some kind of quota system.Paper records do have the advantage of being able to be reviewed very quickly - a great deal of info can be scanned for the relevant data, and notes may be present within the records exactly at the appropriate places.Reviewing electronic records can be much slower (click click page scroll click page scroll mouse around some more wait for next page click wait for next page etc etc etc etc).
(Paper can also be used much less intrusively while interacting with a patient.
)As an IT guy, I see the advantages of electronic records (access from different points, patient reminders, interdepartmental / interorganization coordination, outcomes analysis, etc etc) are overwhelming.But for my wife the primary care doc, the time lost to her may have to be time taken from each patient encounter, and also be a threat to seeing enough patients in a day to pay the bills.
"Ease of use" is more than just "nice to have" in this case.
Seems to me that IT is just barely becoming adequate for this task, and that IT types who automatically condemn docs for their resistance may be guilty of that arrogance and ignorance that IT is occasionally famous for.Seen both sides -</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464073</id>
	<title>Re:one word: protectionism</title>
	<author>Anonymous</author>
	<datestamp>1245923100000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>1</modscore>
	<htmltext><p>Sorry, but as a physician, you come to the table with a prior of zero credibility in a discussion of financial matters.</p><p>Most physicians ought to try working in any other profession besides the guaranteed-high-salary-MD-world before commenting on who it is that lives in a parallel universe.</p><p>Physicians in the US have created a closed system that requires a *state license* to enter, and then they earn 3-10+ times the median salary:<br><a href="http://www.payscale.com/research/US/People\_with\_Jobs\_as\_Physicians\_\%2F\_Doctors/Salary" title="payscale.com">http://www.payscale.com/research/US/People\_with\_Jobs\_as\_Physicians\_\%2F\_Doctors/Salary</a> [payscale.com]<br>commensurate with remarkably low unemployment (while the rest of the US are now around 9.4\% and rising).</p><p>I'm a strong supporter of anyone who creates high value earning as much as possible.  When one builds value or manages high responsibility, they get the money.</p><p>Unfortunately, physicians in the US are not creating significant value despite the costs and their salaries.  The costs to the US society have gone now above 17\% of the nation`s Gross Domestic Product (GDP), and rising at rising four times faster on average than workers` earnings since 1999.  That means more than 1 in 6 of *EVERY* dollar of value created in the US goes to this racket (sic).  High cost, by itself, not a problem: health is extremely important BUT, health results in the US are not very good, on a cost comparison basis with other 1st world countries:<br><a href="http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2006/Sep/Why-Not-the-Best--Results-from-a-National-Scorecard-on-U-S--Health-System-Performance.aspx" title="commonwealthfund.org">http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2006/Sep/Why-Not-the-Best--Results-from-a-National-Scorecard-on-U-S--Health-System-Performance.aspx</a> [commonwealthfund.org]</p><p>For all this expense, and all those salaries, US health is not as good.  Why?</p><p>Becuase care providing is a controlled, state-sponsored monopoly.  In any other industry physicians would all have been fired and improved long ago for such a horrible financial mess coupled with such poor comparative results.  As a physician you and your peers created and profit directly from the high costs in the system.</p><p>I agree with any of your assessment of EMRs.  They are dead on - but interested physicians driving this technology forward with a sincere interest in human health and not solely on protecting their business and on profits would have made EMRs a priority more then 30 years ago when research in this area first started, and solved all those issues.</p><p>And as for "Medical care in most locales in the US has long been collaborative, team-based system" - that`s comic.   A physician`s definition of "team" and what everyone else in the work world means with that word are miles apart.</p></htmltext>
<tokenext>Sorry , but as a physician , you come to the table with a prior of zero credibility in a discussion of financial matters.Most physicians ought to try working in any other profession besides the guaranteed-high-salary-MD-world before commenting on who it is that lives in a parallel universe.Physicians in the US have created a closed system that requires a * state license * to enter , and then they earn 3-10 + times the median salary : http : //www.payscale.com/research/US/People \ _with \ _Jobs \ _as \ _Physicians \ _ \ % 2F \ _Doctors/Salary [ payscale.com ] commensurate with remarkably low unemployment ( while the rest of the US are now around 9.4 \ % and rising ) .I 'm a strong supporter of anyone who creates high value earning as much as possible .
When one builds value or manages high responsibility , they get the money.Unfortunately , physicians in the US are not creating significant value despite the costs and their salaries .
The costs to the US society have gone now above 17 \ % of the nation ` s Gross Domestic Product ( GDP ) , and rising at rising four times faster on average than workers ` earnings since 1999 .
That means more than 1 in 6 of * EVERY * dollar of value created in the US goes to this racket ( sic ) .
High cost , by itself , not a problem : health is extremely important BUT , health results in the US are not very good , on a cost comparison basis with other 1st world countries : http : //www.commonwealthfund.org/Content/Publications/Fund-Reports/2006/Sep/Why-Not-the-Best--Results-from-a-National-Scorecard-on-U-S--Health-System-Performance.aspx [ commonwealthfund.org ] For all this expense , and all those salaries , US health is not as good .
Why ? Becuase care providing is a controlled , state-sponsored monopoly .
In any other industry physicians would all have been fired and improved long ago for such a horrible financial mess coupled with such poor comparative results .
As a physician you and your peers created and profit directly from the high costs in the system.I agree with any of your assessment of EMRs .
They are dead on - but interested physicians driving this technology forward with a sincere interest in human health and not solely on protecting their business and on profits would have made EMRs a priority more then 30 years ago when research in this area first started , and solved all those issues.And as for " Medical care in most locales in the US has long been collaborative , team-based system " - that ` s comic .
A physician ` s definition of " team " and what everyone else in the work world means with that word are miles apart .</tokentext>
<sentencetext>Sorry, but as a physician, you come to the table with a prior of zero credibility in a discussion of financial matters.Most physicians ought to try working in any other profession besides the guaranteed-high-salary-MD-world before commenting on who it is that lives in a parallel universe.Physicians in the US have created a closed system that requires a *state license* to enter, and then they earn 3-10+ times the median salary:http://www.payscale.com/research/US/People\_with\_Jobs\_as\_Physicians\_\%2F\_Doctors/Salary [payscale.com]commensurate with remarkably low unemployment (while the rest of the US are now around 9.4\% and rising).I'm a strong supporter of anyone who creates high value earning as much as possible.
When one builds value or manages high responsibility, they get the money.Unfortunately, physicians in the US are not creating significant value despite the costs and their salaries.
The costs to the US society have gone now above 17\% of the nation`s Gross Domestic Product (GDP), and rising at rising four times faster on average than workers` earnings since 1999.
That means more than 1 in 6 of *EVERY* dollar of value created in the US goes to this racket (sic).
High cost, by itself, not a problem: health is extremely important BUT, health results in the US are not very good, on a cost comparison basis with other 1st world countries:http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2006/Sep/Why-Not-the-Best--Results-from-a-National-Scorecard-on-U-S--Health-System-Performance.aspx [commonwealthfund.org]For all this expense, and all those salaries, US health is not as good.
Why?Becuase care providing is a controlled, state-sponsored monopoly.
In any other industry physicians would all have been fired and improved long ago for such a horrible financial mess coupled with such poor comparative results.
As a physician you and your peers created and profit directly from the high costs in the system.I agree with any of your assessment of EMRs.
They are dead on - but interested physicians driving this technology forward with a sincere interest in human health and not solely on protecting their business and on profits would have made EMRs a priority more then 30 years ago when research in this area first started, and solved all those issues.And as for "Medical care in most locales in the US has long been collaborative, team-based system" - that`s comic.
A physician`s definition of "team" and what everyone else in the work world means with that word are miles apart.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463733</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464535</id>
	<title>NHS IT: last year's hardware at next year's prices</title>
	<author>AGMW</author>
	<datestamp>1245929940000</datestamp>
	<modclass>Interestin</modclass>
	<modscore>2</modscore>
	<htmltext><i>There are tens of thousands possible tests one can subject a patient to, tens of thousands of possible but often ill defined disease concepts and a virtually unlimited set of possible individual patient attributes, states and conditions where each such attribute/state/condition has the potential to influence clinical decision making from guessing the most likely diagnosis to choosing a therapy plan that may help the patient. No matter how you cut it you will end up grossly simplifying many important aspects of this complex business and inevitably upset clinicians that are used to a certain way of doing things and are very fond of the status quo.</i>
<p>
So why not have the ability to "skin" the interface to keep the primadonna clinicians happy? Provide a 'reasonable' default interface and a tool kit that enterprising folk can use to charge the clinicians for making a bespoke interface for that clinician. The clinician then owns his own interface that he can carry around with him (on a thumbdrive maybe).
</p><p>
The system should obviously provide an interface that attempts to provide standard information in a standard way, but should also have the ability to step 'over' the <i>standard way</i> when the clinicians feel it is preventing them from correctly/accurately/fully writing up the patient notes. These occasions should automatically flag themselves up to someone in the "office" who can manaully glean the correct info to fill in the "standard info". It could also notify the writers of the software, providing a feedback loop to help to improve the software for future versions.
</p><p>
My experience of "IT in Healthcare" is the closed shop encouraged by the NHS which means you HAVE to buy from a very small set of approved vendors who then provide last year's hardware at next year's prices!
</p></htmltext>
<tokenext>There are tens of thousands possible tests one can subject a patient to , tens of thousands of possible but often ill defined disease concepts and a virtually unlimited set of possible individual patient attributes , states and conditions where each such attribute/state/condition has the potential to influence clinical decision making from guessing the most likely diagnosis to choosing a therapy plan that may help the patient .
No matter how you cut it you will end up grossly simplifying many important aspects of this complex business and inevitably upset clinicians that are used to a certain way of doing things and are very fond of the status quo .
So why not have the ability to " skin " the interface to keep the primadonna clinicians happy ?
Provide a 'reasonable ' default interface and a tool kit that enterprising folk can use to charge the clinicians for making a bespoke interface for that clinician .
The clinician then owns his own interface that he can carry around with him ( on a thumbdrive maybe ) .
The system should obviously provide an interface that attempts to provide standard information in a standard way , but should also have the ability to step 'over ' the standard way when the clinicians feel it is preventing them from correctly/accurately/fully writing up the patient notes .
These occasions should automatically flag themselves up to someone in the " office " who can manaully glean the correct info to fill in the " standard info " .
It could also notify the writers of the software , providing a feedback loop to help to improve the software for future versions .
My experience of " IT in Healthcare " is the closed shop encouraged by the NHS which means you HAVE to buy from a very small set of approved vendors who then provide last year 's hardware at next year 's prices !</tokentext>
<sentencetext>There are tens of thousands possible tests one can subject a patient to, tens of thousands of possible but often ill defined disease concepts and a virtually unlimited set of possible individual patient attributes, states and conditions where each such attribute/state/condition has the potential to influence clinical decision making from guessing the most likely diagnosis to choosing a therapy plan that may help the patient.
No matter how you cut it you will end up grossly simplifying many important aspects of this complex business and inevitably upset clinicians that are used to a certain way of doing things and are very fond of the status quo.
So why not have the ability to "skin" the interface to keep the primadonna clinicians happy?
Provide a 'reasonable' default interface and a tool kit that enterprising folk can use to charge the clinicians for making a bespoke interface for that clinician.
The clinician then owns his own interface that he can carry around with him (on a thumbdrive maybe).
The system should obviously provide an interface that attempts to provide standard information in a standard way, but should also have the ability to step 'over' the standard way when the clinicians feel it is preventing them from correctly/accurately/fully writing up the patient notes.
These occasions should automatically flag themselves up to someone in the "office" who can manaully glean the correct info to fill in the "standard info".
It could also notify the writers of the software, providing a feedback loop to help to improve the software for future versions.
My experience of "IT in Healthcare" is the closed shop encouraged by the NHS which means you HAVE to buy from a very small set of approved vendors who then provide last year's hardware at next year's prices!
</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463611</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463455</id>
	<title>Hanlon's Razor</title>
	<author>gmuslera</author>
	<datestamp>1245872460000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>3</modscore>
	<htmltext>Is not very surgical, but probably will be the right tool to diagnose this problem.</htmltext>
<tokenext>Is not very surgical , but probably will be the right tool to diagnose this problem .</tokentext>
<sentencetext>Is not very surgical, but probably will be the right tool to diagnose this problem.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465281</id>
	<title>Re:re</title>
	<author>RKThoadan</author>
	<datestamp>1245938760000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>Please quit FUDding on NP education.  The requirements vary by state, but most NPs are going to have a Masters degree (about 6 years) plus some clinical experience (varies).  I have yet to meet an NP that wasn't pleasant to deal with and seemed to actually be doing the job because they enjoyed it and wanted to be in healthcare.  I have met several doctors who were just trying to make heaps of money (and I've met several doctors who were kind, generous and awesome people as well).  For any common problem a NP is generally going to be just as capable as a MD or DO, and oftentimes more capable as they are often more "hands on" than a doctor.  There are times when a doctor is what is needed, but those are really very uncommon, and any NP will get the doctor when needed.</p></htmltext>
<tokenext>Please quit FUDding on NP education .
The requirements vary by state , but most NPs are going to have a Masters degree ( about 6 years ) plus some clinical experience ( varies ) .
I have yet to meet an NP that was n't pleasant to deal with and seemed to actually be doing the job because they enjoyed it and wanted to be in healthcare .
I have met several doctors who were just trying to make heaps of money ( and I 've met several doctors who were kind , generous and awesome people as well ) .
For any common problem a NP is generally going to be just as capable as a MD or DO , and oftentimes more capable as they are often more " hands on " than a doctor .
There are times when a doctor is what is needed , but those are really very uncommon , and any NP will get the doctor when needed .</tokentext>
<sentencetext>Please quit FUDding on NP education.
The requirements vary by state, but most NPs are going to have a Masters degree (about 6 years) plus some clinical experience (varies).
I have yet to meet an NP that wasn't pleasant to deal with and seemed to actually be doing the job because they enjoyed it and wanted to be in healthcare.
I have met several doctors who were just trying to make heaps of money (and I've met several doctors who were kind, generous and awesome people as well).
For any common problem a NP is generally going to be just as capable as a MD or DO, and oftentimes more capable as they are often more "hands on" than a doctor.
There are times when a doctor is what is needed, but those are really very uncommon, and any NP will get the doctor when needed.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464175</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464863</id>
	<title>Maybe its just the best tool for the job?</title>
	<author>Lord Byron II</author>
	<datestamp>1245935340000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>Sometimes paper is better than anything else. Certainly with paper, data security comes down to physical security, whereas with digital, security is a mix of physical and electronic security. Paper doesn't crash, paper doesn't need electricity.</p></htmltext>
<tokenext>Sometimes paper is better than anything else .
Certainly with paper , data security comes down to physical security , whereas with digital , security is a mix of physical and electronic security .
Paper does n't crash , paper does n't need electricity .</tokentext>
<sentencetext>Sometimes paper is better than anything else.
Certainly with paper, data security comes down to physical security, whereas with digital, security is a mix of physical and electronic security.
Paper doesn't crash, paper doesn't need electricity.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463699</id>
	<title>Re:one word: protectionism</title>
	<author>addsalt</author>
	<datestamp>1245961680000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>1</modscore>
	<htmltext><p><div class="quote"><p>When physicians are required to interact in electronic, shared systems, they can't lord over all the responsibility in care environments</p></div><p>As patients, we often forget that most diagnoses are really just a SWAG. A doctor usually can't be 100\% confident that his diagnosis is correct, but does his best based on his expertise and the training he has. If I were a doctor, my daily concern would be malpractice suits. I don't even want to know how many incorrect engineering decisions I make in a year. If I had to be concerned about being sued for every one of those incorrect decisions, I would be lording over the data as well because I know there is always multiple ways to interpret the same data set.</p></div>
	</htmltext>
<tokenext>When physicians are required to interact in electronic , shared systems , they ca n't lord over all the responsibility in care environmentsAs patients , we often forget that most diagnoses are really just a SWAG .
A doctor usually ca n't be 100 \ % confident that his diagnosis is correct , but does his best based on his expertise and the training he has .
If I were a doctor , my daily concern would be malpractice suits .
I do n't even want to know how many incorrect engineering decisions I make in a year .
If I had to be concerned about being sued for every one of those incorrect decisions , I would be lording over the data as well because I know there is always multiple ways to interpret the same data set .</tokentext>
<sentencetext>When physicians are required to interact in electronic, shared systems, they can't lord over all the responsibility in care environmentsAs patients, we often forget that most diagnoses are really just a SWAG.
A doctor usually can't be 100\% confident that his diagnosis is correct, but does his best based on his expertise and the training he has.
If I were a doctor, my daily concern would be malpractice suits.
I don't even want to know how many incorrect engineering decisions I make in a year.
If I had to be concerned about being sued for every one of those incorrect decisions, I would be lording over the data as well because I know there is always multiple ways to interpret the same data set.
	</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463551</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463639</id>
	<title>No evil conspiricy</title>
	<author>addsalt</author>
	<datestamp>1245961200000</datestamp>
	<modclass>Troll</modclass>
	<modscore>-1</modscore>
	<htmltext><p>I wish fear mongering didn't sell articles. Before all the rants begin about how the elitist and corrupt medical community don't want the public to see how they are being manipulated, we need to remember the group of people we are talking about. Most doctors office decisions are made by doctors. While this is a highly skilled group, I wouldn't expect IT to be a strong focus in med school. A much simpler explanation for why IT is not strong in your local doctor's office is because they don't know enough about it to trust it, or understand why and how it could help.</p></htmltext>
<tokenext>I wish fear mongering did n't sell articles .
Before all the rants begin about how the elitist and corrupt medical community do n't want the public to see how they are being manipulated , we need to remember the group of people we are talking about .
Most doctors office decisions are made by doctors .
While this is a highly skilled group , I would n't expect IT to be a strong focus in med school .
A much simpler explanation for why IT is not strong in your local doctor 's office is because they do n't know enough about it to trust it , or understand why and how it could help .</tokentext>
<sentencetext>I wish fear mongering didn't sell articles.
Before all the rants begin about how the elitist and corrupt medical community don't want the public to see how they are being manipulated, we need to remember the group of people we are talking about.
Most doctors office decisions are made by doctors.
While this is a highly skilled group, I wouldn't expect IT to be a strong focus in med school.
A much simpler explanation for why IT is not strong in your local doctor's office is because they don't know enough about it to trust it, or understand why and how it could help.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464665</id>
	<title>No... it's because of the software quality</title>
	<author>RaigetheFury</author>
	<datestamp>1245932280000</datestamp>
	<modclass>Informativ</modclass>
	<modscore>3</modscore>
	<htmltext><p>Go to any doctors office and ask how much they like their software. There is so much crap out there it isn't even funny. I know for a fact, one software company that services more than 20 hospitals and 200 doctors office recently discovered that they had a rounding error in displaying pharmaceuticals. Obviously nothing extremely dangerous... but the fact is there just isn't that many affordable quality software companies out there.</p><p>Hell, <a href="http://www.physiciansehr.org/index.asp" title="physiciansehr.org">http://www.physiciansehr.org/index.asp</a> [physiciansehr.org] and companies like it make it their sole business to find software suitable for your office, and help in the transition. It's huge business.</p><p>I don't honestly believe most medical practitioners are worried about that being used as medical malpractice fodder when weighed against the benefits. The problem comes with the cost and quality. Most doctors don't understand nor care since they have little interaction with it.</p><p>I've evaluated over 20 small doctors office software apps that are rated high and let me tell you... 99\% of them suck ass. I officially dub "suck ass" a technical term meaning, someone was smoking crack when designing the user interface and knew more about making an annoying, non-user friendly piece of trash than making ANYTHING remotely useable by the medical field.</p><p>The transition will happen eventually but some standards need to be in place and universally accepted accreditation certificates need to be available to say "Yes... this software meets these standards". We all know that this will be abused and the bare minimum met... but you have to understand... the standards are SO low... that companies release bugged software knowingly...</p><p>Just ask E-Cast. I can't wait for a federal investigation to happen to those guys.</p><p>Disclaimer: I do not work for E-Cast, nor have I ever worked, contracted for or through any group associated with E-Cast.</p></htmltext>
<tokenext>Go to any doctors office and ask how much they like their software .
There is so much crap out there it is n't even funny .
I know for a fact , one software company that services more than 20 hospitals and 200 doctors office recently discovered that they had a rounding error in displaying pharmaceuticals .
Obviously nothing extremely dangerous... but the fact is there just is n't that many affordable quality software companies out there.Hell , http : //www.physiciansehr.org/index.asp [ physiciansehr.org ] and companies like it make it their sole business to find software suitable for your office , and help in the transition .
It 's huge business.I do n't honestly believe most medical practitioners are worried about that being used as medical malpractice fodder when weighed against the benefits .
The problem comes with the cost and quality .
Most doctors do n't understand nor care since they have little interaction with it.I 've evaluated over 20 small doctors office software apps that are rated high and let me tell you... 99 \ % of them suck ass .
I officially dub " suck ass " a technical term meaning , someone was smoking crack when designing the user interface and knew more about making an annoying , non-user friendly piece of trash than making ANYTHING remotely useable by the medical field.The transition will happen eventually but some standards need to be in place and universally accepted accreditation certificates need to be available to say " Yes... this software meets these standards " .
We all know that this will be abused and the bare minimum met... but you have to understand... the standards are SO low... that companies release bugged software knowingly...Just ask E-Cast .
I ca n't wait for a federal investigation to happen to those guys.Disclaimer : I do not work for E-Cast , nor have I ever worked , contracted for or through any group associated with E-Cast .</tokentext>
<sentencetext>Go to any doctors office and ask how much they like their software.
There is so much crap out there it isn't even funny.
I know for a fact, one software company that services more than 20 hospitals and 200 doctors office recently discovered that they had a rounding error in displaying pharmaceuticals.
Obviously nothing extremely dangerous... but the fact is there just isn't that many affordable quality software companies out there.Hell, http://www.physiciansehr.org/index.asp [physiciansehr.org] and companies like it make it their sole business to find software suitable for your office, and help in the transition.
It's huge business.I don't honestly believe most medical practitioners are worried about that being used as medical malpractice fodder when weighed against the benefits.
The problem comes with the cost and quality.
Most doctors don't understand nor care since they have little interaction with it.I've evaluated over 20 small doctors office software apps that are rated high and let me tell you... 99\% of them suck ass.
I officially dub "suck ass" a technical term meaning, someone was smoking crack when designing the user interface and knew more about making an annoying, non-user friendly piece of trash than making ANYTHING remotely useable by the medical field.The transition will happen eventually but some standards need to be in place and universally accepted accreditation certificates need to be available to say "Yes... this software meets these standards".
We all know that this will be abused and the bare minimum met... but you have to understand... the standards are SO low... that companies release bugged software knowingly...Just ask E-Cast.
I can't wait for a federal investigation to happen to those guys.Disclaimer: I do not work for E-Cast, nor have I ever worked, contracted for or through any group associated with E-Cast.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28468135</id>
	<title>Re:No... it's because of the software quality</title>
	<author>Anonymous</author>
	<datestamp>1245952440000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><blockquote><div><p>I've evaluated over 20 small doctors office software apps that are rated high and let me tell you... 99\% of them suck ass.</p></div></blockquote><p>

How does that work?  1 of the 20 sucked 80\% ass?  5 of the 20 sucked 97\% ass?  Or is it Pentium maths?</p></div>
	</htmltext>
<tokenext>I 've evaluated over 20 small doctors office software apps that are rated high and let me tell you... 99 \ % of them suck ass .
How does that work ?
1 of the 20 sucked 80 \ % ass ?
5 of the 20 sucked 97 \ % ass ?
Or is it Pentium maths ?</tokentext>
<sentencetext>I've evaluated over 20 small doctors office software apps that are rated high and let me tell you... 99\% of them suck ass.
How does that work?
1 of the 20 sucked 80\% ass?
5 of the 20 sucked 97\% ass?
Or is it Pentium maths?
	</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464665</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464269</id>
	<title>Re:Doctors hate technology</title>
	<author>raind</author>
	<datestamp>1245925620000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>From what I've seen - the whole community, Doctors, Nurses and staff have more pressing ideas of what they want to accomplish other than looking at a bsod; or dumb terminals. They are busy actually caring for patients. That being said I wish they were more tech savy.</p></htmltext>
<tokenext>From what I 've seen - the whole community , Doctors , Nurses and staff have more pressing ideas of what they want to accomplish other than looking at a bsod ; or dumb terminals .
They are busy actually caring for patients .
That being said I wish they were more tech savy .</tokentext>
<sentencetext>From what I've seen - the whole community, Doctors, Nurses and staff have more pressing ideas of what they want to accomplish other than looking at a bsod; or dumb terminals.
They are busy actually caring for patients.
That being said I wish they were more tech savy.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464043</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28469187</id>
	<title>Re:lots of work for very little gain</title>
	<author>geekoid</author>
	<datestamp>1245956160000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>IN properly implemented systems I've seen, they work very well, help the doctor, and reduce costs.</p><p>Sadly, when a large company seems to get the contract to do a lot of hospitals, they ahve no idea how to run it, and they fail.</p><p>This is a doable project, it needs someone to run it like an engineering process.<br>Seriously, not one line of code should be written before it's spec'ed.</p><p>Disclaimer: I use to write medical software.</p></htmltext>
<tokenext>IN properly implemented systems I 've seen , they work very well , help the doctor , and reduce costs.Sadly , when a large company seems to get the contract to do a lot of hospitals , they ahve no idea how to run it , and they fail.This is a doable project , it needs someone to run it like an engineering process.Seriously , not one line of code should be written before it 's spec'ed.Disclaimer : I use to write medical software .</tokentext>
<sentencetext>IN properly implemented systems I've seen, they work very well, help the doctor, and reduce costs.Sadly, when a large company seems to get the contract to do a lot of hospitals, they ahve no idea how to run it, and they fail.This is a doable project, it needs someone to run it like an engineering process.Seriously, not one line of code should be written before it's spec'ed.Disclaimer: I use to write medical software.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463663</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28467101</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>JosKarith</author>
	<datestamp>1245948480000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p><div class="quote"><p>No matter how you cut it you will end up grossly simplifying many important aspects of this complex business</p> </div><p>So I'm guessing you come from the surgical rather than pharmacalogical philosophy then...</p></div>
	</htmltext>
<tokenext>No matter how you cut it you will end up grossly simplifying many important aspects of this complex business So I 'm guessing you come from the surgical rather than pharmacalogical philosophy then.. .</tokentext>
<sentencetext>No matter how you cut it you will end up grossly simplifying many important aspects of this complex business So I'm guessing you come from the surgical rather than pharmacalogical philosophy then...
	</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463611</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465999</id>
	<title>Uh...</title>
	<author>Anonymous</author>
	<datestamp>1245942840000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>T in health care has been growing since the 70s. Companies have continually been developing auditing, quality assurance, and regulation software for years. Just because this isn't widely known doesn't mean it doesn't exist.<nobr> <wbr></nobr>...and yes, I'm sure plenty of health care facilities out there don't implement as much technology as they should, but many do. Data Oriented Systems is one of the oldest health care software providers I could find. They have been in operation since the 80s. http://www.dataoriented.com</p></htmltext>
<tokenext>T in health care has been growing since the 70s .
Companies have continually been developing auditing , quality assurance , and regulation software for years .
Just because this is n't widely known does n't mean it does n't exist .
...and yes , I 'm sure plenty of health care facilities out there do n't implement as much technology as they should , but many do .
Data Oriented Systems is one of the oldest health care software providers I could find .
They have been in operation since the 80s .
http : //www.dataoriented.com</tokentext>
<sentencetext>T in health care has been growing since the 70s.
Companies have continually been developing auditing, quality assurance, and regulation software for years.
Just because this isn't widely known doesn't mean it doesn't exist.
...and yes, I'm sure plenty of health care facilities out there don't implement as much technology as they should, but many do.
Data Oriented Systems is one of the oldest health care software providers I could find.
They have been in operation since the 80s.
http://www.dataoriented.com</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28467623</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>demonlapin</author>
	<datestamp>1245950580000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p><div class="quote"><p>Doctors are often subject to intense time pressure and will resist anything that slows them down.</p></div><p>Well, when you get paid the same whether your job takes a minute or an hour, how would you react to something that slows you down?  Especially if you know that none of the money saved in the slowdown will be sent your way?  It may make for inefficiency, but physicians have no real interest in doing something that saves the hospital money but costs them time with their family.</p></div>
	</htmltext>
<tokenext>Doctors are often subject to intense time pressure and will resist anything that slows them down.Well , when you get paid the same whether your job takes a minute or an hour , how would you react to something that slows you down ?
Especially if you know that none of the money saved in the slowdown will be sent your way ?
It may make for inefficiency , but physicians have no real interest in doing something that saves the hospital money but costs them time with their family .</tokentext>
<sentencetext>Doctors are often subject to intense time pressure and will resist anything that slows them down.Well, when you get paid the same whether your job takes a minute or an hour, how would you react to something that slows you down?
Especially if you know that none of the money saved in the slowdown will be sent your way?
It may make for inefficiency, but physicians have no real interest in doing something that saves the hospital money but costs them time with their family.
	</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464281</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464175</id>
	<title>re</title>
	<author>Anonymous</author>
	<datestamp>1245924300000</datestamp>
	<modclass>Interestin</modclass>
	<modscore>1</modscore>
	<htmltext><p>Some things people fail to account for:<br>A) Cost.   Some of these data entry systems are pricey!  Some physicians who only have 5-10 years of practice time left and with private practices do NOT want to invest the time or the money to adopt such a system.  The software runs thousands of dollars.  You assume each and every physician is just REAPING in the cash and has 30,000 to invest in a computer system.  Plus the cost of inputing old records into the data system on top of that. Granted its a system of healing people and what not, but everyone is out there to make a good living for themselves as well.  You invest a lot of time and money to have an opportunity to treat people.  A lot of delayed gratification as well.  Most of ya'll probably went to work right after college/masters, assuming you did one at all.  Some doctors don't get out and make money till they turn 30.  Some even later than that. A neurosurgeon has 9 years of residency training at least.<br>B) Time of entry.  Having used some of these systems.  They are a pain in the butt and not that quick.  In private practice.  Its much easier to write out a note than spend 15-25 mins trying to write an electronic note. Time is limited and using these data systems are not efficient for most physicians! Especially with all the overhead costs of providing care, most doctors do not have the time to spend more than 10? mins per patient.  Anything more and they can't pay the rent or the staff, etc.<br>C) None of the systems are compatible with each other.  For these savings to be realized, Every doctor and point of medical care would require the same software and access.  That is not going to happen without any intervention from a big brother.<br>D) HIPAA sucks.  Adds a lot of overhead, headache and costs.<br>E) DOs are MDs, just a different philosophical background on the cause of the disease.  But in the end they are physicians.  Nurse practioners are not doctors and will never be.  They do not receive the same amount of knowledge and training.  Average primary care physician spends 4 years in college, 4 years in medical school and 3 years in residency.  NP does what?  2 or 4 years max?  BIG difference.<br>F) Doctors are not the big problem here. Granted some do over order exams.  Some do it to protect themselves legally.  You know its not there,but you need a way to document that its not there when you get sued.<br>G) HMOs and insurance... can't be sued for making business decisions.  Setup a lot of roadblocks to not cover patients and create as many road blocks to keep from paying doctors for service.  I worked with a urologist.  HMO basically said we think this procedure was worth $150 (used to be he got $1500 for it 10 years ago).  Its a take it or leave it proposal.  Then if he wants to take it, HMO requires that he personally call in and go through a convoluted phone system that costs him/her time and money.  They want to make it as long as possible so that the person calling in will just give up that money and move on.  Like a mail-in-rebate essentially<nobr> <wbr></nobr>...</p></htmltext>
<tokenext>Some things people fail to account for : A ) Cost .
Some of these data entry systems are pricey !
Some physicians who only have 5-10 years of practice time left and with private practices do NOT want to invest the time or the money to adopt such a system .
The software runs thousands of dollars .
You assume each and every physician is just REAPING in the cash and has 30,000 to invest in a computer system .
Plus the cost of inputing old records into the data system on top of that .
Granted its a system of healing people and what not , but everyone is out there to make a good living for themselves as well .
You invest a lot of time and money to have an opportunity to treat people .
A lot of delayed gratification as well .
Most of ya 'll probably went to work right after college/masters , assuming you did one at all .
Some doctors do n't get out and make money till they turn 30 .
Some even later than that .
A neurosurgeon has 9 years of residency training at least.B ) Time of entry .
Having used some of these systems .
They are a pain in the butt and not that quick .
In private practice .
Its much easier to write out a note than spend 15-25 mins trying to write an electronic note .
Time is limited and using these data systems are not efficient for most physicians !
Especially with all the overhead costs of providing care , most doctors do not have the time to spend more than 10 ?
mins per patient .
Anything more and they ca n't pay the rent or the staff , etc.C ) None of the systems are compatible with each other .
For these savings to be realized , Every doctor and point of medical care would require the same software and access .
That is not going to happen without any intervention from a big brother.D ) HIPAA sucks .
Adds a lot of overhead , headache and costs.E ) DOs are MDs , just a different philosophical background on the cause of the disease .
But in the end they are physicians .
Nurse practioners are not doctors and will never be .
They do not receive the same amount of knowledge and training .
Average primary care physician spends 4 years in college , 4 years in medical school and 3 years in residency .
NP does what ?
2 or 4 years max ?
BIG difference.F ) Doctors are not the big problem here .
Granted some do over order exams .
Some do it to protect themselves legally .
You know its not there,but you need a way to document that its not there when you get sued.G ) HMOs and insurance... ca n't be sued for making business decisions .
Setup a lot of roadblocks to not cover patients and create as many road blocks to keep from paying doctors for service .
I worked with a urologist .
HMO basically said we think this procedure was worth $ 150 ( used to be he got $ 1500 for it 10 years ago ) .
Its a take it or leave it proposal .
Then if he wants to take it , HMO requires that he personally call in and go through a convoluted phone system that costs him/her time and money .
They want to make it as long as possible so that the person calling in will just give up that money and move on .
Like a mail-in-rebate essentially .. .</tokentext>
<sentencetext>Some things people fail to account for:A) Cost.
Some of these data entry systems are pricey!
Some physicians who only have 5-10 years of practice time left and with private practices do NOT want to invest the time or the money to adopt such a system.
The software runs thousands of dollars.
You assume each and every physician is just REAPING in the cash and has 30,000 to invest in a computer system.
Plus the cost of inputing old records into the data system on top of that.
Granted its a system of healing people and what not, but everyone is out there to make a good living for themselves as well.
You invest a lot of time and money to have an opportunity to treat people.
A lot of delayed gratification as well.
Most of ya'll probably went to work right after college/masters, assuming you did one at all.
Some doctors don't get out and make money till they turn 30.
Some even later than that.
A neurosurgeon has 9 years of residency training at least.B) Time of entry.
Having used some of these systems.
They are a pain in the butt and not that quick.
In private practice.
Its much easier to write out a note than spend 15-25 mins trying to write an electronic note.
Time is limited and using these data systems are not efficient for most physicians!
Especially with all the overhead costs of providing care, most doctors do not have the time to spend more than 10?
mins per patient.
Anything more and they can't pay the rent or the staff, etc.C) None of the systems are compatible with each other.
For these savings to be realized, Every doctor and point of medical care would require the same software and access.
That is not going to happen without any intervention from a big brother.D) HIPAA sucks.
Adds a lot of overhead, headache and costs.E) DOs are MDs, just a different philosophical background on the cause of the disease.
But in the end they are physicians.
Nurse practioners are not doctors and will never be.
They do not receive the same amount of knowledge and training.
Average primary care physician spends 4 years in college, 4 years in medical school and 3 years in residency.
NP does what?
2 or 4 years max?
BIG difference.F) Doctors are not the big problem here.
Granted some do over order exams.
Some do it to protect themselves legally.
You know its not there,but you need a way to document that its not there when you get sued.G) HMOs and insurance... can't be sued for making business decisions.
Setup a lot of roadblocks to not cover patients and create as many road blocks to keep from paying doctors for service.
I worked with a urologist.
HMO basically said we think this procedure was worth $150 (used to be he got $1500 for it 10 years ago).
Its a take it or leave it proposal.
Then if he wants to take it, HMO requires that he personally call in and go through a convoluted phone system that costs him/her time and money.
They want to make it as long as possible so that the person calling in will just give up that money and move on.
Like a mail-in-rebate essentially ...</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465851</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>Hognoxious</author>
	<datestamp>1245942180000</datestamp>
	<modclass>Interestin</modclass>
	<modscore>2</modscore>
	<htmltext><blockquote><div><p> I would imagine the picture is very different depending on the country.</p></div> </blockquote><p>I would imagine the article submitter doesn't understand the concept of "other countries".</p><p>I could imagine providers overtesting in a US style pay-as-you-go system - the incentive is clear.  But why would the NHS in the UK (OMG!!! teh sosherlizzum!!!!) do such a thing?  And as you hint at, the NHS has a long record of failed IT implementations too.</p><p>I suspect the problem is to do with medicine itself - every case is different and partly the attitude of its practitioners - doctors are set in their ways and often arrogant.</p></div>
	</htmltext>
<tokenext>I would imagine the picture is very different depending on the country .
I would imagine the article submitter does n't understand the concept of " other countries " .I could imagine providers overtesting in a US style pay-as-you-go system - the incentive is clear .
But why would the NHS in the UK ( OMG ! ! !
teh sosherlizzum ! ! ! !
) do such a thing ?
And as you hint at , the NHS has a long record of failed IT implementations too.I suspect the problem is to do with medicine itself - every case is different and partly the attitude of its practitioners - doctors are set in their ways and often arrogant .</tokentext>
<sentencetext> I would imagine the picture is very different depending on the country.
I would imagine the article submitter doesn't understand the concept of "other countries".I could imagine providers overtesting in a US style pay-as-you-go system - the incentive is clear.
But why would the NHS in the UK (OMG!!!
teh sosherlizzum!!!!
) do such a thing?
And as you hint at, the NHS has a long record of failed IT implementations too.I suspect the problem is to do with medicine itself - every case is different and partly the attitude of its practitioners - doctors are set in their ways and often arrogant.
	</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464163</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463739</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>Anonymous</author>
	<datestamp>1245962160000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p><div class="quote"><p>Trying to get 3 highly paid doctors to agree on a single thing was very difficult, and it was harder still to convince them to enter the same data the same way.</p></div><p>This ^^

With the exception it's usually more than only 3 doctors.

My father-in-law managed a the business for a group of radiologists for 28 years and his 'challenges' at work really surprised. I was amazed at the ancient filing, tracking, and billing methods they used; Mainly because the doctors don't want to spend the money on it and/or can't agree on a course of action.</p></div>
	</htmltext>
<tokenext>Trying to get 3 highly paid doctors to agree on a single thing was very difficult , and it was harder still to convince them to enter the same data the same way.This ^ ^ With the exception it 's usually more than only 3 doctors .
My father-in-law managed a the business for a group of radiologists for 28 years and his 'challenges ' at work really surprised .
I was amazed at the ancient filing , tracking , and billing methods they used ; Mainly because the doctors do n't want to spend the money on it and/or ca n't agree on a course of action .</tokentext>
<sentencetext>Trying to get 3 highly paid doctors to agree on a single thing was very difficult, and it was harder still to convince them to enter the same data the same way.This ^^

With the exception it's usually more than only 3 doctors.
My father-in-law managed a the business for a group of radiologists for 28 years and his 'challenges' at work really surprised.
I was amazed at the ancient filing, tracking, and billing methods they used; Mainly because the doctors don't want to spend the money on it and/or can't agree on a course of action.
	</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463467</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463939</id>
	<title>Who keeps the records?</title>
	<author>Anonymous</author>
	<datestamp>1245921720000</datestamp>
	<modclass>Interestin</modclass>
	<modscore>5</modscore>
	<htmltext><p>I had an interesting experience in China. In 1996, when I received treatment, I kept my own records (they gave me a little paper booklet). This eliminates all the record keeping costs of the doctors and hospitals.</p><p>It might be an interesting model to look into here.</p></htmltext>
<tokenext>I had an interesting experience in China .
In 1996 , when I received treatment , I kept my own records ( they gave me a little paper booklet ) .
This eliminates all the record keeping costs of the doctors and hospitals.It might be an interesting model to look into here .</tokentext>
<sentencetext>I had an interesting experience in China.
In 1996, when I received treatment, I kept my own records (they gave me a little paper booklet).
This eliminates all the record keeping costs of the doctors and hospitals.It might be an interesting model to look into here.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464293</id>
	<title>Re:one word: protectionism</title>
	<author>ndogg</author>
	<datestamp>1245926040000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><blockquote><div><p>In my opinion, refusal to openly adopt electronic medical records is a direct result of overt protectionism by physicians and surgeons.</p></div></blockquote><p>Sure, all those people must be in cahoots.  There must be a conspiracy here.</p><blockquote><div><p>DOs are close</p></div></blockquote><p>Yes, let's promote a profession with foundations as <a href="http://www.quackwatch.com/04ConsumerEducation/QA/osteo.html" title="quackwatch.com">dubious</a> [quackwatch.com] as <a href="http://www.youtube.com/watch?v=A1-vIaNcIsc" title="youtube.com">baby twisting motherfuckers</a> [youtube.com].</p></div>
	</htmltext>
<tokenext>In my opinion , refusal to openly adopt electronic medical records is a direct result of overt protectionism by physicians and surgeons.Sure , all those people must be in cahoots .
There must be a conspiracy here.DOs are closeYes , let 's promote a profession with foundations as dubious [ quackwatch.com ] as baby twisting motherfuckers [ youtube.com ] .</tokentext>
<sentencetext>In my opinion, refusal to openly adopt electronic medical records is a direct result of overt protectionism by physicians and surgeons.Sure, all those people must be in cahoots.
There must be a conspiracy here.DOs are closeYes, let's promote a profession with foundations as dubious [quackwatch.com] as baby twisting motherfuckers [youtube.com].
	</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463551</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28466377</id>
	<title>Andy Kessler is a Wall Street analyst turned autho</title>
	<author>Anonymous</author>
	<datestamp>1245944760000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>The subject says it all</p><p>This guy has no clue what he's talking about - it's completely hearsay and conjecture</p><p>The man exhibits absolutely no experience or insight in to the health care industry as it relates to IT.</p><p>It'd be like me writing an article about art.</p></htmltext>
<tokenext>The subject says it allThis guy has no clue what he 's talking about - it 's completely hearsay and conjectureThe man exhibits absolutely no experience or insight in to the health care industry as it relates to IT.It 'd be like me writing an article about art .</tokentext>
<sentencetext>The subject says it allThis guy has no clue what he's talking about - it's completely hearsay and conjectureThe man exhibits absolutely no experience or insight in to the health care industry as it relates to IT.It'd be like me writing an article about art.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28466609</id>
	<title>Metal Church</title>
	<author>Anonymous</author>
	<datestamp>1245945960000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>I prey upon your morbid fears of terminal disease<br>You won't know the difference, now it's time for surgery<br>Another shot, another pill, two weeks therapy<br>I take all major credit cards, it's your money that I need</p><p>I'm a healer!<br>I will keep you all alive.<br>I'm a healer!<br>Fake healer.</p><p>(and more, but you really got rock the fuck out to these words instead of just reading them, so get the CD because it's ALL good)</p></htmltext>
<tokenext>I prey upon your morbid fears of terminal diseaseYou wo n't know the difference , now it 's time for surgeryAnother shot , another pill , two weeks therapyI take all major credit cards , it 's your money that I needI 'm a healer ! I will keep you all alive.I 'm a healer ! Fake healer .
( and more , but you really got rock the fuck out to these words instead of just reading them , so get the CD because it 's ALL good )</tokentext>
<sentencetext>I prey upon your morbid fears of terminal diseaseYou won't know the difference, now it's time for surgeryAnother shot, another pill, two weeks therapyI take all major credit cards, it's your money that I needI'm a healer!I will keep you all alive.I'm a healer!Fake healer.
(and more, but you really got rock the fuck out to these words instead of just reading them, so get the CD because it's ALL good)</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463715</id>
	<title>Up coding</title>
	<author>MrMarket</author>
	<datestamp>1245961860000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext>We're tired of waiting for docs to adopt EMRs, so we're about to roll out a claims-based PHR for our members to keep track of basic things like physician encounters, vaccinations, drug lists and interactions, etc -- basically anything you can get from an insurance claim. I'm not looking forward to the switchboard lighting up on day one when they discover they've been diagnosed (a.k.a up-coded) with conditions for re-reimbursement reasons rather than actual diagnostic reasons.</htmltext>
<tokenext>We 're tired of waiting for docs to adopt EMRs , so we 're about to roll out a claims-based PHR for our members to keep track of basic things like physician encounters , vaccinations , drug lists and interactions , etc -- basically anything you can get from an insurance claim .
I 'm not looking forward to the switchboard lighting up on day one when they discover they 've been diagnosed ( a.k.a up-coded ) with conditions for re-reimbursement reasons rather than actual diagnostic reasons .</tokentext>
<sentencetext>We're tired of waiting for docs to adopt EMRs, so we're about to roll out a claims-based PHR for our members to keep track of basic things like physician encounters, vaccinations, drug lists and interactions, etc -- basically anything you can get from an insurance claim.
I'm not looking forward to the switchboard lighting up on day one when they discover they've been diagnosed (a.k.a up-coded) with conditions for re-reimbursement reasons rather than actual diagnostic reasons.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464397</id>
	<title>Re:Who keeps the records?</title>
	<author>drunkahol</author>
	<datestamp>1245927300000</datestamp>
	<modclass>Interestin</modclass>
	<modscore>2</modscore>
	<htmltext><p>I actually took part in a trial of a system like this at my local GP's when I was still at school.  I've still got the credit card sized optical card that has a store of all my patient records at that time.</p><p>Don't know what the reasons for the demise of the project were, but carrying your own data around with you is exactly what people don't like about ID cards.  It could also scratch easily and doctors had no access to the data unless you were actually in the practice with your card.</p><p>Centrally stored universally accessible (with applicable restrictions if you ABSOLUTELY need them) are the only way forward.  Been knocked over by a bus in a strange city?  Have medical complications that it would be just great if the Doctors treating you had access to?</p></htmltext>
<tokenext>I actually took part in a trial of a system like this at my local GP 's when I was still at school .
I 've still got the credit card sized optical card that has a store of all my patient records at that time.Do n't know what the reasons for the demise of the project were , but carrying your own data around with you is exactly what people do n't like about ID cards .
It could also scratch easily and doctors had no access to the data unless you were actually in the practice with your card.Centrally stored universally accessible ( with applicable restrictions if you ABSOLUTELY need them ) are the only way forward .
Been knocked over by a bus in a strange city ?
Have medical complications that it would be just great if the Doctors treating you had access to ?</tokentext>
<sentencetext>I actually took part in a trial of a system like this at my local GP's when I was still at school.
I've still got the credit card sized optical card that has a store of all my patient records at that time.Don't know what the reasons for the demise of the project were, but carrying your own data around with you is exactly what people don't like about ID cards.
It could also scratch easily and doctors had no access to the data unless you were actually in the practice with your card.Centrally stored universally accessible (with applicable restrictions if you ABSOLUTELY need them) are the only way forward.
Been knocked over by a bus in a strange city?
Have medical complications that it would be just great if the Doctors treating you had access to?</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463939</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465233</id>
	<title>NEMSIS</title>
	<author>taliesinangelus</author>
	<datestamp>1245938400000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext>Hospitals/Clinics are one thing but there is a movement to capture some even more valuable date - ambulance / emergency response calls.

<a href="http://www.nemsis.org/" title="nemsis.org" rel="nofollow">http://www.nemsis.org/</a> [nemsis.org]</htmltext>
<tokenext>Hospitals/Clinics are one thing but there is a movement to capture some even more valuable date - ambulance / emergency response calls .
http : //www.nemsis.org/ [ nemsis.org ]</tokentext>
<sentencetext>Hospitals/Clinics are one thing but there is a movement to capture some even more valuable date - ambulance / emergency response calls.
http://www.nemsis.org/ [nemsis.org]</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463467</id>
	<title>Electronic Health Records is very hard</title>
	<author>dreadlord76</author>
	<datestamp>1245872640000</datestamp>
	<modclass>Informativ</modclass>
	<modscore>5</modscore>
	<htmltext>Having worked in development of EMRs, it was an extremely challenging area to work in.  Trying to get 3 highly paid doctors to agree on a single thing was very difficult, and it was harder still to convince them to enter the same data the same way.  In a particular area, such as diabetic care, it was possible to templatize the intake notes.  But when dealing with general care, it became a very difficult data input issue, and meaningful data extraction was messy.<br>

A very large HMO has spent Billions on an EMR, with major IT consulting involved, and little to show for it. The benefits were very clear over 15 years ago.  The medical community wants it to save money, and also to document against malpractice suits.  The OP's take on why it has not been adopted was definitely not the view at the VP levels of the HMOs...</htmltext>
<tokenext>Having worked in development of EMRs , it was an extremely challenging area to work in .
Trying to get 3 highly paid doctors to agree on a single thing was very difficult , and it was harder still to convince them to enter the same data the same way .
In a particular area , such as diabetic care , it was possible to templatize the intake notes .
But when dealing with general care , it became a very difficult data input issue , and meaningful data extraction was messy .
A very large HMO has spent Billions on an EMR , with major IT consulting involved , and little to show for it .
The benefits were very clear over 15 years ago .
The medical community wants it to save money , and also to document against malpractice suits .
The OP 's take on why it has not been adopted was definitely not the view at the VP levels of the HMOs.. .</tokentext>
<sentencetext>Having worked in development of EMRs, it was an extremely challenging area to work in.
Trying to get 3 highly paid doctors to agree on a single thing was very difficult, and it was harder still to convince them to enter the same data the same way.
In a particular area, such as diabetic care, it was possible to templatize the intake notes.
But when dealing with general care, it became a very difficult data input issue, and meaningful data extraction was messy.
A very large HMO has spent Billions on an EMR, with major IT consulting involved, and little to show for it.
The benefits were very clear over 15 years ago.
The medical community wants it to save money, and also to document against malpractice suits.
The OP's take on why it has not been adopted was definitely not the view at the VP levels of the HMOs...</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28470837</id>
	<title>Re:one word: protectionism</title>
	<author>Anonymous</author>
	<datestamp>1245962880000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p><div class="quote"><p>The nugget of this is not explained really in the article:</p><p>Cost is *NOT* the barrier, but "lucrative business model hidden" what they mean is the intrinsic structure of how medical care is delivered and who gets to be responsible for care delivery.</p><p>In my opinion, refusal to openly adopt electronic medical records is a direct result of overt protectionism by physicians and surgeons.  For good reason, society has left medical care in the hands of competent, trained people.  However, competency and training has been industrialized to only 1 kind of person, with one kind of standardized training: the MD, and basically no one else, regardless of training or ability is allowed by license to practice medicine, or reap the financial rewards of such extreme responsibility.  NPs have wiggled their way in a bit and DOs are close, but basically no one else.</p><p>When physicians are required to interact in electronic, shared systems, they can't lord over all the responsibility in care environments, and then they won't be the only ones who run all the medical care and take home most all the money.  They will lose their self-created and maintained monopoly on responsibility for care.</p><p>Anyone who has worked a hospital environment learns in the first few weeks exactly what the MD care delivery scheme is all about.</p></div><p>You are so off base you have no idea.  The cost IS the biggest factor.  The ROI on some of these multi million dollar a year EMR systems is negative.  A hospital has to foot a huge upfront bill for a multi year implmentation that may never pay off.    The doctors don't care one way or another, they just want to see the highest volume of patients possible to get the most reimbursement.  If the electronic system slows them down (and many do, due to poor design) they reject the system and forcing a doctor to do anything without them going down the street to another hospital is difficult.</p></div>
	</htmltext>
<tokenext>The nugget of this is not explained really in the article : Cost is * NOT * the barrier , but " lucrative business model hidden " what they mean is the intrinsic structure of how medical care is delivered and who gets to be responsible for care delivery.In my opinion , refusal to openly adopt electronic medical records is a direct result of overt protectionism by physicians and surgeons .
For good reason , society has left medical care in the hands of competent , trained people .
However , competency and training has been industrialized to only 1 kind of person , with one kind of standardized training : the MD , and basically no one else , regardless of training or ability is allowed by license to practice medicine , or reap the financial rewards of such extreme responsibility .
NPs have wiggled their way in a bit and DOs are close , but basically no one else.When physicians are required to interact in electronic , shared systems , they ca n't lord over all the responsibility in care environments , and then they wo n't be the only ones who run all the medical care and take home most all the money .
They will lose their self-created and maintained monopoly on responsibility for care.Anyone who has worked a hospital environment learns in the first few weeks exactly what the MD care delivery scheme is all about.You are so off base you have no idea .
The cost IS the biggest factor .
The ROI on some of these multi million dollar a year EMR systems is negative .
A hospital has to foot a huge upfront bill for a multi year implmentation that may never pay off .
The doctors do n't care one way or another , they just want to see the highest volume of patients possible to get the most reimbursement .
If the electronic system slows them down ( and many do , due to poor design ) they reject the system and forcing a doctor to do anything without them going down the street to another hospital is difficult .</tokentext>
<sentencetext>The nugget of this is not explained really in the article:Cost is *NOT* the barrier, but "lucrative business model hidden" what they mean is the intrinsic structure of how medical care is delivered and who gets to be responsible for care delivery.In my opinion, refusal to openly adopt electronic medical records is a direct result of overt protectionism by physicians and surgeons.
For good reason, society has left medical care in the hands of competent, trained people.
However, competency and training has been industrialized to only 1 kind of person, with one kind of standardized training: the MD, and basically no one else, regardless of training or ability is allowed by license to practice medicine, or reap the financial rewards of such extreme responsibility.
NPs have wiggled their way in a bit and DOs are close, but basically no one else.When physicians are required to interact in electronic, shared systems, they can't lord over all the responsibility in care environments, and then they won't be the only ones who run all the medical care and take home most all the money.
They will lose their self-created and maintained monopoly on responsibility for care.Anyone who has worked a hospital environment learns in the first few weeks exactly what the MD care delivery scheme is all about.You are so off base you have no idea.
The cost IS the biggest factor.
The ROI on some of these multi million dollar a year EMR systems is negative.
A hospital has to foot a huge upfront bill for a multi year implmentation that may never pay off.
The doctors don't care one way or another, they just want to see the highest volume of patients possible to get the most reimbursement.
If the electronic system slows them down (and many do, due to poor design) they reject the system and forcing a doctor to do anything without them going down the street to another hospital is difficult.
	</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463551</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465163</id>
	<title>This is not true.</title>
	<author>Anonymous</author>
	<datestamp>1245937920000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>Having worked for a major hosptial here in Cleveland I have to say that this story is just wrong.  You must be signling out one aspect that you don't have a grasp on and claiming to know something.</p><p>If you want to complain about something complain about the two faced government who through Medicare and Medicaid agree to pay an amount for procedures, but can and do decide to pay less.  They will retro-adjust the lower reimbursements for several years!!  You should try to run your business when Uncle Scam has his fist where their heads up your arse.</p></htmltext>
<tokenext>Having worked for a major hosptial here in Cleveland I have to say that this story is just wrong .
You must be signling out one aspect that you do n't have a grasp on and claiming to know something.If you want to complain about something complain about the two faced government who through Medicare and Medicaid agree to pay an amount for procedures , but can and do decide to pay less .
They will retro-adjust the lower reimbursements for several years ! !
You should try to run your business when Uncle Scam has his fist where their heads up your arse .</tokentext>
<sentencetext>Having worked for a major hosptial here in Cleveland I have to say that this story is just wrong.
You must be signling out one aspect that you don't have a grasp on and claiming to know something.If you want to complain about something complain about the two faced government who through Medicare and Medicaid agree to pay an amount for procedures, but can and do decide to pay less.
They will retro-adjust the lower reimbursements for several years!!
You should try to run your business when Uncle Scam has his fist where their heads up your arse.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28468669</id>
	<title>Laziness?</title>
	<author>LoudMusic</author>
	<datestamp>1245954300000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>I think it has more to do with the actual staff not wanting to have to learn how to do record keeping and retrieval a new way. Keep in mind these people have packed their brains with medical data and how to apply it to the point of doing much else isn't particularly easy. So they've learned how to track what they're doing one way and learning how to track it another way could be a royal pain in the ass. Not to mention the time it takes to convert old data to a new system.</p><p>But I agree that it needs to happen for a multitude of reasons. The people I know in the medical field, my wife included, who started into their practices after "the age of computers" are constantly complaining about all the paper work they have to do when it could all be done on a computer in a tenth the time, more accurate, and information could flow more easily between medical facilities.</p><p>Give it another 10 to 20 years and all the paper pushers will have retired. If you are a software engineer I suggest getting lined up for a huge market potential. They're going to have shit loads of cash and motivated decision makers.</p></htmltext>
<tokenext>I think it has more to do with the actual staff not wanting to have to learn how to do record keeping and retrieval a new way .
Keep in mind these people have packed their brains with medical data and how to apply it to the point of doing much else is n't particularly easy .
So they 've learned how to track what they 're doing one way and learning how to track it another way could be a royal pain in the ass .
Not to mention the time it takes to convert old data to a new system.But I agree that it needs to happen for a multitude of reasons .
The people I know in the medical field , my wife included , who started into their practices after " the age of computers " are constantly complaining about all the paper work they have to do when it could all be done on a computer in a tenth the time , more accurate , and information could flow more easily between medical facilities.Give it another 10 to 20 years and all the paper pushers will have retired .
If you are a software engineer I suggest getting lined up for a huge market potential .
They 're going to have shit loads of cash and motivated decision makers .</tokentext>
<sentencetext>I think it has more to do with the actual staff not wanting to have to learn how to do record keeping and retrieval a new way.
Keep in mind these people have packed their brains with medical data and how to apply it to the point of doing much else isn't particularly easy.
So they've learned how to track what they're doing one way and learning how to track it another way could be a royal pain in the ass.
Not to mention the time it takes to convert old data to a new system.But I agree that it needs to happen for a multitude of reasons.
The people I know in the medical field, my wife included, who started into their practices after "the age of computers" are constantly complaining about all the paper work they have to do when it could all be done on a computer in a tenth the time, more accurate, and information could flow more easily between medical facilities.Give it another 10 to 20 years and all the paper pushers will have retired.
If you are a software engineer I suggest getting lined up for a huge market potential.
They're going to have shit loads of cash and motivated decision makers.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464973</id>
	<title>My Experience Confirms This</title>
	<author>curmudgeon99</author>
	<datestamp>1245936540000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext>I worked in a hospital in college and for insurance companies after and I can confirm this. Doctors, for example, are only in it for the money. While some of you may be able to cite examples of good doctors, they are rare. Most are in it to get rich and so it follows obviously that they are going to do as many tests as possible--cost be damned--and if called on it they can claim they're protecting themselves from malpractice suits. In fact, it's just wallet padding.
Insurance companies have their own version of this. They are trying to find any excuse not to pay for stuff while they are collecting their ever-rising premiums. The only solution to this problem that I can see is the Public Option. Hence, all the entities who have gotten fabulously wealthy on the current Fee-for-Service model, are against it. That includes physicians, Big Pharma, medical product vendors such as Baxter and of course hospitals and the insurance industry.
The public option is the only way to go my friends, unless you or your immediate family are one of the few getting rich off of the status quo.</htmltext>
<tokenext>I worked in a hospital in college and for insurance companies after and I can confirm this .
Doctors , for example , are only in it for the money .
While some of you may be able to cite examples of good doctors , they are rare .
Most are in it to get rich and so it follows obviously that they are going to do as many tests as possible--cost be damned--and if called on it they can claim they 're protecting themselves from malpractice suits .
In fact , it 's just wallet padding .
Insurance companies have their own version of this .
They are trying to find any excuse not to pay for stuff while they are collecting their ever-rising premiums .
The only solution to this problem that I can see is the Public Option .
Hence , all the entities who have gotten fabulously wealthy on the current Fee-for-Service model , are against it .
That includes physicians , Big Pharma , medical product vendors such as Baxter and of course hospitals and the insurance industry .
The public option is the only way to go my friends , unless you or your immediate family are one of the few getting rich off of the status quo .</tokentext>
<sentencetext>I worked in a hospital in college and for insurance companies after and I can confirm this.
Doctors, for example, are only in it for the money.
While some of you may be able to cite examples of good doctors, they are rare.
Most are in it to get rich and so it follows obviously that they are going to do as many tests as possible--cost be damned--and if called on it they can claim they're protecting themselves from malpractice suits.
In fact, it's just wallet padding.
Insurance companies have their own version of this.
They are trying to find any excuse not to pay for stuff while they are collecting their ever-rising premiums.
The only solution to this problem that I can see is the Public Option.
Hence, all the entities who have gotten fabulously wealthy on the current Fee-for-Service model, are against it.
That includes physicians, Big Pharma, medical product vendors such as Baxter and of course hospitals and the insurance industry.
The public option is the only way to go my friends, unless you or your immediate family are one of the few getting rich off of the status quo.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465027</id>
	<title>Re:one word: protectionism</title>
	<author>modmans2ndcoming</author>
	<datestamp>1245937020000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>Our hospital is looking at the cost issue closely. I think we are close to deciding to allow our partnering physicians to pay a huge discount for an EMR system that we are developing and can be used for all their patients. I think that a relationship like this is where the industry will go because hospitals have the volume to justify the costs of setting up the system, and offering a low buying to the system and free setup will engender loyalty from the doctors.</p></htmltext>
<tokenext>Our hospital is looking at the cost issue closely .
I think we are close to deciding to allow our partnering physicians to pay a huge discount for an EMR system that we are developing and can be used for all their patients .
I think that a relationship like this is where the industry will go because hospitals have the volume to justify the costs of setting up the system , and offering a low buying to the system and free setup will engender loyalty from the doctors .</tokentext>
<sentencetext>Our hospital is looking at the cost issue closely.
I think we are close to deciding to allow our partnering physicians to pay a huge discount for an EMR system that we are developing and can be used for all their patients.
I think that a relationship like this is where the industry will go because hospitals have the volume to justify the costs of setting up the system, and offering a low buying to the system and free setup will engender loyalty from the doctors.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463733</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28471117</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>Anonymous</author>
	<datestamp>1245920580000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>&gt; Please spare me the conspiration theories. A sizeable chunk of the medical industry is composed of small companies whose main selling point is precisely efficiency and subsequent cost savings. This, the big medical companies can't provide anyway, there's no conspiration, you wouldn't believe the amount of paperwork you need to keep up to date to comply with regulations in this industry and especially with new products, therefore they simply sell same old.</p><p>It's the insurance companies that would want prices to stay high. When prices are extremely low, no one needs insurance. When prices are higher, people want insurance, but it's cheap enough that they do it themselves (and therefore pay attention to the price). But when prices get high enough, you need insurance through your employer. Then the price is another layer away from you, and the insurance companies can overcharge for everything too.</p><p>From another angle: insurance is entire profit-driven. Even a good insurance company is leery to switch over its records system, because that has a high up-front cost. And an evil insurance company also likes to use the excuse of flaky systems to conveniently misplace forms and deny you coverage. (funny, though, they always manage to collect your monthly fee...)</p></htmltext>
<tokenext>&gt; Please spare me the conspiration theories .
A sizeable chunk of the medical industry is composed of small companies whose main selling point is precisely efficiency and subsequent cost savings .
This , the big medical companies ca n't provide anyway , there 's no conspiration , you would n't believe the amount of paperwork you need to keep up to date to comply with regulations in this industry and especially with new products , therefore they simply sell same old.It 's the insurance companies that would want prices to stay high .
When prices are extremely low , no one needs insurance .
When prices are higher , people want insurance , but it 's cheap enough that they do it themselves ( and therefore pay attention to the price ) .
But when prices get high enough , you need insurance through your employer .
Then the price is another layer away from you , and the insurance companies can overcharge for everything too.From another angle : insurance is entire profit-driven .
Even a good insurance company is leery to switch over its records system , because that has a high up-front cost .
And an evil insurance company also likes to use the excuse of flaky systems to conveniently misplace forms and deny you coverage .
( funny , though , they always manage to collect your monthly fee... )</tokentext>
<sentencetext>&gt; Please spare me the conspiration theories.
A sizeable chunk of the medical industry is composed of small companies whose main selling point is precisely efficiency and subsequent cost savings.
This, the big medical companies can't provide anyway, there's no conspiration, you wouldn't believe the amount of paperwork you need to keep up to date to comply with regulations in this industry and especially with new products, therefore they simply sell same old.It's the insurance companies that would want prices to stay high.
When prices are extremely low, no one needs insurance.
When prices are higher, people want insurance, but it's cheap enough that they do it themselves (and therefore pay attention to the price).
But when prices get high enough, you need insurance through your employer.
Then the price is another layer away from you, and the insurance companies can overcharge for everything too.From another angle: insurance is entire profit-driven.
Even a good insurance company is leery to switch over its records system, because that has a high up-front cost.
And an evil insurance company also likes to use the excuse of flaky systems to conveniently misplace forms and deny you coverage.
(funny, though, they always manage to collect your monthly fee...)</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464163</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28466767</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>Anonymous</author>
	<datestamp>1245946800000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p><i>Trying to get 3 highly paid doctors to agree on a single thing was very difficult, and it was harder still to convince them to enter the same data the same way.  </i></p><p>Trying to get 3 highly paid software engineers to agree on a single thing can be very difficult.  And getting them to all agree on the same format for input fields can be even harder.  You describe one of the main fallacies of using computers in medical record keeping...it's useful for mundane stuff.  But all the years of medical science, and all the types of medical training, are not easily converted into a database by people who know little or nothing about medicine, nor how to interact with highly trained individuals in a profession where there is both science and art.  The art of medicine isn't easily input into computers, as the engineer doesn't know how to measure physician's guesses and thought processes.</p><p>Now, add to that the problem of keeping private and secure electronic records which will be available to any physician, clinic, hospital, insurance company, or prying governmental agency, not to mention the computer software companies and their employees, and anyone who can listen in on electronic communications between locations.  In my opinion, the only data that should be available nationwide for ER's should be special conditions that an MD would need to know about before treating a patient who can't talk, or can't recall his medical history...things like medications allergic to, and whether or not someone has a condition that would make normal treatment counter-indicated.  Giving insurance companies other information was a huge mistake, as clerks and bean counters started comparing costs without the ability to see the full picture.</p><p>I guess it's a bit like artists being asked to only use cheap white paint for all their paintings, because the other colors cost more and don't cover a canvass more completely than cheap white paint does.  Asking 3 artists to agree on which fields a computer program should ask about which cheap white paint they use might be a good analogy.</p></htmltext>
<tokenext>Trying to get 3 highly paid doctors to agree on a single thing was very difficult , and it was harder still to convince them to enter the same data the same way .
Trying to get 3 highly paid software engineers to agree on a single thing can be very difficult .
And getting them to all agree on the same format for input fields can be even harder .
You describe one of the main fallacies of using computers in medical record keeping...it 's useful for mundane stuff .
But all the years of medical science , and all the types of medical training , are not easily converted into a database by people who know little or nothing about medicine , nor how to interact with highly trained individuals in a profession where there is both science and art .
The art of medicine is n't easily input into computers , as the engineer does n't know how to measure physician 's guesses and thought processes.Now , add to that the problem of keeping private and secure electronic records which will be available to any physician , clinic , hospital , insurance company , or prying governmental agency , not to mention the computer software companies and their employees , and anyone who can listen in on electronic communications between locations .
In my opinion , the only data that should be available nationwide for ER 's should be special conditions that an MD would need to know about before treating a patient who ca n't talk , or ca n't recall his medical history...things like medications allergic to , and whether or not someone has a condition that would make normal treatment counter-indicated .
Giving insurance companies other information was a huge mistake , as clerks and bean counters started comparing costs without the ability to see the full picture.I guess it 's a bit like artists being asked to only use cheap white paint for all their paintings , because the other colors cost more and do n't cover a canvass more completely than cheap white paint does .
Asking 3 artists to agree on which fields a computer program should ask about which cheap white paint they use might be a good analogy .</tokentext>
<sentencetext>Trying to get 3 highly paid doctors to agree on a single thing was very difficult, and it was harder still to convince them to enter the same data the same way.
Trying to get 3 highly paid software engineers to agree on a single thing can be very difficult.
And getting them to all agree on the same format for input fields can be even harder.
You describe one of the main fallacies of using computers in medical record keeping...it's useful for mundane stuff.
But all the years of medical science, and all the types of medical training, are not easily converted into a database by people who know little or nothing about medicine, nor how to interact with highly trained individuals in a profession where there is both science and art.
The art of medicine isn't easily input into computers, as the engineer doesn't know how to measure physician's guesses and thought processes.Now, add to that the problem of keeping private and secure electronic records which will be available to any physician, clinic, hospital, insurance company, or prying governmental agency, not to mention the computer software companies and their employees, and anyone who can listen in on electronic communications between locations.
In my opinion, the only data that should be available nationwide for ER's should be special conditions that an MD would need to know about before treating a patient who can't talk, or can't recall his medical history...things like medications allergic to, and whether or not someone has a condition that would make normal treatment counter-indicated.
Giving insurance companies other information was a huge mistake, as clerks and bean counters started comparing costs without the ability to see the full picture.I guess it's a bit like artists being asked to only use cheap white paint for all their paintings, because the other colors cost more and don't cover a canvass more completely than cheap white paint does.
Asking 3 artists to agree on which fields a computer program should ask about which cheap white paint they use might be a good analogy.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463467</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465925</id>
	<title>Are doctors truly necessary in most circumstances?</title>
	<author>levicivita</author>
	<datestamp>1245942480000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>2</modscore>
	<htmltext>A lot of problems in driving the industry towards higher rates of adoption of modern technology are the arcane and sacrosant practices of doctors.  <br> <br> In my experience, in most situations, a simple algorithmic deterministic decision tree (with the right medical tests at the nodes) is sufficient to correctly diagnose and treat most diseases.  I've seen my highly paid doctors I've been to under my snazzy uber-exclusive insurance plan repeatedly go to a *.nih (I think) page and reading about the various possible conditions.  The human doctor is only important when dealing with the exceptions and the hard / rare cases, not with the bulk of minor, commoditized afflictions that affect mankind. <br> <br> It is purely a matter of personal preference that the current generation of middle aged baby boomers are so attached to the personal touch of another human reading them a website.  However your kids, raised in a webcentric era, might feel differently when asked to choose between paying $1,200 for 60 minutes with a reputable doctor (most of which spent filling paperwork and waiting) and $89 for going to a modern clinic where they follow an automated set of tests administered by a nurse, with results feeding into a computer (a doctor is called only if an exception is triggered). <br> <br>
And yes, don't give me the sob story of that one time where sheer human genius saved someone's life.  First, there will always be a doctor on standby to deal with exceptions, and complications.  Second, you cannot drive policy off exceptions like this.  Third, the high price of current practices drive many people away from medical care early in their afflictions, possibly outweighing the benefit of customized care.  <br> <br> Also, customized care means you are relying on your knucklehead doctor to be up to date with all the medical research not only in his field, but in all related fields.  Put it this way - who would you rather ask your random general knowledge questions: wikipedia, or a single smart educated professor?  <br> <br> In conclusion, the best thing to do might be to offer people both alternatives (at appropriate price points) and let them choose.</htmltext>
<tokenext>A lot of problems in driving the industry towards higher rates of adoption of modern technology are the arcane and sacrosant practices of doctors .
In my experience , in most situations , a simple algorithmic deterministic decision tree ( with the right medical tests at the nodes ) is sufficient to correctly diagnose and treat most diseases .
I 've seen my highly paid doctors I 've been to under my snazzy uber-exclusive insurance plan repeatedly go to a * .nih ( I think ) page and reading about the various possible conditions .
The human doctor is only important when dealing with the exceptions and the hard / rare cases , not with the bulk of minor , commoditized afflictions that affect mankind .
It is purely a matter of personal preference that the current generation of middle aged baby boomers are so attached to the personal touch of another human reading them a website .
However your kids , raised in a webcentric era , might feel differently when asked to choose between paying $ 1,200 for 60 minutes with a reputable doctor ( most of which spent filling paperwork and waiting ) and $ 89 for going to a modern clinic where they follow an automated set of tests administered by a nurse , with results feeding into a computer ( a doctor is called only if an exception is triggered ) .
And yes , do n't give me the sob story of that one time where sheer human genius saved someone 's life .
First , there will always be a doctor on standby to deal with exceptions , and complications .
Second , you can not drive policy off exceptions like this .
Third , the high price of current practices drive many people away from medical care early in their afflictions , possibly outweighing the benefit of customized care .
Also , customized care means you are relying on your knucklehead doctor to be up to date with all the medical research not only in his field , but in all related fields .
Put it this way - who would you rather ask your random general knowledge questions : wikipedia , or a single smart educated professor ?
In conclusion , the best thing to do might be to offer people both alternatives ( at appropriate price points ) and let them choose .</tokentext>
<sentencetext>A lot of problems in driving the industry towards higher rates of adoption of modern technology are the arcane and sacrosant practices of doctors.
In my experience, in most situations, a simple algorithmic deterministic decision tree (with the right medical tests at the nodes) is sufficient to correctly diagnose and treat most diseases.
I've seen my highly paid doctors I've been to under my snazzy uber-exclusive insurance plan repeatedly go to a *.nih (I think) page and reading about the various possible conditions.
The human doctor is only important when dealing with the exceptions and the hard / rare cases, not with the bulk of minor, commoditized afflictions that affect mankind.
It is purely a matter of personal preference that the current generation of middle aged baby boomers are so attached to the personal touch of another human reading them a website.
However your kids, raised in a webcentric era, might feel differently when asked to choose between paying $1,200 for 60 minutes with a reputable doctor (most of which spent filling paperwork and waiting) and $89 for going to a modern clinic where they follow an automated set of tests administered by a nurse, with results feeding into a computer (a doctor is called only if an exception is triggered).
And yes, don't give me the sob story of that one time where sheer human genius saved someone's life.
First, there will always be a doctor on standby to deal with exceptions, and complications.
Second, you cannot drive policy off exceptions like this.
Third, the high price of current practices drive many people away from medical care early in their afflictions, possibly outweighing the benefit of customized care.
Also, customized care means you are relying on your knucklehead doctor to be up to date with all the medical research not only in his field, but in all related fields.
Put it this way - who would you rather ask your random general knowledge questions: wikipedia, or a single smart educated professor?
In conclusion, the best thing to do might be to offer people both alternatives (at appropriate price points) and let them choose.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465355</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>Anonymous</author>
	<datestamp>1245939240000</datestamp>
	<modclass>Informativ</modclass>
	<modscore>1</modscore>
	<htmltext><p>What you say is largely true. As an MD I've participated on a group that developed a standardized XML EMR format 10 years ago -- despite being available this has not been widely implemented by Healthcare IT vendors -- so don't blame the doctors!</p><p>In my experience, Healthcare IT vendors produce crappy software for $$$ that often doesn't help the MDs do their work more efficiently. Don't blame the doctors for this situation.</p></htmltext>
<tokenext>What you say is largely true .
As an MD I 've participated on a group that developed a standardized XML EMR format 10 years ago -- despite being available this has not been widely implemented by Healthcare IT vendors -- so do n't blame the doctors ! In my experience , Healthcare IT vendors produce crappy software for $ $ $ that often does n't help the MDs do their work more efficiently .
Do n't blame the doctors for this situation .</tokentext>
<sentencetext>What you say is largely true.
As an MD I've participated on a group that developed a standardized XML EMR format 10 years ago -- despite being available this has not been widely implemented by Healthcare IT vendors -- so don't blame the doctors!In my experience, Healthcare IT vendors produce crappy software for $$$ that often doesn't help the MDs do their work more efficiently.
Don't blame the doctors for this situation.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463467</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465003</id>
	<title>Re:one word: protectionism</title>
	<author>Anonymous</author>
	<datestamp>1245936840000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>This the kind of paranoid, conspiracy theory BS put out by chiropractors and other 'alternative medicine' quacks.</p><p>Rather than argue science they make these kind of accusations to redirect attention away from the fact that they have nothing valuable to offer and no credibility.  Here we have a the 'the cabal is keeping us out' in the costume of IT as the enemy of MD uber-control.</p><p>If this were a story about a successful IT deployment at a hospital, you'd see these comments saying the IT infrastructure supports the MD dictators.</p></htmltext>
<tokenext>This the kind of paranoid , conspiracy theory BS put out by chiropractors and other 'alternative medicine ' quacks.Rather than argue science they make these kind of accusations to redirect attention away from the fact that they have nothing valuable to offer and no credibility .
Here we have a the 'the cabal is keeping us out ' in the costume of IT as the enemy of MD uber-control.If this were a story about a successful IT deployment at a hospital , you 'd see these comments saying the IT infrastructure supports the MD dictators .</tokentext>
<sentencetext>This the kind of paranoid, conspiracy theory BS put out by chiropractors and other 'alternative medicine' quacks.Rather than argue science they make these kind of accusations to redirect attention away from the fact that they have nothing valuable to offer and no credibility.
Here we have a the 'the cabal is keeping us out' in the costume of IT as the enemy of MD uber-control.If this were a story about a successful IT deployment at a hospital, you'd see these comments saying the IT infrastructure supports the MD dictators.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463551</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28481899</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>inline\_four</author>
	<datestamp>1246029480000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>I worked on a similar project for the mental health industry in the 1990's.  Same exact problem.  We'd get 3 or 4 respected psychiatrists in the room and they'd butt heads for an hour on how to represent in the system seemingly the most basic of concepts.  I don't know what the answer is, but it seems like we need to be very watchful of how flexible the solutions we come up with are and at the same time not let the medical professionals off the hook completely when it comes to reasonable standardization.  There are examples already in other countries that have waited a while and recently implemented EMR systems.  Surely, they're worth studying.</p></htmltext>
<tokenext>I worked on a similar project for the mental health industry in the 1990 's .
Same exact problem .
We 'd get 3 or 4 respected psychiatrists in the room and they 'd butt heads for an hour on how to represent in the system seemingly the most basic of concepts .
I do n't know what the answer is , but it seems like we need to be very watchful of how flexible the solutions we come up with are and at the same time not let the medical professionals off the hook completely when it comes to reasonable standardization .
There are examples already in other countries that have waited a while and recently implemented EMR systems .
Surely , they 're worth studying .</tokentext>
<sentencetext>I worked on a similar project for the mental health industry in the 1990's.
Same exact problem.
We'd get 3 or 4 respected psychiatrists in the room and they'd butt heads for an hour on how to represent in the system seemingly the most basic of concepts.
I don't know what the answer is, but it seems like we need to be very watchful of how flexible the solutions we come up with are and at the same time not let the medical professionals off the hook completely when it comes to reasonable standardization.
There are examples already in other countries that have waited a while and recently implemented EMR systems.
Surely, they're worth studying.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463467</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465299</id>
	<title>I'd be happy...</title>
	<author>SCHecklerX</author>
	<datestamp>1245938880000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>... if they would just come up with a standardized paper form for health history.  It could be a word, ooxml, pdf, whatever.  I walk into the specialist du-jour, and just hand them the #!@#$@!$ piece of paper.</p></htmltext>
<tokenext>... if they would just come up with a standardized paper form for health history .
It could be a word , ooxml , pdf , whatever .
I walk into the specialist du-jour , and just hand them the # !
@ # $ @ ! $ piece of paper .</tokentext>
<sentencetext>... if they would just come up with a standardized paper form for health history.
It could be a word, ooxml, pdf, whatever.
I walk into the specialist du-jour, and just hand them the #!
@#$@!$ piece of paper.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464935</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>electroniceric</author>
	<datestamp>1245936120000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>2</modscore>
	<htmltext>I think you've pretty much hit the nail on the head.  Since medicine itself is more art than science, doctors need to once convey the right information about the patient, but also pass along coded messages about their judgment on the situation  that are tailored to the recipient.  The example I know intimately is that if you're a pathologist and you see something that looks like it's a little suspicious, but you're dealing with an oncologist and surgeon who you think are a little too hot to trot in the surgery department, you're going to pull back on the language to give them a message that they can wait.  Of course you also haven't met the patient, so you don't want to take over the decision of surgery or not.

A lot that kind of thing goes into each handoff of the patient from one person to another.  It's absolutely true that it scales poorly and queries ever more poorly.  And it is a product of the way doctors are educated, so I'm dubious that just writing better software can fix it.

I do believe the autonomy and control thing is part of the issue, but I think it works in a different way.  Doctors work by using their "medical judgment and experience" (generally matching and interpolating patterns they've seen before) and they are called upon to act very quickly.  At the same time, most work for small businesses in which they are part or majority owners.  So they do very little formal development of their workflows, and tend to accumulate them without ever building in mechanisms for improvement.  Look at the work of Brent James.  They standardized workflows and then audited those standardizations, forcing a doctor to either follow the protocol or fix it, they began to really reduce mistakes and improve quality.  That kind of effort is essential to improving quality, yet it's very rarely given much attention.  IT isn't going to solve these problems by itself, but a good software development process could help if the docs buy into articulating and reviewing their workflows and the information they're passing.</htmltext>
<tokenext>I think you 've pretty much hit the nail on the head .
Since medicine itself is more art than science , doctors need to once convey the right information about the patient , but also pass along coded messages about their judgment on the situation that are tailored to the recipient .
The example I know intimately is that if you 're a pathologist and you see something that looks like it 's a little suspicious , but you 're dealing with an oncologist and surgeon who you think are a little too hot to trot in the surgery department , you 're going to pull back on the language to give them a message that they can wait .
Of course you also have n't met the patient , so you do n't want to take over the decision of surgery or not .
A lot that kind of thing goes into each handoff of the patient from one person to another .
It 's absolutely true that it scales poorly and queries ever more poorly .
And it is a product of the way doctors are educated , so I 'm dubious that just writing better software can fix it .
I do believe the autonomy and control thing is part of the issue , but I think it works in a different way .
Doctors work by using their " medical judgment and experience " ( generally matching and interpolating patterns they 've seen before ) and they are called upon to act very quickly .
At the same time , most work for small businesses in which they are part or majority owners .
So they do very little formal development of their workflows , and tend to accumulate them without ever building in mechanisms for improvement .
Look at the work of Brent James .
They standardized workflows and then audited those standardizations , forcing a doctor to either follow the protocol or fix it , they began to really reduce mistakes and improve quality .
That kind of effort is essential to improving quality , yet it 's very rarely given much attention .
IT is n't going to solve these problems by itself , but a good software development process could help if the docs buy into articulating and reviewing their workflows and the information they 're passing .</tokentext>
<sentencetext>I think you've pretty much hit the nail on the head.
Since medicine itself is more art than science, doctors need to once convey the right information about the patient, but also pass along coded messages about their judgment on the situation  that are tailored to the recipient.
The example I know intimately is that if you're a pathologist and you see something that looks like it's a little suspicious, but you're dealing with an oncologist and surgeon who you think are a little too hot to trot in the surgery department, you're going to pull back on the language to give them a message that they can wait.
Of course you also haven't met the patient, so you don't want to take over the decision of surgery or not.
A lot that kind of thing goes into each handoff of the patient from one person to another.
It's absolutely true that it scales poorly and queries ever more poorly.
And it is a product of the way doctors are educated, so I'm dubious that just writing better software can fix it.
I do believe the autonomy and control thing is part of the issue, but I think it works in a different way.
Doctors work by using their "medical judgment and experience" (generally matching and interpolating patterns they've seen before) and they are called upon to act very quickly.
At the same time, most work for small businesses in which they are part or majority owners.
So they do very little formal development of their workflows, and tend to accumulate them without ever building in mechanisms for improvement.
Look at the work of Brent James.
They standardized workflows and then audited those standardizations, forcing a doctor to either follow the protocol or fix it, they began to really reduce mistakes and improve quality.
That kind of effort is essential to improving quality, yet it's very rarely given much attention.
IT isn't going to solve these problems by itself, but a good software development process could help if the docs buy into articulating and reviewing their workflows and the information they're passing.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464281</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465331</id>
	<title>US EMR / POE experience - cynicism &amp; skepticis</title>
	<author>Anonymous</author>
	<datestamp>1245939120000</datestamp>
	<modclass>Interestin</modclass>
	<modscore>1</modscore>
	<htmltext><p>  The initial article's analysis of these complex issues is infantile and myopic.  Referring to conspiracy theories to explain why everyone doesn't jump to the commands of those who push EMR is just paranoid, and gets about as much respect from me as the schizophrenic ED patient's reports of what the voices in his head are saying.
</p><p>
Disclosure:<br>
  I am an MD.  After 4 years of college (undergrad degrees in math &amp; chemistry), 4 years of med school, 5 years of general surgery residency, 2 years of fellowship training, and 3 years of bench research, I now have been an attending surgeon for over 10 years.  Despite the below experiences, I was and am still an advocate for mature, reasonable, responsible, and efficient EMR and POE.</p><p>
  As an intern, I and my peers were subjected to the introduction of the first-ever system-wide "physician order entry" system.  The best comparison might be the African-American patients "enrolled" in the Tuskegee syphilis studies.</p><p>
  The experience has been reported by Dr. Massaro, although a number of points are missing:</p><p>
Massaro TA.  Introducing physician order entry at a major academic medical center: II. Impact on medical education.  Acad Med. 1993 Jan;68(1):25-30.</p><p>
Massaro TA. Introducing physician order entry at a major academic medical center: I. Impact on organizational culture and behavior.
Acad Med. 1993 Jan;68(1):20-5.</p><p>
  The so-called "pilot" project took all of the feedback from the resident physicians, which was 98\% negative, and cherry-picked out the 2\% positive responses to justify a full roll-out of the system.</p><p>
  To state that there were confrontations with the housestaff is putting it mildly.  Many of us were computer-literate.  The obvious inadequacies of the system and inefficiencies which dramatically took us away from patient care were persistenly NOT addressed for YEARS.  Documentation of adverse patient outcomes and events rooted in the inadequacies and check failures of the system was universally spun around and regurgitated as a failure of the end-users to "understand" the system.  The only way the end-users (residents, NOT attendings or administrators or nurses) were finally able to get any audience with the company representatives and the hospital administration was through confrontation.</p><p>
  The inefficiencies of the initial system were disastrous.  As an intern on a busy surgical service, a typical day consisted of over 8 hours inputting orders at light-pen-enabled computer terminals located at central nursing stations and visible to the patients, who often remarked how their doctors did not have time for them but instead were "playing computer games".  Shifting a SINGLE intern from putting in orders from the preconceived structured pathways (e.g. IV fluids -&gt; D5NS, 1000 mL -&gt; rate: 100 mL/hour -&gt; start: now) to instead a simple free-form type-in (e.g. please start IV fluids: D5NS @ 100 mL/hour) shut the in-patient pharmacy down in a single day, as they had eliminated the capacities to handle any exceptions.</p><p>
  The housestaff voted to go on strike when we reached the point where we felt that continuing with the system was causing more harm than just shutting everything down; in the state of Virginia, we were classified as state employees and did not have the legal right to strike.  Our initial access to free legal counsel options from the University's Law School students (imagine a free legal clinic run by the students) was terminated by the administration, so we assessed dues from all housestaff and created our own independent legal fund.</p><p>
Ultimately, the only things that seemed to work to finally get our grievances with the system heard were:<br>
1.  the adverse patient outcomes attributable to the system being leaked to reporters for both local and national newschains<br>
2.  resident complaints to the ACGME and RRCs resulting in site reviews of all the residency programs</p><p>
  The system was revised, and by the end of my residency, was efficient and flexible to the point that it was</p></htmltext>
<tokenext>The initial article 's analysis of these complex issues is infantile and myopic .
Referring to conspiracy theories to explain why everyone does n't jump to the commands of those who push EMR is just paranoid , and gets about as much respect from me as the schizophrenic ED patient 's reports of what the voices in his head are saying .
Disclosure : I am an MD .
After 4 years of college ( undergrad degrees in math &amp; chemistry ) , 4 years of med school , 5 years of general surgery residency , 2 years of fellowship training , and 3 years of bench research , I now have been an attending surgeon for over 10 years .
Despite the below experiences , I was and am still an advocate for mature , reasonable , responsible , and efficient EMR and POE .
As an intern , I and my peers were subjected to the introduction of the first-ever system-wide " physician order entry " system .
The best comparison might be the African-American patients " enrolled " in the Tuskegee syphilis studies .
The experience has been reported by Dr. Massaro , although a number of points are missing : Massaro TA .
Introducing physician order entry at a major academic medical center : II .
Impact on medical education .
Acad Med .
1993 Jan ; 68 ( 1 ) : 25-30 .
Massaro TA .
Introducing physician order entry at a major academic medical center : I. Impact on organizational culture and behavior .
Acad Med .
1993 Jan ; 68 ( 1 ) : 20-5 .
The so-called " pilot " project took all of the feedback from the resident physicians , which was 98 \ % negative , and cherry-picked out the 2 \ % positive responses to justify a full roll-out of the system .
To state that there were confrontations with the housestaff is putting it mildly .
Many of us were computer-literate .
The obvious inadequacies of the system and inefficiencies which dramatically took us away from patient care were persistenly NOT addressed for YEARS .
Documentation of adverse patient outcomes and events rooted in the inadequacies and check failures of the system was universally spun around and regurgitated as a failure of the end-users to " understand " the system .
The only way the end-users ( residents , NOT attendings or administrators or nurses ) were finally able to get any audience with the company representatives and the hospital administration was through confrontation .
The inefficiencies of the initial system were disastrous .
As an intern on a busy surgical service , a typical day consisted of over 8 hours inputting orders at light-pen-enabled computer terminals located at central nursing stations and visible to the patients , who often remarked how their doctors did not have time for them but instead were " playing computer games " .
Shifting a SINGLE intern from putting in orders from the preconceived structured pathways ( e.g .
IV fluids - &gt; D5NS , 1000 mL - &gt; rate : 100 mL/hour - &gt; start : now ) to instead a simple free-form type-in ( e.g .
please start IV fluids : D5NS @ 100 mL/hour ) shut the in-patient pharmacy down in a single day , as they had eliminated the capacities to handle any exceptions .
The housestaff voted to go on strike when we reached the point where we felt that continuing with the system was causing more harm than just shutting everything down ; in the state of Virginia , we were classified as state employees and did not have the legal right to strike .
Our initial access to free legal counsel options from the University 's Law School students ( imagine a free legal clinic run by the students ) was terminated by the administration , so we assessed dues from all housestaff and created our own independent legal fund .
Ultimately , the only things that seemed to work to finally get our grievances with the system heard were : 1. the adverse patient outcomes attributable to the system being leaked to reporters for both local and national newschains 2. resident complaints to the ACGME and RRCs resulting in site reviews of all the residency programs The system was revised , and by the end of my residency , was efficient and flexible to the point that it was</tokentext>
<sentencetext>  The initial article's analysis of these complex issues is infantile and myopic.
Referring to conspiracy theories to explain why everyone doesn't jump to the commands of those who push EMR is just paranoid, and gets about as much respect from me as the schizophrenic ED patient's reports of what the voices in his head are saying.
Disclosure:
  I am an MD.
After 4 years of college (undergrad degrees in math &amp; chemistry), 4 years of med school, 5 years of general surgery residency, 2 years of fellowship training, and 3 years of bench research, I now have been an attending surgeon for over 10 years.
Despite the below experiences, I was and am still an advocate for mature, reasonable, responsible, and efficient EMR and POE.
As an intern, I and my peers were subjected to the introduction of the first-ever system-wide "physician order entry" system.
The best comparison might be the African-American patients "enrolled" in the Tuskegee syphilis studies.
The experience has been reported by Dr. Massaro, although a number of points are missing:
Massaro TA.
Introducing physician order entry at a major academic medical center: II.
Impact on medical education.
Acad Med.
1993 Jan;68(1):25-30.
Massaro TA.
Introducing physician order entry at a major academic medical center: I. Impact on organizational culture and behavior.
Acad Med.
1993 Jan;68(1):20-5.
The so-called "pilot" project took all of the feedback from the resident physicians, which was 98\% negative, and cherry-picked out the 2\% positive responses to justify a full roll-out of the system.
To state that there were confrontations with the housestaff is putting it mildly.
Many of us were computer-literate.
The obvious inadequacies of the system and inefficiencies which dramatically took us away from patient care were persistenly NOT addressed for YEARS.
Documentation of adverse patient outcomes and events rooted in the inadequacies and check failures of the system was universally spun around and regurgitated as a failure of the end-users to "understand" the system.
The only way the end-users (residents, NOT attendings or administrators or nurses) were finally able to get any audience with the company representatives and the hospital administration was through confrontation.
The inefficiencies of the initial system were disastrous.
As an intern on a busy surgical service, a typical day consisted of over 8 hours inputting orders at light-pen-enabled computer terminals located at central nursing stations and visible to the patients, who often remarked how their doctors did not have time for them but instead were "playing computer games".
Shifting a SINGLE intern from putting in orders from the preconceived structured pathways (e.g.
IV fluids -&gt; D5NS, 1000 mL -&gt; rate: 100 mL/hour -&gt; start: now) to instead a simple free-form type-in (e.g.
please start IV fluids: D5NS @ 100 mL/hour) shut the in-patient pharmacy down in a single day, as they had eliminated the capacities to handle any exceptions.
The housestaff voted to go on strike when we reached the point where we felt that continuing with the system was causing more harm than just shutting everything down; in the state of Virginia, we were classified as state employees and did not have the legal right to strike.
Our initial access to free legal counsel options from the University's Law School students (imagine a free legal clinic run by the students) was terminated by the administration, so we assessed dues from all housestaff and created our own independent legal fund.
Ultimately, the only things that seemed to work to finally get our grievances with the system heard were:
1.  the adverse patient outcomes attributable to the system being leaked to reporters for both local and national newschains
2.  resident complaints to the ACGME and RRCs resulting in site reviews of all the residency programs
  The system was revised, and by the end of my residency, was efficient and flexible to the point that it was</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464367</id>
	<title>Re:lots of work for very little gain</title>
	<author>malkavian</author>
	<datestamp>1245926760000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>Throwing money at a problem with sod all in the way of technical review doesn't help.  That's exactly what the government in the UK did with their NPfIT project (National Project for Information Technology), which is the system whereby all medical records are supposed to be digital and available nationally.</p><p>The specifications were a joke, with each of the "commercial partners" building it differently, with different understandings of the data to the extent that I have the strong suspicion that they wouldn't actually be fully compatible with each other.</p><p>Also, the decision on the system was taken by a quick look at it in ONE hospital, where it worked perfectly, and then it was decided that would be the core for everything, without working out if it would really scale properly.  Then there was the whole set of "revisions" where the initial would mean you couldn't do things you historically could, and you'd be stuck in a backwater for a decade.</p><p>Whole rafts of products were promised which still aren't available and working for it, making it pretty rubbish for day to day usage (in many cases, extra people have had to be hired to perform the 'work arounds' to cope with the increased workload of having to follow a seriously strict method of entering data, such that followup appointments take about 15 mins to book, where they used to take a few seconds with a receptionist).</p><p>The chap who headed the whole thing up in the early days was one Richard Granger, whose large claim to fame was that he initially failed his degree, and it took his mother writing to Princess Anne to lean on Bristol University to let him do a retake of the exam (which normally isn't allowed).</p><p>The core Cerner product at the heart of it is actually pretty good as a one off.  But scaling up isn't what it was designed to do.   As every slashdot story needs a crap analogy, I have one for it that I mention to people to describe my take on it:</p><p>To deliver newspapers to the door, you'll find it hard to get better than a kid on a bike doing a paper round.  The whole NPfIT project makes the assumption that because that's a good mechanism for delivery, it's got rid of the fleets of heavy trucks, and does the entire delivery from the printing works by hiring tens of thousands of kids on bikes instead.</p></htmltext>
<tokenext>Throwing money at a problem with sod all in the way of technical review does n't help .
That 's exactly what the government in the UK did with their NPfIT project ( National Project for Information Technology ) , which is the system whereby all medical records are supposed to be digital and available nationally.The specifications were a joke , with each of the " commercial partners " building it differently , with different understandings of the data to the extent that I have the strong suspicion that they would n't actually be fully compatible with each other.Also , the decision on the system was taken by a quick look at it in ONE hospital , where it worked perfectly , and then it was decided that would be the core for everything , without working out if it would really scale properly .
Then there was the whole set of " revisions " where the initial would mean you could n't do things you historically could , and you 'd be stuck in a backwater for a decade.Whole rafts of products were promised which still are n't available and working for it , making it pretty rubbish for day to day usage ( in many cases , extra people have had to be hired to perform the 'work arounds ' to cope with the increased workload of having to follow a seriously strict method of entering data , such that followup appointments take about 15 mins to book , where they used to take a few seconds with a receptionist ) .The chap who headed the whole thing up in the early days was one Richard Granger , whose large claim to fame was that he initially failed his degree , and it took his mother writing to Princess Anne to lean on Bristol University to let him do a retake of the exam ( which normally is n't allowed ) .The core Cerner product at the heart of it is actually pretty good as a one off .
But scaling up is n't what it was designed to do .
As every slashdot story needs a crap analogy , I have one for it that I mention to people to describe my take on it : To deliver newspapers to the door , you 'll find it hard to get better than a kid on a bike doing a paper round .
The whole NPfIT project makes the assumption that because that 's a good mechanism for delivery , it 's got rid of the fleets of heavy trucks , and does the entire delivery from the printing works by hiring tens of thousands of kids on bikes instead .</tokentext>
<sentencetext>Throwing money at a problem with sod all in the way of technical review doesn't help.
That's exactly what the government in the UK did with their NPfIT project (National Project for Information Technology), which is the system whereby all medical records are supposed to be digital and available nationally.The specifications were a joke, with each of the "commercial partners" building it differently, with different understandings of the data to the extent that I have the strong suspicion that they wouldn't actually be fully compatible with each other.Also, the decision on the system was taken by a quick look at it in ONE hospital, where it worked perfectly, and then it was decided that would be the core for everything, without working out if it would really scale properly.
Then there was the whole set of "revisions" where the initial would mean you couldn't do things you historically could, and you'd be stuck in a backwater for a decade.Whole rafts of products were promised which still aren't available and working for it, making it pretty rubbish for day to day usage (in many cases, extra people have had to be hired to perform the 'work arounds' to cope with the increased workload of having to follow a seriously strict method of entering data, such that followup appointments take about 15 mins to book, where they used to take a few seconds with a receptionist).The chap who headed the whole thing up in the early days was one Richard Granger, whose large claim to fame was that he initially failed his degree, and it took his mother writing to Princess Anne to lean on Bristol University to let him do a retake of the exam (which normally isn't allowed).The core Cerner product at the heart of it is actually pretty good as a one off.
But scaling up isn't what it was designed to do.
As every slashdot story needs a crap analogy, I have one for it that I mention to people to describe my take on it:To deliver newspapers to the door, you'll find it hard to get better than a kid on a bike doing a paper round.
The whole NPfIT project makes the assumption that because that's a good mechanism for delivery, it's got rid of the fleets of heavy trucks, and does the entire delivery from the printing works by hiring tens of thousands of kids on bikes instead.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463663</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28466491</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>BigGar'</author>
	<datestamp>1245945360000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>Sounds like your experience is not unlike mine in working on SAP installations.<br>Businesses need to change long running business processes to model the software's processes/templates.<br>There's often a lot of resistance to changing these processes; usually for no reason other than institutional inertia.<br>If you don't have buy-in from the top for the need to make these changes then the implementation is almost doomed to failure.</p></htmltext>
<tokenext>Sounds like your experience is not unlike mine in working on SAP installations.Businesses need to change long running business processes to model the software 's processes/templates.There 's often a lot of resistance to changing these processes ; usually for no reason other than institutional inertia.If you do n't have buy-in from the top for the need to make these changes then the implementation is almost doomed to failure .</tokentext>
<sentencetext>Sounds like your experience is not unlike mine in working on SAP installations.Businesses need to change long running business processes to model the software's processes/templates.There's often a lot of resistance to changing these processes; usually for no reason other than institutional inertia.If you don't have buy-in from the top for the need to make these changes then the implementation is almost doomed to failure.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463467</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464043</id>
	<title>Doctors hate technology</title>
	<author>Datamonstar</author>
	<datestamp>1245922860000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext>No really, Doctors hate technology for the most part from what I've seen, as they see it as intrusive and contradictory to their long history of practice. The number one concern I hear voiced is that having to deal with electronic records, especially with the patient present takes the doctor's attention away from the patient and that's a big no for most physicians. The other one I hear alot is that from the patient's viewpoint it looks a whole lot less intimidating and polite to have a doctor staring at a paper chart than a hand-held device. Something about a person staring into a screen as they attempt to hold a conversation with you is still a bit unnerving and something that we haven't fully gotten used to for the most part, I guess.</htmltext>
<tokenext>No really , Doctors hate technology for the most part from what I 've seen , as they see it as intrusive and contradictory to their long history of practice .
The number one concern I hear voiced is that having to deal with electronic records , especially with the patient present takes the doctor 's attention away from the patient and that 's a big no for most physicians .
The other one I hear alot is that from the patient 's viewpoint it looks a whole lot less intimidating and polite to have a doctor staring at a paper chart than a hand-held device .
Something about a person staring into a screen as they attempt to hold a conversation with you is still a bit unnerving and something that we have n't fully gotten used to for the most part , I guess .</tokentext>
<sentencetext>No really, Doctors hate technology for the most part from what I've seen, as they see it as intrusive and contradictory to their long history of practice.
The number one concern I hear voiced is that having to deal with electronic records, especially with the patient present takes the doctor's attention away from the patient and that's a big no for most physicians.
The other one I hear alot is that from the patient's viewpoint it looks a whole lot less intimidating and polite to have a doctor staring at a paper chart than a hand-held device.
Something about a person staring into a screen as they attempt to hold a conversation with you is still a bit unnerving and something that we haven't fully gotten used to for the most part, I guess.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28478877</id>
	<title>Re:IT and Medicine are a Bad Fit</title>
	<author>dkf</author>
	<datestamp>1246006980000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p><div class="quote"><p>If you read the literature on Description Logics you'll see that even PhD logicians have a hard time symbolically storing this kind of abstract data into a piece of software, let alone a doc with little computer training.</p></div><p>There are two big problems in this area.</p><ol> <li>The logics used are right at the limit of what can be reasoned about automatically; even after decades of work, it's still very very difficult to go beyond First Order Logic in an automated fashion.</li><li>Getting two clinicians to agree on a single description of <i>one</i> patient seems to be impossible, and the medical literature is deliberately inconsistent and often whimsical. What right do we have to expect mere logic to withstand such sabotage? If doctors had been essentially engineers-of-the-body, this would have been all solved years ago. Chemists and physicists don't have this difficulty either. Even programmers are usually on the same page (or can Google it to figure it out.) Medicine just has to be different/difficult.</li></ol><p>Still, if EHRs were essentially just free plain text with images as attachments (or, thinking about it, perhaps a big MediaWiki installation) that would be a big step forward as they would capture current practice with little extra effort. But people had to insist on asking for the moon on a stick...</p></div>
	</htmltext>
<tokenext>If you read the literature on Description Logics you 'll see that even PhD logicians have a hard time symbolically storing this kind of abstract data into a piece of software , let alone a doc with little computer training.There are two big problems in this area .
The logics used are right at the limit of what can be reasoned about automatically ; even after decades of work , it 's still very very difficult to go beyond First Order Logic in an automated fashion.Getting two clinicians to agree on a single description of one patient seems to be impossible , and the medical literature is deliberately inconsistent and often whimsical .
What right do we have to expect mere logic to withstand such sabotage ?
If doctors had been essentially engineers-of-the-body , this would have been all solved years ago .
Chemists and physicists do n't have this difficulty either .
Even programmers are usually on the same page ( or can Google it to figure it out .
) Medicine just has to be different/difficult.Still , if EHRs were essentially just free plain text with images as attachments ( or , thinking about it , perhaps a big MediaWiki installation ) that would be a big step forward as they would capture current practice with little extra effort .
But people had to insist on asking for the moon on a stick.. .</tokentext>
<sentencetext>If you read the literature on Description Logics you'll see that even PhD logicians have a hard time symbolically storing this kind of abstract data into a piece of software, let alone a doc with little computer training.There are two big problems in this area.
The logics used are right at the limit of what can be reasoned about automatically; even after decades of work, it's still very very difficult to go beyond First Order Logic in an automated fashion.Getting two clinicians to agree on a single description of one patient seems to be impossible, and the medical literature is deliberately inconsistent and often whimsical.
What right do we have to expect mere logic to withstand such sabotage?
If doctors had been essentially engineers-of-the-body, this would have been all solved years ago.
Chemists and physicists don't have this difficulty either.
Even programmers are usually on the same page (or can Google it to figure it out.
) Medicine just has to be different/difficult.Still, if EHRs were essentially just free plain text with images as attachments (or, thinking about it, perhaps a big MediaWiki installation) that would be a big step forward as they would capture current practice with little extra effort.
But people had to insist on asking for the moon on a stick...
	</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465565</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464543</id>
	<title>Why would anyone want to use lousy software?</title>
	<author>meander</author>
	<datestamp>1245930120000</datestamp>
	<modclass>Interestin</modclass>
	<modscore>2</modscore>
	<htmltext><p><div class="quote"><p>However, the biggest stop to systems like this is the medical staff. Doctors seem to think they're above having to enter medical details - as it's mere clerical work (I've heard: "I didn't spend years at med. school, just to be a secretary") and they, personally, don't gain anything from a system such as this. Until somoeone gieves the profession as a whole a kick up the rear, this kind of prima-donna attitude will prevail.</p></div><p>I speak as a general practitioner of many decades, and I've been playing with computers since the early 70's. The main reason medical records software is not accepted is that it sucks.</p><p>My 24" screen holds far less information than a bunch of scribbled A4 pages. Time is what I lack, and scrolling through pages &amp; sections on a screen is just not very efficient.</p><p>Yes, there are some great aspects in most of the software I have used over the last decade, but as far as being a place to store info that I want to easily access &amp; collate later, all too often it is too bloody slow &amp; awkward.</p><p>Except for one feature of electronic records, I would go back to pencil &amp; paper.</p><p>The only really successful feature was the first; writing scripts &amp; recording the fact that a script was written. In the 'old' days, you would write a script, then the phone would ring, on hanging up, you forgot to record what you had just prescribed, leading to problems down the track. Software to prescribe &amp; automatically store a record of that transaction has been fantastically useful for both myself &amp; the patient.</p><p>I have sat here for some 10 minutes, and the only other feature I like is that my notes are more legible to me down the track. As a computer nerd, I want to love these systems, but so far they are not very good.</p></div>
	</htmltext>
<tokenext>However , the biggest stop to systems like this is the medical staff .
Doctors seem to think they 're above having to enter medical details - as it 's mere clerical work ( I 've heard : " I did n't spend years at med .
school , just to be a secretary " ) and they , personally , do n't gain anything from a system such as this .
Until somoeone gieves the profession as a whole a kick up the rear , this kind of prima-donna attitude will prevail.I speak as a general practitioner of many decades , and I 've been playing with computers since the early 70 's .
The main reason medical records software is not accepted is that it sucks.My 24 " screen holds far less information than a bunch of scribbled A4 pages .
Time is what I lack , and scrolling through pages &amp; sections on a screen is just not very efficient.Yes , there are some great aspects in most of the software I have used over the last decade , but as far as being a place to store info that I want to easily access &amp; collate later , all too often it is too bloody slow &amp; awkward.Except for one feature of electronic records , I would go back to pencil &amp; paper.The only really successful feature was the first ; writing scripts &amp; recording the fact that a script was written .
In the 'old ' days , you would write a script , then the phone would ring , on hanging up , you forgot to record what you had just prescribed , leading to problems down the track .
Software to prescribe &amp; automatically store a record of that transaction has been fantastically useful for both myself &amp; the patient.I have sat here for some 10 minutes , and the only other feature I like is that my notes are more legible to me down the track .
As a computer nerd , I want to love these systems , but so far they are not very good .</tokentext>
<sentencetext>However, the biggest stop to systems like this is the medical staff.
Doctors seem to think they're above having to enter medical details - as it's mere clerical work (I've heard: "I didn't spend years at med.
school, just to be a secretary") and they, personally, don't gain anything from a system such as this.
Until somoeone gieves the profession as a whole a kick up the rear, this kind of prima-donna attitude will prevail.I speak as a general practitioner of many decades, and I've been playing with computers since the early 70's.
The main reason medical records software is not accepted is that it sucks.My 24" screen holds far less information than a bunch of scribbled A4 pages.
Time is what I lack, and scrolling through pages &amp; sections on a screen is just not very efficient.Yes, there are some great aspects in most of the software I have used over the last decade, but as far as being a place to store info that I want to easily access &amp; collate later, all too often it is too bloody slow &amp; awkward.Except for one feature of electronic records, I would go back to pencil &amp; paper.The only really successful feature was the first; writing scripts &amp; recording the fact that a script was written.
In the 'old' days, you would write a script, then the phone would ring, on hanging up, you forgot to record what you had just prescribed, leading to problems down the track.
Software to prescribe &amp; automatically store a record of that transaction has been fantastically useful for both myself &amp; the patient.I have sat here for some 10 minutes, and the only other feature I like is that my notes are more legible to me down the track.
As a computer nerd, I want to love these systems, but so far they are not very good.
	</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463663</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463611</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>Anonymous</author>
	<datestamp>1245960840000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>Yep, people outside the field grossly underestimate its complexity. There are tens of thousands possible tests one can subject a patient to, tens of thousands of possible but often ill defined disease concepts and a virtually unlimited set of possible individual patient attributes, states and conditions where each such attribute/state/condition has the potential to influence clinical decision making from guessing the most likely diagnosis to choosing a therapy plan that may help the patient. No matter how you cut it you will end up grossly simplifying many important aspects of this complex business and inevitably upset clinicians that are used to a certain way of doing things and are very fond of the status quo.</p></htmltext>
<tokenext>Yep , people outside the field grossly underestimate its complexity .
There are tens of thousands possible tests one can subject a patient to , tens of thousands of possible but often ill defined disease concepts and a virtually unlimited set of possible individual patient attributes , states and conditions where each such attribute/state/condition has the potential to influence clinical decision making from guessing the most likely diagnosis to choosing a therapy plan that may help the patient .
No matter how you cut it you will end up grossly simplifying many important aspects of this complex business and inevitably upset clinicians that are used to a certain way of doing things and are very fond of the status quo .</tokentext>
<sentencetext>Yep, people outside the field grossly underestimate its complexity.
There are tens of thousands possible tests one can subject a patient to, tens of thousands of possible but often ill defined disease concepts and a virtually unlimited set of possible individual patient attributes, states and conditions where each such attribute/state/condition has the potential to influence clinical decision making from guessing the most likely diagnosis to choosing a therapy plan that may help the patient.
No matter how you cut it you will end up grossly simplifying many important aspects of this complex business and inevitably upset clinicians that are used to a certain way of doing things and are very fond of the status quo.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463467</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463883</id>
	<title>As someone who has worked on it...</title>
	<author>freedom\_india</author>
	<datestamp>1245921000000</datestamp>
	<modclass>Informativ</modclass>
	<modscore>5</modscore>
	<htmltext><p>...there are multiple reasons and road blocks (natural and artificial):<br>1) Healthcare is about making profit. It is not about caring for health. I have seen many IT companies bite the dust during proposals by stating their systems could help caring for health quicker and much better. That's the last thing Blue Cross or anyone else wants.<br>The idea for IT companies is to open a presentation with how to increase profits. That, as far as i know, is the only presentation which interests the healthcare company.<br>2) There are combinational factors; for instance doctors and software don't go well together psychologically except in times of peace, which is rare. Instead of adopting touch screen systems and throw-away laptops small enough and tough enough, most companies insist on producing massive software run in PCs and Servers in a serene a/c room. Excuse me, which doctor has sanguinely traversed through a maze of Visual Basic or PowerBuilder application menus?<br>3) IT companies should seriously stop considering "integrated" systems which connect doctors with nurses with patients with pharmacies. No, for the last fcuking time, no we don't need integrated crap. All we need is a simple system that can be accessed with a max of three clicks and accepts voice input.<br>4) Record management: HIPAA is not exactly an easy job. Any standard created by a committee is, by definition, an as$ to work with.<br>5) Changes in systems result in changes in behavior and processes: something hated by surgeons, doctors and hospitals.<br>Don't attribute to malice what can be explained by stupidity.</p></htmltext>
<tokenext>...there are multiple reasons and road blocks ( natural and artificial ) : 1 ) Healthcare is about making profit .
It is not about caring for health .
I have seen many IT companies bite the dust during proposals by stating their systems could help caring for health quicker and much better .
That 's the last thing Blue Cross or anyone else wants.The idea for IT companies is to open a presentation with how to increase profits .
That , as far as i know , is the only presentation which interests the healthcare company.2 ) There are combinational factors ; for instance doctors and software do n't go well together psychologically except in times of peace , which is rare .
Instead of adopting touch screen systems and throw-away laptops small enough and tough enough , most companies insist on producing massive software run in PCs and Servers in a serene a/c room .
Excuse me , which doctor has sanguinely traversed through a maze of Visual Basic or PowerBuilder application menus ? 3 ) IT companies should seriously stop considering " integrated " systems which connect doctors with nurses with patients with pharmacies .
No , for the last fcuking time , no we do n't need integrated crap .
All we need is a simple system that can be accessed with a max of three clicks and accepts voice input.4 ) Record management : HIPAA is not exactly an easy job .
Any standard created by a committee is , by definition , an as $ to work with.5 ) Changes in systems result in changes in behavior and processes : something hated by surgeons , doctors and hospitals.Do n't attribute to malice what can be explained by stupidity .</tokentext>
<sentencetext>...there are multiple reasons and road blocks (natural and artificial):1) Healthcare is about making profit.
It is not about caring for health.
I have seen many IT companies bite the dust during proposals by stating their systems could help caring for health quicker and much better.
That's the last thing Blue Cross or anyone else wants.The idea for IT companies is to open a presentation with how to increase profits.
That, as far as i know, is the only presentation which interests the healthcare company.2) There are combinational factors; for instance doctors and software don't go well together psychologically except in times of peace, which is rare.
Instead of adopting touch screen systems and throw-away laptops small enough and tough enough, most companies insist on producing massive software run in PCs and Servers in a serene a/c room.
Excuse me, which doctor has sanguinely traversed through a maze of Visual Basic or PowerBuilder application menus?3) IT companies should seriously stop considering "integrated" systems which connect doctors with nurses with patients with pharmacies.
No, for the last fcuking time, no we don't need integrated crap.
All we need is a simple system that can be accessed with a max of three clicks and accepts voice input.4) Record management: HIPAA is not exactly an easy job.
Any standard created by a committee is, by definition, an as$ to work with.5) Changes in systems result in changes in behavior and processes: something hated by surgeons, doctors and hospitals.Don't attribute to malice what can be explained by stupidity.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463529</id>
	<title>It's a good thing</title>
	<author>Anonymous</author>
	<datestamp>1245873300000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>"making medical records available for data analysis" will also lead to easier abuse and leakage of said data.</p><p>All your medical data managed by one IT service provider ('cause that's where IT in healthcare usually leads to)? There's no way this could go wrong.</p><p>Incidentally what was the name of the social website that tries to sell its users' data after going out of business?</p></htmltext>
<tokenext>" making medical records available for data analysis " will also lead to easier abuse and leakage of said data.All your medical data managed by one IT service provider ( 'cause that 's where IT in healthcare usually leads to ) ?
There 's no way this could go wrong.Incidentally what was the name of the social website that tries to sell its users ' data after going out of business ?</tokentext>
<sentencetext>"making medical records available for data analysis" will also lead to easier abuse and leakage of said data.All your medical data managed by one IT service provider ('cause that's where IT in healthcare usually leads to)?
There's no way this could go wrong.Incidentally what was the name of the social website that tries to sell its users' data after going out of business?</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28466917</id>
	<title>HIMSS</title>
	<author>DynaSoar</author>
	<datestamp>1245947580000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>Healthcare Information and Management Systems Society. That's the professional organization and journal dedicated to the subject. The picture they paint is very different from that of a Wall Street analyst writing for TR, apparently in a backhanded attempt at promoting his book on the subject. From TFA: "Using electronic health records, in combination with data mining and search technology, would make this kind of analysis much easier." Would? Try has, and incorporates distributed archiving with fast retrieval, administrative and management analysis functions, billing, interfacing with all sort of outside agencies using their own formats, all conforming to stringent security requirements but capable of being examined by governmental oversight agencies.</p><p>For my MHA, I specialized in medical informatics. It was a huge field 20 years ago, and has grown more since then. The main hurdle for the industry as a whole is the fact that it's so diverse that there's no standardization and so enormous that none is likely to happen. And like any collection of commercial enterprises, the various entities are continually coming up with improvements, "improvements", lateral changes, and repairs to the FUBARs created by those.</p><p>While the industry as a whole is somewhat hobbled, the individual entities where records, treatment, billing and admin/management are required to perform with high proficiency (due in large part to liability) have adopted IT extensively and make good use of it. At my local clinic here in Appalachia there are as many support and admin people as there are doctors and nurses just to keep the IT based ball rolling, and virtually nothing happens that's not pushed through their in house net to at least 3 people. My main provider is the Veterans Administration, with an abysmal record of institutionalized foot dragging and bureaucratic quagmires. But they're heavily wired inside and connected to all other VA facilities outside by a network so extensive, complete and blazingly fast that it'd make any provider network proud and makes a mockery of the VA's constant insistence in almost every other area that it can't do this, can't afford that, and sorry that's not might job and I wouldn't do it if it was unless three people agreed to make me and figure the odds on three people agreeing on something in this place.</p><p>The delivery end of the industry is 18\% of the US economy. That's a lot of industry to supply and support. At its present growth rate it'll double in 30 years. That means they'll need to be supplied in that time with as much as exists already, all the while continuing to support and upgrade all that presently exists. One skewed statistic that makes health care IT appear to lag is the fact that they spend 2\% of their revenues on IT where banks spend 8\%. Fine, but consider the fact that health care handles far more customers with the same infrastructure, and the supplies and equipment cost much more than in other industries, plus the fact that it has far more higher paid workers.</p><p>And the US$19Bn infusion from the Obama administration? That'd cover 14 months of IT spending in US hospitals. Entities smaller than hospitals, support agencies, suppliers, and the associated juggernauts of insurance and health related government agencies aren't included in that figure. Figure those in and the 19 billion will add about 30\% to the amount expected to be spent in the next year on IT industry wide.</p><p>Health care is not slow to adopt IT. They love it and adopt all they can. IT can't keep up with health care. Not their fault, they do a great job trying, but it's like trying to keep track of all the pieces from an explosion in progress. How tough is it to keep up? Consider:</p><p>The gross national product of the US rose from $2Bn to $4Bn from 1951 to 1971. The US health care industry including all associated support, supply and financial control (ie. insurance) will grow from $2Bn to $4Bn from 2008 to 2015. Not the same "dollars", but it's still a doubling rate almost 3 times the US "golden era".</p></htmltext>
<tokenext>Healthcare Information and Management Systems Society .
That 's the professional organization and journal dedicated to the subject .
The picture they paint is very different from that of a Wall Street analyst writing for TR , apparently in a backhanded attempt at promoting his book on the subject .
From TFA : " Using electronic health records , in combination with data mining and search technology , would make this kind of analysis much easier .
" Would ?
Try has , and incorporates distributed archiving with fast retrieval , administrative and management analysis functions , billing , interfacing with all sort of outside agencies using their own formats , all conforming to stringent security requirements but capable of being examined by governmental oversight agencies.For my MHA , I specialized in medical informatics .
It was a huge field 20 years ago , and has grown more since then .
The main hurdle for the industry as a whole is the fact that it 's so diverse that there 's no standardization and so enormous that none is likely to happen .
And like any collection of commercial enterprises , the various entities are continually coming up with improvements , " improvements " , lateral changes , and repairs to the FUBARs created by those.While the industry as a whole is somewhat hobbled , the individual entities where records , treatment , billing and admin/management are required to perform with high proficiency ( due in large part to liability ) have adopted IT extensively and make good use of it .
At my local clinic here in Appalachia there are as many support and admin people as there are doctors and nurses just to keep the IT based ball rolling , and virtually nothing happens that 's not pushed through their in house net to at least 3 people .
My main provider is the Veterans Administration , with an abysmal record of institutionalized foot dragging and bureaucratic quagmires .
But they 're heavily wired inside and connected to all other VA facilities outside by a network so extensive , complete and blazingly fast that it 'd make any provider network proud and makes a mockery of the VA 's constant insistence in almost every other area that it ca n't do this , ca n't afford that , and sorry that 's not might job and I would n't do it if it was unless three people agreed to make me and figure the odds on three people agreeing on something in this place.The delivery end of the industry is 18 \ % of the US economy .
That 's a lot of industry to supply and support .
At its present growth rate it 'll double in 30 years .
That means they 'll need to be supplied in that time with as much as exists already , all the while continuing to support and upgrade all that presently exists .
One skewed statistic that makes health care IT appear to lag is the fact that they spend 2 \ % of their revenues on IT where banks spend 8 \ % .
Fine , but consider the fact that health care handles far more customers with the same infrastructure , and the supplies and equipment cost much more than in other industries , plus the fact that it has far more higher paid workers.And the US $ 19Bn infusion from the Obama administration ?
That 'd cover 14 months of IT spending in US hospitals .
Entities smaller than hospitals , support agencies , suppliers , and the associated juggernauts of insurance and health related government agencies are n't included in that figure .
Figure those in and the 19 billion will add about 30 \ % to the amount expected to be spent in the next year on IT industry wide.Health care is not slow to adopt IT .
They love it and adopt all they can .
IT ca n't keep up with health care .
Not their fault , they do a great job trying , but it 's like trying to keep track of all the pieces from an explosion in progress .
How tough is it to keep up ?
Consider : The gross national product of the US rose from $ 2Bn to $ 4Bn from 1951 to 1971 .
The US health care industry including all associated support , supply and financial control ( ie .
insurance ) will grow from $ 2Bn to $ 4Bn from 2008 to 2015 .
Not the same " dollars " , but it 's still a doubling rate almost 3 times the US " golden era " .</tokentext>
<sentencetext>Healthcare Information and Management Systems Society.
That's the professional organization and journal dedicated to the subject.
The picture they paint is very different from that of a Wall Street analyst writing for TR, apparently in a backhanded attempt at promoting his book on the subject.
From TFA: "Using electronic health records, in combination with data mining and search technology, would make this kind of analysis much easier.
" Would?
Try has, and incorporates distributed archiving with fast retrieval, administrative and management analysis functions, billing, interfacing with all sort of outside agencies using their own formats, all conforming to stringent security requirements but capable of being examined by governmental oversight agencies.For my MHA, I specialized in medical informatics.
It was a huge field 20 years ago, and has grown more since then.
The main hurdle for the industry as a whole is the fact that it's so diverse that there's no standardization and so enormous that none is likely to happen.
And like any collection of commercial enterprises, the various entities are continually coming up with improvements, "improvements", lateral changes, and repairs to the FUBARs created by those.While the industry as a whole is somewhat hobbled, the individual entities where records, treatment, billing and admin/management are required to perform with high proficiency (due in large part to liability) have adopted IT extensively and make good use of it.
At my local clinic here in Appalachia there are as many support and admin people as there are doctors and nurses just to keep the IT based ball rolling, and virtually nothing happens that's not pushed through their in house net to at least 3 people.
My main provider is the Veterans Administration, with an abysmal record of institutionalized foot dragging and bureaucratic quagmires.
But they're heavily wired inside and connected to all other VA facilities outside by a network so extensive, complete and blazingly fast that it'd make any provider network proud and makes a mockery of the VA's constant insistence in almost every other area that it can't do this, can't afford that, and sorry that's not might job and I wouldn't do it if it was unless three people agreed to make me and figure the odds on three people agreeing on something in this place.The delivery end of the industry is 18\% of the US economy.
That's a lot of industry to supply and support.
At its present growth rate it'll double in 30 years.
That means they'll need to be supplied in that time with as much as exists already, all the while continuing to support and upgrade all that presently exists.
One skewed statistic that makes health care IT appear to lag is the fact that they spend 2\% of their revenues on IT where banks spend 8\%.
Fine, but consider the fact that health care handles far more customers with the same infrastructure, and the supplies and equipment cost much more than in other industries, plus the fact that it has far more higher paid workers.And the US$19Bn infusion from the Obama administration?
That'd cover 14 months of IT spending in US hospitals.
Entities smaller than hospitals, support agencies, suppliers, and the associated juggernauts of insurance and health related government agencies aren't included in that figure.
Figure those in and the 19 billion will add about 30\% to the amount expected to be spent in the next year on IT industry wide.Health care is not slow to adopt IT.
They love it and adopt all they can.
IT can't keep up with health care.
Not their fault, they do a great job trying, but it's like trying to keep track of all the pieces from an explosion in progress.
How tough is it to keep up?
Consider:The gross national product of the US rose from $2Bn to $4Bn from 1951 to 1971.
The US health care industry including all associated support, supply and financial control (ie.
insurance) will grow from $2Bn to $4Bn from 2008 to 2015.
Not the same "dollars", but it's still a doubling rate almost 3 times the US "golden era".</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28466999</id>
	<title>It's becasue</title>
	<author>geekoid</author>
	<datestamp>1245948000000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>HL7 is an expensive pile of shit.</p></htmltext>
<tokenext>HL7 is an expensive pile of shit .</tokentext>
<sentencetext>HL7 is an expensive pile of shit.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465269</id>
	<title>Well..</title>
	<author>FatherOfONe</author>
	<datestamp>1245938700000</datestamp>
	<modclass>Flamebait</modclass>
	<modscore>0</modscore>
	<htmltext><p>Ok, I am in the heath care industry and am in I.T.</p><p>My first thought was that this is yet another attempt by an Obama supporter to help try and gain support for his socialist program.  I think I still may be right on that one.</p><p>However, the core reason is that the health care industry is slow to move is that the cost of validating systems is huge.  If a mistake is made it can put a company out of business.  I am not saying this is a bad thing but a lot of businesses do the math and say it is cheaper to do it in a manual way.  Now it looks like we want to force these companies to spend the money weather they like it or not.  This is good for me, but I realize a lot of companies will be going out of business because of the cost.  Sometimes a Rolodex works better than spending 5 million on an Oracle solution.</p></htmltext>
<tokenext>Ok , I am in the heath care industry and am in I.T.My first thought was that this is yet another attempt by an Obama supporter to help try and gain support for his socialist program .
I think I still may be right on that one.However , the core reason is that the health care industry is slow to move is that the cost of validating systems is huge .
If a mistake is made it can put a company out of business .
I am not saying this is a bad thing but a lot of businesses do the math and say it is cheaper to do it in a manual way .
Now it looks like we want to force these companies to spend the money weather they like it or not .
This is good for me , but I realize a lot of companies will be going out of business because of the cost .
Sometimes a Rolodex works better than spending 5 million on an Oracle solution .</tokentext>
<sentencetext>Ok, I am in the heath care industry and am in I.T.My first thought was that this is yet another attempt by an Obama supporter to help try and gain support for his socialist program.
I think I still may be right on that one.However, the core reason is that the health care industry is slow to move is that the cost of validating systems is huge.
If a mistake is made it can put a company out of business.
I am not saying this is a bad thing but a lot of businesses do the math and say it is cheaper to do it in a manual way.
Now it looks like we want to force these companies to spend the money weather they like it or not.
This is good for me, but I realize a lot of companies will be going out of business because of the cost.
Sometimes a Rolodex works better than spending 5 million on an Oracle solution.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464603</id>
	<title>Health Care vs FedEx</title>
	<author>readin</author>
	<datestamp>1245931260000</datestamp>
	<modclass>Interestin</modclass>
	<modscore>2</modscore>
	<htmltext>I recently saw President Obama make a comment about how FedEx can track every single package everywhere, but we can't even get medical records to follow a patient from one doctor to another.
<br> <br>
Well, Fed Ex is a private entity with very little government regulation, while medicine is subject to government involvement all over the place.  The government either pays for medical care (medicade, medicare), determines how it will be paid for (tax incentives) or mandates that it doesn't need to be paid for (get wheeled into any emergency room and they <i>must</i> at least stabilize you, or so I've heard).  Government then regulates the tracking of information (privacy regulations - no such privacy regulations apply to FedEx package locations).  If something goes wrong, government is involved in deciding malpractice verdicts and awards.  From start to finish, government has its hands in the mix.
<br> <br>
I remember reading about the difficulties the IRS had with automation due to the complexity of the tax code.  Is it any wonder the medical profession would have trouble automating given the complexity of the rules associated with health care in this country?
<br> <br>
A couple other key differences between FedEx and Health Care.  First, most people feel no moral obligation to provide package shipping to everyone in the country.
<br> <br>
Second, it is far easier for consumers to evaluate the effectiveness of FedEx than it is for them to evaluate the effectiveness of their medical care.  With FedEx, you can verify that the contents weren't broken, and you can compare the speed similar shipments sent by other companies.  That's easy.  With doctors, well, recently someone I care about had an abscess in his neck.  The doctor was thinking the pain was just lingering effects of a sore throat. But when it didn't clear up. he theorized an abscess and sent the person to the emergency room for an MRI.  The abscess was found and removed by surgery that night.  Did the doctor nearly cost this person his life by not recognizing the abscess until it was close to breaking through a vein causing blood poisoning?  Or did the doctor save this person's life by recognizing the abscess in time?  It's not so easy for someone like me to know.</htmltext>
<tokenext>I recently saw President Obama make a comment about how FedEx can track every single package everywhere , but we ca n't even get medical records to follow a patient from one doctor to another .
Well , Fed Ex is a private entity with very little government regulation , while medicine is subject to government involvement all over the place .
The government either pays for medical care ( medicade , medicare ) , determines how it will be paid for ( tax incentives ) or mandates that it does n't need to be paid for ( get wheeled into any emergency room and they must at least stabilize you , or so I 've heard ) .
Government then regulates the tracking of information ( privacy regulations - no such privacy regulations apply to FedEx package locations ) .
If something goes wrong , government is involved in deciding malpractice verdicts and awards .
From start to finish , government has its hands in the mix .
I remember reading about the difficulties the IRS had with automation due to the complexity of the tax code .
Is it any wonder the medical profession would have trouble automating given the complexity of the rules associated with health care in this country ?
A couple other key differences between FedEx and Health Care .
First , most people feel no moral obligation to provide package shipping to everyone in the country .
Second , it is far easier for consumers to evaluate the effectiveness of FedEx than it is for them to evaluate the effectiveness of their medical care .
With FedEx , you can verify that the contents were n't broken , and you can compare the speed similar shipments sent by other companies .
That 's easy .
With doctors , well , recently someone I care about had an abscess in his neck .
The doctor was thinking the pain was just lingering effects of a sore throat .
But when it did n't clear up .
he theorized an abscess and sent the person to the emergency room for an MRI .
The abscess was found and removed by surgery that night .
Did the doctor nearly cost this person his life by not recognizing the abscess until it was close to breaking through a vein causing blood poisoning ?
Or did the doctor save this person 's life by recognizing the abscess in time ?
It 's not so easy for someone like me to know .</tokentext>
<sentencetext>I recently saw President Obama make a comment about how FedEx can track every single package everywhere, but we can't even get medical records to follow a patient from one doctor to another.
Well, Fed Ex is a private entity with very little government regulation, while medicine is subject to government involvement all over the place.
The government either pays for medical care (medicade, medicare), determines how it will be paid for (tax incentives) or mandates that it doesn't need to be paid for (get wheeled into any emergency room and they must at least stabilize you, or so I've heard).
Government then regulates the tracking of information (privacy regulations - no such privacy regulations apply to FedEx package locations).
If something goes wrong, government is involved in deciding malpractice verdicts and awards.
From start to finish, government has its hands in the mix.
I remember reading about the difficulties the IRS had with automation due to the complexity of the tax code.
Is it any wonder the medical profession would have trouble automating given the complexity of the rules associated with health care in this country?
A couple other key differences between FedEx and Health Care.
First, most people feel no moral obligation to provide package shipping to everyone in the country.
Second, it is far easier for consumers to evaluate the effectiveness of FedEx than it is for them to evaluate the effectiveness of their medical care.
With FedEx, you can verify that the contents weren't broken, and you can compare the speed similar shipments sent by other companies.
That's easy.
With doctors, well, recently someone I care about had an abscess in his neck.
The doctor was thinking the pain was just lingering effects of a sore throat.
But when it didn't clear up.
he theorized an abscess and sent the person to the emergency room for an MRI.
The abscess was found and removed by surgery that night.
Did the doctor nearly cost this person his life by not recognizing the abscess until it was close to breaking through a vein causing blood poisoning?
Or did the doctor save this person's life by recognizing the abscess in time?
It's not so easy for someone like me to know.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465039</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>jellomizer</author>
	<datestamp>1245937080000</datestamp>
	<modclass>Informativ</modclass>
	<modscore>3</modscore>
	<htmltext><p>Medical Doctors are in General very difficult to work with. There are a lot of factors...</p><p>1. Society says they are the smartest people around. They think that too.  So when they go out of their area of expertise and they don't know exactly what is happening, they will avoid trying to learn about it but become defensive about it. And will not give respect to people who do know about such areas and let them ask the right questions so they can fix the problem. I have had Doctors yell at me, when I call them and say, "I hear you are having some problems with the system, could you explain them to me so I can see how I can fix it?" just as themselves will go to a patient and ask a similar question even when they have the problem written down as for the reason for the appointment.  This makes them high maintenance and people don't necessarily want to deal with them. House may be a cool TV show, but you really wouldn't want to with him.</p><p>2. Doctors are trained in medical not business, they are MDs not MBAs. Yet a lot of them run their own practice and need to deal with all the business of running the practice and not working on the medicine. Many practices are so overworked that they don't have time to analyze or listen to ideas that will improve their practice.</p><p>3. Most practices are small business. Good EMR and PM (Practice Management) system are not cheap (like most professional apps), and there is a sticker shock for paying thousands of dollars for software, even for a glorified access database.  They feel like they are getting ripped off by paying such high prices for software. So they will go with their crappy methods before getting ripped off.</p><p>4. Open Source is not an option. Sorry Open Source fans. In a career where you can get sued in an instant you need somewhere to point the lawyers away from you. (Hence part of the high cost for medical software) Yes this is a lame excuse for Microsoft (who makes general use software) but for specialty software companies they are under the guns of lawyers all the time.</p><p>5. MD are known to make a lot of money. This doesn't always attract good, nice, or even smart people.  Remember "What do you call the person who graduated with the lowest score in Med School?" answer "Doctor". A lot of people are just in it for the money. They may say they like helping people but they are in it for the money (How a lot of doctors in California will prescribe "medical marijuana" for "problems sleeping") They will be so tight with their money and be blind to all benefits such systems will have, and will not pay unless things work the way THEY want it to.</p><p>6. Uneducated staff. For most practices you will have 1 or 2 doctors  1 or 2 nurses (with Associates or BA degrees) then a staff of 4 or 5 with High School degrees. That staff runs the business for the most part. They lack the patience or discipline to learn such technologies and to use it for its best advantage.  Also many of them feel sub adequate (as they need to deal with the high egos of the Doctors) so they are afraid to ask questions or point out problems.</p></htmltext>
<tokenext>Medical Doctors are in General very difficult to work with .
There are a lot of factors...1 .
Society says they are the smartest people around .
They think that too .
So when they go out of their area of expertise and they do n't know exactly what is happening , they will avoid trying to learn about it but become defensive about it .
And will not give respect to people who do know about such areas and let them ask the right questions so they can fix the problem .
I have had Doctors yell at me , when I call them and say , " I hear you are having some problems with the system , could you explain them to me so I can see how I can fix it ?
" just as themselves will go to a patient and ask a similar question even when they have the problem written down as for the reason for the appointment .
This makes them high maintenance and people do n't necessarily want to deal with them .
House may be a cool TV show , but you really would n't want to with him.2 .
Doctors are trained in medical not business , they are MDs not MBAs .
Yet a lot of them run their own practice and need to deal with all the business of running the practice and not working on the medicine .
Many practices are so overworked that they do n't have time to analyze or listen to ideas that will improve their practice.3 .
Most practices are small business .
Good EMR and PM ( Practice Management ) system are not cheap ( like most professional apps ) , and there is a sticker shock for paying thousands of dollars for software , even for a glorified access database .
They feel like they are getting ripped off by paying such high prices for software .
So they will go with their crappy methods before getting ripped off.4 .
Open Source is not an option .
Sorry Open Source fans .
In a career where you can get sued in an instant you need somewhere to point the lawyers away from you .
( Hence part of the high cost for medical software ) Yes this is a lame excuse for Microsoft ( who makes general use software ) but for specialty software companies they are under the guns of lawyers all the time.5 .
MD are known to make a lot of money .
This does n't always attract good , nice , or even smart people .
Remember " What do you call the person who graduated with the lowest score in Med School ?
" answer " Doctor " .
A lot of people are just in it for the money .
They may say they like helping people but they are in it for the money ( How a lot of doctors in California will prescribe " medical marijuana " for " problems sleeping " ) They will be so tight with their money and be blind to all benefits such systems will have , and will not pay unless things work the way THEY want it to.6 .
Uneducated staff .
For most practices you will have 1 or 2 doctors 1 or 2 nurses ( with Associates or BA degrees ) then a staff of 4 or 5 with High School degrees .
That staff runs the business for the most part .
They lack the patience or discipline to learn such technologies and to use it for its best advantage .
Also many of them feel sub adequate ( as they need to deal with the high egos of the Doctors ) so they are afraid to ask questions or point out problems .</tokentext>
<sentencetext>Medical Doctors are in General very difficult to work with.
There are a lot of factors...1.
Society says they are the smartest people around.
They think that too.
So when they go out of their area of expertise and they don't know exactly what is happening, they will avoid trying to learn about it but become defensive about it.
And will not give respect to people who do know about such areas and let them ask the right questions so they can fix the problem.
I have had Doctors yell at me, when I call them and say, "I hear you are having some problems with the system, could you explain them to me so I can see how I can fix it?
" just as themselves will go to a patient and ask a similar question even when they have the problem written down as for the reason for the appointment.
This makes them high maintenance and people don't necessarily want to deal with them.
House may be a cool TV show, but you really wouldn't want to with him.2.
Doctors are trained in medical not business, they are MDs not MBAs.
Yet a lot of them run their own practice and need to deal with all the business of running the practice and not working on the medicine.
Many practices are so overworked that they don't have time to analyze or listen to ideas that will improve their practice.3.
Most practices are small business.
Good EMR and PM (Practice Management) system are not cheap (like most professional apps), and there is a sticker shock for paying thousands of dollars for software, even for a glorified access database.
They feel like they are getting ripped off by paying such high prices for software.
So they will go with their crappy methods before getting ripped off.4.
Open Source is not an option.
Sorry Open Source fans.
In a career where you can get sued in an instant you need somewhere to point the lawyers away from you.
(Hence part of the high cost for medical software) Yes this is a lame excuse for Microsoft (who makes general use software) but for specialty software companies they are under the guns of lawyers all the time.5.
MD are known to make a lot of money.
This doesn't always attract good, nice, or even smart people.
Remember "What do you call the person who graduated with the lowest score in Med School?
" answer "Doctor".
A lot of people are just in it for the money.
They may say they like helping people but they are in it for the money (How a lot of doctors in California will prescribe "medical marijuana" for "problems sleeping") They will be so tight with their money and be blind to all benefits such systems will have, and will not pay unless things work the way THEY want it to.6.
Uneducated staff.
For most practices you will have 1 or 2 doctors  1 or 2 nurses (with Associates or BA degrees) then a staff of 4 or 5 with High School degrees.
That staff runs the business for the most part.
They lack the patience or discipline to learn such technologies and to use it for its best advantage.
Also many of them feel sub adequate (as they need to deal with the high egos of the Doctors) so they are afraid to ask questions or point out problems.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463467</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464617</id>
	<title>Re:one word: protectionism</title>
	<author>Anonymous</author>
	<datestamp>1245931440000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>4</modscore>
	<htmltext><p>"4. They don't inter-operate. (When I request old records from other physicians with electronic charts, I enter the pertinent data into my electronic chart by typing it in.)<br>If any skilled group of software engineers were to write a decent, usable EMR that was extensible, and didn't cost an arm and a leg, with an eye to being excellent first and profitable as a consequence, they could be up for a Nobel prize. "</p><p>Whenever this topic comes up, the same answer always eventually comes out to address "4", which is of course VA's VISTA/CPRS.  Not only is it customizable and extensible, but the program and code are free to anyone who wants it.  And I don't see the programmers from the VA winning any Nobels any time soon<nobr> <wbr></nobr>;-).  Read "The Best Care Anywhere." Even if you disagree with the premise, Longman presents an interesting section on how VISTA, and later CPRS came into being.  It's his position that an important (if not primary) reason there is not adoption of electronic medical records in the private sector is because it can actually create a competitive disadvantage.</p><p>Massing huge amounts of electronic, easily accessibly medical information on an individual is really only advantageous to the patient, provider and system if the patient remains with the same providers and same health care system, which of course is true for the Veterans treated by VA.  Long term, detailed information on a patient is advantageous on the patient level because you can monitor more easily preventive health measures and track health status over time; for the provider it means decision making can be more informed which should improve outcomes; for the system it means better outcomes and presumably more competitive advantage.  But here's the rub: patients don't stay with the same providers or same systems.  Health care has become so complicated that person's change their care plan, and hence their providers and health care system often.  If I'm Blue Cross, I can guarantee you I know exactly what the rollover of the person's in my panel are from year to year.  If I'm a hospital administrator, I know exactly how many person's come and go through the plans I have contracts with and how many are seeking care at my facility.  As you point out, unless a facility takes a stab at VISTA/CPRS, EMR's can be insanely expensive to develop.  And deployment, penetration and compliance within a facility/system is a herculean task requiring a major change in culture to ensure adoption.  So, as some sort of health care system administrator, for every patient that moves to another plan and hence gets care from other providers in other hospitals, I have just given my competitors an enormous advantage in their care of this patient.  The patient is able to bring them their complete, beautifully printed out and organized medical record to aid their providers in the care of this person.</p><p>Now, of course, it also says I would have the same benefit when patients come to my system.  The problem is who is going to budge first?  And if someone else budges, and I can attract those patients to my system, then maybe I don't have a good incentive to develop an EMR for my facility in the first place.  Maybe I should spend more money on a finely landscaped, aesthetically beautiful, modern bed tower?  Because, really, the patient is going to leave and go elsewhere eventually.  When they change jobs, their health care plans change.  When life circumstances change (e.g. they now need a family plan), their health care plan changes.  There's a ton reasons person's change health care plans, and very few of them have to do with actually wanting to see a certain person or get care at a specific facility.  Without these lifelong relationships between patient, provider and system, it's hard to convince a facility of any size, be it a small practice of primary care providers to large health care systems buying up hospitals, to invest the time and energy in an EMR.  And it will remain this way until there are clear financial incentives to do so; or the health care system is totally revamped such that lifelong relationships between patients and providers is again feasible.</p><p>later,<br>jeff</p></htmltext>
<tokenext>" 4 .
They do n't inter-operate .
( When I request old records from other physicians with electronic charts , I enter the pertinent data into my electronic chart by typing it in .
) If any skilled group of software engineers were to write a decent , usable EMR that was extensible , and did n't cost an arm and a leg , with an eye to being excellent first and profitable as a consequence , they could be up for a Nobel prize .
" Whenever this topic comes up , the same answer always eventually comes out to address " 4 " , which is of course VA 's VISTA/CPRS .
Not only is it customizable and extensible , but the program and code are free to anyone who wants it .
And I do n't see the programmers from the VA winning any Nobels any time soon ; - ) .
Read " The Best Care Anywhere .
" Even if you disagree with the premise , Longman presents an interesting section on how VISTA , and later CPRS came into being .
It 's his position that an important ( if not primary ) reason there is not adoption of electronic medical records in the private sector is because it can actually create a competitive disadvantage.Massing huge amounts of electronic , easily accessibly medical information on an individual is really only advantageous to the patient , provider and system if the patient remains with the same providers and same health care system , which of course is true for the Veterans treated by VA. Long term , detailed information on a patient is advantageous on the patient level because you can monitor more easily preventive health measures and track health status over time ; for the provider it means decision making can be more informed which should improve outcomes ; for the system it means better outcomes and presumably more competitive advantage .
But here 's the rub : patients do n't stay with the same providers or same systems .
Health care has become so complicated that person 's change their care plan , and hence their providers and health care system often .
If I 'm Blue Cross , I can guarantee you I know exactly what the rollover of the person 's in my panel are from year to year .
If I 'm a hospital administrator , I know exactly how many person 's come and go through the plans I have contracts with and how many are seeking care at my facility .
As you point out , unless a facility takes a stab at VISTA/CPRS , EMR 's can be insanely expensive to develop .
And deployment , penetration and compliance within a facility/system is a herculean task requiring a major change in culture to ensure adoption .
So , as some sort of health care system administrator , for every patient that moves to another plan and hence gets care from other providers in other hospitals , I have just given my competitors an enormous advantage in their care of this patient .
The patient is able to bring them their complete , beautifully printed out and organized medical record to aid their providers in the care of this person.Now , of course , it also says I would have the same benefit when patients come to my system .
The problem is who is going to budge first ?
And if someone else budges , and I can attract those patients to my system , then maybe I do n't have a good incentive to develop an EMR for my facility in the first place .
Maybe I should spend more money on a finely landscaped , aesthetically beautiful , modern bed tower ?
Because , really , the patient is going to leave and go elsewhere eventually .
When they change jobs , their health care plans change .
When life circumstances change ( e.g .
they now need a family plan ) , their health care plan changes .
There 's a ton reasons person 's change health care plans , and very few of them have to do with actually wanting to see a certain person or get care at a specific facility .
Without these lifelong relationships between patient , provider and system , it 's hard to convince a facility of any size , be it a small practice of primary care providers to large health care systems buying up hospitals , to invest the time and energy in an EMR .
And it will remain this way until there are clear financial incentives to do so ; or the health care system is totally revamped such that lifelong relationships between patients and providers is again feasible.later,jeff</tokentext>
<sentencetext>"4.
They don't inter-operate.
(When I request old records from other physicians with electronic charts, I enter the pertinent data into my electronic chart by typing it in.
)If any skilled group of software engineers were to write a decent, usable EMR that was extensible, and didn't cost an arm and a leg, with an eye to being excellent first and profitable as a consequence, they could be up for a Nobel prize.
"Whenever this topic comes up, the same answer always eventually comes out to address "4", which is of course VA's VISTA/CPRS.
Not only is it customizable and extensible, but the program and code are free to anyone who wants it.
And I don't see the programmers from the VA winning any Nobels any time soon ;-).
Read "The Best Care Anywhere.
" Even if you disagree with the premise, Longman presents an interesting section on how VISTA, and later CPRS came into being.
It's his position that an important (if not primary) reason there is not adoption of electronic medical records in the private sector is because it can actually create a competitive disadvantage.Massing huge amounts of electronic, easily accessibly medical information on an individual is really only advantageous to the patient, provider and system if the patient remains with the same providers and same health care system, which of course is true for the Veterans treated by VA.  Long term, detailed information on a patient is advantageous on the patient level because you can monitor more easily preventive health measures and track health status over time; for the provider it means decision making can be more informed which should improve outcomes; for the system it means better outcomes and presumably more competitive advantage.
But here's the rub: patients don't stay with the same providers or same systems.
Health care has become so complicated that person's change their care plan, and hence their providers and health care system often.
If I'm Blue Cross, I can guarantee you I know exactly what the rollover of the person's in my panel are from year to year.
If I'm a hospital administrator, I know exactly how many person's come and go through the plans I have contracts with and how many are seeking care at my facility.
As you point out, unless a facility takes a stab at VISTA/CPRS, EMR's can be insanely expensive to develop.
And deployment, penetration and compliance within a facility/system is a herculean task requiring a major change in culture to ensure adoption.
So, as some sort of health care system administrator, for every patient that moves to another plan and hence gets care from other providers in other hospitals, I have just given my competitors an enormous advantage in their care of this patient.
The patient is able to bring them their complete, beautifully printed out and organized medical record to aid their providers in the care of this person.Now, of course, it also says I would have the same benefit when patients come to my system.
The problem is who is going to budge first?
And if someone else budges, and I can attract those patients to my system, then maybe I don't have a good incentive to develop an EMR for my facility in the first place.
Maybe I should spend more money on a finely landscaped, aesthetically beautiful, modern bed tower?
Because, really, the patient is going to leave and go elsewhere eventually.
When they change jobs, their health care plans change.
When life circumstances change (e.g.
they now need a family plan), their health care plan changes.
There's a ton reasons person's change health care plans, and very few of them have to do with actually wanting to see a certain person or get care at a specific facility.
Without these lifelong relationships between patient, provider and system, it's hard to convince a facility of any size, be it a small practice of primary care providers to large health care systems buying up hospitals, to invest the time and energy in an EMR.
And it will remain this way until there are clear financial incentives to do so; or the health care system is totally revamped such that lifelong relationships between patients and providers is again feasible.later,jeff</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463733</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28469711</id>
	<title>Re:IT is only one facet of healthcare</title>
	<author>Anonymous</author>
	<datestamp>1245958260000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>And after 11-15 years of medical training, the brilliant suggestion for EMR is to have the physician on the front line of data entry?  That's poor utilization of an expensive resource.</p></htmltext>
<tokenext>And after 11-15 years of medical training , the brilliant suggestion for EMR is to have the physician on the front line of data entry ?
That 's poor utilization of an expensive resource .</tokentext>
<sentencetext>And after 11-15 years of medical training, the brilliant suggestion for EMR is to have the physician on the front line of data entry?
That's poor utilization of an expensive resource.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463933</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465947</id>
	<title>An EMR story...</title>
	<author>Anonymous</author>
	<datestamp>1245942600000</datestamp>
	<modclass>Informativ</modclass>
	<modscore>3</modscore>
	<htmltext>In January of this year, I went in to an outpatient surgery center for a procedure.  My operation was scheduled for 10 AM, so I was on-site just before 8 AM.  When I arrived and was ushered back into the staging area, I was next to a septuagenarian who, it turns out, had been at the center since 6 AM.  He had been driven there by one of his adult children, and he hailed from a small town three hours away.  He left home before 3 AM to make sure he arrived on time--his was to be the first procedure of the day for a particular surgeon. [I picked all this up from hearing him interact with his daughter and other family members who were also present.]<br> <br>

My surgeon was running late due to complications in an earlier procedure, so when 10 AM rolled around, both the septuagenarian and I were still waiting for our procedures.  For me, it would clearly be a matter of time.  From overhearing the family, the doctors, and the nurses, however, it was fairly clear that the old man would not have his surgery that day, because he was presenting symptoms that suggested he may have bronchitis or pneumonia.<br> <br>

As is standard procedure, each surgical patient has a pre-operative screening with his or her regular physician, to ensure that the patient is well before the operation.  This man had his visit, including a chest x-ray, but those records never made it to the surgery center.  The man's clinic had EMR technology, so one doctor suggested that they just pull up the records.  That's where they ran into some problems.  The only terminal with EMR access at the nurses' station in the surgery center could not access the records for that patient.  Multiple people tried their logons on that terminal, but none of them could pull up the records.  There were discussions as to whether or not the clinic was on the same EMR network as was the hospital.  One nurse commented that she had cared for a patient in the main building and accessed records from the same clinic system.  Finally, another nurse mentioned that there was another terminal in a records room in the surgery center, so she and a doctor headed off to try to access the EMR from there.<br> <br>In the mean time, this poor old gent is starting to cough a lot, and appears to be in much pain.  No one was able to reach his primary physician by phone, and the patient's home-town clinic was not open that day.  The doctor and nurse returned from the records room, and indicated that they had no better luck.  An older nurse then mentioned that she thought the main hospital had access to more healt-care networks than did the surgery center.  Someone was dispatched to the hospital to try and pull up the records.<br> <br>It turns out that my physician was havin a really rough time.  His first patient, who was in for what was thought to be a minor rotator cuff repair, apparantly had old baseball injuries about which the physician was unaware.  In the end, the doctor was able to patch him up, but three out of four of the primary ligaments or tendons were beyond repair. [That bit of information was picked up by my wife in the waiting room, when the surgeon came out to tell the other man's wife how things went and why they went long, and to tell my wife why I was not yet in surgery.]  I'm just noting that so you'll understand why I was still waiting for surgery as the hour neared 1 PM.<br> <br>The surgery center called over one of the on-call physicians from the hospital, who checked in on the man numerous times during the morning.  He was convinced that the man was too ill for surgery, but the man insisted that his own physician had told him to go ahead.  The family members were upset, because travel took a lot out of their father, and he made the three hour trip specifically for the surgery (a hip replacement).  The on-call doctor made it clear that there would be no surgery that day.  Why were they keeping him waiting is what the family wanted to know.  The on-call doctor wanted to consult with the man's physician, because he felt the man should be admitted to the hospital.  He was trying t</htmltext>
<tokenext>In January of this year , I went in to an outpatient surgery center for a procedure .
My operation was scheduled for 10 AM , so I was on-site just before 8 AM .
When I arrived and was ushered back into the staging area , I was next to a septuagenarian who , it turns out , had been at the center since 6 AM .
He had been driven there by one of his adult children , and he hailed from a small town three hours away .
He left home before 3 AM to make sure he arrived on time--his was to be the first procedure of the day for a particular surgeon .
[ I picked all this up from hearing him interact with his daughter and other family members who were also present .
] My surgeon was running late due to complications in an earlier procedure , so when 10 AM rolled around , both the septuagenarian and I were still waiting for our procedures .
For me , it would clearly be a matter of time .
From overhearing the family , the doctors , and the nurses , however , it was fairly clear that the old man would not have his surgery that day , because he was presenting symptoms that suggested he may have bronchitis or pneumonia .
As is standard procedure , each surgical patient has a pre-operative screening with his or her regular physician , to ensure that the patient is well before the operation .
This man had his visit , including a chest x-ray , but those records never made it to the surgery center .
The man 's clinic had EMR technology , so one doctor suggested that they just pull up the records .
That 's where they ran into some problems .
The only terminal with EMR access at the nurses ' station in the surgery center could not access the records for that patient .
Multiple people tried their logons on that terminal , but none of them could pull up the records .
There were discussions as to whether or not the clinic was on the same EMR network as was the hospital .
One nurse commented that she had cared for a patient in the main building and accessed records from the same clinic system .
Finally , another nurse mentioned that there was another terminal in a records room in the surgery center , so she and a doctor headed off to try to access the EMR from there .
In the mean time , this poor old gent is starting to cough a lot , and appears to be in much pain .
No one was able to reach his primary physician by phone , and the patient 's home-town clinic was not open that day .
The doctor and nurse returned from the records room , and indicated that they had no better luck .
An older nurse then mentioned that she thought the main hospital had access to more healt-care networks than did the surgery center .
Someone was dispatched to the hospital to try and pull up the records .
It turns out that my physician was havin a really rough time .
His first patient , who was in for what was thought to be a minor rotator cuff repair , apparantly had old baseball injuries about which the physician was unaware .
In the end , the doctor was able to patch him up , but three out of four of the primary ligaments or tendons were beyond repair .
[ That bit of information was picked up by my wife in the waiting room , when the surgeon came out to tell the other man 's wife how things went and why they went long , and to tell my wife why I was not yet in surgery .
] I 'm just noting that so you 'll understand why I was still waiting for surgery as the hour neared 1 PM .
The surgery center called over one of the on-call physicians from the hospital , who checked in on the man numerous times during the morning .
He was convinced that the man was too ill for surgery , but the man insisted that his own physician had told him to go ahead .
The family members were upset , because travel took a lot out of their father , and he made the three hour trip specifically for the surgery ( a hip replacement ) .
The on-call doctor made it clear that there would be no surgery that day .
Why were they keeping him waiting is what the family wanted to know .
The on-call doctor wanted to consult with the man 's physician , because he felt the man should be admitted to the hospital .
He was trying t</tokentext>
<sentencetext>In January of this year, I went in to an outpatient surgery center for a procedure.
My operation was scheduled for 10 AM, so I was on-site just before 8 AM.
When I arrived and was ushered back into the staging area, I was next to a septuagenarian who, it turns out, had been at the center since 6 AM.
He had been driven there by one of his adult children, and he hailed from a small town three hours away.
He left home before 3 AM to make sure he arrived on time--his was to be the first procedure of the day for a particular surgeon.
[I picked all this up from hearing him interact with his daughter and other family members who were also present.
] 

My surgeon was running late due to complications in an earlier procedure, so when 10 AM rolled around, both the septuagenarian and I were still waiting for our procedures.
For me, it would clearly be a matter of time.
From overhearing the family, the doctors, and the nurses, however, it was fairly clear that the old man would not have his surgery that day, because he was presenting symptoms that suggested he may have bronchitis or pneumonia.
As is standard procedure, each surgical patient has a pre-operative screening with his or her regular physician, to ensure that the patient is well before the operation.
This man had his visit, including a chest x-ray, but those records never made it to the surgery center.
The man's clinic had EMR technology, so one doctor suggested that they just pull up the records.
That's where they ran into some problems.
The only terminal with EMR access at the nurses' station in the surgery center could not access the records for that patient.
Multiple people tried their logons on that terminal, but none of them could pull up the records.
There were discussions as to whether or not the clinic was on the same EMR network as was the hospital.
One nurse commented that she had cared for a patient in the main building and accessed records from the same clinic system.
Finally, another nurse mentioned that there was another terminal in a records room in the surgery center, so she and a doctor headed off to try to access the EMR from there.
In the mean time, this poor old gent is starting to cough a lot, and appears to be in much pain.
No one was able to reach his primary physician by phone, and the patient's home-town clinic was not open that day.
The doctor and nurse returned from the records room, and indicated that they had no better luck.
An older nurse then mentioned that she thought the main hospital had access to more healt-care networks than did the surgery center.
Someone was dispatched to the hospital to try and pull up the records.
It turns out that my physician was havin a really rough time.
His first patient, who was in for what was thought to be a minor rotator cuff repair, apparantly had old baseball injuries about which the physician was unaware.
In the end, the doctor was able to patch him up, but three out of four of the primary ligaments or tendons were beyond repair.
[That bit of information was picked up by my wife in the waiting room, when the surgeon came out to tell the other man's wife how things went and why they went long, and to tell my wife why I was not yet in surgery.
]  I'm just noting that so you'll understand why I was still waiting for surgery as the hour neared 1 PM.
The surgery center called over one of the on-call physicians from the hospital, who checked in on the man numerous times during the morning.
He was convinced that the man was too ill for surgery, but the man insisted that his own physician had told him to go ahead.
The family members were upset, because travel took a lot out of their father, and he made the three hour trip specifically for the surgery (a hip replacement).
The on-call doctor made it clear that there would be no surgery that day.
Why were they keeping him waiting is what the family wanted to know.
The on-call doctor wanted to consult with the man's physician, because he felt the man should be admitted to the hospital.
He was trying t</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28467283</id>
	<title>Not really</title>
	<author>dorpus</author>
	<datestamp>1245949200000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>I'm a statistician working for a health insurance company.  If there is redundant testing, we are the first to know about it, and we will not pay for it.  The health insurance industry has had no problems implementing IT technology; we have very good databases.  Health care providers have traditionally been in charge of treating patients rather than keeping records, so we have served as a default IT infrastructure.  One of the main obstacles to implementing IT in health care environments is the lack of computer literacy.  A very large number of nurses and physicians still have no idea how to read e-mail or surf the web, even in 2009; until a few months ago, I used to work in a health care environment and witnessed it firsthand.  There is also a shortage of expertise in IT professionals who understand the complexities of health care; a typical computer science graduate knows nothing about medicine and is hung up on the "healing power of echinacea" or whatever.  Both IT professionals and health care professionals regard themselves as smart people, they do not like to look stupid, so they resist learning skills unfamiliar to them.  In many markets, health care providers are given financial incentives to submit their claims electronically.  Larger hospitals and their affiliated clinics can afford to implement such measures, but private practices often cannot.  In many patients, there are extenuating circumstances that require the patient to receive treatments that deviate from standard procedure, so judgements still need to be made by humans on a case by case basis; it is not as simple as issuing tickets to airline passengers or shuffling boxes around in a warehouse.  In summary, there are good structural reasons why the health care industry has been more resistant to implementing IT, not just "greed" or "conspiracies".</p></htmltext>
<tokenext>I 'm a statistician working for a health insurance company .
If there is redundant testing , we are the first to know about it , and we will not pay for it .
The health insurance industry has had no problems implementing IT technology ; we have very good databases .
Health care providers have traditionally been in charge of treating patients rather than keeping records , so we have served as a default IT infrastructure .
One of the main obstacles to implementing IT in health care environments is the lack of computer literacy .
A very large number of nurses and physicians still have no idea how to read e-mail or surf the web , even in 2009 ; until a few months ago , I used to work in a health care environment and witnessed it firsthand .
There is also a shortage of expertise in IT professionals who understand the complexities of health care ; a typical computer science graduate knows nothing about medicine and is hung up on the " healing power of echinacea " or whatever .
Both IT professionals and health care professionals regard themselves as smart people , they do not like to look stupid , so they resist learning skills unfamiliar to them .
In many markets , health care providers are given financial incentives to submit their claims electronically .
Larger hospitals and their affiliated clinics can afford to implement such measures , but private practices often can not .
In many patients , there are extenuating circumstances that require the patient to receive treatments that deviate from standard procedure , so judgements still need to be made by humans on a case by case basis ; it is not as simple as issuing tickets to airline passengers or shuffling boxes around in a warehouse .
In summary , there are good structural reasons why the health care industry has been more resistant to implementing IT , not just " greed " or " conspiracies " .</tokentext>
<sentencetext>I'm a statistician working for a health insurance company.
If there is redundant testing, we are the first to know about it, and we will not pay for it.
The health insurance industry has had no problems implementing IT technology; we have very good databases.
Health care providers have traditionally been in charge of treating patients rather than keeping records, so we have served as a default IT infrastructure.
One of the main obstacles to implementing IT in health care environments is the lack of computer literacy.
A very large number of nurses and physicians still have no idea how to read e-mail or surf the web, even in 2009; until a few months ago, I used to work in a health care environment and witnessed it firsthand.
There is also a shortage of expertise in IT professionals who understand the complexities of health care; a typical computer science graduate knows nothing about medicine and is hung up on the "healing power of echinacea" or whatever.
Both IT professionals and health care professionals regard themselves as smart people, they do not like to look stupid, so they resist learning skills unfamiliar to them.
In many markets, health care providers are given financial incentives to submit their claims electronically.
Larger hospitals and their affiliated clinics can afford to implement such measures, but private practices often cannot.
In many patients, there are extenuating circumstances that require the patient to receive treatments that deviate from standard procedure, so judgements still need to be made by humans on a case by case basis; it is not as simple as issuing tickets to airline passengers or shuffling boxes around in a warehouse.
In summary, there are good structural reasons why the health care industry has been more resistant to implementing IT, not just "greed" or "conspiracies".</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465175</id>
	<title>Re:one word: protectionism</title>
	<author>The Tyro</author>
	<datestamp>1245937980000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>Doctor Dugan, is it?  I have to ask what specialty you practice, and what sort of practice environment you inhabit.</p><p>You sound like you're one of those who wants to throw open the health care licensing gates to anybody who wants to take care of a patient.  Having seen some of the stunts pulled by my fully-educated colleagues over the years, I'm a bit leery of turning over those keys to just anybody, particularly those with even LESS training and knowledge.</p><p>What, exactly, are you proposing as an alternative to the current system?</p><p>And spare me the thinly-veiled "profit-driven whores" implication in why physicians didn't adopt EMRs 30 years ago.  That isn't why, and you know it.  The truth is that the technology sucked even more then than it does now.</p></htmltext>
<tokenext>Doctor Dugan , is it ?
I have to ask what specialty you practice , and what sort of practice environment you inhabit.You sound like you 're one of those who wants to throw open the health care licensing gates to anybody who wants to take care of a patient .
Having seen some of the stunts pulled by my fully-educated colleagues over the years , I 'm a bit leery of turning over those keys to just anybody , particularly those with even LESS training and knowledge.What , exactly , are you proposing as an alternative to the current system ? And spare me the thinly-veiled " profit-driven whores " implication in why physicians did n't adopt EMRs 30 years ago .
That is n't why , and you know it .
The truth is that the technology sucked even more then than it does now .</tokentext>
<sentencetext>Doctor Dugan, is it?
I have to ask what specialty you practice, and what sort of practice environment you inhabit.You sound like you're one of those who wants to throw open the health care licensing gates to anybody who wants to take care of a patient.
Having seen some of the stunts pulled by my fully-educated colleagues over the years, I'm a bit leery of turning over those keys to just anybody, particularly those with even LESS training and knowledge.What, exactly, are you proposing as an alternative to the current system?And spare me the thinly-veiled "profit-driven whores" implication in why physicians didn't adopt EMRs 30 years ago.
That isn't why, and you know it.
The truth is that the technology sucked even more then than it does now.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464073</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463439</id>
	<title>Anus Transplant</title>
	<author>Anonymous</author>
	<datestamp>1245872280000</datestamp>
	<modclass>Troll</modclass>
	<modscore>-1</modscore>
	<htmltext><p><a href="http://goatse.fr/" title="goatse.fr" rel="nofollow">Goatse</a> [goatse.fr] has had an anus transplant!</p></htmltext>
<tokenext>Goatse [ goatse.fr ] has had an anus transplant !</tokentext>
<sentencetext>Goatse [goatse.fr] has had an anus transplant!</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463933</id>
	<title>IT is only one facet of healthcare</title>
	<author>Anonymous</author>
	<datestamp>1245921540000</datestamp>
	<modclass>Informativ</modclass>
	<modscore>5</modscore>
	<htmltext><p>I think there has always been a serious barrier to the uptake of new information technologies among the medical profession. Most HATE taking notes which is why note taking is left to the junior medical staff on ward rounds. Most clinicians take very brief notes, especially surgeons and only verbose when practicing defensive medicine. Most have a personal way to annotate their notes which cannot fit into any template (eg. unconventitional acronyms, stylized diagrams etc) and are loath to learn new ways of doing things. Sometimes surgical notes only make sense to that particular surgeon or surgeons of that sub-specialty (eg. ophthalmic vitreal surgery... very difficult to decipher...pain in the arse reading their notes.. )   Why? I think some of you guys need to see the amount of stuff medical specialists have to learn and the years of training (at least five here in Australia for specialty training, ( that is after 5-6 years medical school and another 1-3 years as general intern and resident) and then another 2-3 years for sub-specialty training which can involve 2-5 exams and possibly a PHD during the training). There is an incredible amount of stress on the person and their families. (Yes, I think the high standard of medical training IS necessary and not just economic gate-keeping by the medical colleges). During all that training before you are a qualified specialist, your hourly rate can be lower than the hospital cleaners or even not allowed to claim paid overtime at all, as the public hospitals here in Australia frequently runs out of money.</p><p>At the end of all that, I don't think many like to be told how to take their notes.</p><p>I don't think you need conspiracy theories to explain poor uptake of EMRs. In NZ where basically doctors can't get sued (generally speaking), doctors STILL hate EMRs and do poor job of entering data into systems. I once worked for an older surgeon and we got called for an emergency laparotomy on a drunk 19 yo male who lacerated his spleen in a car accident. The surgeon hated taking notes and hated talking to patients but was one hell of a surgeon. All his patient notes consisted of scribbles on flashcards. The young guy's abdomen was full of blood. We had no idea at the time where the bleeding was coming from. The surgeon was clamping major arteries by feel blindly as the suckers couldn't keep up. After five hours the surgery was over and the young guy lived. I tell ya, I had a new found respect for the "old school" surgeon. There are times when you REALLY don't care whether a surgeon is good at filling out forms or has polished bed-side manners.</p></htmltext>
<tokenext>I think there has always been a serious barrier to the uptake of new information technologies among the medical profession .
Most HATE taking notes which is why note taking is left to the junior medical staff on ward rounds .
Most clinicians take very brief notes , especially surgeons and only verbose when practicing defensive medicine .
Most have a personal way to annotate their notes which can not fit into any template ( eg .
unconventitional acronyms , stylized diagrams etc ) and are loath to learn new ways of doing things .
Sometimes surgical notes only make sense to that particular surgeon or surgeons of that sub-specialty ( eg .
ophthalmic vitreal surgery... very difficult to decipher...pain in the arse reading their notes.. ) Why ?
I think some of you guys need to see the amount of stuff medical specialists have to learn and the years of training ( at least five here in Australia for specialty training , ( that is after 5-6 years medical school and another 1-3 years as general intern and resident ) and then another 2-3 years for sub-specialty training which can involve 2-5 exams and possibly a PHD during the training ) .
There is an incredible amount of stress on the person and their families .
( Yes , I think the high standard of medical training IS necessary and not just economic gate-keeping by the medical colleges ) .
During all that training before you are a qualified specialist , your hourly rate can be lower than the hospital cleaners or even not allowed to claim paid overtime at all , as the public hospitals here in Australia frequently runs out of money.At the end of all that , I do n't think many like to be told how to take their notes.I do n't think you need conspiracy theories to explain poor uptake of EMRs .
In NZ where basically doctors ca n't get sued ( generally speaking ) , doctors STILL hate EMRs and do poor job of entering data into systems .
I once worked for an older surgeon and we got called for an emergency laparotomy on a drunk 19 yo male who lacerated his spleen in a car accident .
The surgeon hated taking notes and hated talking to patients but was one hell of a surgeon .
All his patient notes consisted of scribbles on flashcards .
The young guy 's abdomen was full of blood .
We had no idea at the time where the bleeding was coming from .
The surgeon was clamping major arteries by feel blindly as the suckers could n't keep up .
After five hours the surgery was over and the young guy lived .
I tell ya , I had a new found respect for the " old school " surgeon .
There are times when you REALLY do n't care whether a surgeon is good at filling out forms or has polished bed-side manners .</tokentext>
<sentencetext>I think there has always been a serious barrier to the uptake of new information technologies among the medical profession.
Most HATE taking notes which is why note taking is left to the junior medical staff on ward rounds.
Most clinicians take very brief notes, especially surgeons and only verbose when practicing defensive medicine.
Most have a personal way to annotate their notes which cannot fit into any template (eg.
unconventitional acronyms, stylized diagrams etc) and are loath to learn new ways of doing things.
Sometimes surgical notes only make sense to that particular surgeon or surgeons of that sub-specialty (eg.
ophthalmic vitreal surgery... very difficult to decipher...pain in the arse reading their notes.. )   Why?
I think some of you guys need to see the amount of stuff medical specialists have to learn and the years of training (at least five here in Australia for specialty training, ( that is after 5-6 years medical school and another 1-3 years as general intern and resident) and then another 2-3 years for sub-specialty training which can involve 2-5 exams and possibly a PHD during the training).
There is an incredible amount of stress on the person and their families.
(Yes, I think the high standard of medical training IS necessary and not just economic gate-keeping by the medical colleges).
During all that training before you are a qualified specialist, your hourly rate can be lower than the hospital cleaners or even not allowed to claim paid overtime at all, as the public hospitals here in Australia frequently runs out of money.At the end of all that, I don't think many like to be told how to take their notes.I don't think you need conspiracy theories to explain poor uptake of EMRs.
In NZ where basically doctors can't get sued (generally speaking), doctors STILL hate EMRs and do poor job of entering data into systems.
I once worked for an older surgeon and we got called for an emergency laparotomy on a drunk 19 yo male who lacerated his spleen in a car accident.
The surgeon hated taking notes and hated talking to patients but was one hell of a surgeon.
All his patient notes consisted of scribbles on flashcards.
The young guy's abdomen was full of blood.
We had no idea at the time where the bleeding was coming from.
The surgeon was clamping major arteries by feel blindly as the suckers couldn't keep up.
After five hours the surgery was over and the young guy lived.
I tell ya, I had a new found respect for the "old school" surgeon.
There are times when you REALLY don't care whether a surgeon is good at filling out forms or has polished bed-side manners.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463649</id>
	<title>Dartmouth College Institute for Health Policy ...</title>
	<author>vic-traill</author>
	<datestamp>1245961260000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext>From TFA:<p><div class="quote"><p>The amount of unnecessary spending is huge. In a project that analyzed 4,000 hospitals, the Dartmouth College Institute for Health Policy and Clinical Practice estimated that eliminating 30 percent of Medicare spending would not change either access to health care or the quality of the care itself.</p></div><p>The first thing I did was go looking for who funds the Dartmouth College Institute for Health Policy and Clinical Practice. Following <a href="http://tdi.dartmouth.edu/excellence.php" title="dartmouth.edu">the second search result</a> [dartmouth.edu] was just too damn funny - excellence.php needs a bit of work, I guess.</p></div>
	</htmltext>
<tokenext>From TFA : The amount of unnecessary spending is huge .
In a project that analyzed 4,000 hospitals , the Dartmouth College Institute for Health Policy and Clinical Practice estimated that eliminating 30 percent of Medicare spending would not change either access to health care or the quality of the care itself.The first thing I did was go looking for who funds the Dartmouth College Institute for Health Policy and Clinical Practice .
Following the second search result [ dartmouth.edu ] was just too damn funny - excellence.php needs a bit of work , I guess .</tokentext>
<sentencetext>From TFA:The amount of unnecessary spending is huge.
In a project that analyzed 4,000 hospitals, the Dartmouth College Institute for Health Policy and Clinical Practice estimated that eliminating 30 percent of Medicare spending would not change either access to health care or the quality of the care itself.The first thing I did was go looking for who funds the Dartmouth College Institute for Health Policy and Clinical Practice.
Following the second search result [dartmouth.edu] was just too damn funny - excellence.php needs a bit of work, I guess.
	</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28467355</id>
	<title>Re:Health Care vs FedEx</title>
	<author>Anonymous</author>
	<datestamp>1245949500000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext>For Obama's dream of FedEx-like medical tracking to come true, there would obviously have to be one nationalized medical organization. Trying to track a FedEx package from UPS's website is pretty difficult, and passing a law telling UPS to integrate FedEx tracking won't turn out well.</htmltext>
<tokenext>For Obama 's dream of FedEx-like medical tracking to come true , there would obviously have to be one nationalized medical organization .
Trying to track a FedEx package from UPS 's website is pretty difficult , and passing a law telling UPS to integrate FedEx tracking wo n't turn out well .</tokentext>
<sentencetext>For Obama's dream of FedEx-like medical tracking to come true, there would obviously have to be one nationalized medical organization.
Trying to track a FedEx package from UPS's website is pretty difficult, and passing a law telling UPS to integrate FedEx tracking won't turn out well.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464603</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28469755</id>
	<title>Re:IT and Medicine are a Bad Fit</title>
	<author>copdk4</author>
	<datestamp>1245958440000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>MOD PARENT UP!</p><p>This is at the heart of the whole issue. Medical Data is hard and that leads to crappy implementations, unintuitive UI, less desire for docs to use it yada yada...</p><p>Although I disagree that one needs to represent everything "symbolically" there are several EMRs with free-text note fields and post-process the notes with NLP for meaningful secondary uses. Yes NLP is not perfect but things are getting much smarter and better.</p><p>PS: Those purist self-righteous PhD Description Logicians. Leave us Alone!!!<nobr> <wbr></nobr>:)</p></htmltext>
<tokenext>MOD PARENT UP ! This is at the heart of the whole issue .
Medical Data is hard and that leads to crappy implementations , unintuitive UI , less desire for docs to use it yada yada...Although I disagree that one needs to represent everything " symbolically " there are several EMRs with free-text note fields and post-process the notes with NLP for meaningful secondary uses .
Yes NLP is not perfect but things are getting much smarter and better.PS : Those purist self-righteous PhD Description Logicians .
Leave us Alone ! ! !
: )</tokentext>
<sentencetext>MOD PARENT UP!This is at the heart of the whole issue.
Medical Data is hard and that leads to crappy implementations, unintuitive UI, less desire for docs to use it yada yada...Although I disagree that one needs to represent everything "symbolically" there are several EMRs with free-text note fields and post-process the notes with NLP for meaningful secondary uses.
Yes NLP is not perfect but things are getting much smarter and better.PS: Those purist self-righteous PhD Description Logicians.
Leave us Alone!!!
:)</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465565</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28466655</id>
	<title>Because the requirements are hard</title>
	<author>plopez</author>
	<datestamp>1245946200000</datestamp>
	<modclass>Interestin</modclass>
	<modscore>2</modscore>
	<htmltext><p>You have the following requirements:</p><p>1) Data integrity. This is very hard. Your typical programmer doesn't understand it. This is a disaster waiting to happen. I personally do not want my records in electronic format. See the disaster called electronic voting as an example now increase the complexity.</p><p>2) You need tight security of records. Electronic security is a joke. And who is liable? How many breaches have there been in the private and government sector in the past few years see this article: <a href="http://hardware.slashdot.org/story/09/06/25/0243221/Reporters-Find-US-Govt-Data-In-Ghana-Market?art\_pos=5" title="slashdot.org">http://hardware.slashdot.org/story/09/06/25/0243221/Reporters-Find-US-Govt-Data-In-Ghana-Market?art\_pos=5</a> [slashdot.org]<br>And security is orthogonal to ease of information sharing.</p><p>3) Ease of data sharing. A major selling point of electronic data is the ease in which data can be shared. But this is orthogonal to point #2. Also if data integrity is violated and the data stream becomes polluted, as in point #1, this is a major liability.</p><p>Getting all three of these major requirements is hard. Very hard. Probably harder than running tests or doing many surgeries. A simple screw up here can have ramification not just for one patient but for millions. See the nightmare called electronic voting to see what will happen.</p><p>AFAIAC, electronic medical records will cost more in lives and money than they will save.</p></htmltext>
<tokenext>You have the following requirements : 1 ) Data integrity .
This is very hard .
Your typical programmer does n't understand it .
This is a disaster waiting to happen .
I personally do not want my records in electronic format .
See the disaster called electronic voting as an example now increase the complexity.2 ) You need tight security of records .
Electronic security is a joke .
And who is liable ?
How many breaches have there been in the private and government sector in the past few years see this article : http : //hardware.slashdot.org/story/09/06/25/0243221/Reporters-Find-US-Govt-Data-In-Ghana-Market ? art \ _pos = 5 [ slashdot.org ] And security is orthogonal to ease of information sharing.3 ) Ease of data sharing .
A major selling point of electronic data is the ease in which data can be shared .
But this is orthogonal to point # 2 .
Also if data integrity is violated and the data stream becomes polluted , as in point # 1 , this is a major liability.Getting all three of these major requirements is hard .
Very hard .
Probably harder than running tests or doing many surgeries .
A simple screw up here can have ramification not just for one patient but for millions .
See the nightmare called electronic voting to see what will happen.AFAIAC , electronic medical records will cost more in lives and money than they will save .</tokentext>
<sentencetext>You have the following requirements:1) Data integrity.
This is very hard.
Your typical programmer doesn't understand it.
This is a disaster waiting to happen.
I personally do not want my records in electronic format.
See the disaster called electronic voting as an example now increase the complexity.2) You need tight security of records.
Electronic security is a joke.
And who is liable?
How many breaches have there been in the private and government sector in the past few years see this article: http://hardware.slashdot.org/story/09/06/25/0243221/Reporters-Find-US-Govt-Data-In-Ghana-Market?art\_pos=5 [slashdot.org]And security is orthogonal to ease of information sharing.3) Ease of data sharing.
A major selling point of electronic data is the ease in which data can be shared.
But this is orthogonal to point #2.
Also if data integrity is violated and the data stream becomes polluted, as in point #1, this is a major liability.Getting all three of these major requirements is hard.
Very hard.
Probably harder than running tests or doing many surgeries.
A simple screw up here can have ramification not just for one patient but for millions.
See the nightmare called electronic voting to see what will happen.AFAIAC, electronic medical records will cost more in lives and money than they will save.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28467135</id>
	<title>Because the structures aren't there</title>
	<author>Eskarel</author>
	<datestamp>1245948660000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>I can tell you what the problem is. It's a problem of process.</p><p>Any half decent programmer can implement the framework for an EMR, it's not really all that technically difficult. Providing access to a database isn't hard, putting security descriptors on a database isn't hard, converting physical records to electronic ones isn't all that hard either.</p><p>What's hard is getting the data from all the doctors and hospitals into one place, positively identifying the people involved(doctor, patient, etc), working out who ought to be able to see the record and under what circumstances.</p><p>Every one of these projects treats the problem as a purely technical problem. It's not, from a purely technical perspective it's not even particularly challenging, a 1st year Uni student could probably implement most of it.</p><p>The fundamental problem is that in order to be able to generate a centralized Electronic Medical Record you have to be capable of generating a centralized physical medical record, at least in theory even if it wouldn't be practical. At present, no country has the capability of doing this and so each and every one of these projects fails.</p></htmltext>
<tokenext>I can tell you what the problem is .
It 's a problem of process.Any half decent programmer can implement the framework for an EMR , it 's not really all that technically difficult .
Providing access to a database is n't hard , putting security descriptors on a database is n't hard , converting physical records to electronic ones is n't all that hard either.What 's hard is getting the data from all the doctors and hospitals into one place , positively identifying the people involved ( doctor , patient , etc ) , working out who ought to be able to see the record and under what circumstances.Every one of these projects treats the problem as a purely technical problem .
It 's not , from a purely technical perspective it 's not even particularly challenging , a 1st year Uni student could probably implement most of it.The fundamental problem is that in order to be able to generate a centralized Electronic Medical Record you have to be capable of generating a centralized physical medical record , at least in theory even if it would n't be practical .
At present , no country has the capability of doing this and so each and every one of these projects fails .</tokentext>
<sentencetext>I can tell you what the problem is.
It's a problem of process.Any half decent programmer can implement the framework for an EMR, it's not really all that technically difficult.
Providing access to a database isn't hard, putting security descriptors on a database isn't hard, converting physical records to electronic ones isn't all that hard either.What's hard is getting the data from all the doctors and hospitals into one place, positively identifying the people involved(doctor, patient, etc), working out who ought to be able to see the record and under what circumstances.Every one of these projects treats the problem as a purely technical problem.
It's not, from a purely technical perspective it's not even particularly challenging, a 1st year Uni student could probably implement most of it.The fundamental problem is that in order to be able to generate a centralized Electronic Medical Record you have to be capable of generating a centralized physical medical record, at least in theory even if it wouldn't be practical.
At present, no country has the capability of doing this and so each and every one of these projects fails.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464797</id>
	<title>Consultants with no incentive to deliver</title>
	<author>Anonymous</author>
	<datestamp>1245934740000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>The reason the NHS system is such a debacle is the culture of absolute gold plating everything so that the blame can never be laid at your door.  This leads to people taking on consultants who themselves can justify taking the project to the nth degree of abstraction and documentation.  I work on agile projects - they expect production ready code for a tiny vertical slice of the system in 2 weeks from the project start.  We have delivered enormous (globally renowned<nobr> <wbr></nobr>.coms, oil pipeline systems, you name it) by this method.  This is how public sector software should be delivered - demonstrate your progress with a working system, not with documentation.</p></htmltext>
<tokenext>The reason the NHS system is such a debacle is the culture of absolute gold plating everything so that the blame can never be laid at your door .
This leads to people taking on consultants who themselves can justify taking the project to the nth degree of abstraction and documentation .
I work on agile projects - they expect production ready code for a tiny vertical slice of the system in 2 weeks from the project start .
We have delivered enormous ( globally renowned .coms , oil pipeline systems , you name it ) by this method .
This is how public sector software should be delivered - demonstrate your progress with a working system , not with documentation .</tokentext>
<sentencetext>The reason the NHS system is such a debacle is the culture of absolute gold plating everything so that the blame can never be laid at your door.
This leads to people taking on consultants who themselves can justify taking the project to the nth degree of abstraction and documentation.
I work on agile projects - they expect production ready code for a tiny vertical slice of the system in 2 weeks from the project start.
We have delivered enormous (globally renowned .coms, oil pipeline systems, you name it) by this method.
This is how public sector software should be delivered - demonstrate your progress with a working system, not with documentation.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463663</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28468121</id>
	<title>Re:one word: protectionism</title>
	<author>Anonymous</author>
	<datestamp>1245952440000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p><div class="quote"><p>Most physicians ought to try working in any other profession besides the guaranteed-high-salary-MD-world before commenting on who it is that lives in a parallel universe.</p></div><p>Oh, that's cute!  Did you catch the part about his '94 Corolla?  From personal experience, I see <em>very</em> few rich doctors under the age of 50 or so.  Seriously, that myth died when Medicare and HMOs took over.  Young doctors are considered successful if they can manage to pay student loans while living in a house that keeps the rainwater out and driving a car that starts most days of the year.</p><p>Sure, you can trot out a few cardiologists or plastic surgeons as counterexamples, for but each of those I can present 100 family practitioners.</p></div>
	</htmltext>
<tokenext>Most physicians ought to try working in any other profession besides the guaranteed-high-salary-MD-world before commenting on who it is that lives in a parallel universe.Oh , that 's cute !
Did you catch the part about his '94 Corolla ?
From personal experience , I see very few rich doctors under the age of 50 or so .
Seriously , that myth died when Medicare and HMOs took over .
Young doctors are considered successful if they can manage to pay student loans while living in a house that keeps the rainwater out and driving a car that starts most days of the year.Sure , you can trot out a few cardiologists or plastic surgeons as counterexamples , for but each of those I can present 100 family practitioners .</tokentext>
<sentencetext>Most physicians ought to try working in any other profession besides the guaranteed-high-salary-MD-world before commenting on who it is that lives in a parallel universe.Oh, that's cute!
Did you catch the part about his '94 Corolla?
From personal experience, I see very few rich doctors under the age of 50 or so.
Seriously, that myth died when Medicare and HMOs took over.
Young doctors are considered successful if they can manage to pay student loans while living in a house that keeps the rainwater out and driving a car that starts most days of the year.Sure, you can trot out a few cardiologists or plastic surgeons as counterexamples, for but each of those I can present 100 family practitioners.
	</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464073</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464419</id>
	<title>The Many Layers of Complexity</title>
	<author>trydk</author>
	<datestamp>1245927900000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>5</modscore>
	<htmltext>As always this is a relatively simple problem wrapped in layers of -- to a certain extent unnecessary -- complexity.<br>
<br>
The simple idea is to have a system that records the patients history of illnesses and treatment (including medication, obviously) and which is easily communicated across different places of diagnose and treatment (GP, specialists, consultants, hospitals,<nobr> <wbr></nobr>...).<br>
<br>
This specific problem could easily be solved with standard software like Lotus Notes, Microsoft SharePoint and similar systems, but that is where the simplicity stops and the layers of complexity start.<br>
<br>
Sorry if I am going down a well-travelled trail here.<br>
<br>
Firstly, it is very difficult to get people and organisations to standardise on a single system for good and for bad reasons. (Like "We've already got Lotus Notes, why should we get a Microsoft product?" -- plug in whatever conflicting product/system names you can think of.) This means that a single <em>system</em> probably is out of the question, which leaves us with a standardised interchange format instead.<br>
<br>
OK, now we have a gazillion systems happily exchanging information in a standardised format, so everybody is happy, right?<br>
<br>
Wrong!<br>
<br>
Because secondly, who is responsible for the safekeeping of the data? This is two-fold: Who is responsible for storing the data and who is responsible for who has access to the data?<br>
<br>
So 2a, Responsibility for storing the data: If every place of diagnose and treatment is responsible for storing own data, how can a patient be sure that any specific institution treating her has access to all the information? This needs some centralised storage or at least "mediating" (much like peer-to-peer systems, e.g. torrents, need a "meeting place", like The Pirate Bay, where they can find the trackers so they know where to find the peers). Either system suffers from the problem of connectivity dependence, i.e. if they cannot get access to either the storage, the "mediator" or the peers, information cannot be retrieved. This is still better than paper-based systems, if you are treated in different places, geographically.<br>
<br>
This leads to 2b, Responsibility for who has access to the data: I would obviously like for my GP to send information directly to the hospital and for the nurses, doctors, consultants and surgeons treating me to see my records, but -- being the famous person, I am<nobr> <wbr></nobr>... not -- I would be quite weary if just about anyone could look at my records. How is this problem solved?<br>
<br>
Thirdly, who would be responsible for correcting errors and mistakes in the records? This problem is not really an issue relating only to electronic records, but is a general issue, which crops up all the time. Should you, as the patient, be allowed to correct mistakes you know about? If that is the case, how do the professionals make sure that you are not trying to tamper with the system for some ulterior motive (everything from trying to cover medical problems for insurance purposes to hypochondria)? If you are not allowed to correct mistakes, how do you tell them that you did <em>not</em> receive a certain medication two years ago and, in fact, is allergic to it?<br>
<br>
Fourthly, a system relying on doctors, specialists and consultants to type would probably be doomed, at least for now. It seems that doctors, etc. at all the hospitals I have seen, rely on dictation, having a pool of secretaries typing it in and updating the records, which introduces unnecessary delays and adds an extra risk of introducing errors.<br>
<br>
These are some of the many problems facing such a system and I am sure I have left out many, just as relevant. I honestly do not believe that the fear of transparency regarding the treatment is the major stumbling block for the introduction of electronic medical records, but rather the diverse types of problems facing the system.</htmltext>
<tokenext>As always this is a relatively simple problem wrapped in layers of -- to a certain extent unnecessary -- complexity .
The simple idea is to have a system that records the patients history of illnesses and treatment ( including medication , obviously ) and which is easily communicated across different places of diagnose and treatment ( GP , specialists , consultants , hospitals , ... ) .
This specific problem could easily be solved with standard software like Lotus Notes , Microsoft SharePoint and similar systems , but that is where the simplicity stops and the layers of complexity start .
Sorry if I am going down a well-travelled trail here .
Firstly , it is very difficult to get people and organisations to standardise on a single system for good and for bad reasons .
( Like " We 've already got Lotus Notes , why should we get a Microsoft product ?
" -- plug in whatever conflicting product/system names you can think of .
) This means that a single system probably is out of the question , which leaves us with a standardised interchange format instead .
OK , now we have a gazillion systems happily exchanging information in a standardised format , so everybody is happy , right ?
Wrong ! Because secondly , who is responsible for the safekeeping of the data ?
This is two-fold : Who is responsible for storing the data and who is responsible for who has access to the data ?
So 2a , Responsibility for storing the data : If every place of diagnose and treatment is responsible for storing own data , how can a patient be sure that any specific institution treating her has access to all the information ?
This needs some centralised storage or at least " mediating " ( much like peer-to-peer systems , e.g .
torrents , need a " meeting place " , like The Pirate Bay , where they can find the trackers so they know where to find the peers ) .
Either system suffers from the problem of connectivity dependence , i.e .
if they can not get access to either the storage , the " mediator " or the peers , information can not be retrieved .
This is still better than paper-based systems , if you are treated in different places , geographically .
This leads to 2b , Responsibility for who has access to the data : I would obviously like for my GP to send information directly to the hospital and for the nurses , doctors , consultants and surgeons treating me to see my records , but -- being the famous person , I am ... not -- I would be quite weary if just about anyone could look at my records .
How is this problem solved ?
Thirdly , who would be responsible for correcting errors and mistakes in the records ?
This problem is not really an issue relating only to electronic records , but is a general issue , which crops up all the time .
Should you , as the patient , be allowed to correct mistakes you know about ?
If that is the case , how do the professionals make sure that you are not trying to tamper with the system for some ulterior motive ( everything from trying to cover medical problems for insurance purposes to hypochondria ) ?
If you are not allowed to correct mistakes , how do you tell them that you did not receive a certain medication two years ago and , in fact , is allergic to it ?
Fourthly , a system relying on doctors , specialists and consultants to type would probably be doomed , at least for now .
It seems that doctors , etc .
at all the hospitals I have seen , rely on dictation , having a pool of secretaries typing it in and updating the records , which introduces unnecessary delays and adds an extra risk of introducing errors .
These are some of the many problems facing such a system and I am sure I have left out many , just as relevant .
I honestly do not believe that the fear of transparency regarding the treatment is the major stumbling block for the introduction of electronic medical records , but rather the diverse types of problems facing the system .</tokentext>
<sentencetext>As always this is a relatively simple problem wrapped in layers of -- to a certain extent unnecessary -- complexity.
The simple idea is to have a system that records the patients history of illnesses and treatment (including medication, obviously) and which is easily communicated across different places of diagnose and treatment (GP, specialists, consultants, hospitals, ...).
This specific problem could easily be solved with standard software like Lotus Notes, Microsoft SharePoint and similar systems, but that is where the simplicity stops and the layers of complexity start.
Sorry if I am going down a well-travelled trail here.
Firstly, it is very difficult to get people and organisations to standardise on a single system for good and for bad reasons.
(Like "We've already got Lotus Notes, why should we get a Microsoft product?
" -- plug in whatever conflicting product/system names you can think of.
) This means that a single system probably is out of the question, which leaves us with a standardised interchange format instead.
OK, now we have a gazillion systems happily exchanging information in a standardised format, so everybody is happy, right?
Wrong!

Because secondly, who is responsible for the safekeeping of the data?
This is two-fold: Who is responsible for storing the data and who is responsible for who has access to the data?
So 2a, Responsibility for storing the data: If every place of diagnose and treatment is responsible for storing own data, how can a patient be sure that any specific institution treating her has access to all the information?
This needs some centralised storage or at least "mediating" (much like peer-to-peer systems, e.g.
torrents, need a "meeting place", like The Pirate Bay, where they can find the trackers so they know where to find the peers).
Either system suffers from the problem of connectivity dependence, i.e.
if they cannot get access to either the storage, the "mediator" or the peers, information cannot be retrieved.
This is still better than paper-based systems, if you are treated in different places, geographically.
This leads to 2b, Responsibility for who has access to the data: I would obviously like for my GP to send information directly to the hospital and for the nurses, doctors, consultants and surgeons treating me to see my records, but -- being the famous person, I am ... not -- I would be quite weary if just about anyone could look at my records.
How is this problem solved?
Thirdly, who would be responsible for correcting errors and mistakes in the records?
This problem is not really an issue relating only to electronic records, but is a general issue, which crops up all the time.
Should you, as the patient, be allowed to correct mistakes you know about?
If that is the case, how do the professionals make sure that you are not trying to tamper with the system for some ulterior motive (everything from trying to cover medical problems for insurance purposes to hypochondria)?
If you are not allowed to correct mistakes, how do you tell them that you did not receive a certain medication two years ago and, in fact, is allergic to it?
Fourthly, a system relying on doctors, specialists and consultants to type would probably be doomed, at least for now.
It seems that doctors, etc.
at all the hospitals I have seen, rely on dictation, having a pool of secretaries typing it in and updating the records, which introduces unnecessary delays and adds an extra risk of introducing errors.
These are some of the many problems facing such a system and I am sure I have left out many, just as relevant.
I honestly do not believe that the fear of transparency regarding the treatment is the major stumbling block for the introduction of electronic medical records, but rather the diverse types of problems facing the system.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463551</id>
	<title>one word:  protectionism</title>
	<author>drDugan</author>
	<datestamp>1245873480000</datestamp>
	<modclass>Interestin</modclass>
	<modscore>3</modscore>
	<htmltext><p>The nugget of this is not explained really in the article:</p><p>Cost is *NOT* the barrier, but "lucrative business model hidden" what they mean is the intrinsic structure of how medical care is delivered and who gets to be responsible for care delivery.</p><p>In my opinion, refusal to openly adopt electronic medical records is a direct result of overt protectionism by physicians and surgeons.  For good reason, society has left medical care in the hands of competent, trained people.  However, competency and training has been industrialized to only 1 kind of person, with one kind of standardized training: the MD, and basically no one else, regardless of training or ability is allowed by license to practice medicine, or reap the financial rewards of such extreme responsibility.  NPs have wiggled their way in a bit and DOs are close, but basically no one else.</p><p>When physicians are required to interact in electronic, shared systems, they can't lord over all the responsibility in care environments, and then they won't be the only ones who run all the medical care and take home most all the money.  They will lose their self-created and maintained monopoly on responsibility for care.</p><p>Anyone who has worked a hospital environment learns in the first few weeks exactly what the MD care delivery scheme is all about.</p></htmltext>
<tokenext>The nugget of this is not explained really in the article : Cost is * NOT * the barrier , but " lucrative business model hidden " what they mean is the intrinsic structure of how medical care is delivered and who gets to be responsible for care delivery.In my opinion , refusal to openly adopt electronic medical records is a direct result of overt protectionism by physicians and surgeons .
For good reason , society has left medical care in the hands of competent , trained people .
However , competency and training has been industrialized to only 1 kind of person , with one kind of standardized training : the MD , and basically no one else , regardless of training or ability is allowed by license to practice medicine , or reap the financial rewards of such extreme responsibility .
NPs have wiggled their way in a bit and DOs are close , but basically no one else.When physicians are required to interact in electronic , shared systems , they ca n't lord over all the responsibility in care environments , and then they wo n't be the only ones who run all the medical care and take home most all the money .
They will lose their self-created and maintained monopoly on responsibility for care.Anyone who has worked a hospital environment learns in the first few weeks exactly what the MD care delivery scheme is all about .</tokentext>
<sentencetext>The nugget of this is not explained really in the article:Cost is *NOT* the barrier, but "lucrative business model hidden" what they mean is the intrinsic structure of how medical care is delivered and who gets to be responsible for care delivery.In my opinion, refusal to openly adopt electronic medical records is a direct result of overt protectionism by physicians and surgeons.
For good reason, society has left medical care in the hands of competent, trained people.
However, competency and training has been industrialized to only 1 kind of person, with one kind of standardized training: the MD, and basically no one else, regardless of training or ability is allowed by license to practice medicine, or reap the financial rewards of such extreme responsibility.
NPs have wiggled their way in a bit and DOs are close, but basically no one else.When physicians are required to interact in electronic, shared systems, they can't lord over all the responsibility in care environments, and then they won't be the only ones who run all the medical care and take home most all the money.
They will lose their self-created and maintained monopoly on responsibility for care.Anyone who has worked a hospital environment learns in the first few weeks exactly what the MD care delivery scheme is all about.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464991</id>
	<title>Absolutely</title>
	<author>Anonymous</author>
	<datestamp>1245936780000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>3</modscore>
	<htmltext><p>It's not protectionism or any of that other trite conspiratorial nonsense that keeps physicians from using EMR (you can't get ten physicians to agree on damned-near ANYTHING, from what PACS software to use, to what size coffee cups to keep in the surgery waiting area... how do you expect them to engage in any kind of organized conspiracy to keep using paper?)  You want to know why physicians dread EMRs?</p><p>Well... being one (and a tech geek to boot), I'll tell you:</p><p>It's the UI.... that and the cost.  If you can make it fast, user-friendly, intuitive, lightweight, and inexpensive, the world will beat a path to your door.</p><p>For example, when I was an intern, we were evaulating a hospital-based order-entry system from TDS.  It was the old light-pen system, and the damned thing took 14 screens to order an Xray.</p><p>I'm now a practicing ER physician... nobody is under greater time pressure than I am, and the EMRs that I've seen so far will slow me down.  My colleagues at a nearby hospital who use one of the tablet-based systems complain bitterly about how slow it is.</p><p>Make it faster and easier to use than paper.  Make it... you know... an actual upgrade?  Not some ugly, unwieldy kludge forced by some data-mining, numbers-obsessed bureaucrat.  Doctors generally aren't geeks... they care about ease of use.  A system that doesn't make it easier to take care of patients will be universally despised, and resisted by everyone on the medical staff.</p><p>Physicians have enough to do, and enough to worry about.  Want to have medical staff buy-in?  Make the EMR an asset instead of a liability.</p></htmltext>
<tokenext>It 's not protectionism or any of that other trite conspiratorial nonsense that keeps physicians from using EMR ( you ca n't get ten physicians to agree on damned-near ANYTHING , from what PACS software to use , to what size coffee cups to keep in the surgery waiting area... how do you expect them to engage in any kind of organized conspiracy to keep using paper ?
) You want to know why physicians dread EMRs ? Well... being one ( and a tech geek to boot ) , I 'll tell you : It 's the UI.... that and the cost .
If you can make it fast , user-friendly , intuitive , lightweight , and inexpensive , the world will beat a path to your door.For example , when I was an intern , we were evaulating a hospital-based order-entry system from TDS .
It was the old light-pen system , and the damned thing took 14 screens to order an Xray.I 'm now a practicing ER physician... nobody is under greater time pressure than I am , and the EMRs that I 've seen so far will slow me down .
My colleagues at a nearby hospital who use one of the tablet-based systems complain bitterly about how slow it is.Make it faster and easier to use than paper .
Make it... you know... an actual upgrade ?
Not some ugly , unwieldy kludge forced by some data-mining , numbers-obsessed bureaucrat .
Doctors generally are n't geeks... they care about ease of use .
A system that does n't make it easier to take care of patients will be universally despised , and resisted by everyone on the medical staff.Physicians have enough to do , and enough to worry about .
Want to have medical staff buy-in ?
Make the EMR an asset instead of a liability .</tokentext>
<sentencetext>It's not protectionism or any of that other trite conspiratorial nonsense that keeps physicians from using EMR (you can't get ten physicians to agree on damned-near ANYTHING, from what PACS software to use, to what size coffee cups to keep in the surgery waiting area... how do you expect them to engage in any kind of organized conspiracy to keep using paper?
)  You want to know why physicians dread EMRs?Well... being one (and a tech geek to boot), I'll tell you:It's the UI.... that and the cost.
If you can make it fast, user-friendly, intuitive, lightweight, and inexpensive, the world will beat a path to your door.For example, when I was an intern, we were evaulating a hospital-based order-entry system from TDS.
It was the old light-pen system, and the damned thing took 14 screens to order an Xray.I'm now a practicing ER physician... nobody is under greater time pressure than I am, and the EMRs that I've seen so far will slow me down.
My colleagues at a nearby hospital who use one of the tablet-based systems complain bitterly about how slow it is.Make it faster and easier to use than paper.
Make it... you know... an actual upgrade?
Not some ugly, unwieldy kludge forced by some data-mining, numbers-obsessed bureaucrat.
Doctors generally aren't geeks... they care about ease of use.
A system that doesn't make it easier to take care of patients will be universally despised, and resisted by everyone on the medical staff.Physicians have enough to do, and enough to worry about.
Want to have medical staff buy-in?
Make the EMR an asset instead of a liability.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463733</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28466433</id>
	<title>I work in this field.  It's a *big* field.</title>
	<author>talldean</author>
	<datestamp>1245945000000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext>Just looking on the billing side alone, the two-volume set of hardback books describing just the 837 EDI transaction (payor's outbound patient claim) is 2000+ pages of text.  There are many, many different transactions, making tens of thousands of pages of documentation just on file formats.  Save a very, very few projects ever successfully built, it's hard to find a business with more required process.  The human body is complex, and I think we often underestimate the scope of the healthcare system; it's much more than just getting a yearly flu shot at the family practice doc's.

Someone spoke about Obama saying that FedEx can track a box anywhere; why can't we track medical records?  Well, we *can* track medical records anywhere; we just can't always read them.  Can FedEx track UPS packages?  USPS?  UK Postal Mail?  It's a bunch of different systems, and the analogy was so broken, it kind of illustrates he doesn't yet understand the types of problems the industry has to overcome.

Much like the ongoing disaster of rebuilding the air traffic control system, peoples lives depend on these systems for proper care and treatment.  Give us awhile.  We'll get there, but we write code, not magic; it's going to take awhile.</htmltext>
<tokenext>Just looking on the billing side alone , the two-volume set of hardback books describing just the 837 EDI transaction ( payor 's outbound patient claim ) is 2000 + pages of text .
There are many , many different transactions , making tens of thousands of pages of documentation just on file formats .
Save a very , very few projects ever successfully built , it 's hard to find a business with more required process .
The human body is complex , and I think we often underestimate the scope of the healthcare system ; it 's much more than just getting a yearly flu shot at the family practice doc 's .
Someone spoke about Obama saying that FedEx can track a box anywhere ; why ca n't we track medical records ?
Well , we * can * track medical records anywhere ; we just ca n't always read them .
Can FedEx track UPS packages ?
USPS ? UK Postal Mail ?
It 's a bunch of different systems , and the analogy was so broken , it kind of illustrates he does n't yet understand the types of problems the industry has to overcome .
Much like the ongoing disaster of rebuilding the air traffic control system , peoples lives depend on these systems for proper care and treatment .
Give us awhile .
We 'll get there , but we write code , not magic ; it 's going to take awhile .</tokentext>
<sentencetext>Just looking on the billing side alone, the two-volume set of hardback books describing just the 837 EDI transaction (payor's outbound patient claim) is 2000+ pages of text.
There are many, many different transactions, making tens of thousands of pages of documentation just on file formats.
Save a very, very few projects ever successfully built, it's hard to find a business with more required process.
The human body is complex, and I think we often underestimate the scope of the healthcare system; it's much more than just getting a yearly flu shot at the family practice doc's.
Someone spoke about Obama saying that FedEx can track a box anywhere; why can't we track medical records?
Well, we *can* track medical records anywhere; we just can't always read them.
Can FedEx track UPS packages?
USPS?  UK Postal Mail?
It's a bunch of different systems, and the analogy was so broken, it kind of illustrates he doesn't yet understand the types of problems the industry has to overcome.
Much like the ongoing disaster of rebuilding the air traffic control system, peoples lives depend on these systems for proper care and treatment.
Give us awhile.
We'll get there, but we write code, not magic; it's going to take awhile.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28466083</id>
	<title>Re:As someone who has worked on it...</title>
	<author>westlake</author>
	<datestamp>1245943320000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p><i>Healthcare is about making profit.</i> </p><p>Of course it is about profit.</p><p> Someone has to make the investment. In research. Labor. Facilities and so on.</p><p> Someone has to pay the geek a competitive wage if they want him as a system administrator - or in any other role.<br>
&nbsp;</p></htmltext>
<tokenext>Healthcare is about making profit .
Of course it is about profit .
Someone has to make the investment .
In research .
Labor. Facilities and so on .
Someone has to pay the geek a competitive wage if they want him as a system administrator - or in any other role .
 </tokentext>
<sentencetext>Healthcare is about making profit.
Of course it is about profit.
Someone has to make the investment.
In research.
Labor. Facilities and so on.
Someone has to pay the geek a competitive wage if they want him as a system administrator - or in any other role.
 </sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463883</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464653</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>ronaldo1</author>
	<datestamp>1245932040000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>2</modscore>
	<htmltext><p>U.S. Department of Veterans Affairs developed VistA - for everyone.</p><p>I am surprised the open source pundits dont know about this one.</p><p><a href="http://en.wikipedia.org/wiki/VistA" title="wikipedia.org" rel="nofollow">http://en.wikipedia.org/wiki/VistA</a> [wikipedia.org]<br>disclaimer: i work for the dva on vista every day</p></htmltext>
<tokenext>U.S. Department of Veterans Affairs developed VistA - for everyone.I am surprised the open source pundits dont know about this one.http : //en.wikipedia.org/wiki/VistA [ wikipedia.org ] disclaimer : i work for the dva on vista every day</tokentext>
<sentencetext>U.S. Department of Veterans Affairs developed VistA - for everyone.I am surprised the open source pundits dont know about this one.http://en.wikipedia.org/wiki/VistA [wikipedia.org]disclaimer: i work for the dva on vista every day</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463467</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463663</id>
	<title>lots of work for very little gain</title>
	<author>Anonymous</author>
	<datestamp>1245961380000</datestamp>
	<modclass>Informativ</modclass>
	<modscore>4</modscore>
	<htmltext>The NHS has showed that throwing money at the problem doesn't, in fact, help. For years they've spent billions on trying to get everyone's records on line. There's been lots of fine talk about the advantages of having the records of a patient who lives in Dorset available to a GP in Fife (for example). However, in practice, the benefits (as for most IT projects - especially government run / sponsored ones) seem to be mostly theoretical, uncostable and intangible.
<p>
However, the biggest stop to systems like this is the medical staff. Doctors seem to think they're above having to enter medical details - as it's mere clerical work (I've heard: "I didn't spend years at med. school, just to be a secretary") and they, personally, don't gain anything from a system such as this. Until somoeone gieves the profession as a whole a kick up the rear, this kind of prima-donna attitude will prevail.
</p><p>
In the end, it's a people problem - not a tech. problem.</p></htmltext>
<tokenext>The NHS has showed that throwing money at the problem does n't , in fact , help .
For years they 've spent billions on trying to get everyone 's records on line .
There 's been lots of fine talk about the advantages of having the records of a patient who lives in Dorset available to a GP in Fife ( for example ) .
However , in practice , the benefits ( as for most IT projects - especially government run / sponsored ones ) seem to be mostly theoretical , uncostable and intangible .
However , the biggest stop to systems like this is the medical staff .
Doctors seem to think they 're above having to enter medical details - as it 's mere clerical work ( I 've heard : " I did n't spend years at med .
school , just to be a secretary " ) and they , personally , do n't gain anything from a system such as this .
Until somoeone gieves the profession as a whole a kick up the rear , this kind of prima-donna attitude will prevail .
In the end , it 's a people problem - not a tech .
problem .</tokentext>
<sentencetext>The NHS has showed that throwing money at the problem doesn't, in fact, help.
For years they've spent billions on trying to get everyone's records on line.
There's been lots of fine talk about the advantages of having the records of a patient who lives in Dorset available to a GP in Fife (for example).
However, in practice, the benefits (as for most IT projects - especially government run / sponsored ones) seem to be mostly theoretical, uncostable and intangible.
However, the biggest stop to systems like this is the medical staff.
Doctors seem to think they're above having to enter medical details - as it's mere clerical work (I've heard: "I didn't spend years at med.
school, just to be a secretary") and they, personally, don't gain anything from a system such as this.
Until somoeone gieves the profession as a whole a kick up the rear, this kind of prima-donna attitude will prevail.
In the end, it's a people problem - not a tech.
problem.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28466883</id>
	<title>Oh give it up.</title>
	<author>tthomas48</author>
	<datestamp>1245947340000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>The lawsuit nonsense is just media hype. Texas has capped damages on medial lawsuits, and guess what? My health insurance didn't go down one bit. In fact it keeps going up. Time to retire that stupid meme.</p></htmltext>
<tokenext>The lawsuit nonsense is just media hype .
Texas has capped damages on medial lawsuits , and guess what ?
My health insurance did n't go down one bit .
In fact it keeps going up .
Time to retire that stupid meme .</tokentext>
<sentencetext>The lawsuit nonsense is just media hype.
Texas has capped damages on medial lawsuits, and guess what?
My health insurance didn't go down one bit.
In fact it keeps going up.
Time to retire that stupid meme.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464163</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>c0p0n</author>
	<datestamp>1245924240000</datestamp>
	<modclass>Informativ</modclass>
	<modscore>5</modscore>
	<htmltext><p>I would imagine the picture is very different depending on the country. I work on long term conditions monitoring systems in the UK and obviously our main client is the NHS. Even though our systems (or similar systems from other companies) will save the NHS a lot of money in the medium term it's been very slow to adapt due to the layers and layers and layers of management and middle management which also has a high rotation rate. It's not phobia to tech but politics (ie predecessor project on hold while I get mine to completion type of thing) for the most part.</p><p>About the article, it's fairly misleading and uninformed in my experience:</p><p><div class="quote"><p>Too bad the medical industry has a vested interest in inefficiency.</p></div><p>Please spare me the conspiration theories. A sizeable chunk of the medical industry is composed of small companies whose main selling point is precisely efficiency and subsequent cost savings. This, the big medical companies can't provide anyway, there's no conspiration, you wouldn't believe the amount of paperwork you need to keep up to date to comply with regulations in this industry and especially with new products, therefore they simply sell same old.</p></div>
	</htmltext>
<tokenext>I would imagine the picture is very different depending on the country .
I work on long term conditions monitoring systems in the UK and obviously our main client is the NHS .
Even though our systems ( or similar systems from other companies ) will save the NHS a lot of money in the medium term it 's been very slow to adapt due to the layers and layers and layers of management and middle management which also has a high rotation rate .
It 's not phobia to tech but politics ( ie predecessor project on hold while I get mine to completion type of thing ) for the most part.About the article , it 's fairly misleading and uninformed in my experience : Too bad the medical industry has a vested interest in inefficiency.Please spare me the conspiration theories .
A sizeable chunk of the medical industry is composed of small companies whose main selling point is precisely efficiency and subsequent cost savings .
This , the big medical companies ca n't provide anyway , there 's no conspiration , you would n't believe the amount of paperwork you need to keep up to date to comply with regulations in this industry and especially with new products , therefore they simply sell same old .</tokentext>
<sentencetext>I would imagine the picture is very different depending on the country.
I work on long term conditions monitoring systems in the UK and obviously our main client is the NHS.
Even though our systems (or similar systems from other companies) will save the NHS a lot of money in the medium term it's been very slow to adapt due to the layers and layers and layers of management and middle management which also has a high rotation rate.
It's not phobia to tech but politics (ie predecessor project on hold while I get mine to completion type of thing) for the most part.About the article, it's fairly misleading and uninformed in my experience:Too bad the medical industry has a vested interest in inefficiency.Please spare me the conspiration theories.
A sizeable chunk of the medical industry is composed of small companies whose main selling point is precisely efficiency and subsequent cost savings.
This, the big medical companies can't provide anyway, there's no conspiration, you wouldn't believe the amount of paperwork you need to keep up to date to comply with regulations in this industry and especially with new products, therefore they simply sell same old.
	</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463467</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463875</id>
	<title>Information is a double edged sword.</title>
	<author>Bob\_Who</author>
	<datestamp>1245920760000</datestamp>
	<modclass>Redundant</modclass>
	<modscore>0</modscore>
	<htmltext>I agree.  I think there is a lot of fear and apprehension of putting data "on the record", particularly in a litigious society.  It is as likely to work against you as in your favor.  If on the one hand that information limits privacy or insurance policy coverage for patients, it may also be implemented in exposing incompetence, neglect, and greed.  Its a double edged sword, since in truth, people behave like there is an angle on one shoulder and a devil on the other.  We only want to reveal the good stuff, so the diploma is on the wall, and the malpractice settlement remains undisclosed.  Information Technology won't do a thing to change human nature, but it sure as heck will make our medical process more efficient.  Lets move forward then, in spite of the perceived cultural drawbacks and fears.</htmltext>
<tokenext>I agree .
I think there is a lot of fear and apprehension of putting data " on the record " , particularly in a litigious society .
It is as likely to work against you as in your favor .
If on the one hand that information limits privacy or insurance policy coverage for patients , it may also be implemented in exposing incompetence , neglect , and greed .
Its a double edged sword , since in truth , people behave like there is an angle on one shoulder and a devil on the other .
We only want to reveal the good stuff , so the diploma is on the wall , and the malpractice settlement remains undisclosed .
Information Technology wo n't do a thing to change human nature , but it sure as heck will make our medical process more efficient .
Lets move forward then , in spite of the perceived cultural drawbacks and fears .</tokentext>
<sentencetext>I agree.
I think there is a lot of fear and apprehension of putting data "on the record", particularly in a litigious society.
It is as likely to work against you as in your favor.
If on the one hand that information limits privacy or insurance policy coverage for patients, it may also be implemented in exposing incompetence, neglect, and greed.
Its a double edged sword, since in truth, people behave like there is an angle on one shoulder and a devil on the other.
We only want to reveal the good stuff, so the diploma is on the wall, and the malpractice settlement remains undisclosed.
Information Technology won't do a thing to change human nature, but it sure as heck will make our medical process more efficient.
Lets move forward then, in spite of the perceived cultural drawbacks and fears.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28466015</id>
	<title>A few comments from a guy from this field...</title>
	<author>jockeys</author>
	<datestamp>1245942900000</datestamp>
	<modclass>Informativ</modclass>
	<modscore>2</modscore>
	<htmltext>I spent a few years writing commercial healthcare software, and here are a few quick thoughts:<br>
1.  HIPAA is a problem.  everything you do, EVERYTHING, has to be HIPAA compliant.  this means checking, rechecking, checking a 3rd time and then hiring an outside party to check your checking.  if you screw up in any way, it's possible to be held criminally liable, personally.  the HIPAA rule book was around 1200 pages long the last time I had to use it.  My small company (150 employees) had a full time staff of FIVE that did nothing but interpret HIPAA and document changes everytime some politician lobbied some bullshit minor rule change thru the system.  Each time this happened, we had a mere 90 days to version our software to match.  This is a big deal when you have 3 developers working on 4-5 million lines of code.  Summary: any screwups can land you in jail, so review and testing is off the scale thorough.<br> <br>
2.  Mistakes can be fatal.  During my time writing healthcare software, I had to opportunity to work on a system I'll call the Pill-Counting-Robot.  It did exactly what you'd think it would do: scripts would come down the wire, the robot would count pills into a bottle and label it.  Counting the wrong kind of pill can mean instant death for a patient.  Counting the wrong number of pills can make a patient very sick or dead.  Printing the wrong instructions on the label can also kill them.  ZERO SCREWUPS CAN HAPPEN!  None.  Not one.  We debugged that thing for months on end, trying as hard as we could to break it... we did testing with red and green M&amp;Ms to make sure it never mixed medicine.  You really don't even want to hear what kinds of scary mistakes that thing can make when it jams or crushes a pill or breaks a pill in half, etc, etc.  Summary: a tiny glitch can kill people.<br> <br>
3.  The final roadblock to quick progress is ancient standards.  When scripts go over the wire, they use a format called NCPDP.  This was made in the 70's for use over non-duplex modems.  It is slow as snot.  It cannot handle whitespaces in the wrong place, it can't handle variable length text, and it can't handle certain kinds of punctuation.  It definitely can't handle long names or hypenated names (e.g. married folks who share names with eachother).  And yet, as bad and old and broken as the standard was, we were required to use it because of a federal mandate.  See Item 1.  Summary: laws make the field obsolete and obtuse.</htmltext>
<tokenext>I spent a few years writing commercial healthcare software , and here are a few quick thoughts : 1 .
HIPAA is a problem .
everything you do , EVERYTHING , has to be HIPAA compliant .
this means checking , rechecking , checking a 3rd time and then hiring an outside party to check your checking .
if you screw up in any way , it 's possible to be held criminally liable , personally .
the HIPAA rule book was around 1200 pages long the last time I had to use it .
My small company ( 150 employees ) had a full time staff of FIVE that did nothing but interpret HIPAA and document changes everytime some politician lobbied some bullshit minor rule change thru the system .
Each time this happened , we had a mere 90 days to version our software to match .
This is a big deal when you have 3 developers working on 4-5 million lines of code .
Summary : any screwups can land you in jail , so review and testing is off the scale thorough .
2. Mistakes can be fatal .
During my time writing healthcare software , I had to opportunity to work on a system I 'll call the Pill-Counting-Robot .
It did exactly what you 'd think it would do : scripts would come down the wire , the robot would count pills into a bottle and label it .
Counting the wrong kind of pill can mean instant death for a patient .
Counting the wrong number of pills can make a patient very sick or dead .
Printing the wrong instructions on the label can also kill them .
ZERO SCREWUPS CAN HAPPEN !
None. Not one .
We debugged that thing for months on end , trying as hard as we could to break it... we did testing with red and green M&amp;Ms to make sure it never mixed medicine .
You really do n't even want to hear what kinds of scary mistakes that thing can make when it jams or crushes a pill or breaks a pill in half , etc , etc .
Summary : a tiny glitch can kill people .
3. The final roadblock to quick progress is ancient standards .
When scripts go over the wire , they use a format called NCPDP .
This was made in the 70 's for use over non-duplex modems .
It is slow as snot .
It can not handle whitespaces in the wrong place , it ca n't handle variable length text , and it ca n't handle certain kinds of punctuation .
It definitely ca n't handle long names or hypenated names ( e.g .
married folks who share names with eachother ) .
And yet , as bad and old and broken as the standard was , we were required to use it because of a federal mandate .
See Item 1 .
Summary : laws make the field obsolete and obtuse .</tokentext>
<sentencetext>I spent a few years writing commercial healthcare software, and here are a few quick thoughts:
1.
HIPAA is a problem.
everything you do, EVERYTHING, has to be HIPAA compliant.
this means checking, rechecking, checking a 3rd time and then hiring an outside party to check your checking.
if you screw up in any way, it's possible to be held criminally liable, personally.
the HIPAA rule book was around 1200 pages long the last time I had to use it.
My small company (150 employees) had a full time staff of FIVE that did nothing but interpret HIPAA and document changes everytime some politician lobbied some bullshit minor rule change thru the system.
Each time this happened, we had a mere 90 days to version our software to match.
This is a big deal when you have 3 developers working on 4-5 million lines of code.
Summary: any screwups can land you in jail, so review and testing is off the scale thorough.
2.  Mistakes can be fatal.
During my time writing healthcare software, I had to opportunity to work on a system I'll call the Pill-Counting-Robot.
It did exactly what you'd think it would do: scripts would come down the wire, the robot would count pills into a bottle and label it.
Counting the wrong kind of pill can mean instant death for a patient.
Counting the wrong number of pills can make a patient very sick or dead.
Printing the wrong instructions on the label can also kill them.
ZERO SCREWUPS CAN HAPPEN!
None.  Not one.
We debugged that thing for months on end, trying as hard as we could to break it... we did testing with red and green M&amp;Ms to make sure it never mixed medicine.
You really don't even want to hear what kinds of scary mistakes that thing can make when it jams or crushes a pill or breaks a pill in half, etc, etc.
Summary: a tiny glitch can kill people.
3.  The final roadblock to quick progress is ancient standards.
When scripts go over the wire, they use a format called NCPDP.
This was made in the 70's for use over non-duplex modems.
It is slow as snot.
It cannot handle whitespaces in the wrong place, it can't handle variable length text, and it can't handle certain kinds of punctuation.
It definitely can't handle long names or hypenated names (e.g.
married folks who share names with eachother).
And yet, as bad and old and broken as the standard was, we were required to use it because of a federal mandate.
See Item 1.
Summary: laws make the field obsolete and obtuse.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28473843</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>Dripdry</author>
	<datestamp>1245930540000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>on the contrary, it is NOT conspiracy theory.</p><p>My girlfriend works at Children's Memorial in Chicago, and she repeatedly has to deal with doctors who ask for kickbacks (cash, items, trips) to do simple tasks associated with research grants. of course the grants can't pay so the docs help as little as possible.</p><p>also, this:<br>Basically, it spells out that overuse of medicine and doctors' drive to make as much money as possible really is at the root cause of our mess of a healthcare system:<br><a href="http://www.newyorker.com/reporting/2009/06/01/090601fa\_fact\_gawande" title="newyorker.com" rel="nofollow">http://www.newyorker.com/reporting/2009/06/01/090601fa\_fact\_gawande</a> [newyorker.com]<br>it's a bit of a read but but I found it fascinating enough to get through.</p><p>Please, before you label something a conspiracy theory, please look into the idea that the article's author may know a little more about the subject and did do some digging. On the other hand, it IS slashdot so I can understand the skepticism regarding the legitimacy of the article.</p></htmltext>
<tokenext>on the contrary , it is NOT conspiracy theory.My girlfriend works at Children 's Memorial in Chicago , and she repeatedly has to deal with doctors who ask for kickbacks ( cash , items , trips ) to do simple tasks associated with research grants .
of course the grants ca n't pay so the docs help as little as possible.also , this : Basically , it spells out that overuse of medicine and doctors ' drive to make as much money as possible really is at the root cause of our mess of a healthcare system : http : //www.newyorker.com/reporting/2009/06/01/090601fa \ _fact \ _gawande [ newyorker.com ] it 's a bit of a read but but I found it fascinating enough to get through.Please , before you label something a conspiracy theory , please look into the idea that the article 's author may know a little more about the subject and did do some digging .
On the other hand , it IS slashdot so I can understand the skepticism regarding the legitimacy of the article .</tokentext>
<sentencetext>on the contrary, it is NOT conspiracy theory.My girlfriend works at Children's Memorial in Chicago, and she repeatedly has to deal with doctors who ask for kickbacks (cash, items, trips) to do simple tasks associated with research grants.
of course the grants can't pay so the docs help as little as possible.also, this:Basically, it spells out that overuse of medicine and doctors' drive to make as much money as possible really is at the root cause of our mess of a healthcare system:http://www.newyorker.com/reporting/2009/06/01/090601fa\_fact\_gawande [newyorker.com]it's a bit of a read but but I found it fascinating enough to get through.Please, before you label something a conspiracy theory, please look into the idea that the article's author may know a little more about the subject and did do some digging.
On the other hand, it IS slashdot so I can understand the skepticism regarding the legitimacy of the article.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464281</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28467223</id>
	<title>Lawyers want clear data less</title>
	<author>Anonymous</author>
	<datestamp>1245949020000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>Lawyers are not more keen to see clear medical records. They benefit from misinformation about medicine &amp; science in general. Lawsuits just have to show that maybe, just maybe, the doctor is a at fault.</p><p>Consider Cerebral Palsy lawsuits. The lawyer doesn't have to show that the doctor's actions caused the condition. There just has to be "something more the the doctor could do" to prevent it. Of course, medical records might eventually prove that no obstetrician can prevent Cerebral Palsy, and take away the lawsuit avenue all together.</p></htmltext>
<tokenext>Lawyers are not more keen to see clear medical records .
They benefit from misinformation about medicine &amp; science in general .
Lawsuits just have to show that maybe , just maybe , the doctor is a at fault.Consider Cerebral Palsy lawsuits .
The lawyer does n't have to show that the doctor 's actions caused the condition .
There just has to be " something more the the doctor could do " to prevent it .
Of course , medical records might eventually prove that no obstetrician can prevent Cerebral Palsy , and take away the lawsuit avenue all together .</tokentext>
<sentencetext>Lawyers are not more keen to see clear medical records.
They benefit from misinformation about medicine &amp; science in general.
Lawsuits just have to show that maybe, just maybe, the doctor is a at fault.Consider Cerebral Palsy lawsuits.
The lawyer doesn't have to show that the doctor's actions caused the condition.
There just has to be "something more the the doctor could do" to prevent it.
Of course, medical records might eventually prove that no obstetrician can prevent Cerebral Palsy, and take away the lawsuit avenue all together.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28466155</id>
	<title>Re:Who keeps the records?</title>
	<author>Qzukk</author>
	<datestamp>1245943680000</datestamp>
	<modclass>Informativ</modclass>
	<modscore>2</modscore>
	<htmltext><p><i>Have medical complications that it would be just great if the Doctors treating you had access to?</i></p><p>Buy a damn medalert bracelet.  A million times faster than triage staff trying to figure out whether you've given your medical records to google or microsoft and what your userid is to get them back.</p></htmltext>
<tokenext>Have medical complications that it would be just great if the Doctors treating you had access to ? Buy a damn medalert bracelet .
A million times faster than triage staff trying to figure out whether you 've given your medical records to google or microsoft and what your userid is to get them back .</tokentext>
<sentencetext>Have medical complications that it would be just great if the Doctors treating you had access to?Buy a damn medalert bracelet.
A million times faster than triage staff trying to figure out whether you've given your medical records to google or microsoft and what your userid is to get them back.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464397</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464185</id>
	<title>Too few computers, too little bandwidth</title>
	<author>ldrydenb</author>
	<datestamp>1245924480000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>5</modscore>
	<htmltext><p>I can't speak for the US or private medicine but I've seen numerous electronic record systems piloted in the NHS.</p><p>My colleagues would love to have fast access to up-to-date clinical notes rather than play pass-the-parcel (or more often, hide &amp; seek) with a patient's paper case-file(s), but wards tend to have one or two computers per ward and community services may have one computer between three to five staff. So at the end of a shift, when ward staff would be writing their notes, there'd be a queue for the computer. Similarly, before setting out on their visits at the start of the day and after returning from their visits at the end of the day, all community staff want access to the computer at the same time. Also, security dictates that as little information as possible is stored on the user's machine, so the intranet is swamped at these times and users face frustrating lags (I've been unable to access records in time for an appointment as the system was "oversubscribed").</p><p>To increase computer access to usable levels in my former service would have required a 3-400\% increase in the number of computers provided to healthcare staff. I have no idea what the resource implications would have been for the service's intranet, but I imagine that a commensurate increase in server capacity (and in the IT department staffing, to take care of all of this) wouldn't be cheap. As a health service manager, having to decide between enough hospital beds or enough computers, which do you suppose is more likely to keep you in your job?</p></htmltext>
<tokenext>I ca n't speak for the US or private medicine but I 've seen numerous electronic record systems piloted in the NHS.My colleagues would love to have fast access to up-to-date clinical notes rather than play pass-the-parcel ( or more often , hide &amp; seek ) with a patient 's paper case-file ( s ) , but wards tend to have one or two computers per ward and community services may have one computer between three to five staff .
So at the end of a shift , when ward staff would be writing their notes , there 'd be a queue for the computer .
Similarly , before setting out on their visits at the start of the day and after returning from their visits at the end of the day , all community staff want access to the computer at the same time .
Also , security dictates that as little information as possible is stored on the user 's machine , so the intranet is swamped at these times and users face frustrating lags ( I 've been unable to access records in time for an appointment as the system was " oversubscribed " ) .To increase computer access to usable levels in my former service would have required a 3-400 \ % increase in the number of computers provided to healthcare staff .
I have no idea what the resource implications would have been for the service 's intranet , but I imagine that a commensurate increase in server capacity ( and in the IT department staffing , to take care of all of this ) would n't be cheap .
As a health service manager , having to decide between enough hospital beds or enough computers , which do you suppose is more likely to keep you in your job ?</tokentext>
<sentencetext>I can't speak for the US or private medicine but I've seen numerous electronic record systems piloted in the NHS.My colleagues would love to have fast access to up-to-date clinical notes rather than play pass-the-parcel (or more often, hide &amp; seek) with a patient's paper case-file(s), but wards tend to have one or two computers per ward and community services may have one computer between three to five staff.
So at the end of a shift, when ward staff would be writing their notes, there'd be a queue for the computer.
Similarly, before setting out on their visits at the start of the day and after returning from their visits at the end of the day, all community staff want access to the computer at the same time.
Also, security dictates that as little information as possible is stored on the user's machine, so the intranet is swamped at these times and users face frustrating lags (I've been unable to access records in time for an appointment as the system was "oversubscribed").To increase computer access to usable levels in my former service would have required a 3-400\% increase in the number of computers provided to healthcare staff.
I have no idea what the resource implications would have been for the service's intranet, but I imagine that a commensurate increase in server capacity (and in the IT department staffing, to take care of all of this) wouldn't be cheap.
As a health service manager, having to decide between enough hospital beds or enough computers, which do you suppose is more likely to keep you in your job?</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463599</id>
	<title>What's wrong with redundancy?</title>
	<author>Khamura</author>
	<datestamp>1245960720000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext>Am I alone in thinking that some systems are better off with a buffer of redundancy rather than streamlined efficiency?</htmltext>
<tokenext>Am I alone in thinking that some systems are better off with a buffer of redundancy rather than streamlined efficiency ?</tokentext>
<sentencetext>Am I alone in thinking that some systems are better off with a buffer of redundancy rather than streamlined efficiency?</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28466517</id>
	<title>Re:one word: protectionism</title>
	<author>Anonymous</author>
	<datestamp>1245945480000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>Why would they want a nobel prize when they could make 100x that by making profit their priority? It's like asking why don't more doctors donate their time to third world nations, or even the working poor in the states, because it would be a good cause.  There's a lot of greedy people pervasively through out the system. I do work in IT for a Hospital and clinical entity, and I've seen it from the vendors, I've and i see it from the physicians, and you also see it in the administrative staff.</p><p>My personal observation is that it's hard to compare most hospitals/clinics/whatnot with  wall street/airlines. The reason is that it's like comparing a 5,000 LB gorilla's buying power with that of a mosquito.  I don't know these industries, but I'd wager they are large enough they rolled their own systems, or contracted a system out for specifically their needs. One would think a hospital's needs would be largely identical from place to place, but from everything I've seen, that is not the case.</p><p>I agree with you, cost is a huge barrier. After paying for the product---and let me say you never buy one thing.... it's many modules of one company for each hospital niche, or different products for different niches. Modules are just as expensive as full systems from other companies... The pricing is disgusting, then tack on 20-30\% yearly maintenance, for every module or system you purchase, then the the various 'time' you buy from them for odds and ends, the IT staff, the servers, the power, the cooling.  It all adds up, but my observations is that the vendors systems and modules take up an absolutely incredible amount of the cost, and their often priced on a 'bed size' 'physician size', etc metric.</p><p>So, by saying cost needs to come down, i agree, but take a look at not just the hospitals, take a look at the sick profits of these hospital vendors take in: GE, Siemens, Phizer, Mckesson, Cardinal, etc.  You want to see where money goes. That is where a whole giant chunk goes.</p></htmltext>
<tokenext>Why would they want a nobel prize when they could make 100x that by making profit their priority ?
It 's like asking why do n't more doctors donate their time to third world nations , or even the working poor in the states , because it would be a good cause .
There 's a lot of greedy people pervasively through out the system .
I do work in IT for a Hospital and clinical entity , and I 've seen it from the vendors , I 've and i see it from the physicians , and you also see it in the administrative staff.My personal observation is that it 's hard to compare most hospitals/clinics/whatnot with wall street/airlines .
The reason is that it 's like comparing a 5,000 LB gorilla 's buying power with that of a mosquito .
I do n't know these industries , but I 'd wager they are large enough they rolled their own systems , or contracted a system out for specifically their needs .
One would think a hospital 's needs would be largely identical from place to place , but from everything I 've seen , that is not the case.I agree with you , cost is a huge barrier .
After paying for the product---and let me say you never buy one thing.... it 's many modules of one company for each hospital niche , or different products for different niches .
Modules are just as expensive as full systems from other companies... The pricing is disgusting , then tack on 20-30 \ % yearly maintenance , for every module or system you purchase , then the the various 'time ' you buy from them for odds and ends , the IT staff , the servers , the power , the cooling .
It all adds up , but my observations is that the vendors systems and modules take up an absolutely incredible amount of the cost , and their often priced on a 'bed size ' 'physician size ' , etc metric.So , by saying cost needs to come down , i agree , but take a look at not just the hospitals , take a look at the sick profits of these hospital vendors take in : GE , Siemens , Phizer , Mckesson , Cardinal , etc .
You want to see where money goes .
That is where a whole giant chunk goes .</tokentext>
<sentencetext>Why would they want a nobel prize when they could make 100x that by making profit their priority?
It's like asking why don't more doctors donate their time to third world nations, or even the working poor in the states, because it would be a good cause.
There's a lot of greedy people pervasively through out the system.
I do work in IT for a Hospital and clinical entity, and I've seen it from the vendors, I've and i see it from the physicians, and you also see it in the administrative staff.My personal observation is that it's hard to compare most hospitals/clinics/whatnot with  wall street/airlines.
The reason is that it's like comparing a 5,000 LB gorilla's buying power with that of a mosquito.
I don't know these industries, but I'd wager they are large enough they rolled their own systems, or contracted a system out for specifically their needs.
One would think a hospital's needs would be largely identical from place to place, but from everything I've seen, that is not the case.I agree with you, cost is a huge barrier.
After paying for the product---and let me say you never buy one thing.... it's many modules of one company for each hospital niche, or different products for different niches.
Modules are just as expensive as full systems from other companies... The pricing is disgusting, then tack on 20-30\% yearly maintenance, for every module or system you purchase, then the the various 'time' you buy from them for odds and ends, the IT staff, the servers, the power, the cooling.
It all adds up, but my observations is that the vendors systems and modules take up an absolutely incredible amount of the cost, and their often priced on a 'bed size' 'physician size', etc metric.So, by saying cost needs to come down, i agree, but take a look at not just the hospitals, take a look at the sick profits of these hospital vendors take in: GE, Siemens, Phizer, Mckesson, Cardinal, etc.
You want to see where money goes.
That is where a whole giant chunk goes.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463733</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464883</id>
	<title>training training training</title>
	<author>tresstatus</author>
	<datestamp>1245935640000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext>i work as a systems engineer for a healthcare company.  on a daily basis, i have to deal with nurses that use our systems.  what it comes down to is nurses might be good at what they do, but they otherwise lack the skills to do anything else.  most of them, even the ones in their twenties, barely know how to use a mouse.  putting everything on the computer adds a step of complexity to what they do.  management at our facilities loves what we do because it makes reporting and accountability easier.  nurses hate what we do because regardless of how easy we make it on a computer, it will always be easier to write it down on a form.  they also hate it because it makes it easier for anyone to expose mistakes that they make.
<br>
<br>
if someone keys in Joe Bob's diagnosis and medications wrong, we know exactly who did it.  if someone steals meds while they are stocking our machine, we know exactly who did it.  that is a threat to a lot of people and really puts the management of a lot of places in a bind.  on the one hand, it's hard to get good people; a nurse could be an excellent nurse and be completely computer illiterate.  on the other hand, it's easier to run reports based on stuff in a database as opposed to stuff written on forms.
<br>
<br>
what we've found is that if we make it "idiot proof", they will find a way to be a bigger idiot.  8)</htmltext>
<tokenext>i work as a systems engineer for a healthcare company .
on a daily basis , i have to deal with nurses that use our systems .
what it comes down to is nurses might be good at what they do , but they otherwise lack the skills to do anything else .
most of them , even the ones in their twenties , barely know how to use a mouse .
putting everything on the computer adds a step of complexity to what they do .
management at our facilities loves what we do because it makes reporting and accountability easier .
nurses hate what we do because regardless of how easy we make it on a computer , it will always be easier to write it down on a form .
they also hate it because it makes it easier for anyone to expose mistakes that they make .
if someone keys in Joe Bob 's diagnosis and medications wrong , we know exactly who did it .
if someone steals meds while they are stocking our machine , we know exactly who did it .
that is a threat to a lot of people and really puts the management of a lot of places in a bind .
on the one hand , it 's hard to get good people ; a nurse could be an excellent nurse and be completely computer illiterate .
on the other hand , it 's easier to run reports based on stuff in a database as opposed to stuff written on forms .
what we 've found is that if we make it " idiot proof " , they will find a way to be a bigger idiot .
8 )</tokentext>
<sentencetext>i work as a systems engineer for a healthcare company.
on a daily basis, i have to deal with nurses that use our systems.
what it comes down to is nurses might be good at what they do, but they otherwise lack the skills to do anything else.
most of them, even the ones in their twenties, barely know how to use a mouse.
putting everything on the computer adds a step of complexity to what they do.
management at our facilities loves what we do because it makes reporting and accountability easier.
nurses hate what we do because regardless of how easy we make it on a computer, it will always be easier to write it down on a form.
they also hate it because it makes it easier for anyone to expose mistakes that they make.
if someone keys in Joe Bob's diagnosis and medications wrong, we know exactly who did it.
if someone steals meds while they are stocking our machine, we know exactly who did it.
that is a threat to a lot of people and really puts the management of a lot of places in a bind.
on the one hand, it's hard to get good people; a nurse could be an excellent nurse and be completely computer illiterate.
on the other hand, it's easier to run reports based on stuff in a database as opposed to stuff written on forms.
what we've found is that if we make it "idiot proof", they will find a way to be a bigger idiot.
8)</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463841</id>
	<title>real or perceived difficulty?</title>
	<author>CaptainNerdCave</author>
	<datestamp>1245963360000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>is it some sort of real problem, or just the expected difficulties?  is it the curmudgeons in bureaucratic positions that are afraid of "new", or is there something else at work here, like mentioned above (easily finding extra charges, etc)?</p><p>for a while, i sold insurance for AFLAC.  around my area, there is a HUGE hospital system, Meritcare; the last time i checked, they had around 20k employees (that's 10-15\% of the working population, depending on the radius used for calculating).</p><p>they will not permit AFLAC to come in  and offer their products because of the perceived difficulty of presenting and making it available to everyone.</p><p>maybe it's just me, but if wal-mart can find a way to share something with all of their employees, i'm pretty sure a relatively small hospital system can.</p></htmltext>
<tokenext>is it some sort of real problem , or just the expected difficulties ?
is it the curmudgeons in bureaucratic positions that are afraid of " new " , or is there something else at work here , like mentioned above ( easily finding extra charges , etc ) ? for a while , i sold insurance for AFLAC .
around my area , there is a HUGE hospital system , Meritcare ; the last time i checked , they had around 20k employees ( that 's 10-15 \ % of the working population , depending on the radius used for calculating ) .they will not permit AFLAC to come in and offer their products because of the perceived difficulty of presenting and making it available to everyone.maybe it 's just me , but if wal-mart can find a way to share something with all of their employees , i 'm pretty sure a relatively small hospital system can .</tokentext>
<sentencetext>is it some sort of real problem, or just the expected difficulties?
is it the curmudgeons in bureaucratic positions that are afraid of "new", or is there something else at work here, like mentioned above (easily finding extra charges, etc)?for a while, i sold insurance for AFLAC.
around my area, there is a HUGE hospital system, Meritcare; the last time i checked, they had around 20k employees (that's 10-15\% of the working population, depending on the radius used for calculating).they will not permit AFLAC to come in  and offer their products because of the perceived difficulty of presenting and making it available to everyone.maybe it's just me, but if wal-mart can find a way to share something with all of their employees, i'm pretty sure a relatively small hospital system can.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465327</id>
	<title>Re:As someone who has worked on it...</title>
	<author>MarkvW</author>
	<datestamp>1245939120000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>If you can avoid HIPAA by avoiding IT,you should do it.  HIPAA is a big pain.</p></htmltext>
<tokenext>If you can avoid HIPAA by avoiding IT,you should do it .
HIPAA is a big pain .</tokentext>
<sentencetext>If you can avoid HIPAA by avoiding IT,you should do it.
HIPAA is a big pain.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463883</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28467165</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>Blakey Rat</author>
	<datestamp>1245948720000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>From my experience trying to roll out a pharmacy system at a regional hospital, the nurses were the big opposition. The doctors and pharmacists not only adopted the system quickly, but they frequently gave us positive feedback on how well it worked.</p></htmltext>
<tokenext>From my experience trying to roll out a pharmacy system at a regional hospital , the nurses were the big opposition .
The doctors and pharmacists not only adopted the system quickly , but they frequently gave us positive feedback on how well it worked .</tokentext>
<sentencetext>From my experience trying to roll out a pharmacy system at a regional hospital, the nurses were the big opposition.
The doctors and pharmacists not only adopted the system quickly, but they frequently gave us positive feedback on how well it worked.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464281</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464485</id>
	<title>wrong answer</title>
	<author>August\_zero</author>
	<datestamp>1245929040000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>5</modscore>
	<htmltext><p>"Hypothesis: making medical records available for data analysis might expose redundancy, over-testing, and other methods of extracting profits from the fee-for-service model"</p><p>Besides being perhaps the most ignorant thing I have read this morning, this statement reminds me of the irony inherent in listening to tech people whine about how medical caregivers have no trust or knowledge of IT, while the caregivers complain non-stop that IT has no idea how to design a decent medical record system.</p></htmltext>
<tokenext>" Hypothesis : making medical records available for data analysis might expose redundancy , over-testing , and other methods of extracting profits from the fee-for-service model " Besides being perhaps the most ignorant thing I have read this morning , this statement reminds me of the irony inherent in listening to tech people whine about how medical caregivers have no trust or knowledge of IT , while the caregivers complain non-stop that IT has no idea how to design a decent medical record system .</tokentext>
<sentencetext>"Hypothesis: making medical records available for data analysis might expose redundancy, over-testing, and other methods of extracting profits from the fee-for-service model"Besides being perhaps the most ignorant thing I have read this morning, this statement reminds me of the irony inherent in listening to tech people whine about how medical caregivers have no trust or knowledge of IT, while the caregivers complain non-stop that IT has no idea how to design a decent medical record system.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464685</id>
	<title>US only problem</title>
	<author>Anonymous</author>
	<datestamp>1245932700000</datestamp>
	<modclass>Interestin</modclass>
	<modscore>1</modscore>
	<htmltext><p>In countries with sane health care systems, the government forces the hospitals and practitioners to do exactly what you say: "making medical records available for data analysis might expose redundancy, over-testing, and other methods of extracting profits from the fee-for-service model".</p><p>They can do this, because the government is the one paying the bill. Optimizing the quality/cost ratio is an important part of keeping health care payable.</p><p>I guess the US has some catching up to do to stop all the abuses of private health care.</p></htmltext>
<tokenext>In countries with sane health care systems , the government forces the hospitals and practitioners to do exactly what you say : " making medical records available for data analysis might expose redundancy , over-testing , and other methods of extracting profits from the fee-for-service model " .They can do this , because the government is the one paying the bill .
Optimizing the quality/cost ratio is an important part of keeping health care payable.I guess the US has some catching up to do to stop all the abuses of private health care .</tokentext>
<sentencetext>In countries with sane health care systems, the government forces the hospitals and practitioners to do exactly what you say: "making medical records available for data analysis might expose redundancy, over-testing, and other methods of extracting profits from the fee-for-service model".They can do this, because the government is the one paying the bill.
Optimizing the quality/cost ratio is an important part of keeping health care payable.I guess the US has some catching up to do to stop all the abuses of private health care.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28467133</id>
	<title>Closed Source is the problem</title>
	<author>davek</author>
	<datestamp>1245948660000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>I have been developing EMR software for 3 years now.  The company is small, but our software is an industry standard and is deployed in thousands of facilities across the world.</p><p>The main problem I see is one of trust.  Our software runs entirely as a black box, without the client having knowledge how the software works or even how the database is structured (mostly because we don't know either *sigh*).  Clients have to call our tech support to even add a new user to the system.  The proprietary nature of our software ensures a) low quality, and b) 100\% dependence on us for routine maintenance.  New facilities, especially smaller ones, will not be willing to give up such control.</p><p>Then there's the problem of interfaces.  All these proprietary systems must talk to each other in a flawless, seamless manner.  HL7 goes some way to fix that, but in my experience HL7 is simply a business TLA-buzzword that really means nothing.  Each interface is coded specifically for the system its talking to, because they all have their different quirks.</p><p>I believe the first EMR that is truly transparent and open source will be the turning point in Health Care IT.  This industry is basically made for the software-as-service model.  However, that requires a fundamental shift in our business model, and we all know how easily that happens.</p></htmltext>
<tokenext>I have been developing EMR software for 3 years now .
The company is small , but our software is an industry standard and is deployed in thousands of facilities across the world.The main problem I see is one of trust .
Our software runs entirely as a black box , without the client having knowledge how the software works or even how the database is structured ( mostly because we do n't know either * sigh * ) .
Clients have to call our tech support to even add a new user to the system .
The proprietary nature of our software ensures a ) low quality , and b ) 100 \ % dependence on us for routine maintenance .
New facilities , especially smaller ones , will not be willing to give up such control.Then there 's the problem of interfaces .
All these proprietary systems must talk to each other in a flawless , seamless manner .
HL7 goes some way to fix that , but in my experience HL7 is simply a business TLA-buzzword that really means nothing .
Each interface is coded specifically for the system its talking to , because they all have their different quirks.I believe the first EMR that is truly transparent and open source will be the turning point in Health Care IT .
This industry is basically made for the software-as-service model .
However , that requires a fundamental shift in our business model , and we all know how easily that happens .</tokentext>
<sentencetext>I have been developing EMR software for 3 years now.
The company is small, but our software is an industry standard and is deployed in thousands of facilities across the world.The main problem I see is one of trust.
Our software runs entirely as a black box, without the client having knowledge how the software works or even how the database is structured (mostly because we don't know either *sigh*).
Clients have to call our tech support to even add a new user to the system.
The proprietary nature of our software ensures a) low quality, and b) 100\% dependence on us for routine maintenance.
New facilities, especially smaller ones, will not be willing to give up such control.Then there's the problem of interfaces.
All these proprietary systems must talk to each other in a flawless, seamless manner.
HL7 goes some way to fix that, but in my experience HL7 is simply a business TLA-buzzword that really means nothing.
Each interface is coded specifically for the system its talking to, because they all have their different quirks.I believe the first EMR that is truly transparent and open source will be the turning point in Health Care IT.
This industry is basically made for the software-as-service model.
However, that requires a fundamental shift in our business model, and we all know how easily that happens.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28467855</id>
	<title>Interestingly</title>
	<author>kilodelta</author>
	<datestamp>1245951360000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext>The pharmaceutical distribution chain has been computerized for quite a while now. They have histories for every person, drug, etc. It's just that the information isn't necessarily shared across the chains like CVS, Walgreens, et al. But the upshot is that the drug companies and the pharmacies know their customer base very well.</htmltext>
<tokenext>The pharmaceutical distribution chain has been computerized for quite a while now .
They have histories for every person , drug , etc .
It 's just that the information is n't necessarily shared across the chains like CVS , Walgreens , et al .
But the upshot is that the drug companies and the pharmacies know their customer base very well .</tokentext>
<sentencetext>The pharmaceutical distribution chain has been computerized for quite a while now.
They have histories for every person, drug, etc.
It's just that the information isn't necessarily shared across the chains like CVS, Walgreens, et al.
But the upshot is that the drug companies and the pharmacies know their customer base very well.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464031</id>
	<title>Compter illiteate &amp; overstretched staff more l</title>
	<author>yes it is</author>
	<datestamp>1245922860000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>5</modscore>
	<htmltext>(Disclaimer:  IHAPSITF - I have a  PhD scholarship in this field).
<p>
In most healthcare systems, staff are very busy, and computer illiteracy is rife.  To get good with these electronic systems you've got to use them constantly, and when half the staff or more don't understand why they're doing a particular thing in a particular way.  There's also a workplace culture of written notes, and often a limited number of computer terminals per staff member.  So with queuing for terminals, fairly high friction processes for retrieving data and so on and so forth, there are quite high barriers to entry from a human point of view.
</p><p>
Don't get me wrong, EHRs have potential, and can reap benifits (especially for management - they can also make floor staff's job harder).  Some kind of robust iphone-like  device  which is a secure platform for data entry and retrieval, might make it sufficiently easy and efficient from an end-user's perspective to decrease implementation barriers.</p></htmltext>
<tokenext>( Disclaimer : IHAPSITF - I have a PhD scholarship in this field ) .
In most healthcare systems , staff are very busy , and computer illiteracy is rife .
To get good with these electronic systems you 've got to use them constantly , and when half the staff or more do n't understand why they 're doing a particular thing in a particular way .
There 's also a workplace culture of written notes , and often a limited number of computer terminals per staff member .
So with queuing for terminals , fairly high friction processes for retrieving data and so on and so forth , there are quite high barriers to entry from a human point of view .
Do n't get me wrong , EHRs have potential , and can reap benifits ( especially for management - they can also make floor staff 's job harder ) .
Some kind of robust iphone-like device which is a secure platform for data entry and retrieval , might make it sufficiently easy and efficient from an end-user 's perspective to decrease implementation barriers .</tokentext>
<sentencetext>(Disclaimer:  IHAPSITF - I have a  PhD scholarship in this field).
In most healthcare systems, staff are very busy, and computer illiteracy is rife.
To get good with these electronic systems you've got to use them constantly, and when half the staff or more don't understand why they're doing a particular thing in a particular way.
There's also a workplace culture of written notes, and often a limited number of computer terminals per staff member.
So with queuing for terminals, fairly high friction processes for retrieving data and so on and so forth, there are quite high barriers to entry from a human point of view.
Don't get me wrong, EHRs have potential, and can reap benifits (especially for management - they can also make floor staff's job harder).
Some kind of robust iphone-like  device  which is a secure platform for data entry and retrieval, might make it sufficiently easy and efficient from an end-user's perspective to decrease implementation barriers.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465517</id>
	<title>Re:Health Care vs FedEx</title>
	<author>Anonymous</author>
	<datestamp>1245940260000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>Obama is wrong.  FedEx has shitloads of packages lost and stolen each year.  FedEx doesn't track very package everywhere; they often estimate where the package would be.  If you send a package from Philly to LA and the online tracking says that it's in Austin, there isn't really a way to tell that it wasn't stolen before it made it on the truck.</p></htmltext>
<tokenext>Obama is wrong .
FedEx has shitloads of packages lost and stolen each year .
FedEx does n't track very package everywhere ; they often estimate where the package would be .
If you send a package from Philly to LA and the online tracking says that it 's in Austin , there is n't really a way to tell that it was n't stolen before it made it on the truck .</tokentext>
<sentencetext>Obama is wrong.
FedEx has shitloads of packages lost and stolen each year.
FedEx doesn't track very package everywhere; they often estimate where the package would be.
If you send a package from Philly to LA and the online tracking says that it's in Austin, there isn't really a way to tell that it wasn't stolen before it made it on the truck.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464603</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463757</id>
	<title>Re:one word: protectionism</title>
	<author>Anonymous</author>
	<datestamp>1245962340000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p><div class="quote"><p>When physicians are required to interact in electronic, shared systems, they can't lord over all the responsibility in care environments, and then they won't be the only ones who run all the medical care and take home most all the money.</p></div><p>This all sounds good, but how exactly does charting via PC (instead of by hand) somehow change the rules that Doctors (regardless of if they are DOs or MDs) are the ones who write the orders that all the other practitioners follow? Granted, FNPs (Family Nurse Practitioners) and PAs (Physician Assistants) can now write orders and scripts, but thats because they are now filling in the position of general practitioner that most MDs have abandoned in pursuit of more lucrative specializations. Plus, there is currently a push to make it mandatory that by 2015 all nursing practitioner programs are based on DNPs (doctorate of nursing practice), and not masters....so they are still all docs...</p></div>
	</htmltext>
<tokenext>When physicians are required to interact in electronic , shared systems , they ca n't lord over all the responsibility in care environments , and then they wo n't be the only ones who run all the medical care and take home most all the money.This all sounds good , but how exactly does charting via PC ( instead of by hand ) somehow change the rules that Doctors ( regardless of if they are DOs or MDs ) are the ones who write the orders that all the other practitioners follow ?
Granted , FNPs ( Family Nurse Practitioners ) and PAs ( Physician Assistants ) can now write orders and scripts , but thats because they are now filling in the position of general practitioner that most MDs have abandoned in pursuit of more lucrative specializations .
Plus , there is currently a push to make it mandatory that by 2015 all nursing practitioner programs are based on DNPs ( doctorate of nursing practice ) , and not masters....so they are still all docs.. .</tokentext>
<sentencetext>When physicians are required to interact in electronic, shared systems, they can't lord over all the responsibility in care environments, and then they won't be the only ones who run all the medical care and take home most all the money.This all sounds good, but how exactly does charting via PC (instead of by hand) somehow change the rules that Doctors (regardless of if they are DOs or MDs) are the ones who write the orders that all the other practitioners follow?
Granted, FNPs (Family Nurse Practitioners) and PAs (Physician Assistants) can now write orders and scripts, but thats because they are now filling in the position of general practitioner that most MDs have abandoned in pursuit of more lucrative specializations.
Plus, there is currently a push to make it mandatory that by 2015 all nursing practitioner programs are based on DNPs (doctorate of nursing practice), and not masters....so they are still all docs...
	</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463551</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28469247</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>scamper\_22</author>
	<datestamp>1245956400000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>I worked in e-health records and PACS systems before.<br>The biggest problem is... trying to do too much at once.<br>Everyone wants to design the perfect system.</p><p>You mention, templatize the intake notes... well... why standardize the intake notes?<br>Why have specific fields?</p><p>I am fully aware of the power of the data once you get all these fields in.  but what use is it if no one can agree on what these fields are or how they should be used?</p><p>As a first step,  a very generic e-health record should be used.  It should literally be nothing more than attaching a bunch of documents to a SECURE patient's record.  PDFs, Word, ODF, pictures, MRI scans... whatever.  Once you have this in place, you have something you didn't have before... an electronic health record that can be accessed by other health professionals.  Hopefully you can standardize on the document formats at least or even have a known set of document formats.</p><p>The next stage comes the interfacing with the various entities.<br>Standardize on prescription forms, test ordering forms... A lot of this work is already standardized as they had paper based standards.  This makes it much easier to do this work.  I wouldn't even settle on one standard.  The fields should be generic enough and always include a 'notes' section for special things or notes that need clarification.</p><p>Once you have this in place, then you can start worrying about getting all the data in a nice format where you can use it for all kinds of good information, like waiting list times, outcome analysis...</p><p>I'll liken this to the internet.  The amount of information is so huge and complex, you can't just make it neat and tidy.  A lot of the first attempts tried to index the internet (Sports, news, country...).  Having to classify and find stuff was difficult.  But that didn't stop people from putting their information online.  Sometimes in nice formats, other times in random ways.  Eventually, through a long process, things get organized... often times in way you would not have expected.  There is no one organization of the internet.</p><p>Some data is captured via google.<br>Various sites expose web services or databases.<br>Links and wikis and blogs and forums are their own kind of organization.</p><p>Yet, I can access all of these from one computer because all the information is online.</p></htmltext>
<tokenext>I worked in e-health records and PACS systems before.The biggest problem is... trying to do too much at once.Everyone wants to design the perfect system.You mention , templatize the intake notes... well... why standardize the intake notes ? Why have specific fields ? I am fully aware of the power of the data once you get all these fields in .
but what use is it if no one can agree on what these fields are or how they should be used ? As a first step , a very generic e-health record should be used .
It should literally be nothing more than attaching a bunch of documents to a SECURE patient 's record .
PDFs , Word , ODF , pictures , MRI scans... whatever. Once you have this in place , you have something you did n't have before... an electronic health record that can be accessed by other health professionals .
Hopefully you can standardize on the document formats at least or even have a known set of document formats.The next stage comes the interfacing with the various entities.Standardize on prescription forms , test ordering forms... A lot of this work is already standardized as they had paper based standards .
This makes it much easier to do this work .
I would n't even settle on one standard .
The fields should be generic enough and always include a 'notes ' section for special things or notes that need clarification.Once you have this in place , then you can start worrying about getting all the data in a nice format where you can use it for all kinds of good information , like waiting list times , outcome analysis...I 'll liken this to the internet .
The amount of information is so huge and complex , you ca n't just make it neat and tidy .
A lot of the first attempts tried to index the internet ( Sports , news , country... ) .
Having to classify and find stuff was difficult .
But that did n't stop people from putting their information online .
Sometimes in nice formats , other times in random ways .
Eventually , through a long process , things get organized... often times in way you would not have expected .
There is no one organization of the internet.Some data is captured via google.Various sites expose web services or databases.Links and wikis and blogs and forums are their own kind of organization.Yet , I can access all of these from one computer because all the information is online .</tokentext>
<sentencetext>I worked in e-health records and PACS systems before.The biggest problem is... trying to do too much at once.Everyone wants to design the perfect system.You mention, templatize the intake notes... well... why standardize the intake notes?Why have specific fields?I am fully aware of the power of the data once you get all these fields in.
but what use is it if no one can agree on what these fields are or how they should be used?As a first step,  a very generic e-health record should be used.
It should literally be nothing more than attaching a bunch of documents to a SECURE patient's record.
PDFs, Word, ODF, pictures, MRI scans... whatever.  Once you have this in place, you have something you didn't have before... an electronic health record that can be accessed by other health professionals.
Hopefully you can standardize on the document formats at least or even have a known set of document formats.The next stage comes the interfacing with the various entities.Standardize on prescription forms, test ordering forms... A lot of this work is already standardized as they had paper based standards.
This makes it much easier to do this work.
I wouldn't even settle on one standard.
The fields should be generic enough and always include a 'notes' section for special things or notes that need clarification.Once you have this in place, then you can start worrying about getting all the data in a nice format where you can use it for all kinds of good information, like waiting list times, outcome analysis...I'll liken this to the internet.
The amount of information is so huge and complex, you can't just make it neat and tidy.
A lot of the first attempts tried to index the internet (Sports, news, country...).
Having to classify and find stuff was difficult.
But that didn't stop people from putting their information online.
Sometimes in nice formats, other times in random ways.
Eventually, through a long process, things get organized... often times in way you would not have expected.
There is no one organization of the internet.Some data is captured via google.Various sites expose web services or databases.Links and wikis and blogs and forums are their own kind of organization.Yet, I can access all of these from one computer because all the information is online.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463467</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463733</id>
	<title>Re:one word: protectionism</title>
	<author>Anonymous</author>
	<datestamp>1245962100000</datestamp>
	<modclass>Informativ</modclass>
	<modscore>5</modscore>
	<htmltext>Parent either is full of it or lives in a parallel universe.
<br>
<br>1. Cost is not a barrier? Our EMR costs each physician many tens of thousands a dollar a year in application support, licensing, databases, and for a phalanx of IS personnel in various departments (local, regional, EMR, hospital IS).
<br>2. MD's have a monopoly? What planet are you on? DO's have had precisely equivalent standing for decades in medical practice in the United States, and NP's are far from being "wiggled in." As a primary care physician, when I send a patient to the cardiologist or pulmonologist, half the time the entire consult is done by a PA or NP.
<br>3. Please direct me to the land you describe where I can have control over my care environment and take home most of the money. I can't get a contracting pregnant lady into labor and delivery without asking for permission from two nurses, and I'm not aware that the balance of power in any health system I've worked in has been any different before and after transition from paper records. Medical care in most locales in the US has long been collaborative, team-based system, even if you've met a few physicians who are jerks or drive nice cars. (I am looking forward to upgrading my '94 Corolla by 2014.)

<br> <br>EMR systems have poor market penetration, in my direct experience over the last 9 years, because:
<br>1. Many, if not most, suck in a medium to large way;
<br>2. They are incredibly expensive;
<br>3. They can often be hard to use, and are typically more labor-intensive than paper charts for most physicians in the US;
<br>4. They don't inter-operate. (When I request old records from other physicians with electronic charts, I enter the pertinent data into my electronic chart by typing it in.)

<br>If any skilled group of software engineers were to write a decent, usable EMR that was extensible, and didn't cost an arm and a leg, with an eye to being excellent first and profitable as a consequence, they could be up for a Nobel prize.
<br>TFA refers to cardiac CT to prevent heart attacks. The author, too, lives in a dream world - contrary to her thesis, this test has been shown to help with the boat payments of radiologists and equipment manufacturers, but there is no evidence it helps prevent heart attacks.</htmltext>
<tokenext>Parent either is full of it or lives in a parallel universe .
1. Cost is not a barrier ?
Our EMR costs each physician many tens of thousands a dollar a year in application support , licensing , databases , and for a phalanx of IS personnel in various departments ( local , regional , EMR , hospital IS ) .
2. MD 's have a monopoly ?
What planet are you on ?
DO 's have had precisely equivalent standing for decades in medical practice in the United States , and NP 's are far from being " wiggled in .
" As a primary care physician , when I send a patient to the cardiologist or pulmonologist , half the time the entire consult is done by a PA or NP .
3. Please direct me to the land you describe where I can have control over my care environment and take home most of the money .
I ca n't get a contracting pregnant lady into labor and delivery without asking for permission from two nurses , and I 'm not aware that the balance of power in any health system I 've worked in has been any different before and after transition from paper records .
Medical care in most locales in the US has long been collaborative , team-based system , even if you 've met a few physicians who are jerks or drive nice cars .
( I am looking forward to upgrading my '94 Corolla by 2014 .
) EMR systems have poor market penetration , in my direct experience over the last 9 years , because : 1 .
Many , if not most , suck in a medium to large way ; 2 .
They are incredibly expensive ; 3 .
They can often be hard to use , and are typically more labor-intensive than paper charts for most physicians in the US ; 4 .
They do n't inter-operate .
( When I request old records from other physicians with electronic charts , I enter the pertinent data into my electronic chart by typing it in .
) If any skilled group of software engineers were to write a decent , usable EMR that was extensible , and did n't cost an arm and a leg , with an eye to being excellent first and profitable as a consequence , they could be up for a Nobel prize .
TFA refers to cardiac CT to prevent heart attacks .
The author , too , lives in a dream world - contrary to her thesis , this test has been shown to help with the boat payments of radiologists and equipment manufacturers , but there is no evidence it helps prevent heart attacks .</tokentext>
<sentencetext>Parent either is full of it or lives in a parallel universe.
1. Cost is not a barrier?
Our EMR costs each physician many tens of thousands a dollar a year in application support, licensing, databases, and for a phalanx of IS personnel in various departments (local, regional, EMR, hospital IS).
2. MD's have a monopoly?
What planet are you on?
DO's have had precisely equivalent standing for decades in medical practice in the United States, and NP's are far from being "wiggled in.
" As a primary care physician, when I send a patient to the cardiologist or pulmonologist, half the time the entire consult is done by a PA or NP.
3. Please direct me to the land you describe where I can have control over my care environment and take home most of the money.
I can't get a contracting pregnant lady into labor and delivery without asking for permission from two nurses, and I'm not aware that the balance of power in any health system I've worked in has been any different before and after transition from paper records.
Medical care in most locales in the US has long been collaborative, team-based system, even if you've met a few physicians who are jerks or drive nice cars.
(I am looking forward to upgrading my '94 Corolla by 2014.
)

 EMR systems have poor market penetration, in my direct experience over the last 9 years, because:
1.
Many, if not most, suck in a medium to large way;
2.
They are incredibly expensive;
3.
They can often be hard to use, and are typically more labor-intensive than paper charts for most physicians in the US;
4.
They don't inter-operate.
(When I request old records from other physicians with electronic charts, I enter the pertinent data into my electronic chart by typing it in.
)

If any skilled group of software engineers were to write a decent, usable EMR that was extensible, and didn't cost an arm and a leg, with an eye to being excellent first and profitable as a consequence, they could be up for a Nobel prize.
TFA refers to cardiac CT to prevent heart attacks.
The author, too, lives in a dream world - contrary to her thesis, this test has been shown to help with the boat payments of radiologists and equipment manufacturers, but there is no evidence it helps prevent heart attacks.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463551</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28466681</id>
	<title>Re:lots of work for very little gain</title>
	<author>Anonymous</author>
	<datestamp>1245946320000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>If every patientcarried a card in their wallet with these 3 items, lot of money woud be saved:<br>1. list of medications<br>2. name of primary care doctor<br>3. list of major surgical procedures<br>no ned for list of diseases since we can deduce these from the med list.</p><p>there it is  a one penny solution for 35\% of all of the problems I encounter in my office.</p></htmltext>
<tokenext>If every patientcarried a card in their wallet with these 3 items , lot of money woud be saved : 1. list of medications2 .
name of primary care doctor3 .
list of major surgical proceduresno ned for list of diseases since we can deduce these from the med list.there it is a one penny solution for 35 \ % of all of the problems I encounter in my office .</tokentext>
<sentencetext>If every patientcarried a card in their wallet with these 3 items, lot of money woud be saved:1. list of medications2.
name of primary care doctor3.
list of major surgical proceduresno ned for list of diseases since we can deduce these from the med list.there it is  a one penny solution for 35\% of all of the problems I encounter in my office.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463663</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28469805</id>
	<title>Re:IT is only one facet of healthcare</title>
	<author>Rich0</author>
	<datestamp>1245958620000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>2</modscore>
	<htmltext><p>Your example is a good one, but after having all these arteries clamped and fixed, how many patients then go on and die because some nurse adminsters the wrong drug - or the drug that the records say is the right drug but that was due to some kind of clerical error?</p><p>My concern is that for every miracle life saved there are probably 500 lost or otherwise shortened through the medical meat grinder.  Quite a bit of pain and suffering too as patients take needlessly long to recover from less critical problems.</p><p>Medicine seems to be optimized to handle these kinds of major trauma scenarios and less optimized to handle some poor guy with sepsis who is about 95\% likely to recover with prompt and correct treatment and about 50\% likely to die if there is much delay in getting them the care they need, but in the meantime there isn't any blood pooling on the floor.</p></htmltext>
<tokenext>Your example is a good one , but after having all these arteries clamped and fixed , how many patients then go on and die because some nurse adminsters the wrong drug - or the drug that the records say is the right drug but that was due to some kind of clerical error ? My concern is that for every miracle life saved there are probably 500 lost or otherwise shortened through the medical meat grinder .
Quite a bit of pain and suffering too as patients take needlessly long to recover from less critical problems.Medicine seems to be optimized to handle these kinds of major trauma scenarios and less optimized to handle some poor guy with sepsis who is about 95 \ % likely to recover with prompt and correct treatment and about 50 \ % likely to die if there is much delay in getting them the care they need , but in the meantime there is n't any blood pooling on the floor .</tokentext>
<sentencetext>Your example is a good one, but after having all these arteries clamped and fixed, how many patients then go on and die because some nurse adminsters the wrong drug - or the drug that the records say is the right drug but that was due to some kind of clerical error?My concern is that for every miracle life saved there are probably 500 lost or otherwise shortened through the medical meat grinder.
Quite a bit of pain and suffering too as patients take needlessly long to recover from less critical problems.Medicine seems to be optimized to handle these kinds of major trauma scenarios and less optimized to handle some poor guy with sepsis who is about 95\% likely to recover with prompt and correct treatment and about 50\% likely to die if there is much delay in getting them the care they need, but in the meantime there isn't any blood pooling on the floor.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463933</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28475515</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>Propofol</author>
	<datestamp>1245937620000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p>This post makes a number of generalizations that need to be addressed:</p><p><div class="quote"><p>Medical Doctors are in General very difficult to work with. There are a lot of factors...</p><p>1. Society says they are the smartest people around. They think that too. So when they go out of their area of expertise and they don't know exactly what is happening, they will avoid trying to learn about it but become defensive about it. And will not give respect to people who do know about such areas and let them ask the right questions so they can fix the problem.</p></div><p>As a doctor I could make the same generalization about people in IT with equal validity. (I can give a patient potentially lethal drugs if used incorrectly but I am not allowed to install firefox on my computer at work.) Your statement describes almost any group who's work requires a high level expertise in a specific area.</p><p><div class="quote"><p>2. Doctors are trained in medical not business,<nobr> <wbr></nobr>...</p></div><p>Correct - Med school 6 years, intern x 2 yrs, specialty training 5 years. I have been studying for some exam or the other during the entire period. Really cuts into my quake arena and UrbanTerror time. With some exceptions most physicians know very little about IT.</p><p><div class="quote"><p>3.<nobr> <wbr></nobr>... Good EMR and PM (Practice Management) system are not cheap (like most professional apps), and there is a sticker shock for paying thousands of dollars for software, even for a glorified access database...</p></div><p>In my experience in hospitals, medical record systems are very expensive, have poor user interfaces, are not flexible enough to deal with widely varying requirements of different specialties and does not always comprehensively tie in all the departments. There is a degree of vendor tie in that makes MS look benign.</p><p><div class="quote"><p>4. Open Source is not an option. Sorry Open Source fans. In a career where you can get sued in an instant you need somewhere to point the lawyers away from you. (Hence part of the high cost for medical software) Yes this is a lame excuse for Microsoft (who makes general use software) but for specialty software companies they are under the guns of lawyers all the time.</p></div><p>It may be the only option. What is needed is in fact an open source system which can be modified to suit individual needs and is not tied to a particular company. What is required is a company to modify &amp; maintain the system.
What happens after you have spent a large sum of money, you have several years worth of medical information in a proprietery database and the company goes bankrupt? Who do you sue then?</p><p><div class="quote"><p>5. MD are known to make a lot of money. This doesn't always attract good, nice, or even smart people.  Remember "What do you call the person who graduated with the lowest score in Med School?" answer "Doctor". A lot of people are just in it for the money. They may say they like helping people but they are in it for the money (How a lot of doctors in California will prescribe "medical marijuana" for "problems sleeping") They will be so tight with their money and be blind to all benefits such systems will have, and will not pay unless things work the way THEY want it to.</p></div><p>Don't shy away from propagating stereotypes. With years spent on a training salary, litigation, odd &amp;long hours of work vs money the equation does not pan out. Medicine is not a way to get rich quick. What does happen is MD's finishing specialty training with large student loans which need to get paid off.</p><p>Regards,
Stefan</p></div>
	</htmltext>
<tokenext>This post makes a number of generalizations that need to be addressed : Medical Doctors are in General very difficult to work with .
There are a lot of factors...1 .
Society says they are the smartest people around .
They think that too .
So when they go out of their area of expertise and they do n't know exactly what is happening , they will avoid trying to learn about it but become defensive about it .
And will not give respect to people who do know about such areas and let them ask the right questions so they can fix the problem.As a doctor I could make the same generalization about people in IT with equal validity .
( I can give a patient potentially lethal drugs if used incorrectly but I am not allowed to install firefox on my computer at work .
) Your statement describes almost any group who 's work requires a high level expertise in a specific area.2 .
Doctors are trained in medical not business , ...Correct - Med school 6 years , intern x 2 yrs , specialty training 5 years .
I have been studying for some exam or the other during the entire period .
Really cuts into my quake arena and UrbanTerror time .
With some exceptions most physicians know very little about IT.3 .
... Good EMR and PM ( Practice Management ) system are not cheap ( like most professional apps ) , and there is a sticker shock for paying thousands of dollars for software , even for a glorified access database...In my experience in hospitals , medical record systems are very expensive , have poor user interfaces , are not flexible enough to deal with widely varying requirements of different specialties and does not always comprehensively tie in all the departments .
There is a degree of vendor tie in that makes MS look benign.4 .
Open Source is not an option .
Sorry Open Source fans .
In a career where you can get sued in an instant you need somewhere to point the lawyers away from you .
( Hence part of the high cost for medical software ) Yes this is a lame excuse for Microsoft ( who makes general use software ) but for specialty software companies they are under the guns of lawyers all the time.It may be the only option .
What is needed is in fact an open source system which can be modified to suit individual needs and is not tied to a particular company .
What is required is a company to modify &amp; maintain the system .
What happens after you have spent a large sum of money , you have several years worth of medical information in a proprietery database and the company goes bankrupt ?
Who do you sue then ? 5 .
MD are known to make a lot of money .
This does n't always attract good , nice , or even smart people .
Remember " What do you call the person who graduated with the lowest score in Med School ?
" answer " Doctor " .
A lot of people are just in it for the money .
They may say they like helping people but they are in it for the money ( How a lot of doctors in California will prescribe " medical marijuana " for " problems sleeping " ) They will be so tight with their money and be blind to all benefits such systems will have , and will not pay unless things work the way THEY want it to.Do n't shy away from propagating stereotypes .
With years spent on a training salary , litigation , odd &amp;long hours of work vs money the equation does not pan out .
Medicine is not a way to get rich quick .
What does happen is MD 's finishing specialty training with large student loans which need to get paid off.Regards , Stefan</tokentext>
<sentencetext>This post makes a number of generalizations that need to be addressed:Medical Doctors are in General very difficult to work with.
There are a lot of factors...1.
Society says they are the smartest people around.
They think that too.
So when they go out of their area of expertise and they don't know exactly what is happening, they will avoid trying to learn about it but become defensive about it.
And will not give respect to people who do know about such areas and let them ask the right questions so they can fix the problem.As a doctor I could make the same generalization about people in IT with equal validity.
(I can give a patient potentially lethal drugs if used incorrectly but I am not allowed to install firefox on my computer at work.
) Your statement describes almost any group who's work requires a high level expertise in a specific area.2.
Doctors are trained in medical not business, ...Correct - Med school 6 years, intern x 2 yrs, specialty training 5 years.
I have been studying for some exam or the other during the entire period.
Really cuts into my quake arena and UrbanTerror time.
With some exceptions most physicians know very little about IT.3.
... Good EMR and PM (Practice Management) system are not cheap (like most professional apps), and there is a sticker shock for paying thousands of dollars for software, even for a glorified access database...In my experience in hospitals, medical record systems are very expensive, have poor user interfaces, are not flexible enough to deal with widely varying requirements of different specialties and does not always comprehensively tie in all the departments.
There is a degree of vendor tie in that makes MS look benign.4.
Open Source is not an option.
Sorry Open Source fans.
In a career where you can get sued in an instant you need somewhere to point the lawyers away from you.
(Hence part of the high cost for medical software) Yes this is a lame excuse for Microsoft (who makes general use software) but for specialty software companies they are under the guns of lawyers all the time.It may be the only option.
What is needed is in fact an open source system which can be modified to suit individual needs and is not tied to a particular company.
What is required is a company to modify &amp; maintain the system.
What happens after you have spent a large sum of money, you have several years worth of medical information in a proprietery database and the company goes bankrupt?
Who do you sue then?5.
MD are known to make a lot of money.
This doesn't always attract good, nice, or even smart people.
Remember "What do you call the person who graduated with the lowest score in Med School?
" answer "Doctor".
A lot of people are just in it for the money.
They may say they like helping people but they are in it for the money (How a lot of doctors in California will prescribe "medical marijuana" for "problems sleeping") They will be so tight with their money and be blind to all benefits such systems will have, and will not pay unless things work the way THEY want it to.Don't shy away from propagating stereotypes.
With years spent on a training salary, litigation, odd &amp;long hours of work vs money the equation does not pan out.
Medicine is not a way to get rich quick.
What does happen is MD's finishing specialty training with large student loans which need to get paid off.Regards,
Stefan
	</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465039</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463887</id>
	<title>Doctors</title>
	<author>Anonymous</author>
	<datestamp>1245921060000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>2</modscore>
	<htmltext><p>Quite simply it is that Doctors believe they are the most intelligent people in the room whenever they walk in.  They will accept no management advice, no time allocation advice, no parking advice, no dietary advice . . . no advice.</p><p>They believe that they are already operating in the most efficient manner and that any change will put patient lives at risk.  Well . . . actually they don't believe this, but this excuse is used every time they don't like something. A quick "OOooooo - patient lives at risk" and any progressive idea is already on the back foot.</p><p>This ideology permeates through the health care system with consultants at the top right down through the chain to the nurses.</p><p>Getting these people to agree on ANYTHING is a Herculean task.</p><p>A friend of mine (a Doctor) was on a committee trying to bring more IT into the healthcare system in Scotland.  He is very IT minded (read geek) and was keen as mustard to help push things along.  Within a handful of months, he was at the end of his tether due to the sheer deluge of nonsensical crap that was being floated purely to waste the committee's time and ensure that nothing got done.</p></htmltext>
<tokenext>Quite simply it is that Doctors believe they are the most intelligent people in the room whenever they walk in .
They will accept no management advice , no time allocation advice , no parking advice , no dietary advice .
. .
no advice.They believe that they are already operating in the most efficient manner and that any change will put patient lives at risk .
Well .
. .
actually they do n't believe this , but this excuse is used every time they do n't like something .
A quick " OOooooo - patient lives at risk " and any progressive idea is already on the back foot.This ideology permeates through the health care system with consultants at the top right down through the chain to the nurses.Getting these people to agree on ANYTHING is a Herculean task.A friend of mine ( a Doctor ) was on a committee trying to bring more IT into the healthcare system in Scotland .
He is very IT minded ( read geek ) and was keen as mustard to help push things along .
Within a handful of months , he was at the end of his tether due to the sheer deluge of nonsensical crap that was being floated purely to waste the committee 's time and ensure that nothing got done .</tokentext>
<sentencetext>Quite simply it is that Doctors believe they are the most intelligent people in the room whenever they walk in.
They will accept no management advice, no time allocation advice, no parking advice, no dietary advice .
. .
no advice.They believe that they are already operating in the most efficient manner and that any change will put patient lives at risk.
Well .
. .
actually they don't believe this, but this excuse is used every time they don't like something.
A quick "OOooooo - patient lives at risk" and any progressive idea is already on the back foot.This ideology permeates through the health care system with consultants at the top right down through the chain to the nurses.Getting these people to agree on ANYTHING is a Herculean task.A friend of mine (a Doctor) was on a committee trying to bring more IT into the healthcare system in Scotland.
He is very IT minded (read geek) and was keen as mustard to help push things along.
Within a handful of months, he was at the end of his tether due to the sheer deluge of nonsensical crap that was being floated purely to waste the committee's time and ensure that nothing got done.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465391</id>
	<title>Define health care</title>
	<author>buckeyeguy</author>
	<datestamp>1245939540000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext>The article seems to define health care as what some of us would call 'direct patient care'... but doctors and hospitals are only part of the big health-care money pie. There are the companies that manufacture the drugs and medical products, and those (like the one I work for) which distribute them. Getting everything from stents to splints distributed to your local doctor, hospital and pharmacy (much of which is ordered electronically) takes a huge amount of IT capacity. Patient records will catch up eventually, but anybody who has worked in an office over the last 20 years and heard "next year, we're going to buy document imaging and scan it all into the system", knows to take that with a big grain of salt... believe it when, and not before, you see it.</htmltext>
<tokenext>The article seems to define health care as what some of us would call 'direct patient care'... but doctors and hospitals are only part of the big health-care money pie .
There are the companies that manufacture the drugs and medical products , and those ( like the one I work for ) which distribute them .
Getting everything from stents to splints distributed to your local doctor , hospital and pharmacy ( much of which is ordered electronically ) takes a huge amount of IT capacity .
Patient records will catch up eventually , but anybody who has worked in an office over the last 20 years and heard " next year , we 're going to buy document imaging and scan it all into the system " , knows to take that with a big grain of salt... believe it when , and not before , you see it .</tokentext>
<sentencetext>The article seems to define health care as what some of us would call 'direct patient care'... but doctors and hospitals are only part of the big health-care money pie.
There are the companies that manufacture the drugs and medical products, and those (like the one I work for) which distribute them.
Getting everything from stents to splints distributed to your local doctor, hospital and pharmacy (much of which is ordered electronically) takes a huge amount of IT capacity.
Patient records will catch up eventually, but anybody who has worked in an office over the last 20 years and heard "next year, we're going to buy document imaging and scan it all into the system", knows to take that with a big grain of salt... believe it when, and not before, you see it.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464231</id>
	<title>Medical IT sucks</title>
	<author>Anonymous</author>
	<datestamp>1245925140000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>4</modscore>
	<htmltext><p>As a medical interpreter, I see health-care IT up close all the time. (I'm writing this in an ER, on an overnight shift.) TFA has a lot of good points, but think the biggest single reason the IT sucks is the sheer complexity of medical information, but also of our byzantine and baffling health system in general.</p><p>All the health systems in town use the same medical-records company, because it's local.  Its design reminds me of Windows 95, and the nurses know more about the workarounds for the bugs than about the intended use. The thing is, few of the doctors and even fewer of the nurses are interested in computers. They're interested in medicine, and computers are a pain in the neck even *before* they break down. They can't tell when the computer is behaving unpredictably, because as far as they're concerned, the computer always behaves unpredictably.</p><p>Am I trying to blame the victims, here? No. I'm saying this is a detailed and ongoing focus group, and they're telling us that the whole IT system is a disaster. And as far as I'm concerned, the most damning critique is that no one I've talked to wants them to change it, because, almost to a person, they're convinced the upgrade will be just as, if not worse.</p></htmltext>
<tokenext>As a medical interpreter , I see health-care IT up close all the time .
( I 'm writing this in an ER , on an overnight shift .
) TFA has a lot of good points , but think the biggest single reason the IT sucks is the sheer complexity of medical information , but also of our byzantine and baffling health system in general.All the health systems in town use the same medical-records company , because it 's local .
Its design reminds me of Windows 95 , and the nurses know more about the workarounds for the bugs than about the intended use .
The thing is , few of the doctors and even fewer of the nurses are interested in computers .
They 're interested in medicine , and computers are a pain in the neck even * before * they break down .
They ca n't tell when the computer is behaving unpredictably , because as far as they 're concerned , the computer always behaves unpredictably.Am I trying to blame the victims , here ?
No. I 'm saying this is a detailed and ongoing focus group , and they 're telling us that the whole IT system is a disaster .
And as far as I 'm concerned , the most damning critique is that no one I 've talked to wants them to change it , because , almost to a person , they 're convinced the upgrade will be just as , if not worse .</tokentext>
<sentencetext>As a medical interpreter, I see health-care IT up close all the time.
(I'm writing this in an ER, on an overnight shift.
) TFA has a lot of good points, but think the biggest single reason the IT sucks is the sheer complexity of medical information, but also of our byzantine and baffling health system in general.All the health systems in town use the same medical-records company, because it's local.
Its design reminds me of Windows 95, and the nurses know more about the workarounds for the bugs than about the intended use.
The thing is, few of the doctors and even fewer of the nurses are interested in computers.
They're interested in medicine, and computers are a pain in the neck even *before* they break down.
They can't tell when the computer is behaving unpredictably, because as far as they're concerned, the computer always behaves unpredictably.Am I trying to blame the victims, here?
No. I'm saying this is a detailed and ongoing focus group, and they're telling us that the whole IT system is a disaster.
And as far as I'm concerned, the most damning critique is that no one I've talked to wants them to change it, because, almost to a person, they're convinced the upgrade will be just as, if not worse.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464019</id>
	<title>Re:one word: protectionism</title>
	<author>nikolag</author>
	<datestamp>1245922680000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext><p><div class="quote"><p>As patients, we often forget that most diagnoses are really just a SWAG. A doctor usually can't be 100\% confident that his diagnosis is correct, but does his best based on his expertise and the training he has. If I were a doctor, my daily concern would be malpractice suits. I don't even want to know how many incorrect engineering decisions I make in a year. If I had to be concerned about being sued for every one of those incorrect decisions, I would be lording over the data as well because I know there is always multiple ways to interpret the same data set.</p></div><p>It stands that You make considerably smaller amount of false engineering decisions. When did You have default value range 1-100 out of possible 0-300 units? It is common thing in medicine.<br>If You put voltmeter at test point number 321, you measure exact that voltage, while in medicine, blood sample can literally be different because the room walls were of different color or because nurse said something or it was not taken in the morning but after the lunch.</p><p>It seems to me that considerable number of problems comes from the fact that engineers are used to work with models, while medicine is done in the real conditions. I agree that science part of medicine makes difference, but the ground is still shaky.</p><p>Just remember, if something is done in one hospital/county/state one way, there is no way that all of it will be the same in next hospital/county/state.</p></div>
	</htmltext>
<tokenext>As patients , we often forget that most diagnoses are really just a SWAG .
A doctor usually ca n't be 100 \ % confident that his diagnosis is correct , but does his best based on his expertise and the training he has .
If I were a doctor , my daily concern would be malpractice suits .
I do n't even want to know how many incorrect engineering decisions I make in a year .
If I had to be concerned about being sued for every one of those incorrect decisions , I would be lording over the data as well because I know there is always multiple ways to interpret the same data set.It stands that You make considerably smaller amount of false engineering decisions .
When did You have default value range 1-100 out of possible 0-300 units ?
It is common thing in medicine.If You put voltmeter at test point number 321 , you measure exact that voltage , while in medicine , blood sample can literally be different because the room walls were of different color or because nurse said something or it was not taken in the morning but after the lunch.It seems to me that considerable number of problems comes from the fact that engineers are used to work with models , while medicine is done in the real conditions .
I agree that science part of medicine makes difference , but the ground is still shaky.Just remember , if something is done in one hospital/county/state one way , there is no way that all of it will be the same in next hospital/county/state .</tokentext>
<sentencetext>As patients, we often forget that most diagnoses are really just a SWAG.
A doctor usually can't be 100\% confident that his diagnosis is correct, but does his best based on his expertise and the training he has.
If I were a doctor, my daily concern would be malpractice suits.
I don't even want to know how many incorrect engineering decisions I make in a year.
If I had to be concerned about being sued for every one of those incorrect decisions, I would be lording over the data as well because I know there is always multiple ways to interpret the same data set.It stands that You make considerably smaller amount of false engineering decisions.
When did You have default value range 1-100 out of possible 0-300 units?
It is common thing in medicine.If You put voltmeter at test point number 321, you measure exact that voltage, while in medicine, blood sample can literally be different because the room walls were of different color or because nurse said something or it was not taken in the morning but after the lunch.It seems to me that considerable number of problems comes from the fact that engineers are used to work with models, while medicine is done in the real conditions.
I agree that science part of medicine makes difference, but the ground is still shaky.Just remember, if something is done in one hospital/county/state one way, there is no way that all of it will be the same in next hospital/county/state.
	</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463699</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463487</id>
	<title>Easy to test</title>
	<author>Allicorn</author>
	<datestamp>1245873060000</datestamp>
	<modclass>Informativ</modclass>
	<modscore>4</modscore>
	<htmltext><p>Were your hypothesis correct then there should be a visibly greater level of non-clinical IT adoption in tolerably resourced, state-funded healthcare schemes - eg the UK.</p></htmltext>
<tokenext>Were your hypothesis correct then there should be a visibly greater level of non-clinical IT adoption in tolerably resourced , state-funded healthcare schemes - eg the UK .</tokentext>
<sentencetext>Were your hypothesis correct then there should be a visibly greater level of non-clinical IT adoption in tolerably resourced, state-funded healthcare schemes - eg the UK.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463999</id>
	<title>Re:lots of work for very little gain</title>
	<author>badfish99</author>
	<datestamp>1245922260000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext>Of course, in the UK the situation is not helped by the fact that the first 100000 people whose details are entered into the system will be rewarded by having all their private medical history copied onto an unencrypted CD which will then be left on a train by a junior civil servant.</htmltext>
<tokenext>Of course , in the UK the situation is not helped by the fact that the first 100000 people whose details are entered into the system will be rewarded by having all their private medical history copied onto an unencrypted CD which will then be left on a train by a junior civil servant .</tokentext>
<sentencetext>Of course, in the UK the situation is not helped by the fact that the first 100000 people whose details are entered into the system will be rewarded by having all their private medical history copied onto an unencrypted CD which will then be left on a train by a junior civil servant.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463663</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28467737</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>Anonymous</author>
	<datestamp>1245950940000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p>&gt; Society says they are the smartest people around. They think that too. So when they go out of their area of expertise and they don't know exactly what is happening, they will avoid trying to learn about it but become defensive about it.</p><p>I could lean on the the "+" sign on my keyboard for a week and still not agree with this enough.  There's a reason the Beechcraft Bonanza is nick-named "Doctor Killer".</p></htmltext>
<tokenext>&gt; Society says they are the smartest people around .
They think that too .
So when they go out of their area of expertise and they do n't know exactly what is happening , they will avoid trying to learn about it but become defensive about it.I could lean on the the " + " sign on my keyboard for a week and still not agree with this enough .
There 's a reason the Beechcraft Bonanza is nick-named " Doctor Killer " .</tokentext>
<sentencetext>&gt; Society says they are the smartest people around.
They think that too.
So when they go out of their area of expertise and they don't know exactly what is happening, they will avoid trying to learn about it but become defensive about it.I could lean on the the "+" sign on my keyboard for a week and still not agree with this enough.
There's a reason the Beechcraft Bonanza is nick-named "Doctor Killer".</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465039</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464735</id>
	<title>Re:Too few computers, too little bandwidth</title>
	<author>dcherryholmes</author>
	<datestamp>1245933540000</datestamp>
	<modclass>Insightful</modclass>
	<modscore>1</modscore>
	<htmltext>I used to work in Hospital IT (not any more though).  I'm not disputing your insight, but it does surprise me a little..... the idea that the cost for data input of text records could translate into such a significant cost.  I know just walking around the hospital I would routinely see old computers sitting outside of office doors in the hallway, waiting to be carted off and destroyed.  Now, granted, these *were* old POS computers.  But if all you really needed to do was provide a terminal for some data input, how bad-ass do they need to be?  I'm just suggesting, if the budget issue really is that bad, there are probably ways that older, less-sexy, equipment could be re-purposed to bring that down a bit.  Analysis of the server end gets more complex but, if we can assume we're dealing mostly with text, I doubt it would be that horrendous.  The cost of a new server or a few more TB of disk space is practically nothing compared to other expenses I observed being routinely shelled out.  And an oft-touted meme around Slashdot is that part of the point of paying for a *nix admin is that he or she can handle more boxes simultaneously than comparable Windows admins, due to the differences in platforms.  I'm not saying that's true, either, but it seems a lot of smart people posting around here believe that it is.  If so, it casts some skepticism towards the notion that man-power would increase drastically for a doubling or trebling of a bunch of text records.

So, those are a lot of questions I have about your statement.  They are questions, though, not challenges.</htmltext>
<tokenext>I used to work in Hospital IT ( not any more though ) .
I 'm not disputing your insight , but it does surprise me a little..... the idea that the cost for data input of text records could translate into such a significant cost .
I know just walking around the hospital I would routinely see old computers sitting outside of office doors in the hallway , waiting to be carted off and destroyed .
Now , granted , these * were * old POS computers .
But if all you really needed to do was provide a terminal for some data input , how bad-ass do they need to be ?
I 'm just suggesting , if the budget issue really is that bad , there are probably ways that older , less-sexy , equipment could be re-purposed to bring that down a bit .
Analysis of the server end gets more complex but , if we can assume we 're dealing mostly with text , I doubt it would be that horrendous .
The cost of a new server or a few more TB of disk space is practically nothing compared to other expenses I observed being routinely shelled out .
And an oft-touted meme around Slashdot is that part of the point of paying for a * nix admin is that he or she can handle more boxes simultaneously than comparable Windows admins , due to the differences in platforms .
I 'm not saying that 's true , either , but it seems a lot of smart people posting around here believe that it is .
If so , it casts some skepticism towards the notion that man-power would increase drastically for a doubling or trebling of a bunch of text records .
So , those are a lot of questions I have about your statement .
They are questions , though , not challenges .</tokentext>
<sentencetext>I used to work in Hospital IT (not any more though).
I'm not disputing your insight, but it does surprise me a little..... the idea that the cost for data input of text records could translate into such a significant cost.
I know just walking around the hospital I would routinely see old computers sitting outside of office doors in the hallway, waiting to be carted off and destroyed.
Now, granted, these *were* old POS computers.
But if all you really needed to do was provide a terminal for some data input, how bad-ass do they need to be?
I'm just suggesting, if the budget issue really is that bad, there are probably ways that older, less-sexy, equipment could be re-purposed to bring that down a bit.
Analysis of the server end gets more complex but, if we can assume we're dealing mostly with text, I doubt it would be that horrendous.
The cost of a new server or a few more TB of disk space is practically nothing compared to other expenses I observed being routinely shelled out.
And an oft-touted meme around Slashdot is that part of the point of paying for a *nix admin is that he or she can handle more boxes simultaneously than comparable Windows admins, due to the differences in platforms.
I'm not saying that's true, either, but it seems a lot of smart people posting around here believe that it is.
If so, it casts some skepticism towards the notion that man-power would increase drastically for a doubling or trebling of a bunch of text records.
So, those are a lot of questions I have about your statement.
They are questions, though, not challenges.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464185</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463617</id>
	<title>Positive uses</title>
	<author>The Clockwork Troll</author>
	<datestamp>1245960960000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext>While liability is a concern, the medical industry needs to see that there is <a href="http://www.recomdata.com/www/index.html" title="recomdata.com" rel="nofollow">a real bright side</a> [recomdata.com] to analysis of medical data as well.</htmltext>
<tokenext>While liability is a concern , the medical industry needs to see that there is a real bright side [ recomdata.com ] to analysis of medical data as well .</tokentext>
<sentencetext>While liability is a concern, the medical industry needs to see that there is a real bright side [recomdata.com] to analysis of medical data as well.</sentencetext>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28472403</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>Anonymous</author>
	<datestamp>1245924480000</datestamp>
	<modclass>None</modclass>
	<modscore>0</modscore>
	<htmltext><p><div class="quote"><p>Medical Doctors are in General very difficult to work with...</p><p><i>So are software engineers. I am a software engineer and a medical doctor. Software engineers frequently promise much and deliver little.</i> </p><p>1. Society says they are the smartest people around. They think that too.  So when they go out of their area of expertise and they don't know exactly what is happening, they will avoid trying to learn about it but become defensive about it. And will not give respect to people who do know about such areas and let them ask the right questions so they can fix the problem. I have had Doctors yell at me, when I call them and say, "I hear you are having some problems with the system, could you explain them to me so I can see how I can fix it?" just as themselves will go to a patient and ask a similar question even when they have the problem written down as for the reason for the appointment.  This makes them high maintenance and people don't necessarily want to deal with them. House may be a cool TV show, but you really wouldn't want to with him.</p><p><i>Highest average IQ of any profession. That is a fact. Software engineering is a walk in the park compared to the practice of medicine and I've done both. My personal experience bears that out. Many of my colleagues are far, far more intelligent and motivated than any group I've ever been around.</i></p><p>2. Doctors are trained in medical not business, they are MDs not MBAs. Yet a lot of them run their own practice and need to deal with all the business of running the practice and not working on the medicine. Many practices are so overworked that they don't have time to analyze or listen to ideas that will improve their practice.</p><p><i>Agree with the overworked part.</i></p><p>3. Most practices are small business. Good EMR and PM (Practice Management) system are not cheap (like most professional apps), and there is a sticker shock for paying thousands of dollars for software, even for a glorified access database.  They feel like they are getting ripped off by paying such high prices for software. So they will go with their crappy methods before getting ripped off.</p><p>Yep.</p><p>4. Open Source is not an option. Sorry Open Source fans. In a career where you can get sued in an instant you need somewhere to point the lawyers away from you. (Hence part of the high cost for medical software) Yes this is a lame excuse for Microsoft (who makes general use software) but for specialty software companies they are under the guns of lawyers all the time.</p><p><i>Bzzzt, try again. The AMIA Open Source White Paper says otherwise. Many entities run Open Source EMR's like VA's VistA in the private sector and ones like ClearHealth and OpenEMR. Your data for this assertion please?</i> </p><p>5. MD are known to make a lot of money. This doesn't always attract good, nice, or even smart people.  Remember "What do you call the person who graduated with the lowest score in Med School?" answer "Doctor". A lot of people are just in it for the money. They may say they like helping people but they are in it for the money (How a lot of doctors in California will prescribe "medical marijuana" for "problems sleeping") They will be so tight with their money and be blind to all benefits such systems will have, and will not pay unless things work the way THEY want it to.</p><p><i>Data for these assertions please? The price for becoming a doctor is quite high. Yes, it really needs to work the way THEY want it to for very specific but difficult to explain reasons. Bad product+high price=low adoption. Is that so hard to understand? And that would be Bad Product on many, many levels including the proprietary EMR company owns you after you use their product. No conspiracy here.</i></p><p>6. Uneducated staff. For most practices you will have 1 or 2 doctors  1 or 2 nurses (with Associates or BA degrees) then a staff of 4 or 5 with High School degrees. That staff runs the business for the most part. They lack the patience or discipline to learn such technologies and to use it for its best advantage.  Also many of them feel sub adequate (as they need to deal with the high egos of the Doctors) so they are afraid to ask questions or point out problems.</p></div><p><i>More like they lack the time for frequently faulty, frequently lousy, non-standard products that they have to learn over and over again because they are prevented from teaching it in medical school by the 100's of incompatible products out there. The proprietary EMR companies have bought the politicians and are now ramming their proprietary stuff down our throats. Tell your Congresspersons that we need a law that only Affero General Public Licensed software can be purchased with taxpayer money.</i></p></div>
	</htmltext>
<tokenext>Medical Doctors are in General very difficult to work with...So are software engineers .
I am a software engineer and a medical doctor .
Software engineers frequently promise much and deliver little .
1. Society says they are the smartest people around .
They think that too .
So when they go out of their area of expertise and they do n't know exactly what is happening , they will avoid trying to learn about it but become defensive about it .
And will not give respect to people who do know about such areas and let them ask the right questions so they can fix the problem .
I have had Doctors yell at me , when I call them and say , " I hear you are having some problems with the system , could you explain them to me so I can see how I can fix it ?
" just as themselves will go to a patient and ask a similar question even when they have the problem written down as for the reason for the appointment .
This makes them high maintenance and people do n't necessarily want to deal with them .
House may be a cool TV show , but you really would n't want to with him.Highest average IQ of any profession .
That is a fact .
Software engineering is a walk in the park compared to the practice of medicine and I 've done both .
My personal experience bears that out .
Many of my colleagues are far , far more intelligent and motivated than any group I 've ever been around.2 .
Doctors are trained in medical not business , they are MDs not MBAs .
Yet a lot of them run their own practice and need to deal with all the business of running the practice and not working on the medicine .
Many practices are so overworked that they do n't have time to analyze or listen to ideas that will improve their practice.Agree with the overworked part.3 .
Most practices are small business .
Good EMR and PM ( Practice Management ) system are not cheap ( like most professional apps ) , and there is a sticker shock for paying thousands of dollars for software , even for a glorified access database .
They feel like they are getting ripped off by paying such high prices for software .
So they will go with their crappy methods before getting ripped off.Yep.4 .
Open Source is not an option .
Sorry Open Source fans .
In a career where you can get sued in an instant you need somewhere to point the lawyers away from you .
( Hence part of the high cost for medical software ) Yes this is a lame excuse for Microsoft ( who makes general use software ) but for specialty software companies they are under the guns of lawyers all the time.Bzzzt , try again .
The AMIA Open Source White Paper says otherwise .
Many entities run Open Source EMR 's like VA 's VistA in the private sector and ones like ClearHealth and OpenEMR .
Your data for this assertion please ?
5. MD are known to make a lot of money .
This does n't always attract good , nice , or even smart people .
Remember " What do you call the person who graduated with the lowest score in Med School ?
" answer " Doctor " .
A lot of people are just in it for the money .
They may say they like helping people but they are in it for the money ( How a lot of doctors in California will prescribe " medical marijuana " for " problems sleeping " ) They will be so tight with their money and be blind to all benefits such systems will have , and will not pay unless things work the way THEY want it to.Data for these assertions please ?
The price for becoming a doctor is quite high .
Yes , it really needs to work the way THEY want it to for very specific but difficult to explain reasons .
Bad product + high price = low adoption .
Is that so hard to understand ?
And that would be Bad Product on many , many levels including the proprietary EMR company owns you after you use their product .
No conspiracy here.6 .
Uneducated staff .
For most practices you will have 1 or 2 doctors 1 or 2 nurses ( with Associates or BA degrees ) then a staff of 4 or 5 with High School degrees .
That staff runs the business for the most part .
They lack the patience or discipline to learn such technologies and to use it for its best advantage .
Also many of them feel sub adequate ( as they need to deal with the high egos of the Doctors ) so they are afraid to ask questions or point out problems.More like they lack the time for frequently faulty , frequently lousy , non-standard products that they have to learn over and over again because they are prevented from teaching it in medical school by the 100 's of incompatible products out there .
The proprietary EMR companies have bought the politicians and are now ramming their proprietary stuff down our throats .
Tell your Congresspersons that we need a law that only Affero General Public Licensed software can be purchased with taxpayer money .</tokentext>
<sentencetext>Medical Doctors are in General very difficult to work with...So are software engineers.
I am a software engineer and a medical doctor.
Software engineers frequently promise much and deliver little.
1. Society says they are the smartest people around.
They think that too.
So when they go out of their area of expertise and they don't know exactly what is happening, they will avoid trying to learn about it but become defensive about it.
And will not give respect to people who do know about such areas and let them ask the right questions so they can fix the problem.
I have had Doctors yell at me, when I call them and say, "I hear you are having some problems with the system, could you explain them to me so I can see how I can fix it?
" just as themselves will go to a patient and ask a similar question even when they have the problem written down as for the reason for the appointment.
This makes them high maintenance and people don't necessarily want to deal with them.
House may be a cool TV show, but you really wouldn't want to with him.Highest average IQ of any profession.
That is a fact.
Software engineering is a walk in the park compared to the practice of medicine and I've done both.
My personal experience bears that out.
Many of my colleagues are far, far more intelligent and motivated than any group I've ever been around.2.
Doctors are trained in medical not business, they are MDs not MBAs.
Yet a lot of them run their own practice and need to deal with all the business of running the practice and not working on the medicine.
Many practices are so overworked that they don't have time to analyze or listen to ideas that will improve their practice.Agree with the overworked part.3.
Most practices are small business.
Good EMR and PM (Practice Management) system are not cheap (like most professional apps), and there is a sticker shock for paying thousands of dollars for software, even for a glorified access database.
They feel like they are getting ripped off by paying such high prices for software.
So they will go with their crappy methods before getting ripped off.Yep.4.
Open Source is not an option.
Sorry Open Source fans.
In a career where you can get sued in an instant you need somewhere to point the lawyers away from you.
(Hence part of the high cost for medical software) Yes this is a lame excuse for Microsoft (who makes general use software) but for specialty software companies they are under the guns of lawyers all the time.Bzzzt, try again.
The AMIA Open Source White Paper says otherwise.
Many entities run Open Source EMR's like VA's VistA in the private sector and ones like ClearHealth and OpenEMR.
Your data for this assertion please?
5. MD are known to make a lot of money.
This doesn't always attract good, nice, or even smart people.
Remember "What do you call the person who graduated with the lowest score in Med School?
" answer "Doctor".
A lot of people are just in it for the money.
They may say they like helping people but they are in it for the money (How a lot of doctors in California will prescribe "medical marijuana" for "problems sleeping") They will be so tight with their money and be blind to all benefits such systems will have, and will not pay unless things work the way THEY want it to.Data for these assertions please?
The price for becoming a doctor is quite high.
Yes, it really needs to work the way THEY want it to for very specific but difficult to explain reasons.
Bad product+high price=low adoption.
Is that so hard to understand?
And that would be Bad Product on many, many levels including the proprietary EMR company owns you after you use their product.
No conspiracy here.6.
Uneducated staff.
For most practices you will have 1 or 2 doctors  1 or 2 nurses (with Associates or BA degrees) then a staff of 4 or 5 with High School degrees.
That staff runs the business for the most part.
They lack the patience or discipline to learn such technologies and to use it for its best advantage.
Also many of them feel sub adequate (as they need to deal with the high egos of the Doctors) so they are afraid to ask questions or point out problems.More like they lack the time for frequently faulty, frequently lousy, non-standard products that they have to learn over and over again because they are prevented from teaching it in medical school by the 100's of incompatible products out there.
The proprietary EMR companies have bought the politicians and are now ramming their proprietary stuff down our throats.
Tell your Congresspersons that we need a law that only Affero General Public Licensed software can be purchased with taxpayer money.
	</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28465039</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28464483</id>
	<title>Re:Who keeps the records?</title>
	<author>will\_die</author>
	<datestamp>1245928980000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext>For most people this would be a lost item, not unlike the medical records from your childhood.<br>
This was and idea brought up by Bush, but it was for people who were expecting medical problem and instead of having a medilert braclet you had a one that stored your medical records so in the even of an emergency all your latest tests, images and records would be on you.</htmltext>
<tokenext>For most people this would be a lost item , not unlike the medical records from your childhood .
This was and idea brought up by Bush , but it was for people who were expecting medical problem and instead of having a medilert braclet you had a one that stored your medical records so in the even of an emergency all your latest tests , images and records would be on you .</tokentext>
<sentencetext>For most people this would be a lost item, not unlike the medical records from your childhood.
This was and idea brought up by Bush, but it was for people who were expecting medical problem and instead of having a medilert braclet you had a one that stored your medical records so in the even of an emergency all your latest tests, images and records would be on you.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463939</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28468469</id>
	<title>Re:Hanlon's Razor</title>
	<author>TheLoinKing</author>
	<datestamp>1245953700000</datestamp>
	<modclass>Funny</modclass>
	<modscore>5</modscore>
	<htmltext>The Allergists voted to scratch it and the Dermatologists advised against rash moves.
The Gastroenterologists had a gut feeling about it, but the Neurologists thought the administration had a lot of nerve, and the Obstetricians stated they were all laboring under a misconception.
The Ophthalmologists considered the idea short-sighted, the Pathologists yelled, "Over my dead body", while the Pediatricians said, "Grow up!"
The Psychiatrists thought the whole idea was madness, the surgeons decided to wash their hands of the whole thing and the Radiologists could see right through it!
The physicians thought it was a bitter pill to swallow, and the Plastic Surgeons said, "This puts a whole new face on the matter."
The Podiatrists thought it was a step forward, but the Urologists felt the scheme wouldn't hold water. The Anesthesiologists thought the whole idea was a gas and the Cardiologist didn't have the heart to say no.
In the end, the Proctologists left the decision up to some butt hole in Obama Administration.</htmltext>
<tokenext>The Allergists voted to scratch it and the Dermatologists advised against rash moves .
The Gastroenterologists had a gut feeling about it , but the Neurologists thought the administration had a lot of nerve , and the Obstetricians stated they were all laboring under a misconception .
The Ophthalmologists considered the idea short-sighted , the Pathologists yelled , " Over my dead body " , while the Pediatricians said , " Grow up !
" The Psychiatrists thought the whole idea was madness , the surgeons decided to wash their hands of the whole thing and the Radiologists could see right through it !
The physicians thought it was a bitter pill to swallow , and the Plastic Surgeons said , " This puts a whole new face on the matter .
" The Podiatrists thought it was a step forward , but the Urologists felt the scheme would n't hold water .
The Anesthesiologists thought the whole idea was a gas and the Cardiologist did n't have the heart to say no .
In the end , the Proctologists left the decision up to some butt hole in Obama Administration .</tokentext>
<sentencetext>The Allergists voted to scratch it and the Dermatologists advised against rash moves.
The Gastroenterologists had a gut feeling about it, but the Neurologists thought the administration had a lot of nerve, and the Obstetricians stated they were all laboring under a misconception.
The Ophthalmologists considered the idea short-sighted, the Pathologists yelled, "Over my dead body", while the Pediatricians said, "Grow up!
"
The Psychiatrists thought the whole idea was madness, the surgeons decided to wash their hands of the whole thing and the Radiologists could see right through it!
The physicians thought it was a bitter pill to swallow, and the Plastic Surgeons said, "This puts a whole new face on the matter.
"
The Podiatrists thought it was a step forward, but the Urologists felt the scheme wouldn't hold water.
The Anesthesiologists thought the whole idea was a gas and the Cardiologist didn't have the heart to say no.
In the end, the Proctologists left the decision up to some butt hole in Obama Administration.</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463455</parent>
</comment>
<comment>
	<id>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463951</id>
	<title>Re:Electronic Health Records is very hard</title>
	<author>fbjon</author>
	<datestamp>1245921780000</datestamp>
	<modclass>None</modclass>
	<modscore>1</modscore>
	<htmltext>In Finland there are already systems for EMRs, where I'm working they were introduced around 2002 or so, and gradually phased in from a purely paper/folder-based system. Moreover, although different districts use different systems (or a few different systems at least), they have to interoperate in exchanging records. As I understand it, there's an initiative to make systems across the EU interoperate, but I'm not directly involved in the EMR stuff anymore and I can't remember the schedule for that.<p>Now, it may not be a dance on roses, but things aren't in the stone age here, at least.<nobr> <wbr></nobr>:)</p></htmltext>
<tokenext>In Finland there are already systems for EMRs , where I 'm working they were introduced around 2002 or so , and gradually phased in from a purely paper/folder-based system .
Moreover , although different districts use different systems ( or a few different systems at least ) , they have to interoperate in exchanging records .
As I understand it , there 's an initiative to make systems across the EU interoperate , but I 'm not directly involved in the EMR stuff anymore and I ca n't remember the schedule for that.Now , it may not be a dance on roses , but things are n't in the stone age here , at least .
: )</tokentext>
<sentencetext>In Finland there are already systems for EMRs, where I'm working they were introduced around 2002 or so, and gradually phased in from a purely paper/folder-based system.
Moreover, although different districts use different systems (or a few different systems at least), they have to interoperate in exchanging records.
As I understand it, there's an initiative to make systems across the EU interoperate, but I'm not directly involved in the EMR stuff anymore and I can't remember the schedule for that.Now, it may not be a dance on roses, but things aren't in the stone age here, at least.
:)</sentencetext>
	<parent>http://www.semanticweb.org/ontologies/ConversationInstances.owl#comment09_06_25_0228217.28463467</parent>
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