"What happens when the computer won't let you have a medication"

That is much of the idea. When the IPAB (Independent Payment Advisory Board) says that a patient should not get NewMed when the diagnosis is one of 12 diseases, the software can flag the restriction according to the latest rules download.

The doctor can only prescribe a medication through the medical software, so that is that.

The software will save the IPAB and the bureaucracy untold hours and costs by implementing these restrictions in a detailed and immediate way, a way which would be impossible if each prescription required a human review. The doctors will appreciate this, because it will save them from being prosecuted or de-licensed if they had made a mistake and prescribed the wrong thing.

Eventually, the rule base will become so gigantic and sensitive that we really won't need doctors in the usual sense. It will be enough to choose from the checklist of allowed medications and procedures, based on each checklist of medical conditions and the helpful pop-up guides beside each treatment.

Finally, being a doctor will be converted from a hit-or-miss craft into a professional and competent interaction with the vast knowledge of a computerized database.

(I hope the above is sarcasm, but it may not be.)

I can show you, not just tell you, cases in which computerization has hindered, not helped operators monitor process systems.

When your job is monitoring radioactive process systems, fiddling with a computer is not your job. When your job is medicine, fiddling with a computer is not your job.

And here's the rub: when your job is computer programming, medicine is not your job.

Yes, doctors often do not have the time to research medications new to the field. An advisory system would be sensible, but not a dilution of the responsibility to the patient.

Last year, when I temped at the Yale School of Medicine, there was a panic when someone's laptop that contained copious amounts of confidential patient information got stolen. The University faced millions in fines, and EVERY SINGLE MEDICAL DEPARTMENT within the University and the Hospital had to have new encryption software installed on every electronic device that everyone (students, drs, interns, nurses, etc.) used on a daily basis. It was like herding cats to get these people to comply. And I'm talking iPhones, laptops, desktops, everything that anyone used that just might contain any patient information. I shudder to think of the money that got dumped into that enterprise. Although I am happy to say that the department I worked in was one of the few to have 100% compliance before the enforced deadline.

That said, there was an item on the local news about how patient information was available and being SOLD by hackers who have found ways to break into the encrypted systems and compromise patient information, including social security numbers, in numbers into the hundreds of thousands. Nice, huh? It was ABCnews that broke the story.

I have had some insights into the medical (and banking) portions of the software industry and I have been horrified. To keep it short, software is a product where you pretty much get what you pay for; there are no shortcuts. If you go with the lowest bidder, you'll get crap software, nearly every time. Some of the stuff that banks do with their software makes me want to keep all of my money in a Mason jar buried in the back yard.

Having said that, I have seen success stories. The medical lab company that my wife works for has a pretty slick system for managing tests and results. When they collect specimens, they bar-code each draw tube, and scan the bar codes to associate the draws with the patient's name and the doctor's lab order. The system will tell them if they've drawn the proper specimens in the proper types of tubes. (There's a bunch of different types of draw tubes that have different types of preservatives in them. You can recognize them by the colors of the tube stoppers.) Anything that isn't ordered stat gets collected together and sent during the evening to a centralized lab where it gets run overnight.

The machines at the lab scan the bar codes when they run the test, and they associate the test results with the bar code. The system then matches this up with the patient and the doctor. Most of the doctors that use this company have printers in their offices that are tied into the company's network. The results go to their printers and get printed around 5 AM, so when the doctor walks in the next morning, the results of all of the tests he has ordered are wating for him. If a test isn't run for some reason, or a tube is missing, my wife gets a notice in her email in the morning and she can take immediate action to track down the problem. The system might not be saving a lot of money over paper processing, but it sure has sped up the turnaround time -- it used to be that most lab results took 2-3 days to turn around.

Also in the morning, my wife gets a statisitcal reports on all of the tests that were run. If a machine is starting to go off of calibration, she can see that before it becomes a problem. This is a big improvement over the old days when the info was only collected about once a month and had to be hand assembled and plotted.

"That is much of the idea. When the IPAB (Independent Payment Advisory Board) says that a patient should not get NewMed when the diagnosis is one of 12 diseases, the software can flag the restriction according to the latest rules download."

Medicare already works this way -- and the system is 100% gamed. Every doctor worth his or her salt knows diagnosis codes to use that will get the patient whatever treatment the doctor thinks they need.

"Depending on where and when information on a patient's prescriptions were entered, the complete list of medications may only be found across five different screens."

Versus the information being found in five manila folders scattered across the file rooms of five different doctor's offices.

How well encrypted do you think all your paper files and hard-copy xrays are?

I loved M.A.S.H. but I think it is silly to be nostalgic/ sky is falling because they digitized the ubiquitous clipboard hanging at the end of every bed.

Seversl months back, a blogger who happens to be an anaesthetist published some of the standard codes. I was both amused and horrified to note that there are five codes for having been burned by - water skis. Were they in a shop or warehouse, was an accelerant involverd... ER goes CSI!

About four years ago, i changed health care from hospital A to hospital B. They are about seven miles apart. It took two months for A to transfer hard-copy files to B, good it was not Saratoga NY to San Diego CA. So yes, a capability for electronic transfer would be nice. OTOH, I do not really weant my records instantly available to any doctor with a PC, and certainl not to Deputy B. Fife of the two-person police department.

Large hospitals have long budgeted for IT on a large scale. And a local GP can afford some brand of personal computer. But the software cost to the GP, or a free clinic, is ridiculous... Will they be able to contract with a hospital to have their records encoded/stored/accessible rather than every doctor needing to have the entire system?

Personally, I think it's a good thing that John C. Smith can check into a hospital a few minutes after John B. Smith and, because the nurse must use a scanner to confirm his identity before she administers any medication or tests, not get John B. Smith's medication by mistake from a tired or inattentive nurse.

My wife sees three different doctors who each presribe medication to her. Because our health provider uses digitized medical records (from the same database - so no delay between uploads), each one can see what the other one is doing.

And if she goes to the emergency room, a complete record of her medical history is immediately available - no need to have a nurse calling around town or making a distraught husband remember all the medications his wife is on.

On the other hand, the security concerns expressed in this thread are valid ... and worrisome. But, as Watergate showed us, paper files are not secure either. Paper files in a metal box do force the burglar to actually go to the record rather than hiring his neighbor's ten-year-old kid to bring it to him.

I install EMR (Electronic Medical Records) software in Canada. My clients are doctors and clinics.

"software is a product where you pretty much get what you pay for; there are no shortcuts. If you go with the lowest bidder, you'll get crap software, nearly every time."

Not true. There is lots of Open Source software that does a great job. Firefox, Irfanview, Notepad++, etc.

I install an Open Source EMR developed by a University (McMaster) with a large teaching hospital. The software is called Oscar. It is used across Canada by many clinics and University associated hospitals. Look for 'Oscar McMaster'.

I have installed many sites in Montreal and my clients are very happy. Especially with the price. Did I mention that it's Open Source?

If the government does something, you will get government specs for a government price.

¨What happens when the computer won't let you have a medication your doctor feels you need? Do you just go without?¨

Maybe go see a doctor in Tijuana.

Then go to a farmacia. Or if you know what you want, just go straight to a farmacia.

"How well encrypted do you think all your paper files and hard-copy xrays are?"

Since when can a guy in Croatia get my hard-copy files with a few mouse clicks?

See how the bias runs here?

The answer is somewhere in the middle. And it will be accompanied by the hard, nasty realization that people get sick, are sick and die, no matter what is done with their information. Confidentiality might be modesty's last stand, and people might fear that their hemhorroidectomy gets published in the employee newsletter, but nobody got to pick the costume they wear in this play. Yes, we all get colonoscopies after age 50.

I wonder: how much of the drive for confidentiality is by, or on the behalf of, people who need to sucker an employer into paying their medical costs?

"I install an Open Source EMR developed by a University (McMaster) with a large teaching hospital. The software is called Oscar. "

I didn't know that any open source software for that sort of thing existed, although it doesn't particularly surprise me. However, that in itself isn't going to be a cost magic bullet. Linux is open source, but few of the people who use it download the source code and the makefiles and compile it themselves -- most people buy an off-the-shelf package from a vendor like Red Hat. A doctor hasn't got time to keep up with updates and bug fixing for an open source program -- that's why they hire you.

I am absolutely against having all my medical info online. Yeah, a receptionist at my Drs office can go snooping through my file, but that's about the extent of it. The entire world has no business knowing whether I had an STD in college or precancerous cells 3 years ago.

I fail to see how the (made up but here to stay now) Right to Privacy can allow me to have an abortion but not to keep other medical details private.

My sister who works for a hospital, related a story to me on Sunday.

She works for a clinic that is separate from the main hospital. The registration system is an old character based system that looks like it is from the pre-windows days. They ask an 80 year old woman, living in Pennsylvania for her emergency contact. The emergency contact is her niece permanently living in Kentucky. So the software requires that not only the name, phone, but a DOB for the emergency contact.

Why do you need the DOB for an emergency contact you ask?

Apparently the system automatically creates a medical record number (MRN) for the emergency contact, regardless of location and has been doing this for 15+ years!

That no one has said this is stupid or asked why or had it changed after all this time is scary to me from the IT side.

From the personal side -- there are reasons I don't have a Twit or FB account. I limit my online presence to what I feel like revealing. So having a hospital make an MRN for me that I will never be close to bothers the fuck out of me.

¨You need a prescription for drugs in Mexico. What if your doctor isn't allowed to prescribe off-computer?¨

I don´t really know specifically about Tijuana( they may be more delicate about these matters being pushed up against California; but I doubt they are any different) I don´t ever remember actually needing a prescription for anything in ¨middle Mexico¨. Of course, I never tried to get a narcotic that way either; just ordinary prescription drugs.

¨So, wait -- as a healthy person, I'm paying through the nose for health care in America, and if I get sick, I have to pay to take a long trip to Mexico, to go to a drugstore that may or may not have the real medication, and may or may not give it to me.¨

Amy, I like how you fight the power in terms of TSA, but you can´t wimp out on fighting the power in other spheres.

¨may or may not have the real medication¨

just barely caught that before posting.

This might be a problem in Haiti, but not really a problem in Mexico.

I work for a large medical center in Texas as an IT person. The part of EMR that disturbs me is the cloud. All medical records, in addition to being eletronic, will be required to be uploaded and available on a centralized cloud so that once a doctor's office gets permission, they can immediately gain access to the information. However, to enable that, validation of the release of medical records would have to be minimal if anything at all. Add to that the idea that having everything in a centralized place increases the likelihood of hacks and data loss. I'm assuming that they will use fault tolerance at various levels, but still...I hate to trust the government with my medical information.

The Latin Business Chronicle article is good; I did not read your other offering, but LBC paints a good picture.

Ya know counterfeiting is a harsh word, though that is the very word I wanted to employ to describe it myself. Mexicans prefer the word generic; it helps them to get over the fact that it is ripping off.

So under 1 in 10 drugs are not original, and about 1 in 40 are original but not controlled by the medical cartel but rather the medical mafia; choose your mafia( and of course there is always the American Medical Cartel) Would trying to navigate such an uncontrolled medical landscape as Mexico scare you? Of course, Mexican medicine does try to cater to Americans specifically along the border. You can probably find an offering that you could be comfortable with at a price below the cost north of the border.

On a lighter note,

¨Although the active ingredient is present, the medications may be laced with potentially hazardous material. In one case, counterfeit medication for erectile dysfunction was found to have traces of LSD, a psychedelic drug.¨

It took an out of the box, third-worlder to think that one up( and market it!!!). EDD with LSD.
RAD