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HCCD Report New Jersey 08002Group Submission for Health Care Community Discussion Hosted By The Cherry Hill Linux User’s Group Event date & time: December 30, 2008 Summary We focused on Health Care IT System, which are referred to in many debates as the magic bullet that will make health care affordable again. We agree that IT can and must play a major role in Health Care Reform, but it could be a major hindrance if we make the wrong technology choices. The Federal Government through Health and Human Services (HHS) should
Complete Report This event was organized in a very short period of time by the members of the Cherry Hill Linux User’s Group (CHLUG). We are a technical enthusiast group based in Southern New Jersey meeting consistently each month for last 10 years. It was attended to by 12 members of the local community and will be considered the January 2009 CHLUG meeting. Our focus has always been to spread the concept of openness in computing, embodied in the Linux operating system, to our local community. Naturally, many of us are also concerned about the lowly and degrading state of health care in our country. Specifically concerning to us is the popular notion that information technology (IT) should be the main tool for fixing it. As the following report will illustrate, in a general sense, we feel that IT can provide much needed support, but not without with the Department of Health and Human Services (HHS) thoroughly embracing the concept of openness. In fact, embracing “closed “ medical information systems goes against the basic fiber of peer review and scientific validation in our successful medical history and can actually further degrade an already ailing health care system. One major problem that we see with the current state of IT in American medicine is the presence of too many prominent incompatible proprietary vendors. Standards bodies like Certification Committee of Health Care Information Technologies (CCHIT) offer a good start helping to ensure a compatible back end for technicians to support, but do not go far enough ensuring a compatible front end for medical practitioners to use. The result is that doctors and nurses must be expensively trained and retrained on these nonstandard interfaces multiple times over their careers. We discussed at length the waste. There are 2.4 million registered nurses in the US [1]. Each makes roughly $30/hour. Eachnew IT system takes them 8 hours minimally to train, time away from direct patient care. That is $576 million dollars to minimally train nurses. Waste is introduced because it must be repaid each time a nurse changes jobs using a different incompatible, nonstandard system. Previous training many times is useless for the nurse’s long term practice because it is so vendor specific. Additionally, nursing schools are not teaching the electronic health record yet. In our meeting room we had three nurses present, including myself, and a nursing student validating this notion. We talked about cost escalation when considering the 850,000 [2] physicians making about $100/hour on average, given 8 hours training per new system. Thats another $680 million dollars incurred every time physicians rotate presumably several times in their careers. It is also a fact that nurses and doctors resist learning new IT systems. Could it be that practitioners instinctively know it’s a waste of precious resources? Additionally, the truly unforgivable waste in the current vendor dominated system is that at the end of training too many practitioners are still not proficient enough and the IT systems themselves introduce a new opportunity for unsafe practice. Someone in the room cited a study entitled “Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors”[3] published in 2005 supporting this notion. It was noted that this well known study was done at a local academic medical center, Hospital of the University of Pennsylvania. We briefly talked about the similar dollar waste and risk incurred by training pharmacists,dietitians, social workers, medical assistants, clerks and other ancillary staff to use vendorspecific medical IT systems again and again. Our solution to this problem is to federally mandate training all students of medicine andnursing to use the open, freely available, and highly regarded Veterans Health Information Systems and Technology Architecture (VistA). This academic course work should be done before actually practicing in the field and can be incorporated into all medical and nursing school curriculum. It can be accomplished using remote access to the VistA system itself over the Internet without any cost to individual institutions. It would cost the tax payers a negligible amount of money to support, but what they would get in return over time is a renewed medical community knowing better how to perform their role using a standard electronic medical record (EMR) system. The dollar value is realized by less training costs when faced with learning a new system in practice.The true health value of this is safer practice because a base level EMR proficiency is presumed by licensor. Other opportunities to use VistA and other open projects could be encouraged as applicable like this too. Another avoidable problem present in health care that we discussed this evening is the rampant greed that is plaguing what should be an endeavor of the greater good, not that of individual interest. An example of this can easily be found in the many fraudulent medical law suits and mounting pressure for tort reform to address them. More to the point of CHLUG’s concerns the recent overuse of patent law in health care for seemingly obvious technical accomplishments. For example, the U.S. Patent Office recently granted Janus Health patent number 7,249,036 B2 addressing virtually all forms of digital data transfers emanating from a physician housecall [4]. CHLUG believes that large companies wielding vague patents stifle individual innovators from enhancing our medical information systems. As a resolution, we believe that if the concepts of openness are adequately embraced then one should be exempt from liability in law suits stemming from patent infringements. Forexample, if a programmer figures out how to make VistA do a physician housecall and contributes the source code back to the project then they should not be fair game in a law suit from the Janus Health Patent 7,249,036 B2. Our leadership can easily legislate protection for those giving back to our medical systems in this way. Another concern that universally affects all IT systems is balancing the ability to identify people in a ubiquitous system without exposing them to unwarranted privacy exposure risk. Participants in the discussion pointed out that all children in the State of New Jersey,and other states like Arizona, have an immunization number issued early on in life that is nique to them and could serve as a national medical identifier without posing additional risk to financial ruin like using one’s social security number might, for example. It was proposed to have immunization numbers placed on driver’s licenses, or other wallet sizedcards, so that unconscious victims could have their electronic medical record easily accessed in case of emergency. Also concerning to us is the notion of a singular monolithic health care IT system for the entire country as is the case in some foreign nations. Although on the surface it would seem that one common format would be efficient for utilization and support, the decision to choose one vendor over the others seems too hazardous to us given the entrenched interests of closed, proprietary vendor systems already in the American market. We ask HHS to look to our friends in England for an example of what not to do. Their esteemed National Health System (NHS) originally rewarded one major American proprietary vendor over all others, then suddenly dropped them and chose another. This process has been ruinously expensive for their tax payers and does not seem to benefit anyone even the vendors, oddly enough. A better example to look at for guidance is the one implemented by our Canadian friends which seems like it will be much more successful over the long run. This is because much of the underlying architecture of the system was developed openly and locally to suit their needs. One major component is called “HL7 2.3.1 Enhanced” and greatly enriches the potential of the electronic medical record while satisfactorily protecting entrenched vendor interest and patient privacy. The Canadians were intelligent enough to keep this protocol open to anyone for peer review, utilization or enhancement. A final recommendation by one participant was to create a federally funded contest with reward money of $10 million dollars encouraging the development of open source projects for medicine. For example it was said, “We could reward the first team to port HL7 2.3.1 Enhanced to VistA”. CHLUG believes that a contest like this, though emblematic of the enthusiasm in the room, is not necessary because the forces of the opensource community will eventually accomplish this on their own anyway. It will be done probably by tech savvy medical practitioners using the system every day and“scratching their own itch”. That is the nature of openness. The question is how long can we wait for it? Respectfully submitted, University Medical School CHLUG Organizer Bryan Community Organizer
[1] http://www.census.gov/PressRelease/www/releases/archives/facts_for_features_special_editions/004491.html |
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