Two links on the topic of medical IT
Posted by Jacques Chester on Thursday, July 16, 2009
Some of you might know that I’ve harboured a small enthusiasm for aggressively using IT to drive down costs of health care, as well as improving quality, safety and providing data for researchers. In the future it may even be possible to couple these databases to expert systems that provide secondary diagnoses to help doctors do their work and keep an eye out for the bad apples.
In the USA US$20 billion dollars of Obama’s stimulus package has been allocated to encouraging practitioners and hospitals to introduce electronic medical record systems. Each recipient will source and install their own systems.
Much as it pains me to say it, this is a job that cries out for consolidation. Medical records work best when they are universal and portable. The approach taken in the US stimulus bill won’t achieve that. And even if it did aim at a central records service, the history of large IT projects is one of nearly universal failure.
One software package that might be a candidate for such a system is the USA Veteran Health Administration’s system VistA (not to be confused with Windows). The VHA has the lowest cost and the highest safety of any part of the US health system; the stable, mature, universal and user-friendly nature of the VistA system seems to have had a very large role in providing these outcomes. However it looks as though VistA will not even get a look-in as part of the US$20 billion allocated for healthcare IT reform.
This entry was posted on Thursday, July 16th, 2009 at 2:31 PM and filed under Health, IT and Internet, Politics - international.
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When hospitals don’t even report the correct number of wards open, as has happened in Victoria, it’s hard to imagine them getting the details correct.
It looks like the stimulus packages in the US and here are not really geared to improving services for citizens, but keeping select businesses happy.
There are two ways citizens can benefit from a nationwide health record system:
* Epidemiologists can discover patterns easier
* Health professionals know the history of the individual patient
However, the big problem is setting up the appropriate access controls, and ensuring currency of information. This was all defined by the OMG Healthcare Domain Task Force years ago, in the Clinical Observation Access Service, and, in a wider context (but not finalized), the Healthcare Services Specification Project.
Key among the requirements is unambiguous authentication and authorization of consumers of clinical data. By itself, nationwide authentication and authorization systems can provide huge benefits to all types of activities, not just those related to clinical observations, but I’m still to see anything here or in the US (I may have missed it) that pushes such essential infrastructure.
Has anyone else seen initiatives that put the basics in before the medical stuff which depends on the basics?
Posted on 16-Jul-09 at 4:39 pm | PermalinkI should have thought it’s an obvious case for creating, and if necessary mandating, standards for record contents, formats, access protocols etc, but not at all a case for a big centralised database.
Quite the reverse – as you yourself point out, the risk of failure with big centralised projects is very high. And once in they tend to be extremely inflexible, stifling all innovation.
Posted on 17-Jul-09 at 9:08 am | PermalinkVISTA has been freely (as in free beer) available and well regarded for many years but governments just won’t look at something that isn’t proprietory.
I also understood that Vista was based on an old programming language that has it’s problems even for FLOSS people?
The Victorian Government is committed to the Cerner Corporation system as used by Childrens Hospital of Pittsburgh – see below. It’s already running about 3 – 5 years late and over budget to buggery.
Posted on 17-Jul-09 at 12:20 pm | PermalinkFXH — medicine is an area where usability moves from a low-priority non-functional requirement to top of the list behind availability. Unusable systems cost lives.
What worked well about the VHA VistA system was a) it was developed via a prototypical opensource process, with b) substantial, ongoing input from its users.
Posted on 17-Jul-09 at 12:32 pm | Permalinkjacques – I know a lot about VISTA from years ago – I’ve even had a fiddle with it – whats the underlying code language and issues? I forget.
Posted on 17-Jul-09 at 12:43 pm | PermalinkFrom memory not exactly FLOSS but close. MUMPS MUMPS.
From wiki
Posted on 17-Jul-09 at 6:47 pm | Permalinkjacques – comments on MUMPS from a hip, streetwise, young, 2009, savvy, switched on, Web3.00, dude please.
Or even comments from you would do.
Posted on 17-Jul-09 at 6:51 pm | PermalinkI’d say it looks like a classic 1960s programming language: hairy. But the simple fact is that it works, works well and has been proved to work well for decades.
We can live with MUMPS programming for the same reason billions of dollars are moved around by COBOL every day: it works.
Posted on 17-Jul-09 at 6:59 pm | PermalinkOf course, on the other hand.
Posted on 17-Jul-09 at 7:08 pm | Permalinkbut access to code poets who know what they are doing in MUMPS……….?
Posted on 17-Jul-09 at 7:08 pm | Permalinkooh nooo java aahhgggghhhh
Posted on 17-Jul-09 at 7:08 pm | PermalinkI gotta admit, I laughed.
I’ve seen Java described as “the new COBOL” on some websites. I’m unsure if that’s fair to COBOL.
Posted on 17-Jul-09 at 7:10 pm | Permalinkooh quick – I’m getting all nostalgic for #coders and #politics – I might fire up pIRCh
Posted on 17-Jul-09 at 7:12 pm | Permalink