Title translation: the effort to create Electronic Medical Records (EMR) will be a lot bigger than the Y2K effort to make the world’s computer systems survive the arrival of 1 January 2000. Virtually everybody in the US will be impacted, and it will provide a treasure trove of stories about fabulous failures and super successes in the software industry.
If you doubt the truth of the title, consider two facts:
- The US government will attempt, and probably succeed, to control the EMR development and usage process.
- There is no 1 January 2000 – no deadline by which it has to be good enough.
What are the potential problems with EMR? Consider the amount of information about each of us that already exists. Consider just your credit rating. Personally, I think the major credit reporting companies do about as good a job of keeping accurate data as is possible today. Yet there are errors throughout the system, some caused by the deliberate actions of criminals stealing your identity, some caused by some inadvertent screw-up in the literally thousands of companies that send data to the credit agencies. A real universal EMR solution will have even more of your data:
- Much of your financial data allowing you to be billed or more likely just have your accounts debited.
- Information about all your insurance policies.
- Even more identity information than exists today.
- Plus all of your medical records, including test results, X-Rays, doctor visit summaries, ….
It will be a substantial increase in the data that the government, and all of those companies, has about you.
The Health Information Portability and Accountability Act (HIPAA) will become a joke. It will prevent your best friend from finding out how you are doing in the hospital, but will enable any aspect of the medical-insurance-government complex to freely access, and update, any of your information.
Since there will be thousands of companies and agencies that will need to access and update your data, this will have to be the ultimate Cloud Computing solution, with your data spread around the world. See my earlier blog on Data in the Cloud if this doesn’t scare you.
As an aside, we will need a real national ID card to make it work. A couple of decades ago I worked on a student records system. As we were doing some database maintenance, we found up to four different students sharing the same social security number. We guessed they were different because they had different names, genders, and birth dates differing by decades. We also found students with multiple social security numbers, or at least multiple social security numbers all referencing a person with the same name, address, gender and birth date.
There is a fascinating article from the Association of American Physicians and Surgeons (AAPS) titled “Myth 32. Information will improve efficiency and safety.” One of the main points is that EMR systems are inherently very complicated, and thus error prone and hard to use. Again, I suggest you read this article if you think this isn’t a very serious problem. One study reported in the Washington Post and cited in the AAPS article showed that more than one in five hospital medication errors were caused at least in part by computerized systems.
No problem. We’ll simply legislate that the system must be simple to use and increase efficiency. Back in 1897, State Representative T.I. Record of Posen county introduced House Bill #246 in the Indiana House of Representatives that pi should be 3.2, thus simplifying engineering calculations. Fortunately, this bill did not pass.
Personally I believe that EMR is a necessary part of a real solution to cost-effective medical care in the US. I’ve watched an older friend as she deals with a handful of doctors and a pharmacy. There are sometimes communications gaps that could be filled if they all knew what each other was doing. At the moment, the pharmacist has the best view of what she is taking and periodically issues warnings and suggestions. The pharmacist has access to all of her prescription history, and cares.
The AAPS article states a number of problems with using information technology to improve the medical delivery system. In some sense, I believe it is a little too optimistic. The short term (i.e., next 20 years) result will be that we will have a 100GB of medical data on every person in the US. That is except for the 10% which will have more than one set of inconsistent data, and the 25% that will have only 5% of the appropriate data. The data that is there will be about 95% correct, and hopefully the other 5% won’t kill you. This is a lot of data. If my estimate is close, the medical data for a thousand people will be about the same as all of the data in the Library of Congress in 2009. We won’t have any idea how to secure it, nor we will know how to make it available to the “right” processes and people at the right time, nor will we have all of the processes and procedures to do everything we should with it. Even if we get to the point that we solve those minor problems, we still won’t have enough data to determine if this particular John Smith will benefit from a treatment that has a 10% chance of success on average, or will be harmed by a treatment that has a 95% chance of success on average.
In spite of all of that, I firmly believe that we need to aggressively more forward with implementing EMR. According to a story I can’t verify, Napoleon wanted a main road to Paris to be lined with tall trees to shade the troops as they marched triumphantly back to the capital. Some colonel told him that it would take 40 years for the trees to grow to make shade. Napoleon said “Then you’d better get started immediately.” Whether the story is true or not, two hundred years later, the trees are still there providing shade.
The last word:
According to Wikipedia, the world wide cost of the work done in preparation for Y2K was over US$300B. The US government is expected to initially invest something on the order for $45B to encourage or more likely compel doctors and hospitals to use electronic medical records systems. This doesn’t count the billions private companies are spending already on developing their own components and systems, and the billions more that will be spent making them work together. If you are a young software developer looking for a career, I have one phrase for you: “Electronic Medical Records.”
Keep your sense of humor.