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Thread: EMR- Should government set up a common database...

  1. #1
    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    EMR- Should government set up a common database...

    The Boston Globe recently published a lengthy article about the profession wide frustrations with getting EMR to work.

    All the usual complaints of errors and vendor problems.

    A letter to the editor suggested that one way to really help make it work better was if the government set up a database that all vendors and their programs would go through and be compatable with. As I am anything but savvy on this subject but I know many of you are is this an idea who's time has come?

    Simply put is this workable?

    Please keep to the subject as I know this topic quickly turns political which is not my intent as I'm curious as to how to fix this problem we're all facing.



    Here's the letter.

    A major problem with EMR is the incompatibility between systems. A provider wishing to switch systems, or a patient going to different providers, is severely disadvantaged.
    The government should provide a common data bank, and all digital record companies should be required to construct a translator between their system and the common data bank. This way, innovations in the systems of digital providers would allow flexibility of the marketplace.
    Thanks for the civil discussions!
    Last edited by Uncle Fester; 07-31-2014 at 03:57 PM. Reason: transfered letter to top of thread...

  2. #2
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    do you really want the goverment they already have there hands on way to much? I think the medical field chould come up with there own fix.

  3. #3
    Optimentor Diane's Avatar
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    To answer the question of the thread...NO. Government needs to stay out of healthcare.

    Diane
    Anything worth doing is worth doing well.

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    Master OptiBoarder rbaker's Avatar
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    It will be very difficult for me to reply in an apolitical manner but here goes. First of all there can only be a single comprehensive schema and data dictionary. Any application whether designed by the government or a private company must be tested against this database. To my limited knowledge about the only one who seem so comply with anything like these standards is the Veterans Administration.

    Well, that wasn't as difficult as I thought!

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Quote Originally Posted by rbaker View Post
    It will be very difficult for me to reply in an apolitical manner but here goes. First of all there can only be a single comprehensive schema and data dictionary. Any application whether designed by the government or a private company must be tested against this database. To my limited knowledge about the only one who seem so comply with anything like these standards is the Veterans Administration.

    Well, that wasn't as difficult as I thought!
    Thanks Dick! This is the kind of response I'm looking for.

    Any thoughts Sharpstick?
    Last edited by Uncle Fester; 07-30-2014 at 09:49 AM.

  6. #6
    Master OptiBoarder
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    No way. First of all...I agree with Diane, but on a practical manner...so many specialties. Do I want someone who works in orthopedics to have the same program as ophthalmology? No. It is just to specific. You would have to have a government program for each field. Even then...do you think they would put someone with optical knowledge in to work on the optical program. Prob not. We all have experienced insurance websites that were created by people without optical knowledge. It's never good.

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    OptiBoardaholic OptiBoard Silver Supporter
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    Actually EHR/EMR do all follow a single set of structure rules and data inclusions, in theory. The government health reform created what should be included and how it should be structured for universal sharing, Medicare billing rules are the axis of which these rules follow. If any of you have gone through Medicare Attestation then you know what I mean. I THINK it was GW Bush era that created the design (I could be wrong though). Anyway, it is the client side user interface that each company makes to their own recipe. Thats where all the crappiness starts to happen in addition to poor staff training on the software which creates errors or holes in the data.

    Also the grand plan is supposed to have all the patient records uploaded to a cloud like portal that is accessible to docs/pts/biller/nurses/etc... Each person would have special user rights so that a biller for example wouldn't be able to see as much as the doc. We have used one of these portals with Compulink and I actually had some patients take advantage of it.

    I didnt read the article in the Boston Globe so maybe I am off base with my response...Anyway have a nice day

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    I'm doing a lot of schema/db design work right now (we aren't too busy in the lab lol), so my take is a bit different. In a "perfect" system, we have a unique individual table of all the people who are medically "involved". Each row in the table is a person. This row is then linked to things like medications taken, health care history, specialists seen, etc etc etc...

    Each specialty would have separate tables of things like patient notes, x-rays/mri/ct scan dates and links to the scan data and reports, but medications and disease history would be available to all as it is part of the the patient data. So things like a patient vision Rx is stored in the provider tables, but linked to the patient.

    So, when a provider, be it MD/OD/whatever, calls up a patient, the provider can see the information he/she needs to know.

    The schema would be fairly easy to construct, but the devil is in the details, especially if politics are allowed to play a part in the design of the system.

  9. #9
    Pomposity! Spexvet's Avatar
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    It's feasible, and would help. The government wouldn't be the problem - the companies selling *you* the end product will want exclusivity. It'll be the whole Betamax/VHS issue all over again.
    ...Just ask me...

  10. #10
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    There are so many facets to the problem...err, challenge.

    Government funding is one thing. Government regulations on what constitutes a credible EHR is another. Much to my chagrin, we have these regulations now...but the biggest problem I see is: how these regulations get implemented and worked into the various private EHR companies out there is a disaster in my book. The government sets the rules, and the rest of us scramble to find a method to make it work. This is silly. It should be standardized. (ok, standardized for each specialty).

    It would be a heck of a lot easier to administer a single payer system. We've been doing it for decades with medicare and Medicaid. Sure, there is some fraud and mis-management, but at least you know what you are dealing with...both the patients and the providers. In private health care insurance, its dog eat dog. Health care should not be dog eat dog. By and large, medicare is easy to administer and if you are a patient, you know what you are getting. So while I know the government always seems to overpay for toilet seats, this is not exactly the same case in healthcare. Most of the waste is from providers that either abuse the system, or don't communicate with other doctors and hospitals and share information. It shouldn't be this hard. Give me a standard.

    Also remember that optical care is not always considered medical care. Don't think of it as the government taking over eyeglass sales. It's the private carriers like Davis, VSP, etc that are trying to take control of the optical world. In organized optometry, we often seek the legal and administrative relief of government, due to aggressive tactics of private insurance carriers.

    So don't try to fit healthcare into some preconceived notion of political correctness.
    Last edited by fjpod; 07-30-2014 at 03:24 PM.

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    Master OptiBoarder rbaker's Avatar
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    Quote Originally Posted by Spexvet View Post
    It's feasible, and would help. The government wouldn't be the problem - the companies selling *you* the end product will want exclusivity. It'll be the whole Betamax/VHS issue all over again.
    Certainly not. There are specific diagnostic and treatment code that must be adhered to. Can you just imagine different codes for every insurance carrier.

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    Are we talking about a unified file format for patient records or a depot of patient information?

    I think this is an issue for the "industry" to address, EMR is still in its' relative infancy.
    Clinton Tower

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Here's the letter.

    A major problem with EMR is the incompatibility between systems. A provider wishing to switch systems, or a patient going to different providers, is severely disadvantaged.
    The government should provide a common data bank, and all digital record companies should be required to construct a translator between their system and the common data bank. This way, innovations in the systems of digital providers would allow flexibility of the marketplace.
    Thanks for the civil discussions!

  14. #14
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    I agree...ideally, the database would exist like the Social Security database does, living on some (or several) server farms, with access granted only to licensed medical practices.

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    This may open up a can-of-worms as to who owns the "data".

    Right now our practice owns our patient records, under the scenario at hand, would we be forced by the government to release our records to the government?
    Clinton Tower

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    Doh! braheem24's Avatar
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    The patient "Owns" the record,

    I would prefer the data be stored locally at the doctor's office while still accessible through a patient portal that allows the patient to import all health history into his/her own cloud based service.

    The patient would have the option to forward/share files with the doctor of their choosing through their portal.

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    Quote Originally Posted by scriptfiller View Post
    This may open up a can-of-worms as to who owns the "data".

    Right now our practice owns our patient records, under the scenario at hand, would we be forced by the government to release our records to the government?
    Actually, you *don't* own your patient records, you are just their custodian.

  18. #18
    Objection! OptiBoard Gold Supporter shanbaum's Avatar
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    Quote Originally Posted by MikeAurelius View Post
    Actually, you *don't* own your patient records, you are just their custodian.

    That's not generally true, although I can't say for sure that it's untrue in every state. Generally, as for any person, the work product of a physician is his property (unless he's employed by another; an employee's work product is usually the property of the employer). Of course, some of a physician's work product may be in the form of services (like installing a new knee), and one of the distinguishing characteristics of a service is that it's not tangible property.

    Regulations control what he can (or more often, can't) do with the records, but they're his.

    There are already regulations requiring the sharing of such records in certain cases, and that doesn't affect the property rights involved.

  19. #19
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    Thanks shanbaum. Our practice has purchased numerous corporate PV's and the records were always considered property of LUX in our transactions.

    Again, this will open up a can-of-worms as to the technicality and legality of records and the information contained therin.

    Not meant to be "political" but what has the government done right?
    Clinton Tower

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    Pomposity! Spexvet's Avatar
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    Please don't go there. You'll get absolutely no agreement.
    ...Just ask me...

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    Master OptiBoarder CCGREEN's Avatar
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    "In this present crisis, government is not the solution to our problem; government is the problem."
    Can we now move this thread in a better direction?

  22. #22
    Doh! braheem24's Avatar
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    Is this getting political?

    I want to live in a country where I can...


    1. Pay no taxes to subsidize the entitled.
    2. Not be forced to buy insurance.
    3. Buy a machine gun or any gun I choose.

    Now someone please add the countries that will fulfill my dreams...

    I'll start the list alphabetically...

    1. Afghanistan

  23. #23
    Forever Liz's Dad Steve Machol's Avatar
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    Closing this thread now.


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