Wednesday, November 29, 2006

Big employers plan electronic health records (and a manned Mars expedition as a warmup?)

The Wall St. Journal article on this is not yet available electronically, so the article below from the magazine "Red Herring: The Business of Technology" will have to do (perhaps not an inappropriate selection for the purposes of this Healthcare Renewal entry!)

Big employers plan electronic health records - and plan to deliver "a jolt to the US healthcare system", according to the WSJ. Will that "jolt", however, be the jolt that's expected?

Regarding the statement in the Red Herring article below that "... an employer-owned medical database for employees open's a Pandora's Box of privacy and ethical issues", as a former practitioner of occupational medicine in the medical department of a large, unionized municipal transit authority where these issues commonly occurred (e.g., over random drug testing and worker's compensation), I agree.

However, that's the least of the problems. A belief that expertise in computing hardware or in mass-merchandising enables such a venture is quite a quantum leap of faith.

Will the big-corporation approach to EMR work? I'd feel more confortable if the corporations had the complexities of healthcare and healthcare informatics within their core competencies.

See this link
for some of the issues that won't disappear due to corporate will, as well as my previous post on Microsoft's clinical information technology venture here.

Also see the issues that are ongoing at Kaiser regarding their plans to be king of the EMR
(see here and here , and for an alternate view see here). We report, you decide.

Intel, Wal-Mart Plan to become the Bill Gates of EMR

Companies attempt to heal a system that refuses to heal itself, but is Wal-Mart credible on healthcare?

November 29, 2006

By Cassimir Medford

Red Herring

A coalition of businesses including Intel and Wal-Mart will announce a plan that they believe will spur the development of a massive healthcare database in the United States , a digital Holy Grail that has been under debate for more than a decade.

According to Wednesday’s edition of The Wall Street Journal , Intel, which employs almost 100,000 people, and Wal-Mart, the largest private employer in the U.S. , plan to construct a database that will house the health records of their more than 1 million employees.

Hospitals, pharmacies, doctors, and insurers will have access to the database, which will be able to process the medical cost-sharing based on the health plans of the employees.

The healthcare industry has proven adept at adopting medical technology and a little less adept at adopting new drugs, but information technology has emerged painfully slowly in hundreds of systems that don’t communicate with each other.

For the most part, healthcare information systems have remained paper based, with all the errors involved in paper handoffs among doctors, nurses, hospitals, and pharmacies.

... an employer-owned medical database for employees opens a Pandora’s Box of privacy and ethical issues.

Plus the presence of Wal-Mart as one of the commercial leaders of the online patient’s records movement could present some drawbacks.

"Wal-Mart’s track record on the matter of healthcare benefits for employees has been less-than stellar so they are liable to get a lot of negative publicity for this database," said Charles King, principal analyst with PundIT Research.

... Can of Worms

There are also issues around discrimination from the employer, other potential employers, insurance companies, etc., based on an employee’s health records, which will be digitized, organized, and accessible in one place.

“People understand the benefits, but they are concerned about the Big Brother aspects that are troubling to a lot of people,” said Roger Kay, principal analyst of Wayland, Massachusetts-based Endpoint Technologies Associates.

... Under the Intel/Wal-Mart plan, employees will have ultimate control as to who accesses their records, according to the Journal , and they will have full ownership of those records [easier said than done - ed.]

The coalition hopes the healthcare industry will get on board, which could make the database the first or second phase in the general construction of a national patient health records database.

The UK has been trying this in their Connecting for Health government-sponsored national EMR project. They have not been having the best of luck at it:

Blair's barmy army

Critics say the government has blown £70 billion hiring management consultants to do the work of ministers and civil servants — badly. By Bryan Appleyard

Next month the National Audit Office is due to produce a report on government use of management consultants. “Don’t hold your breath,” says Neil Glass. Glass, writing as David Craig, is a whistleblower. His book, Plundering the Public Sector, paints a uniformly bleak picture of consultant greed and government incompetence. Since 1997, he says, consultants have cost the taxpayer £70 billion with either zero or negative returns. He doesn’t expect much from the NAO report because the audit manager, the key figure, of the study is Ron SirDeshpande.

Accenture, one of the giant consultancy firms, employed SirDeshpande for almost eight years before he came to the NAO. For Glass, this means he’s just one of the gang and he won’t dare rock the cosy consultancy boat. A spokesman at the NAO sighs: “I know who you’ve been talking to. Ron SirDeshpande works full time for the NAO and his voice is independent.”

Glass snorts.

On September 28, Accenture pulled out of its £1.9 billion contract with the NHS. Connecting for Health (CfH), a huge computer system, was cutting into Accenture’s profits and threatening its balance sheet with up to $450m in write-offs. Launched in 2002 as a project lasting two years and nine months and costing £2.3 billion, CfH has become a 10-year project with a probable cost of £12.4 billion.

Good luck, Wal Mart, Intel et al.

-- SS


kaiserfraud said...

Hi, guys -

Thought you'd get a kick out of knowing that you're the reference for a CIO "Conflict of Interest" question on one of the blogs for CIO magazine:

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