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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: Mary Cluney who wrote (6221)	3/2/2009 10:31:59 PM
From: i-node	Read Replies (1) \| Respond to of 42652

My guess, from a person who knows very little about this subject, is that there is a finite number of data elements in any persons basic health record and an equal or lesser amount in each patients transaction record. The transactions are all fairly well defined by diagnistic codes. Transactions aren't the problem. There is absolutely no need to share billing information; we already have a facility that works reasonably well for that. What we're talking about is the sharing of patient health records, a totally different thing. You find a mixture of dictated notes from various physicians, opinions and results letters from numerous specialists and referring physicians, lab results, X-rays, other test results, a massive amount of data in totally inconsistent formats. Each of those is accessible by a discrete subset of literally millions of security entities. Transactions utilize a fairly rigorous set of CPT (procedure) and ICD9 (diagnostic) codes. These are insignificant compared to the objective data that is contained in the typical patient chart. I would have thought that rules for taxation would be more variable and less systematic. But what do I know? Actually, it is the other way around. While tax return data is voluminous and derived from many sources it is, for the most part, pretty discrete and well defined. More or less like medical transactions. Health care information is far more complicated -- you have images from disparate sources, many varieties of scanned data (e.g., received faxes and EKGs as well as faxed or locally produced lab results). You could have X-rays, ultrasounds, CT Scans, MRIs, dopplers, correspondence received via fax and through the mail, electronic lab results, physicians SOAP notes, and literally hundreds of other items from different data sources. All with potentially different security rights. I am confident however that health care data can be systematized and computerized making things a lot easier for a lot of people. The solution exists. Yes, I agree about this. I'm not sure the solution exists today but I think one will be arrived at over time. 15 years from now the picture will be different. I just don't think we're there yet and I think it is really dangerous to start pushing these systems before the industry is ready for it. My real issue is with the idea that you'll have one system that does it all. If that happens it will mean that Obgama was successful in putting us on Single Payer -- if THAT has happened, I am confident that computerization of medical records will be the least of our problems.... I've seen a lot of transitions within systems over the years -- from the mid-80s, where we had basically no standards at all, to now where claim data (i.e., transactions) is relatively standardized. I think the best example of what can happen is last May 23, when the National Provider ID went into effect. Basically, it was a simple requirement - instead of each insurance company identifying providers with some internal code, everyone would have a coordinated "NPI" code that would be used on all claims. What we ended up with is a totally convoluted result. By law, everyone had to switch to NPI as of 5/23/08. Any claims containing "legacy" number received by Medicare or Medicaid must, by law be rejected. The problem? You still have to use your legacy number if you call to talk with anyone at Medicare or Medicaid, internally they continue to use these legacy numbers to refer to providers, and so everyone is constantly having to translate between NPI #s and legancy #s. It is utterly stupid. There are a lot of stories I could tell you about problems created when this was set up, but you get the idea. That is just with a minor change like this. Imagine a truly significant change to these systems! I'm thinking I'll retire first; the last year, straightening out NPI problems just about did us in around here. We had providers who couldn't get paid for months because when they incorporated 15 years ago Medicare had put the wrong tax ID on their account. I'm very concerned about the current administration pushing this stuff faster than the industry can accept it.