"...the Washington Post deserves to be read in its entirety. It explores how implementing electronic records became part of the stimulus bill. Not because it's a great idea but because the people who would profit from it lobbied like crazy. It may be a great idea. Suffice it to say that the evidence is highly biased."
The Post states:
"A Washington Post review found that the trade group, the Healthcare Information and Management Systems Society, had worked closely with technology vendors, researchers and other allies in a sophisticated, decade-long campaign to shape public opinion and win over Washington's political machinery.
With financial backing from the industry, they started advocacy groups, generated research to show the potential for massive savings and met routinely with lawmakers and other government officials. Their proposals made little headway in Congress, in part because of the complexity of the issues and questions about whether the technology and federal subsidies would work as billed.
As the downturn worsened last year, advocates helped persuade Obama's advisers to dust off electronic records legislation that had stalled in Congress -- legislation that the advocates had a hand in writing, the Post review found.
Their sudden success shows how the economic crisis created a remarkable opening for a political and financial windfall: the enactment of a sweeping new policy with no bureaucratic delays and virtually no public debate about an initiative aimed at transforming a sector that accounts for more than a sixth of the American economy"
The post continues:
"Middleton said he provided many of those details.
"I sent them a LOT of stuff, many papers and most of the reports. I probably spoke or communicated with David Blumenthal, David Cutler (the health economist on the team), or Dora Hughes about every other week during the heat of the campaign," Middleton said in an e-mail.
In an e-mail, Blumenthal wrote:
"It would be flatout wrong to say Blackford Middleton was a key campaign adviser or had an official role on the campaign. He was one of many people the campaign reached out to, and I personally had minimal contact with him.""
It should be noted that David Blumenthal is the brother of the Attorney General of the State of Connecticut, not that such a relationship would in any way be used to anyone's advantage.
Finally the Post states:
"Under the stimulus package, Medicaid and Medicare providers will receive incentive payments to offset the cost of electronic health record systems they buy. No one knows for sure how widely the technology will be adopted, and no one knows for sure whether those systems will yield the expected savings, specialists said.
Another open question relates to the development of technical standards that define what equipment qualifies for stimulus payments. Some critics contend those standards could choke off innovation and funnel profit to certain vendors, without necessarily improving care.
To qualify for federal funding, the technology must enable "meaningful use" by doctors and others, according to the legislation -- a standard that policymakers, researchers, vendors and others are struggling to define now.
Joseph Antos, a health-care policy specialist who has examined the legislation, said the risks of the technology plan are high because of the haste with which it is being implemented and the special interests seeking to profit from it.
"This is the real way things get done," said Antos, of the American Enterprise Institute, a Washington think tank. "The stimulus bill looked like a bonanza to an awful lot of people.""
Let us again make a few observations:
2. The Government plan unfortunately is based upon the input of a few. This is a classic Government project. One need look no further than the FAA and see that we are fundamentally using an air traffic control system designed in the 1950s! Imagine what a Government system will do to the EMR. Again I have argued that an IETF model used in the Internet is the way to go. If all else fails listen to the customer. As much as I greatly respect my former Harvard colleagues, the engineer side of me is always concerned about the details.
3. The goal is laudable and ultimately the system is needed. However the stress to incorporate a system like this as a "stimulus" forced via strong lobbying will lead to a disaster and loss of money and worse generating lack of future acceptance of such a system. I argue that in the short term it will actually add to the costs of a physician's practice, which of course will result in a reduction of a physician's compensation and the driving of truly competent physician's into a practice not accepting of any insurance, especially Medicare. There will be a new set of "medical services" plans for those with money and not using Medicare and especially not using the new proposed Government plan.
Again one must always be aware of the unintended consequences. Washington does strange things to people's egos. As Wall Street generated Masters of the Universe, Washington creates gods! It becomes the Olympus on the Potomac.
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