Since my last post on CHIT, the economic stimulus package has been passed, and includes on the order of $20 billion to support the development of electronic medical records. A few observations:
- The UK had a nationalized health care system, with standardization at many levels, for decades before it embarked upon its still floundering efforts to create an electronic medical record. The amount budgeted is far less than what the UK has spent thus far. The population of the US is several times larger than the UK, our health care system is nearly completely decentralized, and there is little standardization outside of health care directly provided by the US government. It is likely that several times this amount would be required to arrive at the same point as the British – which is close to nowhere. In short, the amount allocated is not even close to enough to begin to deal with the US problem, let alone craft any functioning product. If the US experience replicates the UK experience, then the amount of money budgeted is far, far short of what will be required.
- How is this money to be spent? This is not a trivial question, but in fact a central question. There are major vendors of CHIT in the US, but their business model is of proprietary software and databases. The kind of portability and accessibility that proponents of the EMR (Electronic Medical Records) tout are anathema to the business models of these vendors. Are the feds to choose one (and compel the scrapping of the competitors)? If history has taught us anything, it is government granted monopoly to any private corporation is a prescription for delay, cost overrun, inefficiency, and corruption. Are the Feds to start from scratch? Are they to stipulate some sort of standard? Either would have the effect of undoing a substantial percentage of the experience and investment in systems to date.
- Can we even find efficient use for the money that has been allocated? Quite seriously, no one has ever had this kind of money to spend on the development of an EMR before. We’re clearly not ready to commence production, and we may not even know where we are in development. Can there possibly be enough researchers and developers to efficiently and effectively utilize $20 billion dollars in funding? The most likely answer? Somewhere between doubtful and inconceivable. Make no mistake: the funds at issue will generate a huge number of ‘instant experts’ and draw everyone with remotely relevant experience into the endeavor. Sadly, there is no one with a large scale success to be recruited, because no one has had success on a large scale.