• Mitch Keamy Photo Mitch Keamy is an anesthesiologist in Las Vegas Nevada Andy Kofke Photo Andy Kofke is a Professor of Neuro-anesthesiology and Critical Care at the University of Pennslvania Mike O'Connor Mike O'Connor is Professor of Anesthesiology and Critical Care at the University of Chicago Rob Dean Photo Rob Dean is a cardiac anesthesiologist in Grand Rapids Michigan, with extensive experience in O.R. administration.

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Mitch Keamy

Hmmmmm. I have 20 random thoughts regarding this whole matter; let me share some of them. I am reminded of an old Eisenhower adage; "if you don't have a good solution to a problem, make the problem bigger." The problem here is 90% commercial and 10% clinical informatics, by which I mean that while there is a certain charm in being able to look up a patient's last abdominal CT from 2004 from an imaging system 4000 miles away, the instances where that is important are rare, and the instances where it makes a difference to patient well being are even more rare. So aside from the obvious telegenic potential of the idea, what drives it? Well, primarily, commerce; it's about claims processing, mostly. But honestly, from down here in the trenches, the inefficiencies in getting money for my services are not a matter of passing claims info; it's the "claims war." The insurance companies employ legions to deny legitimate claims because, for instance, my diagnosis (i.e. knee pain) doesn't match the surgeons (i.e. torn medial meniscus) which then adds $50 of administrative costs to a $200 bill. I employ people to fight with the people they employ to deny my legitimate claims. Nothing about CHIT will decrease this near fraudulent abuse of the reimbursement system, which at last estimate, was a $30 billion dollar a year industry. Nothing will stop that save the elimination of the health insurance industry...

I don't believe that $20 billion will do it either. This task is akin to the interstate highway system or the moon landing in terms of its scope; it will require legislation in every state, and a virtual redefinition of privacy rights, as well as an incredible technology effort and associated infrastructure. You have rightly indicted the plan on this basis. This project is so vast and intricate, that I don't believe it can politically co-exist on an agenda that includes meaningful health care reform; the plate isn't large enough. But that's ok, because I also don't believe that it's really on anybody's agenda for the forseeable future save the folks marketing their various products. I myself wonder what other uses we could put $20 billion (40? 80?) to; that would buy, for instance complete coverage for all medically indigent kids for a year or two. I just see this all as a high tech boondoggle; window dressing instead of an attack on the core issues surrounding inadequacies in our delivery system...

In the end, after the national economy recovers, some or another middle-sized progressive state (Minnesota? Wisconsin? Oregon? Massachusetts? Washington?) will implement a system. Until somebody demonstrates a state-level system that works, there will be no real national initiative; the states are the laboratories...



We can't even develop a functioning system between the services within the Department of Defense. I cannot imagine how daunting a task it would be to try and develop a single EMR for all providers.


I have a friend high up in one of the companies that's made billions in EMR. He and I were just talking about the other day and I made the point to him that the whole ideas behind the EMR wasn't just legibility but the ability to interface with records systems at other hospitals. He insisted this was in the works, but offered no details or timelines. We've been had.

Physician Assistant

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