Category: Politics, Religion & Money

Death By a Thousand Clicks

For 36 years I worked on the technology side of medical information systems. Around 2010 it became obvious to me that the HITECH program under ARRA would be extremely disruptive.

Not only did HITECH distort the market in significant ways, it failed to produce the intended benefits. One effect of HITECH was hospitals that were already using electronic health records were able to switch vendors and buy more expensive systems, knowing that the government would reimburse them if they met the “meaningful use” requirements.

Kaiser Health News and Fortune Magazine have published a lengthy report on what went wrong.

At the same time that hospital decision makers were looking forward to their HITECH reimbursements, the big players went on merger and acquisition binges, creating large regional medical systems. Left behind were many small rural hospitals, called Critical Access Hospitals, that rely upon Medicaid and Medicare money. Many have closed, either because they didn’t have a buyer or, as covered in a recent Nashville Tennessean story, they chose to remain independent.

Proving His Point

An illegal alien from El Salvador with a criminal record, driving for Uber, accused of sexual assault. Link to story.

Jose H. Arevalos-Avalos, 37, was arrested by Immigration and Customs Enforcement agents, because he is in the U.S. illegally and has a criminal record. It is unclear if or how he passed an Uber background check before becoming a driver for the company.
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Arevalos-Avalos was arrested on Friday in Holliston and charged with sexually assaulting a passenger in Ashland. It was not his first arrest. According to an ICE official, Arevalos-Avalos was deported in 2011 after he was convicted of possession of cocaine with intent to distribute in 2010.

For Trump’s supporters, this validates everything that he has been saying about immigration from the day he announced his candidacy. It also highlights the need to regulate Uber’s operations.

An Epic Failure Success

The New York Times has this article about Wisconsin-based Epic Systems. More than half of all patient records in America are stored and retrieved electronically using Epic’s software.

The article is worth reading, despite saying nothing about how Epic became so successful. When the company was starting out it bought operating systems from my former employer, and part of my job early on was generating customized O/S assemblies for Epic. So I know something about the company, and their story is much more interesting than knowing how its sprawling campus is decorated, which is the focus of the NYTimes article.

One important point of business about Epic Systems in the article is that the company is privately held. For contrast, I highly recommend this excellent piece in The New Yorker from last August, about another EHR (Electronic Health Record) company, the publicly traded Athenahealth.

Also in The New Yorker, Atul Gawande talks about the difficulties confronting doctors, including himself, who are required to use Epic’s software. (Note: There is no connection to Epic Games.) If you don’t want to read the article, there is this video explanation, smuggled out of a bunker in an undisclosed location.

https://youtu.be/7fy83E_pFNs

Gawande has no one to blame but himself, however, as his writings were influential on President Obama in requiring the move to electronic patient record keeping. Gawande now has an opportunity to further influence American healthcare, having been picked by Jeff Bezos, Warren Buffett, and Jamie Dimon to head up a new think-tankish venture.