NHIN Direct: Open Healthcare Records and Government as a Platform – O’Reilly Radar

My comment:

While I think this sounds pie-in-the-sky pretty, it’s all theoretical. First of all, electronic medical records (EMRs…sort of like electronic mail!) exist to solve two problems. The first is a billing/transactional problem. They’re designed to maximize physician reimbursement via upcoding for office visits and procedures. Docs are paid for office visits and procedures via highly specialized codes, not for quality, value, communication, or data analysis. Second, they’re designed to protect a doctor in court. That’s why the majority of information within an EMR is irrelevant to the actual clinical situation at hand. 95% of it is legal fluff and the rest is pertinent clinical information. Billing codes that aren’t actual personal diagnoses are meaningless to patients. Giving patients access to codes for 3 to 12 office visits a year isn’t that meaningful. It’s not enough data to even be considered dirty data. That’s not even considering the fact that we spend 1 hour with doctors a year on average and 8,765 hours on our own. Health is much more about our everyday behaviors than the clinical interactions we have documented in our doctors offices. Giving patients access to medical records simply gives them access to billing data and tests. If we think that labs and billing data changes health behaviors, I think we’re delusional. The real issue isn’t the data, it’s the desire to pursue happiness (and health is only one component of happiness) on a daily basis. Why do we want to behave in a healthy way to feel good today and decades in the future? What are other examples of people changing behavior because of data? We do change behavior based on communication…not so much data. We’re creatures of habit. Ninety to 95% of our activity can be predicted based on a months worth of data. I know that life is more fulfilling and more human with more effective means of communication and being social, but I can’t think of a situation where looking at data about my daily life has changed in any significant way the way I live my daily life for the better. I’d like to be proven wrong…
Modern medicine has extended the life of Americans by 40 years in the past 100 years. We solved the problem of dying children with clean water, vaccines, and antibiotics…hence the extra 40 years of life expectancy. Now we’re stuck with the problem of decades of unhealthy behavior and how to prolong our lives as 80-somethings. I’d rather focus on maximizing happiness in the most exciting and active years of our lives. Happiness and experience until we naturally fade away is the new health. Modern medicine with their pills and stents is surely not.

NHIN Direct: Open Healthcare Records and Government as a Platform – O’Reilly Radar