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Obama's $10 billion vs Microsoft's $0

By Will Offensicht  |  October 22, 2007

I was given a document "Barack Obama's Plan for a Healthy America" which gives his ideas for improving health care.  Section (3) Lowering Costs through Investment says:

Obama will invest $10 billion over the next five years to move the US health care system to broad adoption of standards-based electronic health information systems, including electronic health records and will phase in requirements for full implementation of health IT.

Paper pushing accounts for 20% to 30% of the cost of health care.  It would be a very good idea to have a standard system for maintaining health care records, but having the government spend money on this is a bad idea for four reasons:

  1. Government can't seem to get any large-scale computer systems to work.  The IRS spent billions on new computer systems but can't make any progress.  FAA flight control computers are more than 20 years old, but the agency doesn't seem to be able to get a new system working in spite of spending billions.  After 9-11, people realized that FBI computers couldn't share information.  Much money has gone into a new case management system with little if any progress.  The government just can't develop computer systems.
  2. The government has already failed in building a comprehensive medical record system.  The Army, Navy, and Air Force all use different medical records systems.  If an Army soldier is hurt and the nearest doctor is Air Force, the doctor can't get the victim's medical records.  Congress gave the military money to develop a unified record system.  Hundreds of millions of dollars later, all they have is a bunch of studies.
  3. We don't need to develop a new system because private hospitals have developed a medical record system that works extremely well.  Here's how it came to be.

Some years ago, a major hospital chain in Washington was in trouble.  Patients waited in the emergency room for hours and weren't treated well.  Things got so bad that patients told ambulance drivers, "Anywhere but that hospital."  Faced with closure, the board hired one man to fix it.  He found that emergency room people spent 60% of their time looking for patient records.  The problem wasn't doctors, nurses, or the building, it was the medical records system.

"I'll fix it," he said, "but I have to be czar.  You'll fire anybody who gets in my way and you won't like the bills for computers."

After the board fired the first 2 or 3 people who didn't like what he was doing, everybody got out of the way and let him fix it.

He used Microsoft Excel and Word as the front end because hospital people know how to use them.  He basically turned all the medical records into a giant spreadsheet and Word document.

Instead of training, he'd put a computer in a nursing area with a sign, "System under test.  Do not touch."

Nurses are curious; they'd try it.  If they didn't like it, they'd stop using it, and he'd throw it away.  If they kept using it, he'd improve it.  The system goes in with no training at all.  Emergency room waits were eliminated, and the hospital handled twice as many patients with no increase in staff.

The "giant spreadsheet" approach lets nurses and doctors do their own medical studies.  They can separate patients by age, gender, diseases, drugs, and even by zip code.

One doctor asked the computer to list patients who visited the emergency room, went home, came back for the same complaint within a week, and later died of it.  There were few enough of these patients that he was able to find a common symptom.  He persuaded the hospital to change admission criteria so that people with those symptoms would be admitted to the hospital instead of being sent home - this saved lives.  He later found cases where patients were admitted unnecessarily; changing the rules for those cases saved money.

One nurse lived near an incinerator.  When her town started discussing whether to stop using the incinerator, she went to her terminal.  She put in dates when the incinerator ran and asked the computer to plot incinerator runs against babies from her zip code admitted to the hospital for lung problems.  Sure enough, a day or two after the incinerator ran, there was a spike in babies who couldn't breathe coming to the hospital.

At the next meeting, she showed her data.  "I think this thing makes babies sick," she said, "and I don't think it's good for the rest of us either."  The incinerator was shut down.

The man in charge of developing the military records system saw a demo.  He realized that this software would work for the military, but since the contracts were already let, he had no choice but to watch another $300 million of our money go down the drain.

The fourth reason we don't need the government to develop a medical record system is that Microsoft is about to release a "medical vault."  As described in Bill Gates' op-ed piece in the Oct. 5 Wall Street Journal p A17, Microsoft plans to let patients store medical records for free and make money selling advertising.  There are privacy issues, of course, but I suspect that Microsoft will let each user specify what sorts of searches to permit.  I'm used to Google's computers reading my email and offering me ads; I've even bought from one or two.  I'd have no problem letting Microsoft's computers read my medical records, read what medicines I'm taking, and warn me about unusual interactions.  Depending on the disease, I might let Microsoft recommend alternate treatments.

Government-oriented folks like Hillary and Obama don't trust people like you or me to make medical decisions, but I do.  I'd love to enter my medical history, all the drugs and vitamins I take, and my diet if Microsoft would let me, and ask the computer for advice, particularly if Microsoft's medical search engine could point me at the literature.

What if doctors don't like Microsoft?  Once I have all my medical records in Microsoft's vault, if a doctor wants my business, he'll put his information where I can get it.  He can keep a copy for himself if he puts a copy in my vault where other doctors can see it if necessary.

Microsoft would be happy to take our $10 billion if Sen. Obama offers it, but it would be far better to leave things alone.  Microsoft is pretty good at marketing; they and their customers will convert the medical records system if the government stays out of the way.  Soon after Microsoft announced its vault, Google chimed in with a similar offer.

Sen. Obama is correct in saying that we need a medical records system, but the best way to get one is for the government to do nothing and stay out of the way.  He'd do us a lot more good if he could figure out a way to keep people from visiting the doctor when they don't need to.