Pushing on a Rope, Health Reform and Other Delights
By Dario Bollacasa

A couple of days ago I was having breakfast and listening to "Squawk Box" on CNBC. There was a guest: a CEO from some healthcare company, who commented on the previous day's signing of some health reform initiative by President Bush.

The core of the issue was the "realization" that health providers, insurers and patients don't talk well with one-another and that all the exchange of analog information: faxes, papers, reports, lab test results etc. are floating around sometimes without a destination. They get lost in the "system" and the situation has been responsible for a large number of unintended deaths on a yearly basis.

The solution: digitize and computerize everything so the information is available and intelligible for all that go "mining" the databases. This gargantuan push for organizing the data could save, it is estimated, the tidy sum of $80B per year. The cost of collecting all this in coherent manner was not discussed, naturally. Neither was there any discussion on any standard to be applied to the acquisition, digitization and distribution of the information.

I liken this effort to pushing on a rope as nothing much can be expected other than a number of people, probably a large number, will make a lot of money in addition to Google, Yahoo etc. who will provide the search engines to sift through the data.

The day after this educational experience, I went to see my doctor for a physical. I have seen the same doctor for at least a dozen years and my file is rather thick. That file represents my medical history (with this doctor mind you), and if all the information is digitized it will provide partial, if not incorrect version of what has happened to my health and body over the last dozen years.

Why so, you may ask? Is it not all there? No. Over the years I have gone to a number of other doctors so the information is with them and the medical file is likely to have information which is no longer applicable.

To whit, I used to go to rheumatologist because I had pain in my hip joints. The doctor took a lot of x-rays, prescribed anti-inflammatory drugs and has no idea that one year ago I had my hip joints replaced. So anything in my medical history relating to my previous hip joints made of bone is now irrelevant.

And that is only from two doctors. The doctors who took care of my hip replacement have a VERY thick file full of x-rays on the before-hip and the after-hip (like the before-hip stuff has any relevance to the present). I once asked if I could have some on the x-rays because I was into "x-ray" art. No way could I have them: they were part of my medical history, presumably to be retained in perpetuity.

There is also the urologist, the hematologist and a whole slew of information from my four stays in the hospital in 2005. There is no way that I can see that this can be connected unless there is a single repository of the information and a single entity that will record new information and mine the data. In order to get to the last point we need, at the very list, a single health provider. And you know how good the chances are of getting there.

And so it goes, and never mind the dental records of the teeth you no longer have or all the prescription drugs you no longer take. So you see lots of people are ready to push for "reform", but nobody wants to do any pruning of irrelevant data and provide connections from all these different databases.

The system will plod on and serve up another version of the paperless office, which as the people who were sucked into that fiasco well know, resulted in more paper than ever, and more vaults deep in mountains to keep records that nobody wants to retrieve, and which are probably not retrievable (remember microfilm, microfiche and magnetic tapes).

As long as there is buck to be made, there will be salespeople pushing snake oil, going forward, not looking back and never, never learn lessons from past failures.