Just a few quick hits while I wait for my allergy medication to make me functional:
- Someone should invent/widely disseminate a machine readable card which contains basic demographic and medical history on it. I took my daughter to the orthopedist yesterday (no major damage, two little bones broken in her wrist, she’ll be good as new by August), and before the appointment, I had to fill out paperwork. Before I turned it in, I counted the number of times I had to write down her pediatrician’s name, phone number and address. It was six times on five seperate forms. That is ludicrous. It is the same data element that should be pre-printable. What I envision is a chip and pin credit card that slides through a reader so those six data areas are pre-populated and I just have to promise to turn over my house for treatment. Writing things down repeatedly invites error, and transcribing the data into the practice’s electronic medical records is a mindless, thankless job that could be automated.
- This is fascinating from Bloomberg:
Theranos Inc., the health startup that performs many routine tests with only a fingerprick’s worth of blood, plans to announce for the first time that it will become the preferred lab-work provider for a health insurer.Capital BlueCross, a Pennsylvania insurer that covers 725,000 consumers…. Theranos has automated many of the processes in blood testing, resulting in reduced labor and other costs,
Theranos is claiming that its testing system costs half of the typical Medicare fee for service rate. This would be a big deal on a per unit basis. My question on the downside is that we are already probably over tested as a population, would cheaper and faster testing lead to even more testing so the cost per test decreases, but the number of tests ordered per patient episode increases to cancel out the cost savings?
- The Aetna-Humana merger will probably be approved with significant conditions. My personal bet is that Humana Medicare Advantage will need to be spun out as the market concentration is too high:
Aetna and Humana are in nine of the same states in Medicare Advantage. Combined, they would have market share of 88 percent in Kansas, 80 percent in West Virginia, 58 percent in Iowa and 51 percent in Missouri.
If Medicare Advantage is spun out to a different company, then the entire business case for the merger gets a whole lot weaker. There are some efficiencies to eventually be gained by consolidation. If I worked at Humana in my present position, I know I would have two years worth of work on system integration, but after that my current job would be redundant. But the types of efficiencies that can be gained (marketing, strategy, system archi-torture etc) aren’t huge efficiencies. They don’t justify a $37 billion take-over bid. The real gain for Aetna would be market power and market consolidation. In regions where it would bump Aetna from a minor player to a mid-size player, this is probably a net public gain as a slightly more consolidated insurance industry could get better provider payment rates. However in regions where Aetna goes from first among equals to first, this is a massive public loss as Aetna’s management will squeeze the market as hard as they can to capture all relevant consumer surplus for self and shareholder enrichment.
If the FTC conditions are significant spin outs on a regional or state basis wherever the HHI index under a merged entity passes 25% or 30% in each market segment (group, individual, Medicare, Medicaid etc), the deal makes no sense from Aetna’s point of view.
satby
I hated Aetna insurance when I had it. They found more ways to stick me with bills that should have been covered than I had ever experienced with other insurers.
low-tech cyclist
I’m with you all the way on this one, Richard! Let the hospitals and doctors come up with a standard electronic form that can be filled in with the info on the card, and we can carry this card around with our insurance cards.
Hell, why not put the info ON the insurance card – at least, that info that isn’t likely to change much over time?
debbie
The need for a card seems obvious. My mother created a document that listed all her information (doctors, conditions, scripts dosages, etc.) that she’d hand out at her appointments. She’d then refuse to fill out the forms. She usually won, but she was no one’s favorite patient.
As for allergies, I didn’t start getting them until the past few years, and this year feels like the allergies are trying to make up for all the years spring didn’t bother me.
martha
Richard, are your providers on the Epic medical records system? Evil I know, but we love it. Now that we’ve moved, we will seek out new doctors that use Epic so that the last 15 years of our medical life is accessible to them, right there. Mr M had an issue in Hawaii a few years ago. The hospitals there are all Epic-based. Made things so much quicker and they had confidence that he was having his usual asthma/bronchial thingy and not something worse.
Richard Mayhew
@low-tech cyclist: Biggest problem of putting it on the insurance company ID card is that it would contain a massive amount of Private Health Information (PHI) in a compromisable/minimally controlled format. Telling the Privacy Officer and Legal that is what we want to do is guaranteed to produce panic and heart attacks.
A third party vendor where it is voluntary and consumer driven gets around the PHI problem. And it would not be a massive amount of information — name, DOB, SSN, Current PCP information, past PCP information, family medical history (ie one aunt is diabetic, no cardiology events in two generations etc)… don’t even tie medical records to the card, just demographics and rarely updated information — give the consumer a secure online portal to update things as needed…
Richard Mayhew
@martha: Our regular providers are on EPIC, but the pediatric orthopedist is not. I love EPIC as a patient although as a data geek, crosswalking data in and out of that system to play nicely with other systems can be painful, but that skill set has kept me employed in the past, and will do so in the future.
EWG Gestalt
In Germany, they’ve just introduced exactly such a card:
Federal Ministry of Health: The Electronic Health Card
and now mandate its use for all medical transactions for people within the public health system. (A small percentage of people are privately insured by statute.)
Another Holocene Human
I think that shit is a pacifier when you show up and have to wait. If they really need you to fill anything out (say, for legal reasons), they give it to you ahead of time.
I mean, I interact with a number of practitioners all tied to the same hospital network and all on the same computer system. They’re so integrated that I tried to pay my co-pay at one location and they sent the payment towards a bill I had at a different location and totally different practice. You better believe I was surprised when I got a bill in the mail for the $15. WTFBBQ!
So why fill that crap out? Well, some people forget stuff and fill out those forms differently every time. But mostly it is office staff keeping you busy.
Another Holocene Human
@debbie: I can’t imagine having arthritis and then getting that shit dumped in my lap.
japa21
Yes, probably the main reason for the Aetna purchase of Humana (not merger) is the Medicare Advantage position of Humana. Humana was one of the first big Medicare Advantage companies while Aetna is still in a catch-up mode. If Aetna is not allowed to keep Humana’s Medicare Advantage, I am not sure the deal will go through.
As far as filling out forms, they are a total pain. A lot of offices are now letting you fill them out at home, online, prior to your first appointment.
MattF
@EWG Gestalt: I can just guess how RWNJs would react to a government-mandated card with your health information. ‘Freedom’ here means a dozen different incompatible hardware and software ‘standards’.
japa21
One other comment on the Aetna purchase of Humana. Aetna is the largest company in exchange markets. Humana is number two. And they are in different states where their presence is the largest, with minimal overlap.
RSA
@low-tech cyclist:
It wouldn’t even have to be electronic. Just printed text on a paper insurance card that could be scanned at the doctor’s office.
Richard Mayhew
@japa21: If they are in different markets, then the market concentration power argument goes away. Agreed, Humana’s Medicare Advantage business is the crown jewel that Aetna wants.
Redshift
@Another Holocene Human: That hasn’t been my impression at most of the doctors I go to. They’re very good about not having me fill out the forms again if nothing has changed, and more and more of them are putting the forms on their website so you can fill them out in advance. They wouldn’t do either of those if the main purpose was to keep people occupied.
Besides, most people have electronic pacifiers now. :-)
Southern Beale
I’ve had my own concerns about Theranos, which I outlined here. Mostly I’m turned off by the whole RAH RAH CLAP LOUDER WE IS MOST AWESOMEST EVAH hype that seems to surround everything to do with this company and has my bullshit meter ticking.
But on another level, the idea that state laws are directly profiting this one company has me smelling a rat. Furthermore, their technology is proprietary, and we have no real way of knowing whether their testing is accurate or not. I mean shit, there’s an oncologist on trial right now for prescribing chemo to healthy patients so he could fleece the Medicare system. Wouldn’t be the first time unethical practices surfaced in this world.
And finally I really have an issue with how Theranos provides the in-pharmacy tests for big chains like Walgreens and CVS. When the people selling you the drugs are also the people testing you to make sure you need said drugs I think we’re heading into the danger zone.
Southern Beale
WHY AM I IN MODERATION??????????????????????
Southern Beale
Goddammit.
I’m not redoing the post. Just read this about Theranos.
MomSense
For the most part I only go to providers that are part of the same big medical conglomerate. They bought up all the other providers so there aren’t many options. Lab orders are entered in the computer at my PCPs location and then I show up at another location for the tests. It seems very in house except that the company that does the testing is not part of this conglomerate so I get a bill from them that turns out to be not in my network.
Anyway, seeing the eye doctor who is part of the same conglomerate required filling out all of the history paperwork again even though he should be able to access my information since his office is connected to all the other offices. I can understand signing the consent and hipaa forms but entering all the same medical history is silly.
I suspect it is just a time wasting/managing exercise sort of like entering your account information and choosing from the menu at least five times when you call your cable/credit card/insurance company on the telephone. Whenever you finally make your way to a human being they ask you for your information all over again.
Redshift
@debbie: Pollen is apparently getting worse with climate change. A couple of months ago, Jon Stewart was doing a story about news reports that keep saying “this is the worst year for pollen ever!” It looked like it was going to be a standard mocking of journalistic hype, but instead he had an expert on who explained that yes, for the past four or five years, every one has been worse than the last.
I used to have moderate pollen allergies for a while in the spring, and severe ones in the late summer/early fall (weed pollen.) Now I have them solidly from early spring until the first freeze, with an occasional week or so where I can survive without antihistamines.
Jim
I’ve been riding the same horse for years, Richard. It’s ridiculous that we have to fill out so many forms every time. But the general problem is endemic in medicine. Why, for example, can’t my blood pressure be entered digitally into the computer that’s sitting right there, rather than being written down by hand, and re-entered into the computer later, introducing a source of error?
Hoodie
Not just more testing, but also more treatments of questionable efficacy. My latest experiences with medical care make me think that, while well-meaning, a lot of care is of the “just do something” sort. Symptoms are not necessarily clear-cut indicators of a root cause, and tests are often the same. More tests might lead to more “let’s try this.” The internet may be exacerbating this, as it is full of useful, but often misleading, information about various diseases and potential treatments for them. How much is being driven by pharma? I would think they would love more testing, could lead to increased sales.
Gin & Tonic
@RSA: That sort of thing is also useful if you’re incapacitated. Years ago I made up a small printed card, which I laminated in plastic, containing vital medical and other information, which I carry all the time. If I’m in some sort of accident, first responders should find that in my pocket or in my wallet and know whom to call, and how to deal with certain medical facts about me.
SP
@Southern Beale: Yeah, Theranos seems like they have a good technology to bring down healthcare costs, but when a company has Henry F****** Kissinger on the board (plus Sam Nunn, Bill Frist, Riley Bechtel, and a few former military commanders) it makes you wonder if/when they’re going to start committing war crimes. (Sure, in reality they probably see a big market in military field tests and/or services to VA, but still- Kissinger?)
different-church-lady
Isn’t the long-standing hit against this one OMGZGS THEN PEOPLE CAN STEAL YOUR MEDICAL DATA!! (Probably by coming from all the same kinds of people who think Snowden proved Holder was personally reading all your e-mail.)
That and the fact that as far as I can tell from my experience medical administrators and staff don’t give a shit about anything except getting through their day with as little thought as possible.
different-church-lady
@Southern Beale:
For the same reason it’s impossible to figure out how much a medical procedure actually costs: nobody knows.
RAM
I’m all for that blood testing thingamajig. Due to the medications I’m taking for a heart condition plus severe rheumatoid arthritis, I have blood labs done every six months. I’ve got bad veins for sticking, and the sweet young things they’ve got drawing it are a pain. Literally.
Last week, I went in for my usual six months’ blood draw and it took the sweet young thing three separate sticks in both arms, resulting in a fairly spectacular bruise on my left arm, to get enough blood to test. For several years, there was this talkative but brisk lab tech named Debbie who could get a vein the first time every time, but she retired, so now I’m at the mercy of folks who go hunting for a vein the way you might tentatively grope around under a quilt for a garter snake.
So bring on the damned finger prick test…I need all the blood I’ve got in the first place.
Tom
I totally agree with this. My wife has M.S. and takes a lot of prescription medications and supplements. Every time we see a doctor or check in for a medical procedure (MRI, etc.) I have to fill out several pages of the same information. Sometimes even after I’ve spent half an hour on the phone with the nurse giving them the same information.
Davis X. Machina
@MattF: For voting, though? Then it’s ok.
Richard Mayhew
@Southern Beale: Responding to your excellent post, I think the market for the blood dot and analyze are people who are already connected to the healthcare system but who have “shoppable” needs and reasonably high deductibles.
I just had my annual physical. Usually my doc will order a full panel of blood work, but he decided against it this year as there is some interesting evidence that full panels for someone of my age and presenting no other problems are a waste of time and money. If the doc ordered a full panel and if this company was operating in my town, then paying $43 towards my deductible for a full panel at a Walgreens instead of making an appointment at Quest for $87 towards my deductible sounds very tempting. It is fundamentally a generic/readily replicable information commodity, so I am not particulary fussy as to where it gets down. If I’m paying for it via deductible, I am valuing convienence and cost roughly equally at these price points, so the pinprick and analyze scenario wins on both counts.
shell
First turned on the news ths morning and they had a map up with serious flight delays. First I thought it was due to the thunderstorms supposed to roll thru later, but no, United has some kind of computer glitch and tons of flights are grounded. Lovely.
Andy
USB bracelet that can hold medical history. Intended for cyclists who want to inform EMTs in case of a crash. Not the same as what you want, but indication that the future is inevitable.
http://harriscyclery.net/m/product/prolific-design-epic-id-usb-emergency-bracelet-4862.htm
Walker
I am sorry, but this post contains a particular pet peeve of mine.
Bullet points were never designed for full paragraphs, particularly paragraphs of the size of the first. What you want here is a section header, possible embedded into the first line of the paragraph.
Wikipedia has made bullet point abuse rampant, and it is infuriating when grading student papers.
piratedan
@Richard Mayhew: man is THAT a hellacious understatement regarding how well EPIC plays with other vendors in the industry. My understanding of the internal machinations of EPIC has indicated that sometimes it doesn’t play too well with it’s own ancillary branches as well. Is it a step in the right direction, it is but the other caveat is that it’s still a business and the decisions made between vendors on how to play/interact/share data are apparently not based on patient care in all instances.
jheartney
Aside from every medical provider apparently having their own incompatible records system, there’s also the lovely way that when they change/update systems they never bother moving the data over; they just make you fill out the same forms again.
The obvious way to handle this is to mandate a common records format. But of course we can’t do that because SOCHLIZM!!! Also worries about a central records depository being a hacking target. We’re so much safer having all the data scattered in thousands of indifferently secured databases. At least with all the duplication, once they hack it they have the same problems as the legit guys with figuring out what is and isn”t a duplicate record.
? Martin
That’s what the Health app on your iPhone is intended to be. Also a secure means of updating that information directly with your care provider, and an authentication method (fingerprint reader) to confirm that you are that person. ApplePay provides sufficient security to meet HIPAA requirements and can be pretty easily adapted to non-credit card information exchange. A lot of agreements to navigate to get there and a bit more plumbing to put in place, but that’s the intent.
See ResearchKit as evidence of where they’re going. Apple is working with EMR providers (Epic, etc.) to hook in now. The Watch serves as both an extension of this idea and a core component with capabilities beyond what the phone can do.
Microsoft and Google have similar initiatives but theirs have stalled. We’ll see if Apple runs into the same problems. It’s a difficult and expensive problem to solve.
FridayNext
I have a completely unrelated health insurance question.
My wife went in for her routine, annual eye exam, in response to one of those reminder postcards from her eye doctor. She is fully covered for one exam a year. She goes in for her exam, badda bing badda boom, two weeks later we get a bill from the insurance company for the appointment. A call to the insurance company tells us the reason we got billed was because the optometrist coded it for a non-routine exam for vitreous degeneration. (which my wife does NOT have) When she called the eye doctor, they defended the coding and refused to change it because, and I quote “The doctor discussed other problems” with my wife during the exam. Those “other topics” were veiling, floater frequency, and a pimple on her eyelid that wouldn’t go away. For the latter she got some free samples of an optical skin swab (or something like that). She didn’t even have a change in prescription.
We are appealing the decision through the insurance company, obviously, but I wanted to take an informal poll. Both my wife and me are 50 years old. We have had plenty of exams, check-ups, and physicals with a number of different types of doctors. Most of the time insurance or HMO will cover a routine check-up/exam, sometimes there is a co-pay but it’s small. Neither of us has EVER heard of an appointment being upgraded from “routine” to non-routine on the fly and based SOLELY on discussion between a patient and doctor during the visit. It seems to me the eye doctor is trying to get away with something here.
Has anyone else ever experienced this? Sure, if an additional, non-routine test is ordered, I would expect for that test not to be covered. Or a follow up visit for extra tests or procedures. But a routine exam upgraded based purely on what is discussed? That’s crazy right? What are we supposed to do? Record every encounter and make sure all of our discussion topics are officially “routine.”
Anyway, just sitting here filling out the appeal paperwork and I just wanted to make sure I wasn’t the crazy one here. Maybe this is a new thing. I don’t know.
Of course it goes without saying that whatever the problem, I blame Obama.
? Martin
@jheartney: I happen to know that the vision inside the tech industry (Apple but also Microsoft and Google) is that your medical records should be owned by you on a device that you control. From that point you can build gateways to everyones EMR and push/pull the data. The providers and insurers don’t need to agree on common formats so long as these personal repositories can talk to any of them. Your phone or watch or whatever becomes that common format.
That’s how this problem has been solved in a number of other industries – someone from the outside came in, glued all of the shit together, and then basically took the market control away from the incumbents. Facebook would actually be the logical entity to do this, but I don’t think they are interested. Harder for Apple, but they seem to be the ones putting the money/effort in right now.
piratedan
@FridayNext: my guess is that the doc gets a higher reimbursement rate for a “non-routine” visit is my best guess….
japa21
@FridayNext: @FridayNext: I am sure that the doc is also billing a larger amount for this exam than for a routine eye exam.
In my experience, even during a routine exam, the doc will discuss findings and even give some free samples, etc. If the exam did end up including more than normal testing, however, it could reasonably be updated to a non-routine. The unfortunate part is that the normal part of the exam cannot be separated from the non-routine part.
A possible solution would be if the insurance company can reimburse for the cost of a routine exam and the balance would be your responsibility.
mai naem mobile
I’ve been following Theranos for a while. The founder comes across a very smart woman and it sounds like she’s going to have Theranos set up like Google. I also don’t like all the right wingers on the board. Not sure I even understand why she’s got all.these state dept non-scientist types. Phoenix was one of Theranos’ two test markets. They have a deal with Walgreens. Most of their labs are less.than $10 – a lot below $7 total cost(not.copay.) There are people questioning the accuracy of their labs but I’m assuming the tech wouldn’t get through the FDA if it wasn’t giving accurate results. Please note – they don’t do all.labs. They do very few culture related labs beyond urine. If you look at a Quest lab slip and the Theranos menu, there’s quite a few more on Quest. AZ just changed its law – starting this month, that you don’t need a doctors rx for a lab and I have a feeling it was lobbying from Theranos. Theranos can be a genuine disruptor. I would not want to be Quest Lab Corp.
debbie
@Redshift:
My doctor told me to expect this to last through the fall. For me, it’s not just sniffles; I’m bordering on asthma. Highly annoying.
Another Holocene Human
@mai naem mobile: Quest is really cheap, too. I guess the problem is if they lose those contracts with employers. Not feeling sorry for Quest–can’t stand them, personally.
Another Holocene Human
@FridayNext: With my insurance, if you go in for wellcare and they don’t find anything, it’s free, but if you go in for wellcare, and they find something wrong with you, you have to start paying coinsurance.
Causes a lot of people to avoid the wellcare visits because they can’t fucking afford that total annual out of pocket.
shell
@debbie: Yeah, Ive had symptoms for the first time in years. Mainly, constant post-nasal drip that sometimes feels like im gargling.
FridayNext
@Another Holocene Human:
Just so I am clear, are you saying that you would owe the full amount even if no action was taken? Just the mere finding of something wrong triggers payment?
FridayNext
@japa21:
I agree if there were non-normal procedures or tests, then upgrade away. But it didn’t include any non-routine testing. Just the typical “Read the top line. Now is it Better?Worse?Better?Worse? Better?” A glaucoma test, and then a discussion of any questions my wife might had. Same exam she and I have had since we were both in our teens.
According to the office administrator the coding was based solely on matters discussed during the “do you have any concerns or questions about your eyes?” portion of the exam. According to her, because the topics they discussed were not normal or routine, the whole exam becomes non-routine and coded and billed accordingly.
The amount is relatively small, a little less than $200. But our biggest worry is that if this stands and we have to pay the full amount, we are suddenly going to be very careful about what we say or ask our doctor’s and dentists in the future. Which is completely antithetical to the purpose of routine exams and check-ups.
Another Holocene Human
@shell: That has really got to suck.
This means they have to voucher out everybody, though, right? No pretending it’s weather for this one.
I had a friend who was trying to get home to Swampburb, FL from Swampy Asscrack, TX and had a connecting flight. Well, the first flight was fucked due to mechanical but the flight she was transferred to got fucked due to weather and she had to fight with the gate agents to get vouchered because the reassignment had ‘cleared the codes’ and she and everyone else on that flight was in the system as weather delay.
I think they finally caved.
Mnemosyne (tablet)
@FridayNext:
Personally, I would switch doctors, and explain to that office manager why you’re doing it. It does seem more than a little sleazy to me.
FridayNext
@Mnemosyne (tablet):
Oh, absolutely. We go to the same doctor and we are both switching.
japa21
@FridayNext: Well that is ridiculous. I have had plenty of eye exams in my life and even with serious problems (I am blind in one eye due to an accident and it needs to be monitored) the routine exams have always been billed as such and reimbursed as such, even though there is plenty of discussion with the doctor about issues.
I am assuming this doc is in your network. Make sure that you make the insurance company aware of the rationale given for the upgrade in coding as this borders on fraud. Insurance companies take things like that very seriously.
Another Holocene Human
@MomSense:
You noticed that too, huh.
Peter VE
@low-tech cyclist: Maybe we could just adopt the French or German systems: a universal medical ID card
Another Holocene Human
@FridayNext: My insurance sucks, so, yeah. (Although depending on the type of exam, they might very well be taking action right then.)
Does this make people angry? Yes, yes it does.
Another Holocene Human
@Peter VE: Learning from another country? That’s crazy talk.
Another Holocene Human
@shell: Huh, and I just thought I wrecked my immune system with diesel fumes.
Although having my lungs fill up with fluid, that had to be the diesel fumes.
I’ve learned to ask myself “was there a fever” when my ear/nose/throat symptoms get bad. If yes, sleep. If no, irrigate/eat hot peppers/launder the sheets again. (I have allergy to dust mites and mold and non-allergic rhinitis from pollen.)
Gin & Tonic
@? Martin: Facebook would actually be the logical entity to do this
WTF? When you wrote that, did you stop and think that not every human being has (or wants to have) a Facebook account?
different-church-lady
@mai naem mobile:
Oh, so in other words they’re just going to take everyone’s information and share it with the universe?
Roger Moore
@Richard Mayhew:
I would guess that there’s also some ancillary market from people who are anxious about their health and want tests more often than their doctor will prescribe them. Some people would get a full panel far more than once a year if it weren’t such a pain in the arm and wallet. Lowering the cost and the size of the blood draw will let those people check their stats more often.
Fred Fnord
Even assuming our regulators still think monopoly power is a bad thing (and that is not clear since Apple is being levied record fines essentially for challenging Amazon’s overwhelming monopoly via a legally questionable but hardly open-and-shut business practice, but Amazon is not even a subject of regulatory discussion) these ‘spin-off’ deals aren’t always all they are cracked up to be. Often the spun-off entity at least in some business sectors (don’t know about health care) ends up at a huge competitive disadvantage due to size, or is outright sabotaged, and goes under within a few years.
Also, I thought health insurance companies were immune to anti-trust, and I know there are many local areas of monopoly (some states IIRC) so why would regulators object to a merger on the basis of near monopoly when they don’t even have the authority to regulate an absolute monopoly?
RSA
@Gin & Tonic:
Nice idea! Funny you mention this, because just this year I’ve started to carry a laminated card in my wallet that says I have a health care power of attorney, etc., and gives the phone number of my lawyer (who made up the card and gave it to me). If I’m ever in an accident and someone finds this, all sorts of necessary things will start to happen.
jheartney
@? Martin: So what happens if you don’t have an Apple device? Do we have to have an iPhone or Apple watch to get medical treatment? BTW, if it’s an optional thing (i.e. it’s not required, but everything works better if you have an Apple device), it’s not likely to get to critical mass for universal adoption. In any case, why are we putting this critical piece of healthcare infrastructure in the hands of a private monopoly?
That’s the idiocy of depending on a private developer to do this sort of thing – they’re going to build it in such a way as to let them extract rents in some form.
shell
First United airlines. now the Dow is down due to computer glitches. cyber attacks going on
Aardvark Cheeselog
This is so obvious, one wonders why it has not been done. The answer is that it’s not as easy as you think. Though some of the reasons why it’s not easy have to do with our uniquely (for an advanced economy) f***ed-up healthcare delivery system, that system is what it is and any such widget would have to work within it.
Source: I’m a programmer by trade and have worked on electronic medical record systems for the last six years. I have actually done some design work on a widget much like what you describe.
pseudonymous in nc
As others have said, Germany and Taiwan among other nations have health smart cards, because they have actual healthcare systems.
The problem here is partly NIH syndrome, partly that American healthcare is good at treating institutional symptoms and not causes. See also: having to maintain multiple profiles on multiple Patient Portals for multiple healthcare providers. This is stupid in a uniquely American way.
Finally, one of the main functions of the US healthcare “system” is to sell clipboards.
pseudonymous in nc
@jheartney:
This. “We updated our system and we need you to fill out all the forms again for the new system” is a failure condition, and should be treated as such.
Richard Mayhew
@Aardvark Cheeselog: I figured there are probably good technical reasons why it is a massive PITA, I just know the regulatory reasons (We actually like to keep our Compliance, Legal and Privacy people alive, they bring in good cookies….)
? Martin
@Gin & Tonic: Just because they lay out the standard doesn’t mean they need to be the only one carrying it. It just means they have the market power to dictate what that standard ought to be.
@jheartney: All standards like this will come from private entities. And just because Apple or Facebook lays out a standard doesn’t mean that they have exclusive access to it. ResearchKit is open source. Anyone can implement it.
And yes, Apple will extract rent from it, just as they are with ApplePay, but even so it’s a savings to the consumer. Apple is taking the 1.5% of transactions lost to fraud and replacing it with a 0.15% rent paid to Apple. That’s a 90% savings, ultimately to consumers. Sure, it’d be nice if it were 100% savings, but then nobody has figured out how to solve this problem until now, let alone for less. There will be huge savings to both insurers and care providers if you can provide a secure, seamless data exchange with customers. You’ll get the savings just on the reduction on fraud alone, let alone the reduction in check-in and other administrative costs. By comparison the rent will be a gigantic bargain, and the consumer also benefits by taking control of that information which means it’s a lot easier for you to then dump it off on a different provider or just take action in it yourself (as is happening now by many people).
Look, this shit is wicked hard and very expensive to do. It’s been decades since the first EMRs rolled out and nobody has tackled the problem. Nobody wants to invest in it. Apple is willing to, Microsoft is willing to, Google is willing to. Let’s not get too bent out of shape that someone is willing to work on this.
Monala
Every time we go to the doctor, they print out a strip of 6 to 8 sticky notes, that contain all that info: Name, DOB, PCP, insurance #, and it gets stuck onto the top corner of every form used for you that day. So your wish has already been invented, but for some reason hasn’t come to your area.
nathaniel
I have a better idea, reduce the information collected. What need is there for your daughters pediatrician info to be on five forms? I work in government in admin type stuff, and I am constantly fighting the battle against collecting certain information. Most of the time we don’t even use the information except in exceedingly unusual situations. Even in these situations we don’t realize we have the required information, and end up recollecting it anyways.
There is too much information out there already that people don’t properly use, but they want to get more.
Bob Munck
A very good medical records system was developed starting in the 1970s and is now in use in the largest US medical system, the World Health Organization, Mexico, Germany, Finland, Brazil, and a bunch of other countries. It is Public Domain and “open source” which means the basic constituents are available for free. The name of this system is VistA and, as you might infer from the caps in the name, it was developed for the Veterans Administration.
Why isn’t VistA in universal use? Because for some unfathomable reason, we believe that corporations should be able to make a profit from disease and injury. VistA would reduce that profit.