[Deborah]

First, you're ok in a dark alley if you behave well, just don't be on my property after dark without calling first. Other than that, its the usual 'don't commit a felony' kind of stuff. Texas is pretty normal except when it comes to protecting our families and our stuff. mildly pathetic and/or paranoid.

I obviously also lose myself in life, and lose track of where there might be a conversation on a board I've left fall flat, or off completely. My apologies. My major interest in life is actually philosophy and religion, ethics and morality, and the future of our country and world as we attempt to determine where God sits in our big plans <coff>. Healthcare is an important chunk of that, which I'm seeing evidenced in fascinating snippets such as http://www.facebook.com/ext/share.ph...u=Bbr2a&ref=mf .

This EMR issue is going to happen, I do believe it's needed. It's how it will be used that's critical overall from my perspective, requiring some new privacy legislation superseding state laws. I mean serious review of possible abuse and privacy issues and some serious lawmaking being done alongside any IT initiative.

The funding being properly used is a bigger issue. History has proven we're likely to completely blow the money on something ultimately ineffective or benefiting some single hardware or worse. If more isn't standardized what is now piles of bits of information scattered across country with a few wads here and there for varying purposes, will become a big was of information that's not useful or comparable; most likely not even effectively interfaced, beyond passing on info as if via fax.

If it's shortcut by having a list of what data needs to be nationally collectable (which is where it appears headed) being the only real requirement... I think the data collected will be outdated by the time its fully implemented... diseases cured, procedures changed, outcomes differing. Simply making certain all systems are using the same coding and have the same input/output data is the initial issue, and I can't find much on standardizing taking place.

The VA hasn't even made a system that works, with soldiers hand carrying records to their VA, then losing it all if they move. It's obvious the gov't is aware of this issue and intends to implement EMR here, to allow transition of records which will help some get more coverage, and will also rule out more using the VA system as records are interactive (comparing IRS to VA standards of income). In any case, right or wrong, the VA is an obvious base to start from. Unfortunately they are also likely the worst model to use. We should be examining the giants in healthcare providers who have the best ratings in effectiveness for patients, compare their systems (they're about the only ones that do have useful systems) and see how to interface - with each other, with the VA, with new EMR systems and with whatever gov't records its deemed necessary.

Another way of describing my concern for appropriate laws being implemented with any systems: This is a HUGE opportunity for massive abuse. However, I do NOT think that is a reason not to do it. We're better than that, and far further into the 21st century than we're thinking. It has to be done or we'll be losing ground on disease, if we aren't already. (and you thought this was because we wanted to 'improve'?)

In then end, I have no problem with big steps being taken in ways to reduce costs internally and externally. I have no problems with everything being more affordable. I'm personally convinced the fubar in healthcare insurance is the dramatic differences in compensation, requirements, etc, not the perceived cost of healthcare OR insurance.

I do believe the shift needs to be in who does what. We need doctors in IT determining codes, preferred methods, flexibility *required* (meaning if patient has diagnoses A, treatment can be from a variety of codes sorted in different ways to choose from plus room for new treatments and combinations), and assurance that its not an IT venture provided to doctors for use, but an IT venture driven by medical knowledge and standards.

I know personally that most new doctors not only want it, but feel healthcare is suffering tremendously without it. Older doctors are going to need an easy interface and bigtime training on the flexibility allowed. All doctors will need to be encouraged to continue as an Art of Medicine, not some new science of data and statistics.

Can I do it? Nope. All I have is opinions, but I, like many others far better qualified, better keep our eyes open for opportunities.

You might enjoy some of the calls for collaborative efforts such as http://www.casavaria.com/jr/2009/04/16/475/electronic-
medical-records-could-help-find-cures-speed-progress-cut-costs/. We'll see where everyone goes.

We're going to do it wrong as much as we do it right. What's important (in my humble initial opinion) is the controls put in to prevent overflow of information into the wrong hands we need to prevent, the flexibility built in for doctors to have input from research as well as statistics and be able to make use of the art they are trained to provide for the individual, the collectibility of information in a manner that there is a sleek interfaced continuing record available to all individuals about themselves and they alone should be able to give permission to any others (including the gov't) to review it, chunk by chunk (requiring appropriate ability to separate these chunks of information types).

Warm regards,

"Deborah"