Re: Be afraid, be very afraid Health Info

[David Farber <dave () farber net>]

Begin forwarded message:

From: "David P. Reed" <dpreed () reed com>
Date: April 6, 2009 9:26:07 AM EDT
To: dave () farber net
Cc: ip <ip () v2 listbox com>, DV Henkel-Wallace <gumby () henkel-wallace org>
Subject: Re: [IP] Re:    Be afraid, be very afraid Health Info

DV Henkel-Wallace wrote:
> More generally I don't understand the rush to electronic health  
> records, of all things.  There are some serious technical and  
> institutional problems to be addressed (I'm not talking about  
> privacy or other t social issues) and until they have been I don't  
> see the point and in fact consider the shift quite risky

I suspect it is not the "electronic" part of Electronic Health Records  
that creates opportunity.  Instead the key property would be to create  
a health "internet".  That is, a framework that maximizes  
interoperability, interworking, and so forth, just as the Internet  
created same for all communications that can be expressed in bits.

Patients, doctors, and lots of other participants in the health care  
system are "locked in" to their providers by lack of such things as  
portability of their records (which they should own, since the data is  
*about* them - but the property rightsters seem to think that  
ownership in data about individuals should vest in the various feudal  
empires who exploit the patient-serfs).

The system does not reward or support innovation because of lack of  
data sharing among researchers and so forth who might improve our  
health.

Assuming having a single governmental "payer" who runs the system is  
"off the table", the alternative is to create standards to smooth and  
encourage interoperability.  This is the highest single source of  
leverage.  Not surprising it is being subverted and twisted and spun  
by the health "insurance" industry.  (Insurance, hah.  They don't  
manage any risk, since they long ago avoided it, they just extract  
transaction fees of 30% or more on every transaction).

Of course, we could have both: a simpler health finance system (single  
payer or the like), and an interoperable and efficient delivery  
system.  Opposing interoperability because it is not seen as useful is  
analogous to what Bell Labs actively did with respect to the Internet  
in the 20 years from 1975-1995.  Bell Labs presumed that the Internet  
was about "packet switching" vs. "circuit switching". Their management  
was about "lock in" and government monopoly guaranteed profit margins.

That said, if all we get is Electronic "lockin" of Health Records, we  
are more screwed thatn before.  That's likely given the lack of  
thoughtfulness on the part of political actors.






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