Jay wrote in on Dr. John Haughton's post on the health IT provisions in the latest version of the stimulus package. ("Stimulus bill offers docs big incentives for technology, but demands effective use.")

"While a move to EMR is a necessity to reduce medical costs for the
country, I don't believe that providing purely financial incentives for
individual doctors is going to bring about the desired change. So many
doctors are already operating as small business owners so going through
the selection, procurement, integration and ongoing maintenance of an
EMR system is going to be both time consuming and expensive, much more
so than the $40K in incentives.

How many doctors are going to be a position to effectively wade
through the sea of EMR systems to find one that will integrate as
painlessly as possible with their clinical activities. By my judgment,
not that many. At the same time, what happens when a particular system
fails to meet expectations or fails outright; is the doctor paying
someone to be on the phone to work through the technical issues? How
much support is the doctor going to receive as just one small user of a

In my mind, a far better solution and use of the funds would be for
a centralized application commissioned by the federal government."

Stuart wrote in on the same thread, with an alternative suggestion:

Omitted in the "stimulus" bills is EHR using very secure, patient-carried EHR smart cards. They are well-proven, safe, easy to use, effective and in wide use in the EU. The French card system gets especially high marks.
But why ask our EU friends for a proven system when we can waste $20B screwing around for years with web-based systems that are so insecure that Americans will never agree to their use?

Matt liked David Kibbe's post laying out his thinking on ("Why Clinical Groupware May be the Future of Health IT")

B R A V O.  Reliable elimination of paper is enough incentive on its own for MD's to adopt.  So long as there are no productivity losses that have crippled EMR installations. I absolutely love the thoughts posted here.  Very refreshing from a tired industry of same old mouse clicks ..

Ali had this to say about the Obama administration's search for a replacement for Tom Daschle:

"On a related topic, the White House Office for Health Care Reform is also rudderless. I would suggest one of these three luminaries from the non-profit world, each of whom has helped steward our collective understanding of health care reform during an era of complacency:

1. Karen Davis, PhD. President of the Commonwealth Fund.2. Drew Altman, PhD. President & CEO of the Kaiser Family Foundation.3. Risa Lavizzo-Mourey, MD, MBA. President & CEO of the Robert Wood Johnson Foundation."

Tcoyote had this response to Matthew's post today on this week's Washington Times editorial on stimulus funding for healthcare IT that featured a picture of Adolf Hitler.

I heard a 25 minute rant from Rush Limbaugh on Monday on the same topic: this universal national health records repository that would enable the federal government to determine if your doctor was practicing cost effective medicine or not and enabling some bureaucrat to deny YOU, the "dittoheads",  of the healthcare you need. It resurrected Dick Lamm's 1970's line about older people having a duty to die.   It cited a Betsy McCaughy "analysis" of the stimulus bill, and crosswalked to Daschle's book about comparative effectiveness.   It is really scary to think that people listen to this stuff and accept it as gospel.  It's hard to imaging where to begin to unravel it, but  this is REALLY about stopping the creation of a national health board.  Black helicopters will shortly be landing on the hospital roof, you can be sure of that!

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  1. Speaking as a primary care user of a federally standardized, universal EHR system, I can attest that its a double edged sword. It is wonderful being able to access specialist reports and prior records from around the world and teleradiology has been a blessing. That said, implementation resulted in an immediate 30% decrease in productivity because of EHR inefficiency and frequent system crashes. Despite promises that these would resolve as more people became comfortable using it, nothing has changed in 6 years and countless updates. So, if we are willing to swallow a loss of 1/3 of our productivity, then implementing a federal universal EHR may just be the way to go…