In the military, winning versus caring
In response to our August 2 story on ONC health information exchange standards-making ('ONC finds exchange standards hard to nail'), Terry Kimball wrote:
Of course the VA and DOD had problems " and I suspect they still do. The reason? They lost sight of the mission: the patient! Both sides want to 'win' more than they want to ensure that our military get the care they need and deserve. There are a few things that, once decided or acknowledged, will solve these upfront issues and get us on the way to interoperability" and real continuity of care.
First, make a decision on whether we are going to force the use of a structured clinical knowledge base (such as MEDCIN currently used in AHLTA) or a non-structured one such as dictation, hand written and transcribed or scanned.
Second, the VA and DOD should be using the same system regardless of which one it is. Here is where we can evaluate the "chicken and the egg" theory. A veteran has to be a military person before he or she becomes a veteran. Yes?
Just my two cents worth -- after 40 years with the Military Health System and 10 years with AHLTA.
Health IT and the budget crisis
Referring to our August 19 story on Medicaid IT ('IT is focus of new Medicaid "˜paradigm'), Dr. Calvin Sia wrote:
Unlike Medicare, which the federal government controls completely, Medicaid is subject to each individual state's economic status and budget appropriations. Financing interoperable health IT infrastructure is not a high priority for most states when the acute Medicaid needs of the disabled are immediate and in crisis!
Where can we expect financial support to come from in our present political climate?
Schools have health records, too
On our story on August 3 about measuring the public health benefits of health IT ("˜Policymakers press for public health IT measures'), Kathleen Johnson wrote:
School health records include a number of elements for meaningful use, as well as disease surveillance and health trends in the school aged population. For some disadvantaged students, their only health record - electronic or otherwise -- may be in their school health room. School nurses address health promotion and prevention. CPOE for school medications would improve accuracy of medication orders for chronic conditions such as asthma. School nurses are trusted resources for parents and can educate them on the benefits of EHRs.
Please -- first DSL, then EHR
On our story on the FCC's latest push to expand broadband for health care ('FCC broadband plan targets e-health expansion'), Don Reiss wrote:
The expansion of broadband in rural areas is not only needed for the development of EHRs for providers but also for basic Internet services in residential rural areas as well.
Why should we spend so much money to view medical records if I cannot even get DSL where I live, which is dial up-only and where most servers and networks will kick you off. Is this part of the meaningful use of delivery?
Is this how I should expect the EHR will work?
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