Have It When You Need it

Candy_machine

At an event that I attended recently, I heard a young woman explain her philosophy on life.

She said, her grandmother taught her: “Better to have it and not need it, than need it and not have it.”

Thinking about it at the time, it seemed pretty wise–because you never want to be without something you really need. 

And good planning and survival skills say to always be prepared–you never know what happens. 

But then with the fiscal cliff and all the talk about social entitlements, I started to think about this some more. 

In a sense, as a society, we have come to think of social entitlements as something that we better have in case we need it–Unemployment Insurance, Medicare, Social Security, Medicaid and more. 

You never know when it’s your turn to get laid off, sick, old, or needy. 

And isn’t that what’s it for–it’s a safety net–these are like personal insurance and you never want to need the coverage and not have it. 

But as we should know by now, having it–doesn’t come for free. 

So the question is how much social entitlements or insurance do you need–and part of the answer is how much can you afford. 

So is it really better to have it and not need it, than need it and not have it–if you can’t afford what you’re buying?  

In this case, our grandparents and parents having it and not really needing all of it–may mean that we and our children will not be able to have it when we do need it. 

To have social entitlements, we need to be able to pay into the system for it or borrow to finance it. 

Unfortunately, as a nation we have been doing more borrowing, because we have spent beyond our national means–we have even raided our very own social entitlement programs that we hold so dear, to pay for other things–maybe that’s why they call it a trust fund, because you really do have to trust, almost blindly, that there will be something there, when it’s your time to need it. 

It’s great to have it, but if we are gluttons and don’t responsibly plan for genuine needs–then as a nation, we really will be left needing and not having it when the time comes.

In short, spend all your money to soon, and tragically, there won’t be any candy later. 😉

(Source Photo: Andy Blumenthal)

Electronic Health Records, Slow But Steady

Skeleton

The best article I have seen on the subject of Electronic Health Records (EHR) was in Bloomberg BusinessWeek (21 June 2012) called “This machine saves lives so why don’t more hospitals use it.”

What I liked about this article was how straightforward it explained the marketplace, the benefits, the resistance, and the trends.

Some basic statistics on the subject of EHR:

The healthcare industry is $2.7 trillion annually or ~18% of GDP.

Yet we continue to be quite inefficient with only about half of hospitals and doctors projected to be using EHR by end of 2012.

Annual spending on EHR is expected to reach $3.8 billion by 2015.

Basically, EHR is the digitization of our medical records and automation of medical services so that we can:

– Schedule medical appointments online
– Check medical records including lab and test results
– Communicate with our doctors by secure messaging/email
– Send prescriptions into the pharmacy electronically
– Automatically keep track of dosage and refills
– Get alerts as to side effects or interactions of medication
– Analyze symptoms and suggest diagnosis
– Receive prompts as to the latest medical treatments
– Recognize trends like flu outbreaks or epidemics
– File and speed claim processing

So why do many doctor’s seem to resist moving to EHR?

– Cost of conversion in terms of both money and time
– Concern that it can be used against them in medical malpractice suits
– Potential lose of patient privacy
– Lack of interoperability between existing systems (currently, “there are 551 certified medical information software companies in the U.S. selling 1,137 software programs”–the largest of which are from GE and Epic.)

The government is incentivizing the health care industry to make the conversion:

– Hitech Act (2009) “provides $27 billion in financial incentives” including $44K from Medicare and $63K from Medicaid over 5 years for outpatient physicians that can demonstrate “that they are using the technology to improve care.”
– Patient Protection and Affordable Care Act (2010)–a.k.a. Obamacare–calls for “accountable care organizations” to receive extra money from Medicare and Medicaid for keeping patients healthy, rather than by procedure–“they are expected to do so using computers.”

The big loophole in EHR right now seems to be:

– The lack of standards for EHR systems from different vendors to be compatible, so they can “talk” to each other.
– Without interoperability, we risk having silos of physicians, hospitals, labs, and so on that cannot share patient and disease information.

So, we need to get standards or regulations in place in order to ensure that EHR is effective on a national, and then even a global level.

A number of months ago, I went to a specialist for something and saw him a few times; what he didn’t tell me when I started seeing him what that he was retiring within only a few months.

Aside from being annoyed at having to find another doctor and change over, I felt that the doctor was not too ethical in not disclosing his near-term intentions to close up shop and giving me the choice of whether I wanted to still see him.

But what made matters worse is that I got a letter in mail with the notification–not even in person–along with a form to fill out to request a copy of my medical records at a cost per page, so that I could transfer them–hardcopy–elsewhere.

Of course, this was also the doctor who hand wrote prescriptions still and wasn’t able to get test results online.

To me, seeing someone with a great amount of experience was really important, but the flip side was that in terms of organization, he was still in the “dark ages” when it came to technology.

I look forward to the day when we can have both–senior medical professionals who also have the latest technology tools at their disposal for serving the patients.

In the meantime, the medical profession still seems to have some serious catching up to do with the times technologically.

Let’s hope we get there soon so that we not only have the conveniences of modern technology, but also the diagnostic benefits and safeguards.

(Source Photo: Andy Blumenthal)