HCR: a great day for storage

by Robin Harris on Monday, 22 March, 2010

The historic Health Care Reform that Congress passed last night puts America on a path to be competitive with every other industrialized nation. But it is good for the storage industry as well.

Why?

Electronic medical records
As I noted back in ’06:

Medical records are one of the biggest storage opportunities of the next decade – if Americans can be persuaded they are secure. Right now they aren’t, and with the continuing stories about lost laptops and illegal data access, there is no reason for people to get comfortable. Without public support electronic medical record systems are dead and millions of Americans will suffer from medical delay and even death.

HCR fixes part of the problem: outlawing insurance denials based on pre-existing conditions removes a big fear of electronic medical records (EMR). There is still the issue of medical privacy (see Medical privacy is a sick joke), but that is fixable.

Well implemented, EMR, along with other process re-engineering, can deliver the same results for citizens that it did for the Veterans Administration health care system (see Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care from the peer-reviewed New England Journal of Medicine).

The net/net: a common, uniform, EMR takes better care of patients, virtually eliminates prescription errors, enables large-scale studies of treatment protocols, and ensures that a highly mobile population gets consistent care. It’s all good – and massive storage makes it go.

The StorageMojo take
EMR will drive massive growth of medical data, both locally in doctor’s offices and in hospitals, but also in the cloud. Large anonymized data sets will be popular for research – expect Amazon to store them for free – on everything from treatment outcomes to drug interactions and patient education techniques.

While political conservatives demonize science and data-driven policies, the real world work of doing more with less continues. Massive EMR data will be a key driver over the next decades for improving medical outcomes and reducing costs.

Note: Data geeks will like this: Florence Nightingale was not only a public health reformer, but a statistician and pioneer in data visualization. Check this out for details.

Courteous comments welcome, of course. Kudos to the Republicans for their principled work to protect campaign contributions every American’s God-given right to a premature and bankrupt death. But they lost, and a bit of our freedom dies with them.

{ 9 comments… read them below or add one }

@johnmharte Monday, 22 March, 2010 at 2:53 pm

One thing that the VA example doesn’t say EMRs do… make an MD in front of the patient more efficient. Since most of the EMR/EHR benefits are practice management and backend research. The doctor can’t cover more items or see patients more quickly. Add in a hard to use software interface and the patient’s experience with the doctor is now worse.

The VA system runs on a database technology called MUMPS. It’s evil… ;)
http://en.wikipedia.org/wiki/MUMPS#Current_users_of_MUMPS_applications
Then they had to cut off their interfaces with the DoD just two weeks ago b/c of bad data being fed into their EHR. No “patient deaths” resulted…but scary never the less.

So…just be a little careful with the VA studies. They are a sign of some good but not gold… and it’s the VA. They will get it wrong shortly. ;)
http://www.auntminnie.com/index.asp?Sec=sup&Sub=ris&Pag=dis&ItemId=89859&wf=1

As for storage, PACS. Images…
Their active storage and archive storage will always be many times greater than a patient’s medical record. With every new MRI/CT scanner we get…and it’s ever multiplying slice density… the storage grows…and by 100′s of GB per new technology.

Now primary care doctors are really getting into small, portable ultrasound devices. They can diagnose all types of life threatening details in your chest region. Only a matter of time before that is recorded as video and added to your patient record.

The medical records for EMRs are actually pretty efficient.. being a database and all. However with a catch. Since very few of the vendors have come up with good ILM rules inside the application… that data right now lives for ever. I’ve sat on many phone calls with our inpatient vendor about their patient record system asking how we could archive older records and imaged documents. We know 21 years + 1 or 2 would do it…. if you were born in our hospital… but what if you had a major diagnosis on a visit? How long should that stay? Each state = different answer. Sometimes it depends on what type of diagnosis….

I go into all this to say, yes great for storage.
Great of storage, great for a teiring storage solution…

I think bad for the MD and the patient experience… until some of the nice web-based scheduling/personal health record features come along.

I also think the politics of the bill should be left out of this otherwise tech discussion. It’s irrelevant and really didn’t need to be part of your otherwise great blog. I’ll read your blog with a more cautious eye now…. looking for politics vs. good practice.

Rich Seiling Monday, 22 March, 2010 at 9:41 pm

“EMR takes better care of patients, virtually eliminates prescription errors”

EMR is great, but there are still plenty of prescription errors possible as it still depends on nurses to administer drugs and pharmacists and their tech to fill prescriptions. Using EMR can’t make people preform perfectly. I’ve been in several treatment settings with EMR and great people, and they still make mistakes.

Robin, given your much needed railing on the many problems of digital storage and lack of drives meant for archiving, I’m wondering how things like your last article on error rates will affect EMR given the current state of the art. Is my HMO one read error away from loosing my medical history?

Robin Harris Monday, 22 March, 2010 at 11:50 pm

John,

The NEJM study found that “patients receiving appropriate care was 90 percent or greater for 9 of 17 quality-of-care indicators” which says the VA was hardly perfect – but that was good enough to give them the best care in the nation. We can definitely do better. I wrote some more about the VA system on ZDnet: http://blogs.zdnet.com/storage/?p=575

I was talking to some hospital IT folks a couple of months ago and they said that physicians are the ones driving to keep data on line for longer and longer periods. Another + for the storage industry.

By all means watch for bias in what I write – I talk about some of my biases on the About page – and I’m in the process of starting a blog with a focus on politics and technology. We’ll see how that goes. As one who voted for Reagan and is congenitally independent, I am confounded by the current Republican party and what passes for “conservatism” today.

Robin

Robin Harris Tuesday, 23 March, 2010 at 6:10 am

Rich,

According to BusinessWeek (http://www.businessweek.com/magazine/content/06_29/b3993061.htm)

“And while studies show that 3% to 8% of the nation’s prescriptions are filled erroneously, the VA’s prescription accuracy rate is greater than 99.997%, a level most hospitals only dream about.”

To your point I think this is for meds that are picked up, not those that are distributed to admitted patients. There are other techniques for improving the accuracy of those.

Your HMO is backing up your data. It might take a while, but they can get it back.

Robin

Mark Preston Tuesday, 23 March, 2010 at 8:09 am

Well I hope HCR doesn’t morph into a government run bureaucracy like the VA. The level of inefficiency is astounding. I sometimes wonder if it isn’t by design. The ramifications of centralized control of EMR and associated storage , relative to private sector, would be negative.

Inherent in the discussion of medical privacy will be “who has physical possession of the data”. As an extension of that question will be centralized repository (VA style) or distributed repository. Distributed from the standpoint that ownership resides with the person, maybe even physical ownership. You or a designated person allows access to the data. In the end these decisions will impact the overall IT architecture.

Colm Tourque Wednesday, 24 March, 2010 at 7:11 am

“The historic Health Care Reform that Congress passed last night puts America on a path to be competitive with every other industrialized nation. But it is good for the storage industry as well.”
Why would we try to keep on track with other nations that have common 10% unemployment…oh wait we are. Friggin’ brilliant! Stick to the storage.

Robin Harris Wednesday, 24 March, 2010 at 3:59 pm

You must have missed the part where Detroit claimed it couldn’t build competitive cars because health care costs were killing them. We need to get our employers out of the health care business and focused on their core competencies. We also need to bend the cost curve on health care – we can’t afford the current system – and that is why the AMA and many others actually in the business of health care supported the bill.

When I was in France with my family my then 7 year old son got sick. Called an English-speaking doctor in the late afternoon, got an appointment the next morning, saw the doctor with a 10 minute wait and didn’t pay a dime. The French have fine medical care and I, for one, was sold.

Robin

Thomas Jefferson Wednesday, 31 March, 2010 at 9:47 pm

Let’s hope the government takes over storage technology next, nothing will drive prices down like removing any considerations for cost from anyone in the market for storage. Once unlimited storage is completely “free” for users and funded entirely by taxpayers, what can possibly go wrong?

Colm is correct, you are apparently clueless when it comes to basic economics, or even the history of how government meddling in health care for the last 50 years created the very problem in the first place.

Stick to storage.

Robin Harris Wednesday, 31 March, 2010 at 10:23 pm

Tom,

If “government meddling” created this mess – when most observers credit our fee for service model – why is that every other industrialized country with universal insurance has much lower costs than we do? With equal or better results?

Why is it that the VA offers some of the best care in the nation for lowest cost? Why is it that Medicare admin costs are 3%, while HCR guarantees insurance companies 15-20% admin costs?

You probably missed this detail, but the HCR plan has everyone paying for health insurance. Paying. Got that? No free rides. Some people get subsidies, but everyone pays. Which is something that conservatives long ago – like 5 years – thought was a great idea.

And why is it that people who have never taken an econ course or evidently a history course, are so sure they understand how this stuff works?

Answer me that, Tom.

Robin

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