>Here's the best-case scenario for the government's plans to spend $19
>billion on computerized medical records,,,and the worst-case: $19
>billion goes down the drain.

On a weekly basis I get no fewer than 10 articles in various alerts on this
topic, and this has been true for more than 3 years now... in recent months,
the volume has gone up, but the music doesn't sound any better... those of
you with teens know what I'm talking about =)

What's most interesting (for me) is to follow the articles for 3-4 days and
wait for the point/counterpoint discussions to begin, and what's been most
refreshing to me is the counterpoints raised by many in the field of
medicine from varying aspects of the profession, a wide range of age groups,
and both public AND private practice.

Many of them have experienced directly what has taken place over the last
3-6 years with companies coming and going, systems, products and formats no
longer being supported or firms being gobbled up by other firms, lack of
standardization in formats and media forms, and the corruption of systems as
data grows and they are unable to properly process it.  And some have seen
the cost of conversion, maintenance, and a lack of compatibility of data
from other systems issues as well.

One of the earliest posts on my Computerworld blog was over 3 years ago 
http://blogs.computerworld.com/medina  and it addressed many of the concerns
related to a lack of standards, inability to exchange information, issues
related to persistent access, problems with proprietary data formats,
wondering who pays for changes to access controls, and how to deal with
portability of information as patients and caregivers move from practice to
practice, insurance companies are gobbled up, hospitals change allegiances,
etc.   NONE of these issues have sufficiently been addressed, but the desire
is still to charge forward.

A major reason for this is those developing the 'standards' (which are
really nothing more than practices or documented processes) are doing so on
a 'pay to play' basis.  There are a limited number of companies involved in
this, and naturally, the desire is to ensure what's being developed matches
what THEIR products produce and can perform.  There is an obvious lack of
balance or consensus in the process, and the result is going to be a very
narrow 'standard' that suits the needs of few companies and limits the
number of products available in the marketplace.

I've expressed my concerns to members of the Senate and the House who sit on
the committees looking at these issues, I've sent messages to Whitehouse.gov
when the issue pops up there, and I frequently respond to articles such as
the one Bruce posted yesterday... and I think we ALL should start speaking
our mind from the viewpoint of informed professionals with experience in
managing data over long periods of time.  

No one knows the issues better than those who have been faced with them
first hand, so why not share the knowledge?

Larry
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