The Health Care Rosetta Stone?

Yesterday we examined the amazing news that the VA health system has turned around, an about face brought on by the implementation of electronic medical records. The streamlining of procedure and upgrading of efficiency that resulted are proof positive that EMR's are one of the keys to ending our current health care crisis.

Today eMaxHealth looks at another facet of the issue in an article they titled "The Dirty Work of Health Care Information Technology." Using EMRs can eliminate a vast array of problems with the current system but like all computer programs they are only as good as the data put into them. An old saying among computer professionals is "garbage in, garbage out," and that is the point addressed here.

A study by researchers from the Regenstrief Institute, the Indiana University School of Medicine and the Indiana University School of Health and Rehabilitation Sciences, looked at hospital laboratories from five hospital systems in the Indiana Network for Patient Care and found that even in the same metropolitan area - Indianapolis and its suburbs - a variety of names were assigned to the same test - for example: complete blood count, hemogram and CBC.

As EMRs (hopefully) become more common across the health care industry this looms as a critically important element of reform. Currently only 5% of non-VA hospitals use EMR's, with cost of implementation often cited as the main reason for their absence. The fact that many of these digital systems are proprietary or use different coding for the various procedures they document isolates them from each other. Standardized naming conventions are absolutely crucial to using information technology to effect change.

What we need is a Rosetta Stone to translate them. To that end the Regestrief Institute of Indiana developed one over ten years ago: LOINC.

LOINC, the Logical Observation Identifiers Names and Codes database, acts as a universal standard of reference for laboratory and clinical data. In plain English it provides a common language for testing and results that can be correlated to the local test names creating a means of accurately translating from one "dialect" of health care terminology to another. As they put it on their own website:

...most laboratories and other diagnostic care services identify tests in these messages by means of their internal and idiosyncratic code values. Thus, the care system cannot fully "understand" and properly file the results they receive unless they either adopt the producer's laboratory codes (which is impossible if they receive results from multiple sources), or invest in the work to map each result producer's code system to their internal code system. LOINC codes are universal identifiers for laboratory and other clinical observations that solve this problem.

Could this be the Rosetta Stone we need to implement EMRs effectively? If this keeps up, we may some day have a common language that unites all health care providers, improving service across the board.

SOURCE: "The dirty work of health care information technology"
SOURCE: "Logical Observation Identifiers Names and Codes (LOINC®)"
photo courtesy of namlhots, used under this Creative Commons license

A Libertarian Defense of Universal Coverage?

One way to get a person's attention is to hit him or her where it hurts: in the pocketbook. The average American's attention is now on health care reform for that exact reason. Over recent years, increases in the cost of insurance have far outstripped the pace of inflation and put the squeeze on the middle class and the working poor.

Today we will visit two sites in the Blogosphere that have definite opinions on the matter, each coming from different sides of the political spectrum. Lets start with the Daily KOS where the contributor known as HeartlandLiberal gives us a real world example of the rising expense of health care (Note: emphasis his):

This year the IMA medical services group here in Bloomington, IN, is threatening to withdraw from participation in the preferred provider program run by Anthem and used by Indiana University to manage its self-insured health care program through rational cost controls. They will withdraw unless they get a 23% increase in payment. THAT'S A DEMAND FOR A 23% INCREASE IN ONE YEAR.

Indiana University (IU) has a long and distinguished history of offering health care benefits well beyond the norm for the United States, even in the private sector. Click the link above to see the whole post as it includes a reproduction of the detailed memo sent to IU staff.

Then we bounce over to the other side of the ideological divide and visit the American Thinker web site where Randall Hoven, a self professed small government conservative/libertarian, offers a surprising argument in favor of universal health coverage along with detailed health care cost analysis.

The government provides Medicare for the old, Medicaid for the poor, veterans' hospitals for veterans, medical research funding and whatever else adds up to 6.6% of GDP. The federal government forces hospitals to provide emergency treatment to all comers. State governments mandate over 1,900 types of coverage on health insurance. Health care regulations cost the average household over $1,500.

We already have socialized medicine and we are already paying for it -- twice: once in taxes and once privately. What we are not getting is universal coverage.

But if universal care (via emergency rooms) is already mandated, what's the problem? First, it is not the best way to get treatment. For one thing, the condition has to be regarded as a medical emergency. Also, the law does not relieve you of having to pay for that treatment. In fact, medical bills are the leading cause of bankruptcies in the U.S., accounting for half of them.

So while you might not die, the U.S. health care system does give you the age-old offer of "your money or your life".

He presents a wide array of figures and documentation to back up his argument, giving lie to the idea that universal coverage is a left wing issue. As George Halvorson notes in his book, Health Care Reform Now!, universal coverage done right doesn't cost money, it saves money.

As an addendum, here's a link to the National Coalition on Health Care's document, Health Insurance Cost, an easy-to-read summary of health care costs based on 2005 data -- the most recent year for which data is available. Healthy reading!

SOURCE: "23% Increase Demand. Why We Need Health Care Reform" 12/11/07
SOURCE: "A Conservative Case for Universal Health Coverage" 12/12/07
SOURCE: "Health Insurance Costs"
photo courtesy of greefus groinks, used under this Creative Commons license