Forgot your password?
typodupeerror
Government Medicine United States IT Technology

The Savvy Tech Strategy Behind Obamacare 146

Posted by Soulskill
from the i-bet-the-borg-have-low-health-care-costs dept.
snydeq writes "The U.S. health care industry is undergoing several massive transformations, not the least of which is the shift to interoperable EHR (electronic health records) systems. The ONC's Doug Fridsma discusses the various issues that many health care IT and medical providers have raised regarding use of these systems, which are mandated for 2014 under the HITECH Act of 2004, and are all the more important in light of the 2010 Patient Protection and Affordable Care Act, aka Obamacare. Key to the transition, says Fridsma, is transforming health IT for EHRs into something more akin to the Internet, and less like traditional ERP and IT systems. 'I think what we're trying to do is the equivalent of what you've got in the Internet, which is horizontal integration rather than vertical integration,' Fridsma says. 'We've done a lot of work looking at what other countries have done, and we've tried to learn from those experiences. Rather than trying to build this top down and create restrictions, we're really trying to ask, "What's the path of least regret in what we need to do?"'"
This discussion has been archived. No new comments can be posted.

The Savvy Tech Strategy Behind Obamacare

Comments Filter:
  • by hsmith (818216) on Friday July 12, 2013 @03:58PM (#44264493)
    Before the govt started handing out $44k for docs to adopt shitty EHR systems and collect free money. We now have a plethora of shitty EHR systems in hospitals that don't solve any issues at all.

    So, the government created this incentive (Which made a few companies insanely rich, like Epic, Cerner, and Athena) - and created this massive siloed data mess. Anyone who has worked in HIT knows what a complete failure this EHR rollout has been on every front.

    Even better are the CHIIT "certification" standards (aka, a complete pile of shit) which were to ensure that EHR software met a bunch of standards to get that $44k. One of the hallmarks was "Interoperability" - which to CHIIT meant "systems can communicate with themselves" - derp.

    The EHR rollout was a complete failure, mainly due to the govt pushing shit out on the marketplace with their stupid incentives. It is going to take over a decade to untangle the mess of complete crap.
    • by intermodal (534361) on Friday July 12, 2013 @04:04PM (#44264531) Homepage Journal

      This is from the same government that brought us the VA hospital system. I work in HIT myself, and I see nothing good coming of these new technology mandates.

      • by hsmith (818216) on Friday July 12, 2013 @04:24PM (#44264677)
        Good idea, but in reality it should be all revolved around creating true standards and interoperability. Systems communicating together should have been the single desirable element in all of it. Instead, it was an afterthought. Now we get garbage like Commonwell (From the 5 largest EHR vendors) that will create more proprietary garbage.

        The people that created the mess we are in want to fix it? Please.
      • The VA will be moving to a commercial product I think soon.

      • by gzuckier (1155781)

        This is from the same government that brought us the VA hospital system. I work in HIT myself, and I see nothing good coming of these new technology mandates.

        Well, apparently you don't work in medical care quality and outcomes analysis.

        "RAND's study, led by Dr. Steven Asch, found that the VA system delivered higher-quality care than the national sample of private hospitals on all measures except acute care (on which the two samples performed comparably). In nearly every other respect, VA patients received consistently better care across the board, including screening, diagnosis, treatment, and access to follow-up ... Other studies have generated similar findings

        • That may be RAND's verdict, but I don't know a lot of veterans who would agree with their results being better.

    • by cs668 (89484) <cservin@cromagnon.com> on Friday July 12, 2013 @04:04PM (#44264533)

      Actually makes things worse. Because when the EHR's are in place they usually make sure to maximize the billable services provided in the back office so that you make sure to submit every claim possible. This helps to raise healthcare costs instead of lowering them by reducing paperwork......

      • The only billable services from Epic (the EMR that my employer uses) are the software support contract (maintenance patches/upgrades/technical support), any custom build you request (but the system is so flexible it is rarely needed) and training. Those seem pretty standard for any niche system. Epic is a lot more like IBM or Microsoft from a vendor standpoint than they are like GE.

        • by cs668 (89484)

          Sorry I wasn't clear. I meant that many of these systems EMR/EHR have a table or laptop interface that is used by the physician or assistant in the exam room. They will indicate what observations/tests they are doing and what the results are. Those systems will suggest other things they should do, in part to ensure good out come, in part to maximize the coding on the claims that will be submitted from that visit. That is the part I was suggesting would actually drive up the healthcare costs, not the sup

          • by cs668 (89484)

            Wow, just re-read my comment. Sorry about the bad spelling and typos. Just tired I guess!

          • If the reimbursement system emphasizes maximizes the coding rather than the quality of the outcome versus the cost to get that outcome then the software has little responsibility other than providing efficiency.

            • There is a problem though. My mother is involved with an independent home care startup. Home care is part of the new push to provide better care and keeps costs under control. Like I said, there are some problems. First, you need experienced nurses (which are retiring) to provide in-home care since they are often by themselves driving from patient to patient--new grads can not do the job and there is not enough money involved to pay two nurses to travel around while one is in training. The older nurses l

      • by d Bo (2979467)
        Not many EHR's are built around a practice management. Except for example Athena, which in that case I completely agree.
    • by PatHMV (701344) <post@patrickmartin.com> on Friday July 12, 2013 @04:41PM (#44264805) Homepage

      Right on. Moreover, who benefits from all this, anyway? The idea is that the patient benefits, because an ER doc at one facility can see all of that patient's health records when treating him. But what if the patient doesn't want that? The reality is that all this centralized electronic data will benefit insurance companies, not patients. Once certain things (epilepsy, say) are flagged in your electronic, accessible to any person authorized by law to see them (and that will be insurance companies, governments, and probably your own employer at some point), then it's there, and you're tagged for life. Good luck getting a driver's license. Or overcoming the stigma of some unpopular disease.

      I don't WANT all of my medical records out there. I don't think it will benefit me or my health. But these days I have little choice.

      • Why wouldn't you want your doctor to have your complete medical history at hand?

        I understand why you'd want to limit the access to your health records, but not if that includes doctors. Especially if it includes ER doctors.

        • by 0123456 (636235)

          Why wouldn't you want your doctor to have your complete medical history at hand?

          Because if they have it, so does the NSA.

        • Because if doctors have it then everyone has it -- in the above scenario, a patient has epilepsy but essentially doesn't want the government (DMV in this instance) to see that.

          - First of all, he is committing a crime. And anyone knowingly abetting that is in some legal jeapordy (may not be big).
          - Secondly, as soon as the doctor puts it on the chart, it gets stuck in the database. Then the insurer and anyone else who gets to see the database (? DMV) gets to see the diagnosis. It's like the Internet - once

      • by brentrad (1013501)
        So what you're saying is, if you have epilepsy, you want the ability to hide that from the DMV, so that you can still drive your car while having a potentially very dangerous condition to have while driving? You want the "freedom" to continue to endanger the lives of others so that you're not inconvenienced by having to take public transportation. Gee, thanks for your concern for your fellow man.

        Not really that convincing an argument for keeping your medical diagnoses secret.
      • by crazyvas (853396)
        This. And it gets even worse if you have a diagnosis that you don't agree with (much more common than you think). That stays on your centralized, global record forever too. It doesn't take much imagining to see the consequences.
        • by d Bo (2979467)
          indeed, which will ultimately affect how you are rated for health and life insurance. This is a terrible approach to healthcare because if I know my rates will be affected by what I share with my doctor and how they diagnose me, then I probably wouldn't have the proclivity to disclose important information about my health to a physician in the future.
      • by gzuckier (1155781)

        "But what if the patient doesn't want that? "

        Yeah, the last thing you want a doctor to know is what else is going on with your health, what drugs you take that might affect his diagnosis or prescription, what physical or genetic conditions you might have, what family history of disease you have, etc.....

      • by gzuckier (1155781)

        You do realize that the insurance companies already have full access to your medical records, as part of their contract to insure you, electronic or written, and that if your doctor fails to disclose anything he is liable to get his butt kicked, and if you fail to disclose anything you are very likely to NOT get that million dollar claim that we buy insurance against paid? And that the same ACA which pushes for electronic records will take the pressure off the need to hide preexisting conditions from potent

      • They are not YOUR records, they are merely records of your health care. They belong to the doctors or the medical institutions. The medical records are not for your consumption and most practitioners will not let you have them. Sometimes people get a peek at the records but you are not going to get a copy typically. You have no choice about their propagation.

    • by AK Marc (707885) on Friday July 12, 2013 @04:46PM (#44264853)
      As opposed to the EHR before Obama, where I literally had to pay $200 for a hard copy of my X-ray to walk it two doors down the hall to give it to the doctor, who had to go walk down the hall the original place to see the electronic stored copy because the resolution wasn't sufficient on the hard copy, but it was stored electronically. I never had a patient system that talked to any others.

      I moved out of the US, now any doctor I go to in the country, can look me up by name and DOB and see my entire medical history (or health care number, which nobody ever has on them).

      The problem the US commits every time is that they ask the people who profit from the systems, how to make them. Every solution I've seen could have been done better by a bunch of high school students. The pros have a vested interest in making it fail. The worse it works, the longer they have jobs. And never are there financial penalties in government contracts.
      • by ideonexus (1257332) on Saturday July 13, 2013 @09:42PM (#44272929) Homepage Journal

        This. This. This.

        My wife and I had our second child two weeks ago. Despite the fact that we had spent nine months working closely with a clinic that had been monitoring the pregnancy, dispensing the proper medications, and who had midwives and doctors working at the hospital we would be delivering at, when we arrived at the hospital we found that they had NOTHING in their systems regarding my wife and her medical history. We then spent an hour telling the triage nurse everything we knew about the pregnancy from memory, until a doctor from our clinic finally showed up at the hospital with a big folder of printouts that no one had time to look at because my wife delivered a half hour later.

        When we asked afterwards why the hospital had no record of us despite the fact that they knew we would be delivering there, they explained their system had no way to transfer electronic records and that they were still relying on printouts that would have to be entered by hand. Amusingly enough, they were launching a new networked electronic system while we were there that would enable the transfer of records.

        Of course, the hospital staff freely admitted the new system was a complete headache to learn and that they had resisted it as long as possible, but thanks to "Obamacare" they were now required by law to implement such a system. Let that sink in for a moment. Hospitals are perfectly happy to have absolutely no information on the patients that arrive in their emergency rooms in America because upgrading their information systems is a hassle.

        People complain about government regulations, but in this case, I'm perfectly happy to have government give the Medical industry a swift regulatory kick in the ass on this. There is no excuse for endangering human lives like this.

    • Epic and Cerner are the best in the market from an over all EMR standpoint (there are specialty functions they will not due such as Hemodynamics etc). These systems give the IT staff a lot of control and power to implement functions that the staff ask for rather than simply asking the vendor for a feature and waiting for them to build it.

      • by d Bo (2979467)
        You must work for one of them, and Im guessing you only work in the acute care segment. Epic is the most linear, rigid, and costly system in the market. Although I will admit its tightly integrated between acute and ambulatory care. I feel like they might be afraid of competition when it comes to inter-operability. Cerner's products are half-assed at best but they offer much more inter-operability because EMR is a secondary or tertiary market to them and like McKesson, they make their money in other plac
        • 1) I said they were the best in the market, not as good as it will ever be.
          2) I do not work for either
          3) How is Epic Rigid or Linear? I find it is neither. Both system s are only as good as the people who are employed o implement them.

    • by d Bo (2979467)
      Im gonna say you are half correct. Doctors are buying MU certified electronic records systems for two reasons.

      1. The government believes they know what is meaningful in healthcare. As part of a 600 billion dollar stimulus they committed 29 billion dollars on a first-come first-serve basis to general practices and hospitals in order to adopt electronic systems they deem to be meaningful.
      2. Medicare will reduce reimbursements if you are not using an electronic system certified ONC-ATCB. 2% this year,
    • what i love about the article is how the suit blithely goes on about a project he's managing when he has no one competent to build it. the only people he's got are yes boys and girls who will promise everything they think will help their job security and produce nothing but cr*p for show time. gutless people make gutless software.
  • Why not just parse the existing NSA database?

    No point in reinventing the wheel. Like a good neighbor, Big Brother is there!

    • by gl4ss (559668)

      well..

      you know why most of these are top down? so that there's some control on who gets to the data. obviously if you drop that requirement then doing the data sharing between hospitals etc is pretty easy.

    • by Mitreya (579078)

      Why not just parse the existing NSA database?

      Snowden hasn't yet confirmed that NSA trawls medical history. Maybe they don't (yet).

  • Bingo (Score:5, Insightful)

    by Anonymous Coward on Friday July 12, 2013 @04:00PM (#44264501)

    I just filled out my BS bingo card when they called both "horizontal integration" and "vertical integration".

    On topic: The path of least regret would have been single payer system, but we somehow ended up with a Republican profit-utopia called "Obamacare".

    • by h4rr4r (612664) on Friday July 12, 2013 @04:16PM (#44264631)

      Infinity Imaginary mod points to you sir.

    • it's not too late, we could still pass HR 676, Medicare for All [healthcare-now.org].
      • it's not too late, we could still pass HR 676, Medicare for All [healthcare-now.org].

        Doesn't matter if it's the best idea humanity ever came up with, it won't go anywhere in its current form.

        Now, were it to be renamed the Anti-Terrorism Immigration Marriage For the Children to Protect America Act, we might actually be able to move the ball forward...

        • by Culture20 (968837)

          Now, were it to be renamed the Anti-Terrorism Immigration Marriage For the Children to Protect America Act, we might actually be able to move the ball forward...

          ATIMFCPAA is a terrible acronym. Ahtimpfkapahah?

    • On topic: The path of least regret would have been single payer system, but we somehow ended up with a Republican profit-utopia called "Obamacare".

      Yea, almost as if Republicans weren't the only ones who wanted it...

      Partisanship: because independent thought is hard!

    • And here it was the democrats were supposed to be the smart ones.

    • by Geste (527302)

      In the Clinton era (think HRC and Ira Magaziner) the arrogant, doomed approach was to use the Democratic "Big Tent" and invite all players -- pharma and insurers included -- to invent some fanciful "Health Care Reform (TM)" that would make all parties happy. Instead, insurers and pharma burned down the tent, scattered the ashes, then stabbed Health Care Reform to death.

      Fast forward to the Obama admiserablestration, and there's not even a pretense of making anybody happy beyond the guys with the knives.

    • by Anonymous Coward

      It's kind of hard to blame any of it on the Republicans since they were not at all involved in the meetings and didn't vote for it.

    • I just filled out my BS bingo card when they called both "horizontal integration" and "vertical integration".

      On topic: The path of least regret would have been single payer system, but we somehow ended up with a Republican profit-utopia called "Obamacare".

      Maybe he should have had all the meetings in the open, and broadcast on CSPAN, like he promised to do during the campaign [youtube.com], instead of negotiating the entire thing behind closed doors with the corporate executives and buying votes with pork and bribes.

  • by intermodal (534361) on Friday July 12, 2013 @04:02PM (#44264521) Homepage Journal

    There is nothing necessary about what they're mandating.

    Thanks to the way Washington, D.C., works, the end result will be smug bureaucrats patting each other on the back, and doctors wondering if they should just find a different field to work in.

    • There is nothing necessary about what they're mandating.

      Yeah, these computer things are so transient and unnecessary.

  • by Anonymous Coward

    This all sounds good... It sounds good like using Skype to make phone calls until you find out everything has been freely handed to the NSA... Now, everything in your medical records is available to the NSA and Obama... I'm not at all happy about the prospect!

  • by Richy_T (111409) on Friday July 12, 2013 @04:08PM (#44264569) Homepage

    Costs three times as much as the originally budgeted cost, is delivered five times past the deadline and doesn't do a tenth of what was promised.

    • Costs three times as much as the originally budgeted cost, is delivered five times past the deadline and doesn't do a tenth of what was promised.

      You sir, are an optimist.

    • by schwit1 (797399)

      Wait until you find out it only works with Internet Explorer.

      • Wait until you find out it only works with Internet Explorer.

        IE6. With NoScript disabled, and some proprietary ActiveX component that NEVER FUCKING DOWNLOADS RIGHT.

  • by Hatta (162192) on Friday July 12, 2013 @04:13PM (#44264611) Journal

    Other countries have single payer health care, which delivers better outcomes at a lower cost. Try learning from that.

    • by h4rr4r (612664) on Friday July 12, 2013 @04:17PM (#44264639)

      That does not maximize insurance industry profit. Which is in fact the entire point of the ACA.

      • by JWW (79176)

        Yep. It really amazes me that Obama set up the law so that he had to fight with states to set up health care exchanges.

        All he had to do was have the law make health insurance markets work across state lines (easily justified by the commerce clause) and then he would have had to only set up ONE exchange for the whole country.

        But, of course, the insurance companies would not have made as much money that way.

        • by CanHasDIY (1672858) on Friday July 12, 2013 @05:10PM (#44265059) Homepage Journal

          Yep. It really amazes me that Obama set up the law so that he had to fight with states to set up health care exchanges.

          Ah, well, simple answer there - he didn't [house.gov]

          • by JWW (79176)

            Yeah, sure smart ass. I've seen "I'm Just a Bill" on schoolhouse rock.

            But Obama drove the creation and lobbied congress heavily for the bill. If he'd have wanted a singular exchange, he could have gotten it. But he played along with give backs to the insurance industry so they wouldn't fight Obamacare.

            However, the Republicans, in an example of arguing against a compromise that would help make a bad bill better would have argued like mad against a singular national health insurance exchange anyway.

      • Re: (Score:3, Interesting)

        by Anonymous Coward

        That does not maximize insurance industry profit. Which is in fact the entire point of the ACA.

        Nope. The entire point of the ACA is to destroy the insurance industry, causing an emergency for which the only solution will be single-payer.

        They told the insurance industry "sure we're bending you over a barrel here, but at least you are going to get a lot more people buying policies." The insurance industry never wanted this, but tried to get the best deal they could to try to weather the storm.

        But insurance

        • by Nimey (114278)

          Go home, Alex Jones, you're drunk.

        • by brentrad (1013501)

          The entire point of the ACA is to destroy the insurance industry, causing an emergency for which the only solution will be single-payer.

          We can only hope. That would be the best possible outcome. Tell me again what the point of insurance companies is?

          • by Magius_AR (198796)

            Tell me again what the point of insurance companies is?

            To keep your life/finances from being ruined: when your house burns down, when your car gets t-boned, when a sudden disability makes you unable to work, when your spouse dies and you can't afford the bills...etc, etc, etc. Insurance has a purpose -- it is just implemented in a backward and pisspoor fashion in medicine (largely but not solely in part due to the government mucking about with it)

        • by Anonymous Coward

          The disconnect here is rather striking. I watched that entire video and it took me a while to realise that it was anti-ACA, especially since no arguments were made that single-payer was a Bad Thing. If what you say is true, then Obama is a savvy politician who has pwned the Rs and done something that about 70% of the US population wants and most of the rest of the civilised world already enjoys!

          It kind of made my day.

          • by Q-Hack! (37846) *

            Just because 70% of the population wants something, doesn't mean it is a good idea. We may well end up with a single payer system. Good luck finding a doctor when we do.

            There are many things we could have done to bring down the cost of medical care. eg. Force doctors to post their prices. Not force insurance agencies into "must provide" plans. Allow insurance to be purchased across state lines, etc... Hell, just bring back the free market's risk/reward concept to the medical world. Sadly, none of the

    • by Anonymous Coward

      Other countries have single payer health care, which delivers better outcomes at a lower cost. Try learning from that.

      Those are free, democratic and egalitarian societies with a socialist bent.

      We in the US, OTOH, are a feudal republic with an ignorant population that is under the delusion that all they have to do is work hard and they'll be rich.

    • Re: (Score:1, Insightful)

      by dfenstrate (202098)

      Other countries have single payer health care, which delivers better outcomes at a lower cost. Try learning from that.

      And those countries do that by either gaming the statistics, or having a homogenized society where social pressure to conserve public resources can be successfully applied.

      • Re: (Score:3, Insightful)

        by Hatta (162192)

        Single payer just makes sense. A centralized, not for profit system is going to be more efficient than a thousand different companies with their finger in the pie.

        And what's wrong with a little pressure to conserve resources? Waste is rampant in the medical industry. As it is now, hospitals get paid for an x-ray whether it's needed or not. More needless tests means more profit, exactly the wrong incentive. We need to tie funding to outcomes, not procedures, and a centralized system is the right way to

        • Centralized control is not known for its efficiency and lack of waste.

          I don't really care if we have single payer or not, but I think it's foolish to think that making huge changes in the system at once will automatically make things better. France and Germany don't have nearly the difficulties we would have in a single payer system, based on size alone.
      • by Anonymous Coward

        Lower infant mortality, longer life spans, etc. are *clearly* made up statistics. There is *no* way such numbers could ever be come up with that could be trusted-- impossible. /sarcasm

        Facts oppose your opinion. If spreading unsubstantiated FUD is your only counter then you have no rational basis for your opinion.

        If you feel otherwise, provide citations please.

        • Lower infant mortality, longer life spans, etc. are *clearly* made up statistics. There is *no* way such numbers could ever be come up with that could be trusted-- impossible. /sarcasm

          Facts oppose your opinion. If spreading unsubstantiated FUD is your only counter then you have no rational basis for your opinion.

          If you feel otherwise, provide citations please.

          What do those statistics have to do with health care? Infant mortality is calculated so much differently in each country, it's difficult to make any comparison at all, and life span is about life style, not quality of health care systems. Try checking, for instance, cancer survival rates, medical treatment for heart attack victims and survivability, trauma survival after emergency care, and mobility restoration after stroke. That's how you measure the quality of health care, not by when people die, by ho

          • Health care is not trauma care. You're an idiot. Quality of life and lifestyle moderation is exactly what good healthcare is about.

            Do you take your car to a body shop to get your brake pads replaced? If you wait long enough you may have to (have your rotors planed). Maintenance can prevent a lot of problems. Health care is good maintenance.

            • Health care is not trauma care. You're an idiot. Quality of life and lifestyle moderation is exactly what good healthcare is about.

              Do you take your car to a body shop to get your brake pads replaced? If you wait long enough you may have to (have your rotors planed). Maintenance can prevent a lot of problems. Health care is good maintenance.

              So... you take away people's choices in what they eat, force them to exercise, require them to visit a "provider" periodically (ensuring that enough are trained in that field, regardless of their wishes), and soon you'll have lots of much healthier ... slaves. Great plan, Your Grace!

      • by Kjella (173770)

        And those countries do that by either gaming the statistics, or having a homogenized society where social pressure to conserve public resources can be successfully applied.

        And several moderators from the USA! USA! USA! crowd have swallowed it hook, line and sinker already. If any country is doing anything better than the US, they must be lying or the situation is not comparable. Here's how it really works, most of our doctors are public employees working for a public doctor's office or hospital which means they don't have any direct incentive to pad the bills. Private institutions mostly do things by public requisition like this patient needs a back surgery, here's $X to do i

    • by epyT-R (613989)

      their citizens also have few rights, are manipulated by punitive taxation, then routinely have their life choices dictated by the state so that it can cut costs. these savings go right into funding more bureaucratic growth. in many of these countries, life has already hit not worth living status imo.

      while there is no free lunch, ill take freedom over socialism anyday (that includes political shitpiles like obamacare). it's too bad washington doesnt care any more about freedom than these so called 'enlight

      • by Hatta (162192)

        What good is freedom if you can't exercise it for fear of medical bankruptcy? Social safety nets make us all more free.

        • by epyT-R (613989)

          only as free as the government will tolerate the expenditure. If it decides your behavior is too costly (or just uses cost as an excuse to kill behavior it finds 'dangerous' to its powerbase), it will get taxed into oblivion, or made outright illegal...and if you're caught, you lose your healthcare...permanently. I prefer the current system over that because I still retain the choice and the power. healthcare is just one of the current beachheads for socialist governments to chip away at liberty in other

          • Some other beachheads: clean water, large nature reserves, national defense, education, energy, roads and transportation, wireless communications, interstate commerce - to name a few.

            They may have faults and all would benefit from an overlay of local policy (many do have this via state laws and regulations) but all are effective enough and all are governed by standards and policies set by a central authority.

            Health care should be in this list. It is a national concern at the very least. The health and well

  • by msobkow (48369) on Friday July 12, 2013 @04:18PM (#44264647) Homepage Journal

    Remember the EDI systems of old? Have you worked with XML today?

    Those data transfer systems only work because the information formats are standardized amongst the products that claim to support them.

    Unfortunately, EDI standards were often a "kitchen sink" approach with a bazillion "optional" message components to cater to the "special features" of vendors who had enough clout to demand that they be supported.

    A rational, clean, genuine reworking and reengineering of data streams would lead to interoperability and the ability to share information between all the different components involved, while allowing specialized features to be tailored to the vertical segments of the marketplace (doctor's office, hospital, pharmacy, and so on.)

    The unfortunate thing for the IT industry is that there are very few verticals within the horizontal, so if the "big players" provide for those markets, there is little to no market left for anyone who wants to get a foot in the door. I'd be willing to bet that 90% or more of the negative comments in this thread about the initiative are from people who work with or for those smaller players, and who see their jobs disappearing as the megaproviders take over.

    • by h4rr4r (612664)

      Instead of all of this why not have the government provide one piece of software that does this for free to doctors and let that also be the reference implementation?

  • by Cornwallis (1188489) on Friday July 12, 2013 @04:23PM (#44264667)

    As one in the field the only thing "savvy" about the [fill-in-the-blank-government-agency] strategy is the salespeople getting the government to throw boatloads of money at shit that once again WILL FAIL TO DELIVER.

  • >> 'I think what we're trying to do is the equivalent of what you've got in the Internet, which is horizontal integration rather than vertical integration...'

    It's always fun listening to a suit try to describe the interwebs using MBA terminology.

    Next we can look forward to listening to health care issues described as "target markets" and "economies of scale".

  • The U.S. government's track record on security, efficiency and effectiveness is unmatched. This is sure to succeed!
  • According to what I've read (Does the press ever get anything technical correct?) It appears that at least in some software already in use there are no audit trails. USED TO BE the FDA required all software used in the medical industry to be validated. This is not the engineering validation, but rather you have to prove every single operation, starting with the log in. Take that log-in for example. You had to log-in with a valid name and PW. Print the screen before pressing enter and again after to prove

Nothing is faster than the speed of light ... To prove this to yourself, try opening the refrigerator door before the light comes on.

Working...