Politics as usual. North Carolina is not immune.
North and South Carolina: How many more studies do it take to convince your respective General Assemblies to expand Medicaid when the federal government is paying for most of it.
While you are at it, North Carolina, get rid of vehicle inspections; add the state’s portion to existing fees, like South Carolina did.
The Affordable Care Act’s expansion of Medicaid seems to reduce mortality rates, increase enrollment and coverage, and decrease the uninsured rates.
H/T: @_theplugdaily. It does help that their infrastructure is much newer, therefore less adverse to technology.
Electronic Health Records are a good thing, except when they are not. Being disabled, medical professionals are a major part of my life. Interactions with them, for the most part, can’t be avoided. I consider myself a geek and reasonably wise to electronic communication means. I even have a working knowledge of HIPAA and all that entails. Coming to grips with the utter lack of EHR implementation at the consumer level is difficult to deal with. One of the providers has a reasonably popular medical specific web portal. It’s not very functional, but it exists. Another group is part of the region’s largest system. My mind struggles with the concept of a total lack of confidence in modern medical communications and associated technology. Having a secure HIPAA compliant communication portal, app, or even Whatsapp, which is 100% encrypted, suitable for transferring files that can be imported into the record keeping that all facilities are mandated by law to control. As the nation nudges toward a single payer system, despite current politics, inefficiencies become sore wounds and costly. The lack of portable EHR with a common format for the secure interchange of data will come back and bite the clients who are in no position to weather the outcomes. Nobody, not even TPTB, wins in that environment.
Recently, I had a doctors appointment with my family physician. What is interesting about this event? He carried a tablet with a keyboard dock with him as he discusses with the patient. All of our conversations are transcribed and available for reference. The rest of the office only has the standard technologies; desktop computers, printers, faxes, that sort of thing. I printed out the most recent list of medications, and the staff either scanned or typed the information in their systems; couldn’t tell which, and it didn’t occur to me to ask.
As I was researching this post, there are few events in life that haven’t happened to someone else, this being no exception. As early as five years ago, this entered my view:
Healthcare facilities need to work with providers to make it easy for them to deliver excellent care. This includes having ready, instant, and continuous access to complete patient records – access resulting from compatible EHR systems and dependable computer networks. Standards must be set and enforced that allow compatibility across systems. A start has been made in this direction, but it needs to progress quickly yet carefully (Tong, 2012)
If any of my interactions are any guide, these lessons were not learned nor executed. And that is a shame really. Anything close to a potential utopian solution must have the free and fair interchange of Electronic Health Records while automating as much of the nonclinical minutiae of the American Health Care system; even if it remains a continuation of the Affordable Care Act.
North America and UK current systems. Canada is a national network of province systems.
You can’t fault the Democrats and Liberals for trying. After all, the base (which includes me) is finished with half-measures. I am among them, though I’m not quite ready to go all-in for the total government system. My preference is that everyone who is not covered by an employer or Veterans Affairs coverage is eligible for Medicare with everyone 200% or less of poverty level eligible for Medicaid. Medicare isn’t perfect, and I have some issues with it myself, but it is certainly better than the alternative. If I say, Carolinas Healthcare, it’s in my operating interest to take care of patients that are done now in the Emergency Rooms, without having to worry about them getting paid or trying to collect on folks that will probably never pay it back, due to chance or choice.
While Republicans were trying and failing to repeal Obamacare, Democrats in Congress were quietly lining up behind a single-payer health plan that, as written, would fundamentally reshape American health care for every single person in the country.
That plan has now gained the backing of 60 percent of House Democrats, the most support a single-payer plan has ever enjoyed in Congress, and Sen. Bernie Sanders (I-VT) is planning a national campaign for a similar proposal in early September.
But by its author’s own admission, the House single-payer plan — Rep. John Conyers’s (D-MI) HR 676 — may not be ready for legislative prime-time. For instance, it contains only a skeletal outline of how to raise the trillions of dollars needed to achieve the universal, free coverage it wants to give every American.
But the bill is the sudden rage among the Democratic base and its congressional officials, aligning the party with a piece of legislation whose scope and speed would likely be unrivaled by any recent law in the Western world, according to four health care experts.
I wondered out-loud in a draft version of this blog post the following:
I cannot tell if this is the career politician FDA speaking or what, and frankly, this shouldn’t be an issue with any administration, but it sure is with this one.
Upon further review, this is the type of announcement was expected and favored; and consistent with the history of the FDA Commissioner, a political appointee of POTUS45. I fully understand the temptation to speed the process up of software when it comes to medical capabilities. This process has been thought carefully, but two things stand out for me.
- HIPAA is the law of the land when it comes to digital medical records. This is a complicated system; that is where we are. How does this idea of a pre certification tie into these requirements? Blog posts on this subject here, here, here, and here.
- All of this is moot if the majority of citizens can’t access it due to not being covered under Medicare and Medicaid; the very constituency that can be best served by digital medical options in software including telehealth initiatives.
As for point #2, the rules for current Medicare reimbursement are found here (PDF) and are in my opinion, lacking. A change of mindset when it comes to payment overshadows any other aspect of our current system. In my ideal health care system, there would be Medicare for all with the private insurance market to fill gaps similar to Medicare Supplement policies of today and to “jump the line” in services for a fee. Digital medical options, such as Telehealth and Software based Medical Case Management would be included in the base Medicare and Medicaid plans.