Several clauses in the bill are telling. The National Coordinator of Health Information Technology will monitor treatments to make sure the doctor is doing what the federal government deems appropriate and cost-effective so as to reduce costs and "guide" the doctor's decisions (HR.1; p.442, 446). Hospitals and doctors that are not "meaningful users" of the new system will face penalties by the HHS secretary, who will be empowered to impose "more stringent measures of meaningful use over time" (HR.1; p.511, 518, 540-541).
The bill requires all recipients of the funds provided by the act to publish a plan for using the funds, along with purpose, cost, rationale, net job creation, and contact information about the plan to a website Recovery.gov so that the public can review and comment.
Inspectors-general from each department or executive agency will then review, as appropriate, any concerns raised by the public. Any findings of an inspector-general must be relayed immediately to the head of each department and published on Recovery.gov. If it isnt already obvious from these clauses, we can be fairly certain that the US government is very serious about wringing inefficiencies out of the existing system, improving access to, quality of, and affordability of healthcare, forcing accountability on doctors, lawyers, pharmaceutical labs, and so forth, and getting computers to be a central part of it.
The structure of medicine takes place in three separate activity centres. Unfortunately, each of these centres speaks a different language, has varied cultures, and brings in practitioners trained in entirely diverse ways. The three activity centres in medicine are:
1. Practice management: examples are,
a. Asset centres: hospitals, clinics, offices
b. Activities: diagnosis, procedures, prescription
c. Drivers: health system, population health
2. Innovation management: examples are,
a. Asset centres: labs, universities, clinical trials
b. Activities: discovery, creation, r&d, markets
c. Drivers: funding, innovators (long lead time)
3. Risk management: examples are,
a. Asset centres: insurance, legal, evidence / best-practice
b. Activities: statistical, info search
c. Drivers: human rights, events, healthcare has the highest error rate of any industry
|Figure 3: The three activity centres in medicine, and how they interact|
Each of these three areas has grown immensely complex over the last 20 years, and this has engendered a huge growth in medical information which is overloading the ability of the current system.
Sadly, healthcare is the last profession to hold out against widescale automation and reengineering of processes for efficiency. While other industriesretail, accounting, logistics, manufacturing, and so forthhave long since optimised their tasks around the latest information technology, medicine has had a difficult time moving beyond the methods that they settled into in the 1950s.
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