Welcome to today’s edition of Watercooler: Last Week, RedState.   This WC is all about Posts, Reader’s Diaries, and comments at RedState

Hot Topics Last Week:

Well, I was all set to do some work on this section and I noticed that RedState contributors, Kimberly Ross and Andrea Ruth, decided to “bring to you a summary of news from the week and how RedState covered each issue.”

This seems like a duplication of effort needed for this section so for this week I’m just going to refer you to their post.

Recurring Topics at RS:

Healthcare Records, the VA, and government competency

From Greg Scandlen over at The Federalist, there’s this: The past decade of throwing taxpayers’ money at health information technology makes the Solyndra boondoggle look like chump change

President Obama built the HITECH Act into his 2009 stimulus package and appropriated some $20 billion in the first year alone to make it happen. All promised to get everyone’s complete medical records in digital form by 2014.

How are your medical records today? I recently had cataract surgery at my local hospital. They did each eye one month apart. Each time I had to complete the exact same questionnaire about my allergies, the drugs I’m taking, and my medical history. Apparently their information technology couldn’t retain the information for even a month.

We Could Have Foreseen This Outcome

The past decade of throwing taxpayers’ money at health information technology (HIT) makes the Solyndra boondoggle look like chump change. None of this should have been remotely surprising to anyone looking objectively at the evidence. In 2006, the United Kingdom’s $12 billion effort to computerize medical records in the National Health Service was already falling apart, according to a report to Parliament. A few years later, the government candidly admitted it had wasted all the money and was closing the program.

In the United States, even more modest efforts by our own government had already failed. The Veterans Administration spent $167 million to simply computerize its appointments system.

…

At the Department of Defense “top health officials lambasted the department’s central electronic health record system that manages patient files for millions of active duty and retired service members, saying it frustrates doctors because it crashes as often as once a week and generates duplicate records,” again according to NextGov. The article goes on to quote the deputy surgeon general of the Air Force as saying the system was, “slow, unreliable and so cumbersome that clinicians spend 40 percent of their time inputting data into the system, which is time spent away from patients.”

There was absolutely no evidence that this massive spending would succeed, and plenty that it would fail miserably. Now, even the editors of the Washington Postcame to agree the whole project was a fiasco — but only after we wasted $27 billion of taxpayer money.

How did we get in this mess?

Jerome Groopman, MD and Pamela Hartzband, MD, both on the faculty of Harvard Medical School, wrote in the Wall Street Journal that, “The basis for the president’s proposal is a theoretical study published in 2005 by the RAND Corporation (but) in the four years since the report, considerable data have been obtained that undermine their claims.”

They call the proposal, “an elegant exercise in wishful thinking,” and add that the RAND researchers deliberately avoided looking at any negative information [ed. This is helpful to know after the fact!], saying, “We choose to interpret reported evidence of negative or no effect of health information technology as likely being attributable to ineffective or not-yet-effective implementation.”

So, what did we get for all that money?

But many electronic health record systems have pull-down screens listing each of the 68,000 possible diagnosis codes in the World Health Organization’s International Classification of Diseases and 87,000 possible procedure codes.

Or consider what happens when I write a prescription: Every potential drug interaction or side effect listed generates a warning prompt. Inevitably, recognizing that the warnings are generally inapplicable and take time to sort out, clinicians start to bypass the alerts. Sooner or later, ignoring one will lead to serious complications. [ed: It just give you a warm feeling knowing they’ve stopped using these tools – before you know it someone will analyze these data and tell us what we should be doing with the analyses of incomplete data!]

And the results of all of this complexity?

What we have seen in this fiasco is that IT developers were put in the driver’s seat and the needs of actual physicians and clinicians were ignored. Instead of letting the needs of clinicians dictate how systems would work, the physicians were criticized for not changing their practices to fit the needs of the IT system.

The truth is that not all private software initiatives are successful, and I’ve seen more that a few that wasted far more money that these, but once government usurps the individual initiatives in this area, the public suffers.

In an enterprise that has both a customer service and a technical delivery component such as in the IT world, too often the technical delivery side of the business dominates and tells the CS side of the business what they’re going to do rather than the customer service side telling the IT department what the system must do.  It’s an inversion of roles that results in dire consequences to the enterprise.

RS Gatekeeper:

Over in the Tail Wags Dog section of my WaterCooler, that I’ve skipped today, I’ve noticed a pattern emerge that speaks to the willingness of some members to stay engaged with the full community.

Some of the longer comment tails add immensely to the value to the RedState community and occasionally break into tw0, three, or more discussion threads around some aspect related to the posts. Other times the length of the comment thread can best be described as a long tit-for-tat between two people that can reasonably be described as an argument.

FWIW, I’ve noticed a pattern of disengagement by people in the later, argument-like threads, that I haven’t seen in the former, expansion on a theme type discussion threads.  Just saying!

Memorable RS (like) One-Liners: