Hardware

E-medical record systems won't happen and it's not because of privacy issues

If financial institutions can access all of a person's spending history at the touch of a few keys,then why is the medical industry lagging so far behind in regard to our e-medical files? Is it just a matter of money?

If financial institutions can access all of a person's spending history at the touch of a few keys, then why is the medical industry lagging so far behind in regard to our e-medical files? Is it just a matter of money?

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There are a number of things that bother me, from a patient's point of view, about health care in America. First of all, why is it that every single time I go to my doctor, the nurse asks if I have any medication allergies? And why do I have to tell them every single time that, yes, I'm allergic to penicillin? What if I fell in the door of the doctor's office and lost consciousness amidst all those old magazines and pens emblazoned with the names of pharmaceutical companies and couldn't answer the allergy question? Would they be forced to actually turn a page in my medical file and look for the info themselves?

Second, when I visit a doctor, I'm always asked for a list of medications I'm taking. I understand that this a measure to prevent a bad drug interaction with anything that doctor prescribes, but what if I were 103 years old and a little foggy on what I'm taking?

Wouldn't it be nice if we each had an electronic medical database? An administrator would just type a name and up would pop our relevant information like the Properties dialog box of a computer app (but instead of listing size in bytes, it would be pounds). It would also list when we were Created (birth date), Modified (surgeries), and Accessed (last medical visit).

Well, the truth is we do have the technology for this. The problem is that the technology is expensive, and there is no financial incentive for most health care providers to invest in it. So for now, the safety of our health rests on the quality of memories and the doctor's FAX machine.

I know I'm responsible for my personal health information, but honestly, I can't keep track of the strength and dosages of medications I've taken, or the year I had my tonsils out. In fact, I lost access to most of my childhood medical details when my mom passed away.

If someone out there works in the medical IT field, can you let me know what the hold up is?

About

Toni Bowers is Managing Editor of TechRepublic and is the award-winning blogger of the Career Management blog. She has edited newsletters, books, and web sites pertaining to software, IT career, and IT management issues.

60 comments
Lrqausa1
Lrqausa1

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tungstendiadem
tungstendiadem

Next to nothing gets done in the medical industry without it first being done by award winnings gods atop the Mount Olympuses of the medical word, places like Cedars-Sinai, a noone is allowed near anything that can be placed in the category of healthcare equipment without first having completed clinicals. The gods of medicine become the gods of medicine by continued learning and research for decades after their decade or so becoming a doctor, they are revered elders who are constantly growing their knowledge of medicine, and to require them to grow knowledge external to medicine for the purpose of medicine is bordering on heresy. IT people have come under fire for lacking soft skills, and praised their profession for allowing dirty t-shirts, both of these are an impediment to effectively leading a transition to a robust end-to-end data management system amenable to an environment of clinical sterility. Progress is being made, though.

touch0ph
touch0ph

As most have already mentioned: cash is problem. The second problem is adoption. Most doctors offices are very comfortable with their current way of doing things: it works, it's simple and it's the way they've done that for a while. Changing this means and upset in work flow, increased costs and frustrated users. These are growing pains and things are getting better but I'll bet there are no physician offices just raving how awesome their EMR / billing system is.

faith
faith

Some more thoughts on this issue....Privacy and standardization issues aside, I see two more stumbling blocks for physicians in making the move to electronic records systems. Both can be overcome. 1. Most EMRs/EHRs are purchased by CIOs without a lot of input from the physicians who will use them. To some of the less tech-savvy doctors out there, navigating an EMR is mind-boggling and takes an incredible amount of their time. Most EMRs don't even look remotely like the paper chart a physician is accustomed to using. This results in doctors, out of frustration, falling back on using the paper chart. So what happens is that many hospitals and private practices are working in a hybrid situation with half of your medical information on a paper chart and half on the EMR. Neither is complete. No wonder they have to keep asking you the same questions. 2. The other major hold up for moving to EMRs is that in the purchasing process, there doesn't seem to be a lot of consideration put into the "Paper to EMR" conversion process. Usually, hospitals hire staff to scan everything into one giant PDF file that is placed as an archive file in the EMR. Now the physician has to go searching for the information on your meds, old surgeries, etc. and it?s just too time consuming. This is one of the main reasons for such a high failure rate in EMR conversion. We suggest to our clients that they consider digital charts because they look like a paper chart, which means the physician will be more inclined to adapt easily to them. We are hired to scan the paper charts but we offer a conversion solution that makes the end result more user-friendly. Instead of scanning everything into a giant PDF file to be placed under one tab in an EMR, we take the time to do some serious chart-busting...that is, we will sort and prepare the old paper charts before scanning and then bar-code the information from each section of the chart so that when it is integrated with the EMR or digital chart, it ends up under the tabs it is supposed to be. Everything the physician is looking for is behind the tab he expects it to be. Your medical information from 20 years ago isn't buried inside a giant archived file, but is easily accessible by "tabbing" through the digital chart. I think the conversion of Paper to EMR isn?t thought out thoroughly before the purchase of an EMR.

dcolbert
dcolbert

Toni, There is no single, centralized master database with a "Toni Bowers" file in it that all healthcare agencies have universal access to. But there certainly are Electronic Practice Management (EPM) and Electronic Medical Record (EMR) applications available out there. You should do a Google search and educate yourself yourself a bit on the subject. Now, as to why the medical industry isn't progressing as quick as other industry, you are all over the map. The reason they ask you for allergies and for what drugs you are on is probably mostly legal. The medical industry is a huge target for malpractice litigation. Having a SOP that says, "Confirm with the patient even though you've got the data right in front of you" is because if they don't ask, and they didn't have the right file open, you'll sue. As far as patient files are concerned, you've got three different key players. The practices/doctors The IT industry as a whole Government agencies and regulations. I've seen enough sites that illustrate that practices and doctors think that everything was hunky-dory with rooms FULL of huge file cabinets with paper records on every patient, that this model was inexpensive, easy to maintain, and that it allowed practices to operate profitably and efficiently. In constrast, they are afraid of technology and constant upgrade cycles and complex, failure prone equipment that they cannot easily control themselves. This is about the professional and individual hubris of the medical industry, more than anything else. But they're the ones who adopt these solutions, and most of them do not see a benefit or incentive to adopt. It costs more and doesn't directly benefit them in any proportional sense, compared to what they have traditionally done. This "traditionally done" thing is important, too. Haven't you ever been into a practice, and EVERYONE who works there except the candy-striper/intern have been there for 30 years, and they've done things the same for the last 30 years? Do you think the typical practice staff has a LOT of hands on experience with technology over the last 30 years? Then you've got the IT industry. We're used to working in business segments where basic PC skills are just taken for granted. We're anti-social, used to being allowed to work our magic, and used to being allowed a lot of unusual perks and liberties ("Why, yes I do have a pony tail, piercings, and tatoos, and I showed up for the interview in a shirt, tie, jacket, khaki shorts and sandles. Is that a problem?"). We're outrageously expensive, compared to what the medical industry is used to paying their non-medical support staff. We're also an industry that is full of employees with the Gold Complex - and, without intricat knowledge of the human body or having spent 8 to 12 years in school to learn our trade. We're used to people who understand that technology "just acts that way sometimes". Software publishing and developing (especially with relational database management systems) is probably one of the areas where these traits of IT are most pronounced. It is a volatile mix. There isn't liable to be a lot of real effective communication between the first party, above, and this party, as the two industries try to integrate. Then you have the Government. Like HDTV, on the one hand, there are a bunch of Congressmen and law-makers, who don't REALLY understand the technology (Think Republican Congressman Orinn Hatch, who THINKS he knows a LOT about technology, and does, for a crusty old Congressman, but screws up every tech law he tries to write), but have this feeling that deployment is stalling out and they need to do something to push adoption. On the other hand, because they're so busy exploiting the privacy of private citizens using technology, they do understand the security implications. God forbid anyone but THEY should be able to easily access every last bit of data on you, right? So, they pass regulations like HIPAA that are broadly, maybe unconstitutionally vauge at worst, and incredibly confusing, difficult to implement, and potentially expensive at best. Behind it all, there is a fourth party. A lot of this group are Physicians, but they're businessmen first. They are boards of directors, CEOs, and other business owners. They are the doctors who have decided that they don't want to make a real good living examining an oozing sore on your backside. They would rather get rich being a business owner. These last two groups make it inevitable that EPM and EMR systems are going to happen. EMR, especially hosted EMR in shared environments across WAN connections, are going to be a particular challenge. (EMR, think high resolution, high quality bitmap images of things like electronic magnetic resonacence 3D brain scans, anything that would go in a permenent patient record, now stored electronically.) But they're all going to happen. In the next 20 years, the growth of the Health-care/Tech industry will be the fastest growing, most significant change agent in IT and technology in general. The advancements that it will have to make in secure communications including encryption and universal data accessability will affect and impact every other technology industry. Your vision is as short-sighted as were some of the earliest claims about the revolutionary nature of the PC on business in general back in the late 70s. Many of the things that will have to happen to make this a reality have not happened already because there has been no reason to do so. That will change. When I worked at Intel, the pressure of being the sole owner responsible for a server that transacted $11 billion dollars of Intel business a year was immense. If that server died, the losses could be staggering. In health-care, there may be no dollar amount involved, LIVES are what are possibly at stake. And it is a union that is still in infancy. The IT/Healthcare convergence is where the IT/Business convergence was at around 1982, 1983. There is a long way to go.

ShimCode
ShimCode

1. You are propogating your most intimate personal information electronically! - you think ID Theft will hurt you? This is infinitely worse: insurance, jobs, incarceration, etc. 2. You are forfeiting significant control over who gets to see it and spread it around. - Access to paper and ability to spread paper around is way, way, way more difficult than dumping a few Gig to a stick... I'd go on but I've said enough,,,don't be stupid. Take control of the most important information you will even own...money comes and goes...your physical and mental health will always be with you.... Geez...I cannot believe many of these posts!

JimInPA
JimInPA

I work at a health system administering the PACS system (Picture Archive and Communication System) which in simplistic terms stores all imaging procedures performed on a patient within the health system. Here is my take on what the hold up is, first off, in the spirit of the free market a single vendor would have to be chosen to archive all of this data. Sure DICOM and HL7 is supposed to be a standard but anyone who has worked in the field long enough will tell you, everyone has their own interpretation of the standard. The logistics of interfacing to such a system is terrifying at best. Second, HIPAA laws. Your information would be accessable to any medical institution anywhere across the country any time. We have a hard enough time monitoring who's looking at what across two hospitals. I can't imagine what it would be like to try and audit a nationwide system. My suggestion would be a standardized format that everyone is required to follow. This would allow the opportunity for vendors to begin to develope systems which speak the same language. Only then will a central repository to store this data.

absingh
absingh

Physician2Patient Network is a solution for all these problems discussed here, which I have invented about three years ago. I also have a pending U.S. patent (no. 11/447,627) on this technology. I have provided IT support to physicians small medical practices since 1994, where I learned all these problems. I am the founder of MDEC International, the parent company of the P2P Network. We offer an IT solution as well as a business solution to the physicians. Practice Management & EMR software is part of our solution. Unlike other expensive EMR packages, our solution reduces the overhead cost of medical practices, which was one of my primary goals from the begining. We offer FREE membership to patients, and we store their Medical Histories in our data center, which is instantly available to any authorized (by patient) medical facility worldwide. We have conducted a field trial last year where 900+ patients joined the network. At present, our team of 10+ hardworking engineers & programmers are designing the production version of the network. Since it is a healthcare system, and deals with human life, we are designing it to be without a Single-Point-Failure. (That is why it has taken us 3+ years to develop it.) The patient data is stored on more than one Server and synchronized in real-time. The final network system is expected be ready within 2-4 months. Once fully functional, I hope all patients will benefit from it, and it will also improve the quality of services to the patients. Please visit our site www.Physician2Patient.net for furhter details. Please be patient as it will take 1-2 hours to read and understand all about P2P Network. If you like what you read, please help us to spread the word.Once again, the basic membership to patients is FREE. If anybody has comments or questions, feel free to send me an e-mail at absingh@mdecinternational.com

pjcasey75
pjcasey75

One of my clients is a small medical records company that provides paper templates to small medical practice offices, mostly family practices. We investigated developing our solution into an EMR and, technically, it could be done, though the lack of interoperability standards and vague HIPAA regulations are problematic. Economically, the niche market we would serve, that is, small family practices, is under tremendous pressure right now. Many are struggling, some literally failing or consolidating into larger practices (which also means less access in smaller towns) all across the U.S. Fewer med students are opting for family medicine. Declining Medicare reimbursement coupled with rising malpractice insurance premiums continue to be a huge issue. So, while there is still a spirit of service and noble causes among physicians, the fact is that the numbers don't always add up to a small family medicine clinic being a viable business. But as for the likelihood that EMR's will become a reality, here's what I've gathered from being in this market for 8 years. E-medical record systems will indeed happen because large databases of medical information are extremely valuable to big medicine (including hospitals and pharmaceutical companies), big insurance (for risk assessment and other research) and big government (also for research and oversight). They want EMR's for all sorts of reasons - all of them financially justifiable when considered on a large scale. And the benefits which computerization could bring to healthcare overall are real. Therefore these large and powerful entities in our society will continue to drive towards a mandated solution, whether or not providers like them or can make a financial case for them in their small businesses. The problem is that the many advantages of computerized medical record systems (mostly in terms of portability and the value of aggregate data for research) are of little value to a smaller practice versus the low cost, simpler paper systems they are apt to use today. So, the market place today pretty much says to the small practice, you pay the bill - which really can be $70K for a system (I had a physician tell me this was a real quote he received just last week), while others (big guys mentioned above) get the benefits. I have personally spoken to doctors who have closed their offices in part because they could not recoup the cost of their new EMR's. They moved to a larger city and went to work as part of a hospital group - that had an EMR which, of course, they could spread the costs over many doctors. Charting on paper templates is quick and cheap. Templates are faster for keeping complex medical records than any computerized interface I've ever seen. They reduce errors and provide legibility. The biggest resistance to EMR's, after the financial hit, is that they slow down the doctor's record keeping process - inputting via tablet or keyboard is slower. I've been in and around the IT business (another client is a software developer) since the 80's. We learned early that process reengineering should definitely avoid making your highest paid, revenue generating personnel your data entry operator outfitted with a slow interface. So the downside of EMR's is exactly what the small doctor's office sees - high cost, lower productivity - with little chance to benefit from the favorable features of an EMR that a hospital or big enterprise could get. If you're the only doctor in the practice, retrieving a record is as simple as pulling a file out of a drawer. No need to route it to a lab, to another doctor, etc, with anything more sophisticated than a fax machine. Why spend $70K? And as for HIPAA, the doctor can keep the medical record secure with a $10 padlock and a few personnel policies he'd have to implement with a computerized system (and MUCH more) anyway. As the government's recent report confirmed, the resistance among small providers towards adopting EMR's is mostly financial. If the beneficiaries of such a migration to EMR's (big govt, big medicine and big insurance) will foot the bill for the data entry operators (i.e., small physicians offices) to adopt EMR's, then you'll see the resistance decline significantly. Until then, you've got an economic disparity that will keep small practices wondering what on earth is in it for them, and how they can be expected to risk their livelihoods on a hefty EMR investment that allows them to see fewer patients every day.

GSG
GSG

Really? I replaced my system that stores the legal medical record 2 years ago, and it took 9 months to transfer the data, and that was a system that was a major upgrade of the old one! We're swapping out others right now, and we're looking at a year. A week? I'd jump for joy if anything we implement only takes a week.

mmangan
mmangan

Toni....I think you need a new doctor!!! Mine knows exactly what meds I take & what allergies I have. (altho' I keep an up-to-date list in my purse, along with a brief medical history, so I can hand a copy of this document to the office staff when I see a new specialist.) We periodically review my meds list to make sure I'm taking everything properly - and we do this by her referring to my chart in which she writes notes every time I visit. (She later transfers her notes to an office data base.)

bgurman45
bgurman45

It will not happen until there are cooperative standards. As long as there are multiple ways to record and access data, with inadequate privacy controls, forget it. It will take an active standardization group similar to IEEE to develop the standard. If Universal Health Care is to ever come about, the only way it will work IS with a workable, inter-operative standard.

grl
grl

The MIB (Medical Insurance Board) keeeps records of every life insurance applicant in the USA and Canada, unknown to the general public, where many questions about health, past operations, medical conditions, etc are asked. As well, the Hooper-Holmes Bureau has a gigantic database with medical information, related to medical questionnaires and examinations when people are examined before a policy is issued. In Canada, the standard health insurance cards (Social Insurance Number) every citizen has provide some instant medical information more similar to the European than to anything in the USA. The main problem in the USA is the control of the pharmaceutical companies and their stranglehold...and their labelling of every attempt at an even playing field by calling anything universal as being "socialism" -- except of course your SSN number and retirement benefits, those are somehow "exceptions" to the "socialism" label.

Geezer Dude
Geezer Dude

That the technology is expensive is a misconception. There are various programs available that are either free or low cost. The VA VISTA system, a nationaly recogognized system, is free for use by physicians. True, the version of VISTA that's available doesn't have all the bells and whistles that the in house version has, but that's a better not worst case scenario. The full package has componants that are aligned to medical center needs, not those of a private physicians office. A little research on the Web has links to many other free, low cost and reasonably priced subscription packages available. The true reason for not adopting an electronic record, is I believe, the time and resources required to impliment such a system. These systems are so well developed and have so much oversight that maintenance and update are almost non-issues. Congress, the FDA, AMA and other steering bodies need to get off of their dead asses and properly encourage and fund the resources needed to make a national electronic medical records system a reality.

jose.remy
jose.remy

I'm currently in Europe (France), and I feel that your question raise serious difficulties. 1) Note that you could travel and have medical care abroad; 2) As already stated by someone you may have medical care with various hospitals, doctors, nurses and investigations with various labs; 3) In addition, medical information has great diversity and sometime huge size (a scan is several 100 Mb). All these data may not be in same format 4) There is not a common agreement, in fact, about the owner of your medical data, and who, but you, is the administrator of these data; this is a serious issue for example when your medical data contain information about short-mid term threat on your life. As a result, contrary to some advices here, I think the technology is not here yet (although coming through web services). That is, massive, distributed, interoperable software, sharing enough trust is not yet available. And when these software services will be available YOU will be in charge to administer your data (you possibly could delegate this role to some one like your lawyer, who in turn will delegate some medical stuff like medical access rights to a medical doctor, who in turn will rely on tech expert(s) to manage technical aspects). Obviously, you???ll get the service???. If you are ready to pay for it!

Architect
Architect

Why is it that every single time I go to my doctor, the nurse asks if I have any medication allergies? Because it cuts down on their Liability Insurance Premiums. If they don't ask and there's a mistake in you file and/or you've since become allergic to a medication the lawyers will have a field day and the doctors malpractice insurance premiums will rocket out of sight. This question will never go out of existance. The medications questions is also tied to medical insurance liability with patients going to multiple doctors who prescribe different medications which can interact with one another to cause other problems. If they don't ask, the lawyers have a field day! Most days I don't like lawyers having a good day, because it means all of our insurance premiums will go up.

louis.slabbert
louis.slabbert

"and there is no financial incentive for most health care providers to invest in it" Healthcare should not be concerned with profit or financial incentive, other than to stay in business and to provide a better service. That is a massive problem with the healthcare system in the United Stated. Money, money, money Anyone seen the movie Sicko? http://www.imdb.com/title/tt0386032/ Here in the UK the NHS (National Health Service) has been implementing a healthcare database system and obviously it has been having many problems just getting in developed and tested (over budget etc.) Here's a interesting video about it: June 2008-> http://www.e-health-insider.com/news/3893/nhs_electronic_record_films_on_youtube 2007 Feb-> http://www.telegraph.co.uk/news/uknews/1542486/andpound20bn-NHS-computer-system-%27doomed-to-fail%27.html 2006 -> Feb http://www.ft.com/cms/s/0/d8aca40c-ef49-11da-b435-0000779e2340.html 2004 -> http://news.bbc.co.uk/1/hi/uk/3613220.stm

leosaumure
leosaumure

What about Google health? Seems to me, it does all that you wanted...for free.

Osiyo53
Osiyo53

Chuckle ... well, the fact is that financial institutions can access a LOT of a person's spending history. Although it is a bit more complicated than simply a "touch of a button". But they can not access ALL of a person's spending history. If you think they can, then you're mistaken. Add that the "records" they have regularly contain mistakes, due to various reasons. The same thing applies to medical records. First, there are the various laws (federal and state) in the U.S. about privacy. If you go to doctor A and to doctor B, the two can NOT automatically share information with each other about you. One, they must first know that you've been seeing more than one doctor. Which is not automatic. Secondly, you must explicitly give one or both permission to see the data the other has. Privacy rules ... remember? Then there are the issues of mistakes in the records. Which happen routinely for various reasons. Somebody forgot to make the entry. Database got corrupted. Person entering data made a typo. Etc. In the case of the situation where you're making a new visit to your doctor, the doctor or his/her assistant needs to check to see if the medical database containing important info about you is in fact accurate and up to date. Heck, you may have discovered you have an allergy you and your doctor did not know about previously. You might be taking a medication prescribed by a different doctor, or one that was purchased over the counter which THIS doctor did not know about previously. Somebody in the past may have made a mistaken entry in your record. Etc. They're just trying to be through and professional. A person who ASSUMES too much and too often is prone to making more mistakes. Professional medical types try to avoid this. As to the availability of appropriate medical software for keeping records. It seems to me that it is there, and routinely used. I see it all the time. Its in the offices of my family's primary care doctor. And his is a small, suburban, practice. He's been our primary doctor for 18 years, has had such all of that time. And such software is used by the little rural clinic we sometimes use when we're at our lake cabin which is way out in outstate Minnesota. In fact, I don't recall going to any doctor, nurse, or pharmacy; urban or out in the sticks; in years which hasn't had appropriate medical record software. FWIW, I'm not in the medical field. But several of my family and friends are. And in my work (I'm in the building automation, energy management, and security field) I do work in various medical facilities all the time and see the stuff they're got regularly. Observe it's use, occasionally have discussions with them about the stuff. And so forth.

markbebout
markbebout

I work as an IT consultant for medical practices. What you describe here is actually very real occurrence for our aging population. The hold up? Depends on who you talk to, but the consensus is cash. A standard practice that I walk into, for example, consisting of 3 providers doing what I would call the "normal way", usually need to make somewhere in the neighborhood of a $75,000 investment just to get a basic setup running. One of the reasons for the high expense right now is two-fold. First off, there are no economies of scale, making software prices astronomical. Most people don't realize that a decent EHR (Electronic Health Record) application easily runs in the tens of thousands of dollars, and that is just for the software. You have deployment costs, training and support on top of that, as well as associated hardware costs necessary to support the applications. The next major problem is that a medical practice is unlike most other types of business. Every office, regardless of its size, has 2 primary components to it; clinical and operational. Clinical equipment is complex, expensive and predominately stand-alone. Administration consists of reception, scheduling, medical records, billing, collecting, insurance, communication and IT. There is so much disparate information in a medical practice that administrators and doctors have trouble keeping up with the current process. The idea of spending a lot of money and disrupting what can only be described as a band-aid operation is an overwhelming task for most practices.

JohnWarfin
JohnWarfin

Good analysis, dcolbert! There are a couple of underlying common structural problems in your, and many other of the useful analyses posted here. One big block is the complete absence of a workable model for authorizations. The legal framework provided by (just for examples) HIPAA, departments of health, AHA and JCAHO and everone's favorite target- lawyers make the undefined authorizat-osphere just too scary a workplace for medical administrators to make the shift to computer based records. Apart from medical mistakes, EMR systems ADD the opportunity to be sued for PRIVACY errors and makes them ever easier to discover by automated trolling. The VA has had its (frequently described as good) success in large part because it has the government's backing for delineated lines of authority to enter, access, edit and define data measures, formats and structures. By contrast, private healthcare has no firm rights model to establish who can do what, when, or why with even the smallest tads of information. What access should an EMT have at an emergency site- none, or all? How about a volunteer pediatric urologic sonographer in a saturday free health clinic? What about a former drug-addicted felon employed as an substance abuse and mental health counselor? Society says (s)he isn't allowed to vote- should (s)he be able to see if you've been refilling your prescriptions? Says who? See what? The front line of medical care is full of low-paid medical data entry and access personnel who work under the very infrequent direct review or supervision of the people most of us probably THINK make use of medical information. Who is supposed to define, administer, train, maintain, supervise just the ACCESS issues? And once there is access, what about the resulting mandatory archiving, auditing and reporting? The feds succeed in solving this by being big enough to define, train and enforce administrative channels throughout their own medical bureaucracy. In private practice, not-for-profit and volunteer healthcare situations, the administrative overhead just to obtain and maintain HIPAA compliant (to the degree that can avoid being an oxymoron) access to a universal record will remain impossible until someone steps up to define the universal access rights model. Ironically, the money-makers in the healthcare system have benefitted from their own efforts to agree on standards with their MIB database- that is where your records are growing right now- you just can't review, correct or otherwise benefit from them. If the US Government is too scared or busy to acknowledge the need, an opensource standards body should form a working group to provide one. Until then, the free market is going to continue to slice and dice it's healthy pound (s) from our ailing flesh.

h.bohte
h.bohte

This is not a technical issue and never will be. I work in Clinical trials and accessing eRecords is challenging, and if Medical Records were able to be accessed universally it would be a world first. Businesses don't pool information neither do the financial industry. You can't walk into a Bank and the teller looks up your record at a rival bank, or how many claims you made with your insurance company. Neither can Intel look up if a supplier has a poor history of short or late supply with AMD. So if you walked into a Doctors office and they could look up a Hospitals or rival Medical Practice's files it would be a miracle. The last thing a Medical Industry IT Manager cares about is if his system can interface with a rivals, or with a Drug Company so they can see which drugs are being used and their success rate. The only solution would be for Government regulations forcing pooling of critical medical records.

GSG
GSG

You have no choice about how the data is charted. Plus, as someone who worked in Medical Records before switching to IT, and who has installed 6 Electronic Legal Medical Records systems, take my word for it when I say your records are safer in an electronic system than they are on paper. When they are on paper, we have no control over them. Electronic records can be and are audited. I can go in my system, and in less than 10 minutes see every single person that looked at your record, printed it, or did anything else. Oh, and let's say that you say you got the wrong medication. IN paper, it would be easy for the dr to remove the dr order from the chart, re-write it with a different medication, and post-date it. No one would ever know it happened. In the electronic world, we can pull all of that up. Plus, have you heard of HIPAA? We are required to keep all of this data about who did what, and you can't do that in paper. If we don't keep the data, we can get massive fines. As far as dumping a few Gig to a stick, you can't do it, if I don't give you access to the system. We have two people here who can do that, and I'm one of them, and I don't give that ability to anyone.... Ever... Geez...I cannot believe your post.

NickNielsen
NickNielsen

I don't own my health records, they belong to the doctor who created them. The only control I have is signing a HIPAA release form once a year. Your paranoia is blinding you to the issue under discussion: the inability to propagate medical records both rapidly and securely can result in poor or even misguided medical care.

ShimCode
ShimCode

WARNING: First of all...the guy who posted the above message is an Jerkwad. He can go to Hades. Don't believe me? Them a'all go visit that infested site of his ...if you dare! As 'absingh' (apparently some virus spreading foreigner) states...his site takes an hour or two to screw with your PC) ==== So here is my response to his stupid comments... "The patient data is stored on more than one Server" Eureka! Therein lilely lies the major issue on privacy and adoption! Do y'all understand that your medical history - your 'conditions' and the fact that some insurance company, governmental agency, an employer, an ex-spouse, maybe even some flunky IT idiot with an attitude can compromise that personal healthcare data and create a personal Hell for you? More likely make some healthcare provider leary about even seeing you? Wake up y'all! Geez...

wexbell
wexbell

It seems incredible that this discussion makes no acknowledgment of the fact that the rest of the developed world has done this, and a long time ago, and it works well. By contrast, only 4% of smaller practices here are fully electronic. We use steam trains while the rest of the world drives automobiles; something wrong here?

WTRTHS
WTRTHS

A week time yes, but certain aspects will never be converted and have to be manually restored (too difficult). And this is just for private doctors, not for clinics, labs etc. That is a whole different story all together.

ShimCode
ShimCode

To me... the MIB (which has been around a long time) sums up what y'all need to really understand: While certain kinds of information about yourself can be very beneficial and help you...be warned that it can also be used to hurt you - at best - and screw you - and destroy your life...at worst. And not just you... ...but your wife, your kids and sometmes even spread to your friends and associates...and the offspring of your future generations! Don't contribute to this by participating in indiscrimately sharing your most personal information! Now pay attention all you who need to learn. It might could go like this: Uncle Barack smokes quite a bit but never in public. And his spouse Michelle loves to eat fat foods and is rather hefty. There is a marked history of alcolohism. Another gentically related family member has diabetes. Race is an issue. The fuzzy logic of our 'predictive modeling systems' reveals that these people purchase foods and products that are less than healthy. What? Baracks Gramma died of cancer at an early age? Hmmm... Well darn...we just shouldn't elect ...uh..I mean hire.. that fellow! He might could drop dead any day! Or way worse! He might get sick and we'd need to pay a bunch of money to treat his self-induced sickness. Our medical loss ratio will go through the roof and decrease our profits! So let's just not hire him..lets outsource his value/purpose/reason for living to some young lads from some cheaper person that we don't have to be concerned with (i.e. insure). Maybe a young lad from a near 3rd world country like India or China and avoid all that potential crap. ============ Capisce? Comprende? Ya hearing me my Brothers and Sisters? Is this too harsh for you? Hmmm...s

markbebout
markbebout

Geezer, I see what you are saying with regard to the free / low cost systems that are available. While this does offset the up-front cost for the practice, the massive costs associated with moving the practice to a new system, along with all the disparate data sets still make it a very costly system. A couple of thoughts about these low-cost and free systems may help as well. I have headed up integration projects where due to budget realities for the practice, we were forced to make choices between the low-cost alternatives. I can tell you that integrating these systems were very similar to integrating larger, more well known systems in terms of time and effort. The downside is that after all is said and done, there is always functionality that has to be compromised for these smaller systems, so any cost savings evaporates when you account for the functionality that has to still be done the old way. The other downside to these low-cost systems are the quality of the product and support. While certainly not always the case, my experience has been that a company that charges less for their application will offset that with more expensive, and sometimes complicated pricing schemes for support and training. Their logic is that for a cheaper application they provide less support. So while there are low-cost technology alternatives available, as you point out there are still significant costs associated with time and resources (not sure what you include under the category of resources) and practices have to carefully plan and budget for these costs. Mark

WTRTHS
WTRTHS

In fact, even most forms applications that manage patient records have their own database logic (duh...). But as I've frequently seen, switching programs costs a lot of money, as it may well require more than a week of work for all data to be correctly transferred. They are slowly moving to a more unified role, but as the people who are responsible for this usually have no clue what they're doing, the projects are usually wasted. In fact, I think the closest they ever came to a standard was the HL7, and even that differs in several countries. No financial incentive? Big bucks are made with medical software, and because of the strict regulations, very frequent updates are required, making licenses usually expensive, depending on what you want the program to do (integration with existing machines is a disaster), but a "simple" record keeping program is rather cheap in comparison (cheapest one I know between 200-300 ? a year, though most cost around 2000-3000 ? a year). Still, medical IT is making progress I feel. Slowly, but surely.

charro
charro

There are currently at least 20 companies selling user EMR systems, USB flash based, on wristbands and keychains, problems for use are computer knowledge, accuracy of data, update time, privacy, and the host of issues already mentioned. Biggest user base would be the babyboomers and older, who barely know how to use a pc if at all. Most programs generate a "web page" visible from any USB port. Some offer online "up internet" storage with password protected access.

wmrentz
wmrentz

Unless our worthy British compatriot forgot, money is what drove the British Empire. So it seems a tad insincere to hear him slamming the quest for the almighty pound sterling. As a medical practitioner, let me assure you that money is the ONLY thing making the world go 'round in healthcare. The cost of doing business is incredibly high. The potential for litigation, especially here in the former colonies, bordering on insane. From a practitioner's point of view, we've made great strides in electronic record keeping and point of care procedures but, we keep trying to improve. I agree with the posts indicating the need for more compatibility between platforms and data file formats. Standards were not set by our friends at "J-Co., Inc." (BTW, a non-governmental corporation.) While the smaller and newer institutions and practices have an easier task ahead of them, the large tertiary care facilities (my hospital system has 2500 beds) face the challenge of managing data for both future patients and those of the 95 year old who was born at this institution. So...while both Old Glory and the Union Jack wave, let us agree that facing challenges will get us somewhere and that, believe it or not, some of us do care about your health...we're just trying to do it through the haze of poorly constructed healthcare legislation.

herlizness
herlizness

> you are correct, sir ... it's a mantra here: if there isn't a pile of money to be made, nobody will do anything innovative they seem to forget about the tens of thousands of medical professionals at our NIH who work on salary and do massive amounts of research which the private sector then "innovates" on and reaps enormous financial rewards from

GSG
GSG

I'll tell you why... A medicare patient comes in to have a heart cath. Let's say that the typical heart cath costs $10,000 (not really, I'm just using round numbers). This patient has several co-morbid conditions such as Diabetes Mellitus and early stage kidney failure. That pushes the cost to care for the patient up to $30,000. What does Medicare reimburse? Oh, about $5000, if you're lucky. The hospital loses money. Unless the hospital is a for profit, which is rare, they are not in it to make money, because it's an impossibility. Regulations are forcing us to put in expensive systems (try $10 million for hospital charting systems, and that's cheap), yet they are cutting Medicare patients. Then you have your Medicaid payments. In that same scenario, we'd be lucky to get $1000 back. What about people who can't pay? We can't refuse to treat them legally or morally. We'd get nothing back on that patient. Most not for profits stay running because of donations. These are invested and the interest used to help off-set the losses. I've been working in hospitals for over 18 years, and I have yet to get a cost of living raise because funds just aren't there to cover it. That's why there needs to be financial incentives. It's cheaper and easier to use paper, but you need to go to these systems for patient safety and a better continuum of care.

Dr_Zinj
Dr_Zinj

Funny that you should be dissing the U.S. about healthcare not being concerned about financial considerations when the latest news is that the U.K. is considering major cutbacks in their healthcare services for just that very reason. The fact of the matter is that the instinctive drive for self-preservation is what drives people to consume as much healthcare as possible for themselves or their family members. People will exhaust their own resources and then gladly steal resources from others for themselves. Couple that to the christian ethics of the sanctity of life, the requirement for compassion for your fellow humans in their times of need, and the requirement to give freely; and you have a recipe for a disaster of biblical proportions. But whether the U.S. should have government-funded universal healthcare is not the topic of this thread. I work in another one of those top wired rural small hospitals in the U.S. We have an electronic medical system in place. There are literally dozens of different EMSs available, with about a half dozen big ones. So Tony is off by saying they won't happen, they are happening. What isn't happening is a UNIVERSAL medical information exchange system across the entire U.S. There are a multitude of problems when it comes to sharing information between healthcare providers. One problem is each system has different field and record designs making direct exchange of information impossible without complicated inferfaces. Someone (ANSI?) needs to bring a multi-disciplinary team of physicians, nurses, billing specialists, database designers, and patients and spec out all the needs and standards of a universal system. (Actually, you could and should have sub-teams of each of those groups to bring collections of each of their needs to a central group since the job is probably too big for a single project team.) And then certify whether a system meets that standard. HL-7 went part of the way there, but there's a heck of a lot farther it needs to go. HIPAA did a poor job of requiring exchange standards between providers and insurance companies. And that part usually is overlooked while people concentrate on the security aspects of it. John Q. Public really doesn't know squat about HIPAA. They got snookered into blocking most of the people who need quick access to their medical records when all they wanted was access to be limited to people who needed access for their care. And the people who act as the gatekeepers to medical records even today aren't sure what they are doing and so take the most restrictive stance out of fear of retribution. Another barrier is that most of the EMSs in existence are built from a financial need basis. They are not built with the patient's or the healthcare provider's needs in mind; but how to account for services and resources expended in care for financial compensation. Medical systems built by warehouse inventory specialists and bankers don't work well for doctors and nurses trying to ensure good medical care. Google and Microsoft placed claims that they have on-line medical record systems for people. I beg to differ. That they have are moderately secure, internet file exchange services. Providers can pass documents and images back and forth at the authorization of the patient. These are NOT integrated, searchable medical databases with diagnostic and decision support capabilities that most hospital EMSs have. Toss one more barrier in here. The information needs of a hospital are not the information needs of a small medical practice, are not the information needs of a single doctor's office, are not the needs of the therapy technicians, are not the information needs of a patient, and are not the information needs of a community health inspector. These needs all tie back to the standards I mention earlier. Don't look to any of this election's presidential candidates to shed any light here. They are all clueless to the problem. And beware of politicians who say they have the answer; I virtually guarrantee that they have an answer that is more to their financial benefit than it is to any citizen's.

Osiyo53
Osiyo53

FWIW, how is it that financial institutions do not have as accurate a picture of a person's spending history at it might seem at first blush? Using myself as an example ... I have multiple bank accounts in three different banks. I tend to pay cash for a lot of things versus using credit/debit cards. In fact, while I have several credit cards, they're infrequently used. When setting up a financial account with whomever, I don't always give them ALL of the information about myself. I'm not attempting to hide anything. I just don't bother to take the time to list everything, especially if it is not relevant to the current business transaction. Why would I? If its not relevant to the current business being done, none of their business, they have no automatic right to know. Next, mistakes are made. For whatever reason. In the past I've found mistakes in the records of this or that financial institution due to simple typos. Mysterious mistakes that've shown up due to unknown causes (neither I nor they ever figured out exactly what happened), There have been cases where someone meant to add an entry to another person's record but made it in mine. A couple of times it appears that someone deliberately tried to pass himself off a being me. At least, used my name and address. And there has been a time when someone else borrowed money, then took a hike and didn't repay, and a hired collection agency in attempting to track person down came up with some similarities between my info and that other person's ... and assumed that we were one and the same person. And acted as if that were true and a fact. Chuckle, can be a pain the the rear. I remember a time when one credit card was suddenly of no use any more. I called the institution who issued it and asked em "What's up?". Was informed by a lady from said institution that card had been voided because I was dead. This was news to me. I didn't feel very deceased, in fact was feeling pretty good at the time. Young lady ensured me that their records were very accurate and trustworthy. I asked to speak to her boss. Because I was getting nowhere with her. She only followed what was in her "rule book" and what her computer screen told her. When her supervisor came online I expressed great pleasure with the fact that since I was "dead" according to their records, I guessed this meant that I did not need to repay the amount which according to MY records that I still owed them. "Thank you very much !" LOL ... that got someone's attention. And instead of blindly assuming like robots that their computer files were correct, supervisor actually introduced some human intelligence and initiative, reviewed all past records and entries, back checked them to sources. And discovered that the person who'd actually been reported as "deceased" had a name nearly the same as mine, and lived in a geographically near location. In another case, it was a bad loan recovery attempt. Collection agency hired to recover money discovered that someone with name similar to mine in certain ways, and who'd once lived in same city I had previously lived in and did business with same financial institution I had, etc. And they assumed using some probability and correlation algorithm that we were PROBABLY one and the same person. Flagged my credit history. Made strongly worded calls to my home. And even finally sent a very large, strong armed type to my door, talking rough and gruff, threatening to impound my property, and so forth. He got friendlier and more civil when I pointed out that I did not appreciate threats in my own home ... while waving a handgun in his face. A method I don't normally employ, but I dislike threats and large fellows who're making an effort to appear physically overbearing and intimidating in hopes of scaring one into meekly complying with their demands. Nor do I like being called a liar, as he was insisting I was someone who I wasn't. Once I had his attention, I gave him the name and phone number of my family lawyer and told him to get out and I'd see them in court. And I was planning to make it a painful experience for them. He left, I made a call to his home office. Made the same point to them. They suddenly got smarter and started checking records by eye and human mind instead of a mathematical matching algorithm, and discovered that they'd likely made a mistake. Computer records are handy things. But they're not infallible nor always as accurate as one might assume.

NickNielsen
NickNielsen

Open the data files. Create an open specification for patient data files, then point out to all the different vendors that it's to their benefit to use this spec for their application. "We'd love to use your program, but we use the OpenPatient format for our records. Your program doesn't support OpenPatient and since all the hospitals in the area also use OpenPatient format, we don't want to convert..." Unfortunately, I sincerely doubt this can happen without government intervention.

csigler
csigler

I propose we make an open source emr system. If anyone is on board, it would be a good way to get your name out and maybe find some sort of coherence in the medical industry. I deal with medical PM systems and there is almost no consistency between them. Some support ssl some ssh, some don't support any way of communicating. Let?s start a well planned project that has real potential.

dcolbert
dcolbert

I'm having trouble getting my mind around your claim, but I seem to be drawn to an analogy between this and credit records. A business can certianly look up the credit history of an entity seeking credit and find basic information about that entity's credit rating. Medical practices routinely transfer medical records today between "rival" practices, as patients leave and request their historical records transfered to their new practice. For example, when I recently moved from California to Ohio, my GP in California sent all of my records for California to my new GP out here. So what you are saying would be a miracle is already happening in practice and in spirit. Again, lives are in the balance here, so the obvious motivation is to more visability into CERTAIN records where necessary, in something more like real-time, if not real time itself. There are probably regulations in place right now that are currently a roadblock to implementation of this technology. Those roadblocks will be discovered and broken down over time. Eventually, in an emergency situation, there is likely to be a centralized repository of ePHI data that can be accessed universally by any medical care provider. It makes more sense for it TO happen than for it NOT to happen. A dead patient isn't going to give any more money to any industry except the coroner. Even the business incentive is to keep the patient alive. (Thank God).

ShimCode
ShimCode

I see you "Install and maintain grocery POS systems and peripherals (scanners, scales, displays" Hmmm... Gather info on what people purchase and sell it to companies that will use that info to 'help' or screw these people according to what they purchase... To me the Sad Thing is that your profile indicates you have been around for a while and have actually worked for the Services. You should know better...not really

ShimCode
ShimCode

You are actually 1/2 correct! Your medical records will surely be 'propogated rapidly' - but not 'securely!' Are you a person who actually works in IT and believes data is 'secure?!" If so, I pray you do not work for any company that has my info. 'paranioa'...poor and/or misguided care...you are so naive... Hello?!

ShimCode
ShimCode

Wake up dude! I challenge anyone here to support this persons belief that he/she 'doesn't own his health records!?' NN is totally misguided! Wake up Nickie

JimInPA
JimInPA

You should report his post as spam but be prepared to explain why (which it looks like you already did). I would do it myself but as I do not have first hand knowledge of what happens it would not be right for me to do so and as you claim there is viruses and the like to be had, I will not be visiting that site. If you tell me the pan is hot I'm not going to touch it ;)

ShimCode
ShimCode

"rest of the developed world?' - please provide references "A long time ago?" - how long is long? "steam trains?" - please provide some clarification as to differences between what you consider a 'steam train' EMR/EHR' and an 'automobile?' To me, automobiles suck. So might some 'fast follower delay' that allows those early adopters riding costly automobiles allow the rest of us laggard train riders to eventually pass them way more quickly and economically once the PRIVACY, end-user adoption and interoperable standards are worked out? And indeed these are the major issues: privacy - real or perceived end-user adoption interoperable standards C'mom! Give us a break...there are smart people here...some of us have been around for 40-50-60 years...

herlizness
herlizness

> just so others know, it's a lot easier just to close the door; all of those kinds of tactics are also unlawful under the Fair Debt Collection Practices Act

grant300
grant300

I agree. This kind of application is not technically challenging; it simply has a lot of "nooks and cranies" that need to be filled out. Perfect for an OS project. I also agree that it will have to be well planned and, unlike many applications, well architected. That's one of my specialties. Log in and make me a contact. I would like to talk with you about this in more detail off-line.

GSG
GSG

The VA uses it. I can't remember the name of it, but the problem is that you get little support, and it's so difficult to use and support that it's not worth it. Healthcare is different from the rest of the world. Support from a vendor is crucial. If a retail system has a bug, the worst that could happen is that the system goes down for a few hours and sales are lost. In healthcare, if there's a bug in a system and it goes down, you can kill a patient.

GSG
GSG

But this is a peeve of mine. When people learn that I work in healthcare, I get all sorts of comments about how we're making so much money and we need to have reimbursements cut, blah blah blah... I'd love these people to work in healthcare and have to beg for the necessary equipment to do anything because there aren't any funds because some politician is trying to get re-elected and picks on healthcare.

NickNielsen
NickNielsen

with an unarmed opponent. What do you aspire to be? An operator at 1-800-Insults? You just failed the audition.

ShimCode
ShimCode

What's the difference? Of course you can't alter the record...but that was not the subject...what a literal interpretation from an apparently health care illiterate person. And your profile is very impressive indeed! You are a software/IT wizard...and now 'Teach?' Scary but ongoing proof that 'those who can't do...teach'' Bwaa...Haa..Haa... What a dork!

NickNielsen
NickNielsen

Tell him to release your medical records to you because you own them. See how far you get. Push the issue. [i]Question: Who owns the medical record? Answer: The health care provider or facility that created the records owns the original. A patient is entitled to a copy of the record but not the original.[/i] http://tinyurl.com/5av6bj Some hints, so you don't further make an ass of yourself: 1. Do your research before you pop off at the keyboard. 2. Proofread 3. Learn to use the edit button so you don't chain-post like a 4th-grader. 4. Don't condescend to people, especially when you are wrong. It p|sses them off and eliminates any chance you might be accepted or even heard in future. 5. Post a bio. As best I can tell, you've done nothing with your life except join TR. Now go sit on your hands until you find your butt; I suspect you'll be busy for at least a week.

Osiyo53
Osiyo53

But, if I'd have simply closed the door, he would have been shut inside with me. Not exactly what I wanted at the time. The fellow appeared knocking at my door, talked firmly but quite reasonably at first. Saying he just wanted to talk to me about the situation, get my side of the story, and so forth. You know ... the usual approach, used by cops, hard selling salesmen, and so forth. Get IN the door before shifting to the hard sell or giving occupant the bad news you're carrying. The guy's tough talk is also fairly common. Used by independent collection agents and even by staff employees of some collection agencies from time to time. They figure, "Hey, it's worth a shot if it gets this done right here and now.". Often they figure average person doesn't actually know the law that well. Which is true, I hear folks claiming this or that to be legal or illegal all the time in cases where I know that they're wrong in their belief. I'm no lawyer, but have had training in criminal law (was a cop for almost 3 years before I decided it wasn't what I wanted to do); and in business law as part of my general education. So there is a LOT about law in general that I don't know much or anything about. OTOH, within the areas of it I do know something about, I routinely hear someone make a claim that isn't correct. So, as in the case of the fellow I mentioned, it's not uncommon for guy to try to bluff his way through to getting a person to cough up the cash or comply with his demands. If person does actually know something of what the law says ... he simply then says that it's all a misunderstanding. He didn't mean what yah thought he meant. Or whatever. In any event, guy was already inside my home. And not inclined to leave right away. Maybe he was bluffing, probably was. I was kinda amused at first. But not for long as I'd had a hard day at work, was tired, and thinking about going to bed. So when I told him conversation was ended, I was no longer amused and not in the mood to hear threats and that he should get out NOW ... and he kept wanting to run his bluff on me and kept his mouth going ... I decided to cut the conversation short. And to convince him that I meant exactly what I had said. Was I really, really angry? Nope. Was I really in fear of my life or health at the moment? Nope. (If I had been, I might well have just shot him as quickly and as efficiently as I could.) But nor did I intend to let situation get to that point. Simple, he was leaving or I was shooting. Take your pick, guy. My house, my rules. As he left I did tell him that if he decided to come back, better bring a cop with him and a properly made out warrant, summons, or other court papers. A cop (or judge) I would talk to, but not to HIM. Now, don't take all this to mean I advocate waving firearms in people's faces. The story is true. I simply told that part of it in an effort to throw a little amusement into my post.

jerry
jerry

The VA File Manager system was developed in the 80's in a cooperative project among several VA Hospitals. It inherited some characteristics from COSTAR (Computer Stored Ambulatory Record) developed as Mass General Hospital. There are "codes" that identify points of medical information. A code may be entered for a patient and then comments or parameters or modifiers included. Many of the current partially encoded systems are similar today. Users can define new codes; codes may be in groups (or divisions), etc. I used COSTAR in my office for about 10 years in 80s to 90s. Problem is everyone can't agree on how to define codes and they limit your ability to express nuances of medical information. An encoded system would tend to limit new medical knowledge. I now use dictation and some structured information such as reflexes, girth measurements, etc. for comparison. Every system has its flaws and strengths depending on purpose. A perfect one hasn't been devised, but with time more principles will become obvious.

jerry
jerry

The VA File Manager system was developed in the 80's in a cooperative project among several VA Hospitals. It inherited some characteristics from COSTAR (Computer Stored Ambulatory Record) developed as Mass General Hospital. There are "codes" that identify points of medical information. A code may be entered for a patient and then comments or parameters included. Many of the current partially encoded systems are similar today. Users can define new codes; codes may be in groups (or divisions), etc. I used COSTAR in my office for about 10 years in 80s to 90s. Problem is everyone can't agree on how to define codes and they limit your ability to express nuances of medical information. I now use dictation and some structured information such as reflexes, girth measurements, etc. for comparison. Every system has its flaws and strengths depending on purpose. A perfect one hasn't been devised, but with time more principles will become obvious.

SKDTech
SKDTech

it is called SAMS. I don't know what the acronym stands for but it is the military/Tri-Care/VA medical record database.

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