Problems to be solved with Standards

[dwbal...@gmail.com]

I've shared Problems to be solved with Standards

Message from dwbal...@gmail.com:

I have created a Google Docs document with a draft of a list of problems.  They are not sorted in a particular order, but the order they are in may well be an appropriate priority.  The challenge with priority, of course, is that it varies depending on who you are...

Please have a look, and add comments as you see fit.

Dennis

Click to open:

• Problems to be solved with Standards

Google Docs makes it easy to create, store and share online documents, spreadsheets and presentations.

[Mike Fletcher]

Thanks Dennis

For further food for thought, here's an article as published in the
Veterianary Business Journal in the UK and written by the UK Chair of
the Vet-XML Consortium:

http://www.vetxml.org/Documents/20760-VetEnvoy_Vetxml_V2.pdf

It argues the benefits of communication standardisation from the
perspective of the veterinary practice.

On Feb 16, 6:52 am, dwballa...@gmail.com wrote:
> I've shared a document with you:
>
> Problems to be solved with Standardshttp://docs.google.com/Doc?docid=0AdnwXJ4FC1KGZHZkOTY2Nl8waGY1cnZtZ24...
>
> It's not an attachment -- it's stored online at Google Docs. To open this  
> document, just click the link above.

[Alex Sherer]

Thanks Mike,

That's an interesting article. However, I'm going to play devil's
advocate. It seems the primary use case being argued for efficiency
here is insurance claims. There is much higher penetration of
insurance in the UK market than the US, so the use case described in
this article is unlikely in the US except in some specialty practices
or larger groups. We've maybe had 100 claims in 5 years. This UK
practice has that many in 1 month. I am no proponent of pet health
insurance since I don't want to end up where the human docs are now,
so I hope this doesn't become a use case for me.

Suffice it to say that if the driver for standardization is insurance
reimbursement, it will not be designed with the needs of the
practitioner in mind, but with the needs of the insurance company
which as the human docs have so sadly learned means giving the
insurance company a way to more easily deny, delay, audit and
generally make your life miserable. And this will be even more
common if they have machine readable semantic standards so that the
insurance company can automate EMR analysis, audit and reimbursement
delay.

Have no illusions, whoever pays the bills for standardization will
call the shots. Efficiency benefits to the practitioner will accrue
as a side effect of making it more efficient to the insurance
company, but those benefits will not be designed to help the
practitioner in any other way.

Some in this discussion seem to have no problem with the government
ramming standards down our throats for our own good and seem to think
the benefits would be worth it. I for one am no more pleased by this
prospect than having the insurance companies control standards.

Separately, I would point out that this article is basically an
opinion piece as it has no references. This is partly because from
what I've heard at conferences, most of the informatics work that has
been done looking at the cost benefit of EMR adoption has trouble
finding a positive case, much less the 2 or 3 to 1 cost benefit ratio
most business people like to see to be convinced there is good reason
for the adoption of new technology. I suspect the literature on cost
benefit of standards adoption is similarly weak and shallow, if not
worse since no one is making money selling standards like they are EMRs.

It's amazing that even in human medicine with their enormous
financial resources that little independent research is done to
measure the financial costs and benefits of EMRs or standardization
of any kind. At least I'm not seeing it in the AMIA journal.
Everybody (including the president) just runs around SAYING EMRs will
make medicine efficient and fix so many problems.

It seems everyone is touting this imaginary holy grail without even
knowing if it's all worth it. If some practice or chain comes along
that uses EMRs and standards and thereby reaps such huge cost
benefits that they leave their competitors in the dust, then there
will be a use case obvious to all. Somehow, I doubt this will
happen and I suspect that successful private practitioners who are
content with paper will coexist with the informatics advantaged.

Alex Sherer

[Mike Fletcher]

Thanks Alex

You have raised some important considerations. I must say, though,
that the experience of vet practices to date in the UK has generally
been very positive. For instance, the time to compile a claim has been
reduced by half, and the time to settlement reduced at least 3-fold.
In addition, improved communication means practices are kept up to
date on the status of the claim, and queries are handled more
expeditiously.

Mike

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