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Healthcare Technology – A complete cluster….

In Politics on June 13, 2016 by thebetweenthoughts Tagged:

…I’ll let you all finish that tagline.

Given all of the medical advances that are available within the US healthcare system (at least to those that can afford it), I’m sure you may be wondering why I would have a title like that for this blog post.  But if you’ve ever wondered why it takes so long for your medical claims to be processed, why it’s so confusing to read the “bill” (either the the Explanation of Benefits from your insurance plan or the actual invoice you receive from your doctor), why checking the status of claims or finding a doctor is so difficult to do online…then this post may be for you.

[If not, feel free to check out The Ringer – the new site from the folks that brought you Grantland.]

One of the core tenets within our current technological revolution is the ability to access and transfer our information easily.  With the rise of technologies specifically made to make connections between information systems and applications easier (e.g., APIs), we almost take for granted the ability to switch between applications and see all of our information populated.

Yet in healthcare, we see insurance plans and healthcare providers working with archaic administrative systems that are designed to specifically prevent the transfer of information to another system.  While the US government is pushing for greater interoperability (e.g., the ability for systems to connect and transfer information), the current state is one where your medical records, your medical claims, and your personal health information are all locked into one system or another.  For the longest time, I just assumed that this was how things were always going to be.  In a “free market”, you have competing systems doing everything they can to lock in customers.  And one of the most successful ways to do that…is to prevent other systems from accessing your information and preventing your customers from being able to switch to a competitor.  It makes sense from a capitalistic, market-driven perspective…yet I ask once again, is that the system that we want for our health?

Upon reading  The Healing of AmericaI learned that in France and other European countries, all of their medical records (e.g., procedures, claims, etc.) are kept on the security chip that you see on most credit cards these days.  While this chip technology is “new” in America, it’s decades old in Europe…and they’ve taken advantage of it in more ways than just security.  By creating a common system to store and process medical data, they’ve been able to lower the administrative costs associated with healthcare (to the tune of around 5% for insurance plans…vs. the 20% that you typically see in American insurance plans).  Why can’t something like this exist in America?

Sadly…it’s capitalism.  As much as I am a believer in the free market system, I have to question whether or not it should be applied to healthcare.  From a purely technology standpoint, I know many will make the argument that innovation and progress can only be made through the free market system.  But a free market system inherently creates winners and losers…and do we really want losers when it comes to our health?

The healthcare industry (and in particular the healthcare technology industry) truly is the Wild Wild West.  While a few standards do exist, we honestly haven’t seen a more forceful push by the US government to shape the industry into something that will ultimately benefit healthcare consumers.  Obviously, it’s a product of the US government lacking the vision (or at least the consensus vision) of what it wants out of healthcare.  But the longer that we drag our feet as a nation when it comes to answering the question of “what do we want out of healthcare?”, the more entrenched we become in the cluster”what?” that is our current healthcare environment.

;P

[Update: here’s an article on the current state of interoperability.]

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