Nurses unionize to drive up their own wages.
Imagine that being a programmer required a license from the state in order to practice. Now imagine that if you make a significant error, you lose that license, pretty much ensuring you could never make another dollar in salary as a programmer. Say your work consists of doing week-long projects, with a team of 4 other programmers. Your code must be released weekly and must be bug-free. Now what happens when your boss realizes he could save 40% on costs if he cuts your team from 5 to 3? Or to 2? How likely are you to release bug-free code? That's the situation for nurses.
Adding to that, nursing is one of the most dangerous jobs in the country based on the number of on-the-job injuries and missed-work.[3] Most of these injuries are caused since hospital staffs are being cut, which leads to nurses having to lift, turn, and dress patients without additional help.
Furthermore, nursing care levels are directly correlated with improved patient outcomes, shorter hospital stays, lower mortality, and a number of other positive indicators. [4]
So you have hospital management on one side, who's incentives are to cut pay, cut hours, and cut staff (and frankly, to keep patients longer). And then you have nurses / techs / etc. on the other side, who are more likely to injure themselves, more likely to lose their licenses, and more likely to provide substandard care with those cuts. Do you honestly think unionizing is a bad idea?
[1] Barry Hirsch and David Macpherson, “Union Membership and Earnings Data Book,” The Bureau of National Affairs. Bloomberg. 2012. [2] http://www.ananursespace.org/BlogsMain/BlogViewer/?BlogKey=c... [3] http://www.bls.gov/news.release/osh2.nr0.htm [4] http://www.nejm.org/doi/full/10.1056/NEJMsa012247
On another point, I think that a serious problem is Tort Law. Unfortunately it's such a complicated debate I don't think it could ever be resolved in the US. I personally believe the New Zealand government has this perfect with the ACA (http://en.wikipedia.org/wiki/Accident_Compensation_Corporati...). While it is still possible to pursue a civil suit against someone, in the case of a car accident for example. No lawyer is going to do this pro-bono. You have the right to claim medical and loss of work directly from the ACA, therefore the likelihood of a New Zealand judge awarding a large claim would require some serious negligence by the other driver and even then the cost of pursuing that would not be worth the risk. After all, a "normal" person would be satisfied with being medically taken care of and having any loss of income recovered. This will not sit well with those that feel "SOMEONE SHOULD PAY FOR THIS! AND THIS IS THE PAY DAY I'VE BEEN WAITING FOR"
Everybody gets charged differently. Everybody ends up paying different amounts for the same thing. The numbers on bills seem to come out of an after the fact lottery ball mixer.
Probably the best reform would have been to eliminate the tax deductibility of insurance benefits. A much larger fraction of people would choose high deductible plans and be price sensitive shoppers, imposing some market discipline on the system. But of course obamacare is a move in exactly the opposite direction.
"..."
I can't imagine trusting this guy, or anyone willing to work with him, with ... anything, let alone implicit and explicit access to medical information, until he presumably grows up a bit a decade or two from now.
Of course, I'm also one of those members of the MIT community who believe Aaron Swartz should have done some serious time in Club Fed (> a year, i.e. felony), am not in the least swayed by his exit from a mess entirely of his own making ("If you aren't willing to do the time, don't do the crime.", incalculably stupid for someone who suffered from depression), and am rather perturbed by all those taking the side of a criminal again MIT to the point of committing even more crimes against the community, like this one.
To answer the rest of your points, it comes down to character, and his actions and most especially his responses afterwords conclusively demonstrate he isn't worthy of the trust which is required for this sort of access to people's health information.
I don't "dismiss his work" so much as "don't trust him or anyone of such poor judgement to work with him" with a service handling sensitive stuff.
People like you give "hackers" and at least the newer generations of MIT undergraduates a bad name.
ADDED: Your fellow members of the MIT community aren't too impressed with all this including your apology: http://tech.mit.edu/V133/N13/fakeemail.html?comments#comment...
AND MORE ADDED: And now reading them, you did this during "hell week" (midterms)? Were you even still a student then???
FINAL ADDITION: can you show us the slightest evidence you've learned anything but "Don't get caught next time" (assuming the speculation that this was more a PR stunt than anything else per some of the comments in The Tech is false)?
Disclosures: I'm class of 1983 and have close non-academic ties to Course 6.
I don't know what the answer is, but I know that the sooner we take the "art" out of medicine, the sooner healthcare will get a lot better.
Or if you prefer to watch it from 2012's PyCon: https://www.youtube.com/watch?v=R9ITLdmfdLI#t=1587
There are a few basic assumptions underlying your vision that may be useful to flush out further (I can tell you that, from similar experience, what you are going to bump in to is a fundamental lack of desire from the majority of the system to see change).
1. You are betting that Obamacare will actually drive the system towards "accountable" care -- we are a long way off from this unfortunately. I won't rehash it all here, but many ACOs are turning back from the model: http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?...
2. You are betting that patient engagement in their own health will be high, particularly for the high cost, at risk patients. This has been historically proven not to be the case. High touch intervention + technology works (i.e. take a look at the Diabetes Prevention Programs now being run digitally by organizations such as Omada) but technology by itself has had a pretty low hit rate with driving meaningful patient engagement for the at risk populations. For some reading on the challenges of adherence, check out: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661624/
I really do think we need more people working on these problems, so keep at it, and if I can help at all please let me know!
(drop me a line at andrei@humanapi.co)
The commonest reason for transplanted organ failure is that the patient isn't compliant with medication.
This happens in UK (free surgery, free meds) and US (expensive surgery, expensive meds).
It's weird.
You're right, most EHR UI is bad and it's built upon old technology. It entirely pre-dates the "design era". But, part of the reason for this is that healthcare was one of the first major industries to use IT heavily. What these systems lack in modern design principles, they often make up for in stability and ability to support system flows for larger organizations.
I admire your spirit and I hope that you do make an impact on healthcare. But, it might be wise to try and glean some lessons from the past vs. writing everything off as something that "fucking sucks". You might learn something along the way on your path to making health delivery better.
http://delian.io/an-apology-to-president-reif-and-the-mit-co...
I wouldn't have anything to do with him or his company.
3. Jim is released but doesn’t improve his habits and has another heart attack
I like this idea, but patients vary wildly in responsibility. You'd have to have a plan for those who can't or won't keep track of anything.
This is a stunningly huge point of failure with a very high probability that any one patient will either: forget their phone, break their phone, not have a phone, have the wrong phone, have no charge on their phone, not know how to use their phone, have an out-dated phone, etc. I think you get the idea.
The fines did not force more doctors to look at EHRs, it forced many like my Doctor and those in his office complex to sell their practices to big Medical conglomerates. So from a complex of multiple independent practices, many decades old, they all sold. Now they are employees of these conglomerates and there is now staff who deals with EHR, they just ask for print outs and fill out forms.
As for Doctors suddenly becoming responsible for managing their customers care, well that will lead to less individual practices as they won't be able to afford those patients who cannot be managed.
Your now a number to be managed. Fortunately for me my Doctor remembers his long term patients. He will be here till they finally force him out.
Not affiliated, just a huge fan.
Every so often people come up with this idea of the patients holding their medical information rather than the institutions but they tend to suffer greatly in emergency situations and/or have tortuously complicated hierarchies of trust and security.
EHRs should be centralized, but with extremely tight controls, either managed by a non-profit GSE or a government agency with an extremely high level of accountability.
If you go to any healthcare provider, they can request access using your government ID number (driver's license, etc). If you're conscious, you can approve this request using a two-factor auth notification on your phone (SMS, push, whatever). If you're at the ER and unable to approve the request, they can override the request, but its flagged and its going to need to be justified.
The answer, as always, is complete transparency and accountability.
The problem population today is elderly patients with chronic conditions, either landing them in the hospital constantly or requiring regular visits to specialists, labs and pharmacies. This population does not use smart phones. So the burden is on the physicians and hospitals to track the information and coordinate care.
The whole idea of Accountable Care Organizations (What you described as "The New Model") is to coordinate care. ACOs are pilot projects, most just barely starting up. So the reality is only a fraction of the population in the US will be affected by these organizations. The big workflow change is really for the nurses who gather the information, not the physicians. The goal of ACOs is to improve outcomes. ACOs receive bonuses if the can improve outcomes for the same cost or less that is being paid for the same population today.
Also as a FYI, everything you described as Obamacare (ACOs / EHRs) was actually developed and funded in 2009 by ARRA, not last year in the ACA / Obamacare.
Kudos!
Although, I do agree software in hospitals is NOT user friendly!