The New New Deal

[Javelin66]

I am surprised that I'm the first to post this, I figured that Shooter listened to Mr Obama's fireside chats live every Saturday...

Anyway, our future president has announced his intentions for a very ambitious program of infrastructure projects.

http://www.politico.com/news/stories/1208/16258.html

[SlightlyCatholic]

—ELECTRONIC MEDICAL RECORDS: “In addition to connecting our libraries and schools to the Internet, we must also ensure that our hospitals are connected to each other through the Internet. That is why the economic recovery plan I’m proposing will help modernize our health care system – and that won’t just save jobs, it will save lives. We will make sure that every doctor’s office and hospital in this country is using cutting edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes, and help save billions of dollars each year.”

This is all well and good until some hacker comes in and has fun with all those electronic medical records. They'll need a massive IT department to make sure nobody has fun with those records. The good thing about paper is that you know how many copies of something there are and you know where each of those copies are located. Electronic anything means easy access with a mouse, a keyboard, and a computer guru with too much time on his hands.

[PaulR]

Hold on tight!! It is going to be a real ride over the next four years!

[03_SHOOTER]

I am surprised that I'm the first to post this, I figured that Shooter listened to Mr Obama's fireside chats live every Saturday...

Anyway, our future president has announced his intentions for a very ambitious program of infrastructure projects.

http://www.politico.com/news/stories/1208/16258.html

And for what possible reason should I believe anything he's saying now, when he LIED his way through the primaries, and eventually to the election. Until such time as he is actually inaugurated, and attempts to enact his policies, as far as I'm concerned, he's nothing but a typical Liberal, and you can tell he's lying because his lips are moving.

[Woody]

This is all well and good until some hacker comes in and has fun with all those electronic medical records. They'll need a massive IT department to make sure nobody has fun with those records. The good thing about paper is that you know how many copies of something there are and you know where each of those copies are located. Electronic anything means easy access with a mouse, a keyboard, and a computer guru with too much time on his hands.

Paper gets lost stained misfiled or the notes are written by some doctor who
writes like a spider on acid .A proper electronic medical record system would save money and lives .

[SlightlyCatholic]

I don't disagree with your assessment, I just think that in implementing the new system they should be careful to make sure everything is secure.

[Wolfy]

Speaking from recent professional experience, what "modernization" in this sense means is converting to a web-based system... which is neither cost effective, nor does it save any more time or energy than using paper does. We have enough trouble in my shop keeping up with electronic, web-based records of pieces of flight gear, much less entire medical histories of actual people.

Can you imagine what happens if the system crashes when someone is wheeled into the ER? What if no one knows this person is allergic to penicillin because, "Oh no, our massively far-reaching computer system is down!"

Then people will say that the solution of that is to keep paper backups of everything that is electronic. That obviously doubles the amount of work one has to do, negating any advantage the web-based system supposedly gives in the first place.

Two cents ain't worth much these days.

[HairyEyeball]

Never mind the obvious. What happens with this wonder system when you're denied life insurance or have to pay five times the premium for medical insurance when the insurance company's access to those computerized records turns up the fact that your great-grandparents died of cancer in their 30s? Or that your uncle died of alcoholism? Or...

And are we forgetting the first law of computers: Garbage in, garbage out - and no system is going to correct erroneous input (who else has been threatened with legal action for not paying a bill of $0.00?)?

[Skylark]

Anyway, our future president has announced his intentions for a very ambitious program of infrastructure projects.

Good. Our roads and bridges are crumbling. Public works projects like that put money into the economy through putting people to work and cost the public money for a limited period of time while the benefits last much longer. While we're at it, let's work on getting a decent rail system in place.

[CAPSmith]

Never mind the obvious. What happens with this wonder system when you're denied life insurance or have to pay five times the premium for medical insurance

Silly HE, why would that happen when the government is going to provide all those things for us?

[HairyEyeball]

Not to belabor the obvious, but there are only two places a government can obtain the money to underwrite all of these glorious visions: Either it steals it from those who earn it, or it prints 'fiat money', lowering the value of the existing currency - essentially the same result. Any imbecile who believes a government under Baraq Hussein is going to pay his mortgage, buy his car - and gas - and treat his sniffles with first-class medical attention is also planning to dine on rainbow stew, with pie in the sky for dessert.

[03_SHOOTER]

Good. Our roads and bridges are crumbling. Public works projects like that put money into the economy through putting people to work and cost the public money for a limited period of time while the benefits last much longer. While we're at it, let's work on getting a decent rail system in place.

Our roads and bridges are "crumbling" because the State and the Federal governments have been taking all the money that we pay in "road use taxes" (that's the $.18 a gallon that we all pay to the Feds for every gallon of gasoline we buy, plus the State and local taxes which averages out to be $.4653 per gallon), and spent it on Socialist give-away programs instead of what it was supposed to be spent on. Last year alone, the Federal and State governments took in $66.28 Billion in these "road use taxes" on gasoline alone, and that's not counting diesel or aviation fuels. Where did it all go? It sure wasn't used on highways, roads and bridges!

As far as "putting people to work", do you have any idea at all how long it takes to properly train a former Accountant, CEO, Banker, or any other rookie "white collar worker" to build concrete forms, climb and connect 'red iron' steel, tie rebar (rod busting), place concrete properly, lay asphalt, or any of the other aspects of building roads and bridges? A MINIMUM of 2 years, on the job, every day, before they're worth a darn, and at least another 3 before you can trust them to do much of anything without having to stand there watching them all the time.

Rail systems? Another idea that looks real good on paper, but in the harsh light of day, it falls apart like a cereal bar in a thunderstorm. The only place rail systems have worked in America is inside large population centers, and even then they're only marginally successful, and that's completely ignoring the fact that, depending on the specific geology of the area you're talking about building it on, and the billions of dollars in investment (that we really don't have right now), it can take decades from planning until the first person sets foot on one of the trains. Does that by itself make it a "bad" idea? Not really, but until someone figures out how to make any public transportation system that can actually break even, or even be profitable for a City, County, or State to operate, unlike the black holes they keep shoveling money into today, it's so far beyond a bad idea that it's really not worth considering.

[Murray B]

This is all well and good until some hacker comes in and has fun with all those electronic medical records.

Sorry ST, but it probably won't take a hacker. Up here we have had just such a system for years and any clerk with a password can access anyone's records at any time.

This could becorm really be scary if mistakes of the past are repeated.

Dr. Hartmut M Hanauske-Abel writes in his monograph, “Not a slippery slope or sudden subversion: German medicine and National Socialism in 1933”
posted at http://www.bmj.com/archive/7070nd3.htm

Dr Haedenkamp is executive director of the Hartmannbund, one of the two largest German medical associations...On 24 June [1933] Dr Haedenkamp summarises: ...In the future we shall be guided by the strong will of authoritarian leadership, which has received its supremacy from the new State. To serve this State must be the sole objective of the medical profession...

It would be a very bad thing if the profession came to serve the government again and had access to a database with more dirt on people than J. Edgar could have dreamt of. It seems to me that this proposed database has greater risks than benefits.

[SlightlyCatholic]

Sorry ST, but it probably won't take a hacker. Up here we have had just such a system for years and any clerk with a password can access anyone's records at any time.

Have there been widespread cases of information theft?

[HairyEyeball]

Have there been widespread cases of information theft?

Easy to ask, difficult to answer: Unlike 'treeware' records, there are no locks to break, or filing cabinets to force, or papers to handle (and leave 'trace evidence' on). A hacker or cracker can access and download information with no hint left, and the average data entry clerk responsible for those 'confidential' records would never know a file had been compromised.

In an era where HMOs - which millions rely on for medical care and insurance - are run by 'bean counters' whose primary concern is profit, denying treatment or charging higher premiums (does 'pre-existing' or 'congenital' condition sound familiar?) on the basis of such information is well worth the risk of stealing it. Just as in any criminal activity, a rational individual will weigh the risk/reward factor, and given the untraceability of the source, and the 'plausible deniability' of whomever 'authorized' the theft, it would be a fair surmise that such theft is more common than one might want to believe.

[Murray B]

Have there been widespread cases of information theft?

Sorry for the delay in responding ST, but it took time to do some research.

It is impossible to say how widespread the problem is since it is almost impossible to discover if a patient’s rights have been violated unless the perpetrator is reckless. Sadly, I did not find the article I was looking for which involved a clerk working at a mental hospital accessing dirt about a neighbor that she was feuding with. It happened some years ago, which could have been before the HIA was passed.

“The Health Information Act (HIA) was passed by the Alberta Legislature in 1999 and came into effect on April 25, 2001.” From http://www.oipc.ab.ca/hia/

I did find an example of abuse that happened in Calgary, Alberta a short time ago. It is on a lawyer’s site at
http://www.privacylawyer.ca/blog/2007_04_01_pipeda_archive.html

“Earlier this month, a medical clerk was fined $10,000 for unlawfully accessing the personal health information of her lover's wife...The charges were laid under Alberta's Health Information Act. Most other provinces would have no penalty for such conduct.”

“Stephanie MacDonald, who was charged under the Alberta Health Information Act, gained access to test results, biopsy findings and X-rays belonging to Marlene Stallard 17 times between August 2005 and May 2006...MacDonald, who could access information through her capacity as a clerk at the Dr. McPhalen [plastic surgeon] Professional Corporation, maintained she was working under her lover's direction when she accessed the records...MacDonald also said she wasn't aware what she was doing was illegal, noting she'd never been briefed on such practices and her office didn't have a privacy policy.”

The disturbing thing about this medical record database is how easily a clerk or other custodian can access any record they desire. The few restrictions that exist are legal and not implemented by software or hardware. It would be almost impossible for most victims to even find out if their rights had been violated. There is much good political dirt to be mined in such a database.

One example of political dirt mining is the discovery and publication of information about John McCain’s skin cancer treatments. This medical care was his private business and it does not seem that he volunteered the information and yet the whole world knew about it. The publication of such information seems like muckraking to me.

A comprehensive medical database would be full of much such muck for the raking.

A hacker or cracker can access and download information with no hint left, and the average data entry clerk responsible for those 'confidential' records would never know a file had been compromised.


True, and I would have added “intercept” to what a hacker can do. Even so, I think there is a problem with the database even before someone hacks it. If access is based on an honour system then with many custodians there will, almost certainly, be problems. Professionalism alone may not be enough to secure such a system?