Mohammad Al-Ubaydli’s blog

The real Stark Reforms

Posted in Medicine, People / organisations, Politics, Technology by Dr Mohammad Al-Ubaydli on October 2, 2008

Although in a former life I took part in writing a book about it, I never liked the Stark Law “Reforms” of 2007. They initially seemed attractive because they mandated that electronic medical records software be interoperable to qualify for subsidies. But the subsidies from hospitals to physicians’ offices had the wrong incentives. It made for a land-grab that would institutionalize silos for many years to come.

According to the law, a hospital is allowed to cover some of the costs of buying and deploying and EMR at a physician’s office without this subsidy counting as a bribe. However, once one hospital sets up the software, no other hospital is allowed to set up their own software. If a second hospital wants to link their records to the physician’s office records, they have to go through the first hospital.

In 2008, most US hospitals are spending on a land-grab. If they do not align with offices now, their executives worry that they will not be able to do so later. So much for interoperability.

So it is with great pleasure that I read about the real reforms from Representative Stark, HR 6898, no less. Not only is it pushing for software that uses open standards, it even makes the case for open source software. This is a personal obsession of mine so I am happy to include some propaganda from the CEO of MedSphere, a company that provides the open source VistA software:

[CEO] Doyle used the implementation of OpenVista at the Midland Memorial Hospital in Midland, Texas, as an example of the potential savings. Over five years, Midland invested $18,000 per bed in getting OpenVista to work with its existing system and across its facilities. The average for 16 hospitals of comparable size to install a new system and reach the same level of implementation over five years is $71,500 per bed, Doyle said. The installation has to meet certain quality measurements, such as reduction in length of hospital stay, improvement in quality of care, reduction in the number of infections, before it can be declared to have reached stage six.

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