Vendors and interoperability
Making good on the challenge made by President Bush and national information technology coordinator David Brailer on adopting a national electronic medical record would require extensive compromise ("Brailer's IT plans draw fire," Oct. 17, p. 14).
Interoperability will require substantial efforts and concessions by system vendors, their existing clients and the public to support the data interchange envisioned. Brailer's request that the standards proposals attempt to reconcile the differences between state and federal privacy laws will also likely require some compromises on the part of the public (i.e., the privacy advocates) as well as local governments. I disagree that this could "sap public support for electronic healthcare records overall."
There is no question that privacy is a major concern, but I believe that safety, efficiency and quality are much greater issues for consumers of healthcare. I am commonly asked by my patients about the number of particular procedures I have performed, my success and complication rates, and the cost of the care. When patient privacy does occasionally come up, most are not worried about the security of their personal health information, but are frankly bothered by the nuisance the HIPAA rules have created.
Cerner Corp. and several other companies have done an admirable job of trying to interconnect communities where providers have purchased their products. The vendors are understandably reluctant to make data-sharing among vendor applications simple and efficient, but it is disingenuous of Cerner President and Chief Operating Officer Neal Patterson to imply that government imperatives regarding interoperability are pandering to whatever ethereal entity a "Beltway bandit" or "grant baby" is.
I do agree with one thing Patterson suggested, which is that interoperability will be enhanced and simplified if a national patient identifier existed. Perhaps the privacy advocates could lobby for a mechanism to simultaneously protect the patient's data while allowing for the existence of an identifier. I am no fan of big government but without requirements to interoperate, no one will ever be able to make a business case to perpetuate that kind of data-sharing.
Howard Landa Chief medical information officer and chief of urology Hawaii Permanente Medical Group Honolulu
Chief medical information officer and chief of urology
Hawaii Permanente Medical Group
Residency is just the start
It is interesting to me that everyone seems to be crying about how many hours residents are working ("The secret lives of physicians," Modern Physician, October, p. 7). It's not as if things are going to change dramatically after residency.
My workweek ranges from 60 to 80 hours. One weekend in seven I am on call, which starts at 5 p.m. Friday and ends at 7 a.m. Monday. During that time I am paged countless times. I end up with eight to 16 admissions, plus rounds with my own patients and those of other doctors in my call group.
After that, my workweek begins again.
Our local residency program closes down if it's overloaded. I and my partners don't get that luxury.
M.A. Mitchell Osteopath Wichita Falls, Texas
Wichita Falls, Texas