A Modest Proposal For Making Medical Information Systems Beneficial to the Publick


I’m not a particular fan of Old Testament literality, but Genesis 11:4-9 accurately foretells today’s much discussed and much derided Electronic Health Records and Medical Information Systems:

4 And they said, “Come, let us build ourselves a city, and a tower whose top is in the heavens; let us make a name for ourselves, lest we be scattered abroad over the face of the whole earth.”

5 But the Lord came down to see the city and the tower which the sons of men had built.

6 And the Lord said, “Indeed the people are one and they all have one language, and this is what they begin to do; now nothing that they propose to do will be withheld from them.

7 Come, let Us go down and there confuse their language, that they may not understand one another’s speech.”

8 So the Lord scattered them abroad from there over the face of all the earth, and they ceased building the city.

9 Therefore its name is called Babel, because there the Lord confused the language of all the earth; and from there the Lord scattered them abroad over the face of all the earth.

The only folks who hate today’s hotness, Electronic Health Records (EHR), more than physicians are patients themselves. Log onto the EHR site for each of your potentially dozens of healthcare providers. What you’ll see is a narrow, incomplete, and incredibly inaccurate depiction of some isolated aspect of your healthcare. Have any of your other physicians ever seen it? Is there a billing code for “laughter time?”

EHR systems in the US free-market healthcare system are proprietary, meaning there’s countless different databases, user interfaces, and usage models for patient’s health information. None of them talk to each other in any meaningful way, and most practitioners, who ultimately have a business to run, enter spotty and highly inaccurate records which never are communicated to any other practices which treat the patient. Even if they wanted to share info, EHR has “confused the language of all the earth” and encouraged practices to follow the rule of “garbage in – garbage out.”

And now… a modest proposal that doesn’t involve culinary recipes containing your offspring:

A really useful approach to EHR and medical records systems is a unified national (worldwide?) relational database with a robust set of open APIs, accessible to anyone, and easy ways for future implementers …

Are You Pro Life Or Not?


I’m somewhat taken aback by the elephant in the room in America’s healthcare debate. On one hand we hear from the libertarian position that healthcare choices are purely a personal responsibility and there’s no place for the government interference. Some of the more shrill voices equate universal healthcare to slavery. On the other hand we have the descendants of the moral majority taking the high ground in protecting the unborn from death by abortion, and demanding a strong government role in the pro-life cause.

Ironically, both causes are often championed by the same people. The Evangelical community rails against abortion, yet at the same time promotes the gross inequities of American healthcare. Go figure?

This bizarre juxtaposition begins to hint at the shape of our invisible elephant. On the surface of things, American morality assigns each life an infinite value, whether it’s the life of a fetus, the life of a loved one, or perhaps even one’s own life. No price is too much to pay to preserve human life (red blooded American life, that is.) When your child or parent is dying, no stone must remain unturned, no cost is too much for your insurance company to pay, no cost is too much for the government to pay, and ultimately no cost is too much for a moral American to pay. Life is precious, and this is a good thing.

American libertarianism, an evolution of the frontier ethic of self reliance, is one of the core values in our society, and has enabled us to conquer a vast and wild continent. But there’s also a sinister side to libertarianism, the materialistic side which obsesses on what’s “mine.” It posits that people with material wealth possess it because of their own hard work and efforts, and that those who do not labor successfully are, by definition, slackers. Any attempt to “redistribute” accumulated wealth to the slackers is inherently un-American (aka Socialism, Marxism, etc…) In short, supporting the common good is a personal choice, not something that flows from the elected government.

So we have a faction that vehemently insists on the supreme value of human life and we have another faction that prefers to hold fast to 100% of their material possessions, and specifically that the value of their lives as a group is demonstrably (in terms of health outcomes) greater than the value of the tens of millions of …