SENATE BILL: Healthcare Modernization Act of 2013 (Passed)

[President Tyrion]

I support this. Small amendment.

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I'm pretty sure that just storing data in different places is not enough, and I'd venture that no one on this forum is enough of a security expert to legislate a secure network (and it would probably take pages of technical writing), so we can delegate it in theory to Superique's underlings.

[President Tyrion]

I would like to thank Assemblyman DC's complements and I would totally support Senator Tyrion amendment. Even so, I shall say that I'm no expert on technological security as well and all I will probably do is a small piece of roleplaying explaining the measures that I've decided to take in order to provide more security for the system.

For the record, I don't expect you to actually have the technical expertise. I just delegated it to your office because your cabinet department is the appropriate one. You could theoretically even ignore it if you wanted to, from a game dynamics perspective.

[President Tyrion]

Electronic medical records sounds like a great idea, but a lot of times it ends up meaning doctors spending less time listening to and treating patients because they are busy trying to enter data into a computer program. And a lot of times those program's entry forms are codes that do not lend themselves to nuanced assessments of the patient's condition.

What? The info needs to be recorded somehow, and typing it is faster, more efficient, and more communicative than writing it.

And, why assume that the forms cannot be freely filled?

[President Tyrion]

Electronic medical records sounds like a great idea, but a lot of times it ends up meaning doctors spending less time listening to and treating patients because they are busy trying to enter data into a computer program. And a lot of times those program's entry forms are codes that do not lend themselves to nuanced assessments of the patient's condition.

What? The info needs to be recorded somehow, and typing it is faster, more efficient, and more communicative than writing it.

And, why assume that the forms cannot be freely filled?

It is not more communicative for the doctor to be facing a keyboard and computer screen rather than their patient during a consultation.  My perspective both as a patient and as someone with a doctor in the family is that asking doctors to become computer data entryists and IT specialists is problematic. That is basically what this amounts to, in practice. User-friendly technology that would allow patient consultation to develop in high quality, personal ways isn't there at this point. That is a good enough reason to hold off on any mandates for its adoption.

Also I am very concerned about the idea that we are placing medical data on a card. That is a huge privacy risk.

People carry credit cards just fine. Considering there are WAY more back end protections than credit cards (only doctors may access it, and would face stiff penalties for misuse), I don't see a real issue with having the "cards".

With that said, there's also NO indication that the cards themselves need to have any sort of data on them other than name, because technically they could just be access keys and the information itself would be in the database architecture of the system. With software defined networking coming to the forefront, I don't even think there's much chance of a centralized network breach, either.

And doctors carry clipboards all the time, and write down stuff all the time. Is it any different to have them type? It isn't 1990; they don't need to be even tied to the terminal. They could input data on their phone, a tablet, whatever. Plus, is a terminal so intrusive? And let's not assume that the virtualization itself isn't user-friendly; why would it be? Healthy skepticism is fine, but we're designing the system. Why just assume that it will be terrible, based on no actual evidence that it might? Lots of medical companies already deal in computing, and have tons of user-friendly database designs. I'm a little sore on this point, because my cousin actually runs a startup to that end, and, looking at his product, it's insane to me that we could remotely consider that user "unfriendly". The technology exists for it, and has existed for it for years. Furthermore, I am also a patient and I also have a doctor in the family, and I would much rather have my records computerized.

This all just strikes me as negativity for its own sake.

[President Tyrion]

I realize that any dissent from unlimited faith in technology is just considered negativity these days, but I have to try. Things that you might consider user friendly are not the same that an elderly or middle age doctor would consider user friendly.   We are talking about more work for doctors, more expense, more early retirements at a time where we already have a doctor shortage.

I don't think you need "unlimited faith" in technology to see the strength of computerization and data centralization in such a case. Hell, an incredible amount of data is fudged because of poor handwriting alone, and that's not to mention the massive divides created by keeping medical records firmly in hard copy format.

You expect doctors to lose jobs, but for them to have more work?

The one thing I can agree on is that this will certainly incur a short term infrastructure cost.

[President Tyrion]

I realize that any dissent from unlimited faith in technology is just considered negativity these days, but I have to try. Things that you might consider user friendly are not the same that an elderly or middle age doctor would consider user friendly.   We are talking about more work for doctors, more expense, more early retirements at a time where we already have a doctor shortage.

I don't think you need "unlimited faith" in technology to see the strength of computerization and data centralization in such a case. Hell, an incredible amount of data is fudged because of poor handwriting alone, and that's not to mention the massive divides created by keeping medical records firmly in hard copy format.

You expect doctors to lose jobs, but for them to have more work?

The one thing I can agree on is that this will certainly incur a short term infrastructure cost.

I expect doctors will voluntarily leave the profession because they are overwhelmed by IT duties.

Form-filling on a laptop is as much an IT duty as form-filling on paper is a secretarial duty.

[President Tyrion]

Shua is rightly concerned about what may happen with the transition to electronic records. We should make sure above everything that we have the safeguards in place so that such a system will be effective.

Well, that article was certainly being a little silly: As usage went up, so did fraud from that type of usage. That's not really a conclusion worth making.

Nitpicking aside, we should probably ban "Copy and Pasting" altogether.

[President Tyrion]

Have the amendments been adopted?

[President Tyrion]

We do it out of love, Yankee

In any case, I'm ready for a vote.

[President Tyrion]

Perhaps we could change "the system" to "personal information and data collection"?

[President Tyrion]

I'm going to presume that addresses shua's concern, then. I'm going to make this a big fixer amendment.

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We also need to figure out TBA

[President Tyrion]

I frankly don't know where to start with TBA. I'm not any sort of expert on database design and upkeep, especially on this scale.

[President Tyrion]

My expectation would normally be that the initial startup cost is going to be greater than the annual cost.

That's what I thought, too. Perhaps $70 billion (trending toward Nix's high estimate) up front, and $7 billion per year thereafter?

[President Tyrion]

I am ready to pass this.

[President Tyrion]

Aye

Aye... can't believe I'm voting with TNF on a bill.

You'll find we vote on some relatively uncontroversial stuff every now and again, and we tend to push toward moderation to pass things every once in a while, as well. It certainly won't be the last time, in other words.