[Marxism] Cancer and capitalism

Les Schaffer schaffer at optonline.net
Mon Jul 19 11:22:46 MDT 2004

Louis Proyect wrote:

> In 1987 I worked as a Database adminstrator at Memorial 
> Sloan-Kettering. I quite after becoming disillusioned with the 
> hospital's decision to purchase package that did billing extremely 
> well, but a so-so job on demographics. The hospital had a big problem 
> with "Uncle Fred" going into the hospital and coming out looking much 
> worse than when he went in. (That's what happened with Hubert 
> Humphrey, for example.) It seems that the cure (surgery, radiation 
> therapy, chemotherapy, etc.) was as bad as the disease. Pissed-off 
> relatives would often decide not to pay the hospital under such 
> circumstances, so the hospital needed heavy-duty software to dun them.

for the last several months i have been working on some exploratory 
projects with hospitals related to these kinds of databases, as well as 
other acquiring, storing, and delivering vital sign data efficiently 
thru a hospital system.

several undigested thoughts come to mind:

o  Hospitals are easily 20 years behind the curve on implementing 
patient-data (non-billing) systems. Several journal articles have now 
shown conclusively that adding these systems will save lives (think: 
wrong medicine to the patient, amputate the wrong leg, etc)

o Hospitals have __avoided__ investing in these systems for a long time 
due to required capital outlays. NIH has a $100M program to upgrade 
hospitals over ten years, but given the costs of the systems, i am told 
by hospital admins this is a drop in the bucket.

o The current model hospitals are looking at for designing such systems 
is the aircraft industry (Boeing as i recall). Boeing implemented 
similar information tracking systems decades ago to build aircraft.

o Some doctors have expressed concern that the implementation of such 
systems will __reduce__ the face time with a patient, which they fear 
runs counter to the desires they have heard for better bedside manners.

o Nurses express concern that although the new systems could in 
principle save lives, improve delivery of health care, etc., they will 
instead be used for efficiency purposes to simply "cut costs".

o I have worked with one of the state-of-the-art integrated database 
systems to learn about the user interface. it is amateur in design, i 
was shocked this is the best they are offering. x-rays from one database 
thru this user interface, drugs prescribed thru another interface, 
radiology summaries on another tab in another interface, and so on. 
naturally, the company in question has a version upgrade, the cost is 
phenomenal and the hospital i have worked at that uses it is having a 
hard time justifying the incremental upgrade expense. I am told there 
are at least 5 different companies working on these systems, all with 
slightly different designs and mismatched databse connectivity.

o Hospitals are interested in wireless communication schemes for 
transporting data thru its workspace to doctors and nurses on the move. 
( interestingly the US Navy is working on switching over to wireless 
systems for transporting ship data around.) for this and other reasons, 
there are issues of privacy and security. i imagine a whole "growth" 
industry will appear around medical software systems as venture 
capitalists smell ummmm -- what are they called??? -- opportunities that 
will further bog down the system with excess expense. Someone told me 
insurance companies would love to get their hands on patient data and 
designing systems that share easily on the one hand but protect from 
evil eyes on the other is not so easy.

o emergency rooms in particular would like quick access to patients 
medical records independent of where the patient resides and who is 
their primary doctor. this would require standardization amongst all the 
different databases and query interfaces across the country (at least). 
Software geeks here know the keywords (inside joke) are "proprietary", 
"difficult to play well together", "market share", "resistance to 
standardization". Naturally a standard does exist (HL-7) but it does not 
seem to have helped unify large database systems yet.

as the old TV ad used to ask: "Is this any way to run an airline???"

les schaffer

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