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Fueled by the economic stimulus passed by Congress in 2008, the federal government has embarked on a controversial $30 billion program to induce doctors throughout the country to adopt electronic health records (EHRs) by 2014. The purpose is to create an interconnected system of electronic health records to improve safety and reduce medical costs.

But the United Kingdom has spent the last 6 years working on the same idea, and it's proven to be a colossal failure -- so much so that the government is drastically cutting its program. What happened to their plan? Should we be paying attention before rushing ahead with our own?

In 2005 the United Kingdom embarked on the largest investment ($18 billion) in health information technology in the world. Yet despite expectations that the system would increase efficiency and reduce medical errors, their efforts neither improved health nor saved money -- in fact in some cases, they may have led to patient harm.

Britain's government-run medical system is obviously different from our complex public-private insurance system. However, its electronic health record project bears an uncanny resemblance to the program President Obama is starting. Here are the mistakes the British committed that we are now repeating:

Too large and ambitious: The UK project tried to accomplish too much, too fast, attempting to digitize health records for the whole population in a period of four years. This massive undertaking is years behind schedule and has delivered only a fraction of what it promised. Despite all the money poured into the system, the vast majority of hospitals in the UK still don't have integrated electronic health records. Because non-clinicians developed the system, the electronic forms they designed have little to do with how doctors treat patients -- making it unworkable for many physicians. As the Chair of the British House of Commons Public Accounts Committee recently stated, "This is the biggest IT [Information Technology] project in the world and it is turning into the biggest disaster."

Too dependent on commercial, proprietary companies: Rather than create one system and beta-test it, the UK government depended on four companies to build the system, two of which quit or were fired for missing deadlines. So the health records were never developed in the south of England. The computer software was secret and proprietary. There was no accountability to the public, and the vendors did not provide enough technical support to clinicians having trouble using the records.

The resulting software errors and crashes caused missing or incorrect clinical information and sometimes threatened patient safety, for example by causing surgical delays and the cancellation of hundreds of operations.

If a country like Britain -- which already has a national health system and is a fraction of the size of the US -- had so many problems with electronic health records, imagine the problems America would face. Here, instead of four companies competing for contracts, we have dozens of vendors -- most with proprietary software -- vying for billions in stimulus funds. It will be virtually impossible to make their products compatible, therefore not allowing all doctors in different offices to see the same patient's health information.

Even our partial adaption of electronic health records is causing problems. Over the last couple of years, doctors and hospitals have reported to the FDA dozens of medical injuries -- including six deaths and preventable heart attacks -- caused by problems related to computerized health records such as software errors and unreadable computer screens. Some errors resulted in drug doses that were 10 times higher than intended. FDA officials called this the "tip of the iceberg".

More than 50 medical organizations, including the AMA, have called on the Secretary of Health and Human Services to delay the program. In response, the administration delayed some of the required health IT functions, but kept the same 2014 deadline.

How do we avoid the UK's failure? The administration or Congress should slow down the program and delete those parts of the legislation that fine doctors for not using this technology. There's no need to have this system in place by 2014. Instead, we should conduct rigorous studies of the cost-effectiveness of electronic health records systems before mandating their use. Rather than force doctors to choose from dozens of commercial software products developed in secret, we should take a hint from the non-commercial sector, such as the Veterans Administration, which uses "open-source" coding so people can work collaboratively to continuously improve the system.

The Obama administration wants government programs to be based on evidence of effectiveness. Simply following the lead of "IT believers" and salesmen without the requisite evidence will repeat the UK's failures. Now is the time to proceed carefully, consider existing research and the British experience, and chart a more rational course into the digital age of medicine.

Stephen B. Soumerai is Professor of Population Medicine at Harvard Medical School. Anthony Avery is Professor of Primary Care at the University of Nottingham Medical School, UK.

State of the indy music industry looks rosy, so why all the doom-and-gloom about music?

Cory Doctorow at 11:30 PM Wednesday, Dec 1, 2010

TuneCore's Jeff Price has a six-part series analyzing the financial state of the music industry from the point of view of an independent artist. Price offers compelling reasons to believe that although the labels are experiencing a severe downturn, artists as a group are earning more than ever, thanks to the Internet.

I have a feeling that the record industry's rejoinder to this would be, yes, more artists are earning some money from their music, and all told, there's more money going to artists than ever before, but there are fewer opportunities for an artist to sign up to a label like ours that controls so much of the distribution channel that we can guarantee large sums of money for these lottery winners.

In other words, the music industry today is much less winner-take-all, with the benefits diffused to a larger pool of artists at the expense of the few who did so well under the old system. This is what I mean when I say a good copyright system is one that encourages the broadest-possible engagement in culture: more music, from more musicians, reaching more people, at more price-points, in more formats. It's a win for free expression and for art, but it's a loss for some artists and the institutions that supported them.

I don't celebrate those losses: it's terrible to think of people who loved and lived for music losing their jobs (most of the people at labels aren't greedy tools deciding to sue 40,000 music fans; greedy tool-dom is confined to a few powerful decisionmakers). It's sad to think of the tiny pool of musicians who did so well taking a loss (though before we weep for them too much, remember that yesterday's winners are well situated to get even richer from merch, performance and licensing, even without the archaic recorded music industry and its shiny bits of plastic).

But copyright's purpose should be to get as much art made and available as possible -- it's not a full-employment scheme for administrators and marketing people and record-store clerks; it's not a lottery that makes millionaires out of a couple of lucky artists. There's nothing wrong with it doing those things, but they aren't why it's there: it's there to fuel expression and art.

The reality is:

* More musicians are making money off their music now then at any point in history.

* The cost of buying music has gotten lower but the amount of money going into the artist's pocket has increased.

* There are more people listening, sharing, buying, monetizing, stealing and engaging with music than at any other point in history.

* There are more ways for an artist to get heard, become famous and make a living off their music now than at any point in the history of this planet.

* Technology has made it possible for any artist to get distribution, to get discovered, to pursue his/her dreams with no company or person out there making the editorial decision that they are not allowed "in".

* The majority of music now being created and distributed is happening outside of the "traditional" system.

And to reiterate, sales are up...

Seeing that the Nielsen stats are readily accessible and accepted as legitimate, why then are we left with the impression that music sales and revenue are down? The simple answer is album sales and overall gross revenue from music sales (CD and downloads) are down. The increase in music purchases comes from the people buying individual songs. The decrease in revenue comes from a $0.99 song costing less than a $16.98 physical album as well as fewer purchases of physical CDs.

The State of The Music Industry & the Delegitimization of Artists

(via EFF Deep Links)

(Image: Diesel Sweeties tee)

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Wednesday, December 8, 2010

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