About Time/I Don't Get It

Couldn't decide which title to use. It is about time, and I don't get why it took so long.

President Obama is announcing a jobs program aimed at rebuilding infrastructure. Seems to me it's what lots of people, myself included, have argued the original stimulus should have been much more about than it was. (In my case, I admit, I don't what the hell I'm talking about. Biology major. But not completely devoid of non-biological thought.) Too little to do much good, I fear; too late to get it passed. Rs will see to that.

Of course there already has been money going to infrastructure: I've driven past (or have been bogged down in) several highway projects decorated with signs proclaiming as much. And I get that not all stimulus should be short-term, and that it's reasonable to have used money for such things as energy projects, and to save state government jobs, teachers and cops. But how short-term would it be to repair and rebuild roads, dams, plants, bridges? We've ignored them for decades; there must be decades of work. And what of the downstream (is it trickle-down?) effects of people having money to spend, buying stuff, which re-opens shuttered businesses, who hire more people, who have money to spend...

The problem -- among many -- with the administration's caving to Rs in the beginning, adding too much in tax cuts to the stimulus and not enough spending (and yes, devoting too much to needed but not top-priority job-creating spending, larding it with more than a lot of pork), is that it's played right into hands of the most cynical. Namely, by sabotaging recovery congressional Rs can now point to the stimulus and say, as John Boner (who's about to give new meaning to the term "nothing rhymes with orange") just did, that it all proves "we can't spend our way to prosperity."

That's like saying the Donner Party proves you can't pack for a trip.

Sounds Good

Actually, looks good, too. Wonder what those books are, and who's in the picture. Ovoid office, is the gestalt.

To my economically deficient mind, the idea of a massive government investment in infrastructure of all sorts makes sense. As a physician (as I recall), I like the generic concept of electronic medical records, but I think we're a long way from being able to get them into every office and clinic and hospital and to have the kind of interconnectivity Mr. Obama implies. This is for two reasons: the perfect software doesn't exist; and even if it did, lots of doctors would resist it. In my experience, it's a huge step forward; but I understand the reluctance.

I guess I had the best of both worlds: not long before I left, my clinic switched to entirely electronic medical records. But, unlike the systems today, back then what it meant was digitizing all info for instant accessibility. We still dictated our op notes, our office records, but they were instantly transcribed, by human beings, into digital form. The benefits were immediate: no longer did my office have to search for the records of the patient arriving for consultation: they were online. As were the most recent notes of the doc who sent that patient to me. Lab data were available within moments of finishing the tests; as were Xray images and (in theory) the reports of the radiologists. And since the hospital had dedicated computers linked to our clinic, all of the above was available there as well, any time of day or night. It's impossible to exaggerate what a boon that is. So what's the problem?

This: the electronic medical record (EMR) systems now are aimed at eliminating the middle man (or, more likely, woman.) No longer can the doctor dictate his/her reports: they are to be entered electronically, using various algorithms and pre-packaged phrases. Likewise the ordering of labs, onto which are often imposed various protocols for confirming the necessity and/or appropriateness. The results, too often, are the forcing of square pegs into round holes; and dramatically to slow down the process. Op notes, for example, which I could roll out of my head as if a CD had been inserted, may -- depending on the particular program being used -- require several extra minutes to finish, and that has an obvious cascading effect on all subsequently scheduled operations and all the people involved therein. The better the software, the more familiarity with it, the less this is an issue. But it's still significant.

Nor is there any standardization. I could be wrong, but to have perfect communication between providers across the country, there'd need either to be universal acceptance of a single program (investors, anyone?) or some pretty brilliant intercessory software (more investors, anyone?).

It's been a while since I've been deep into the medblogosphere, but I think it's safe to say the majority of doctors are unhappy with their experiences with EMR. Mine, before the square peg/round hole era, was nearly perfect: it was nothing but a vast improvement over paper records. And it's absolutely certain that universality is inevitable. Mr. Obama's aim is highly worthy. But much of the pie remains airborne.