Here is the third of Ken Pool’s blogs written for February 2011. We want to share his insights of healthcare repositories with everyone. As always, we enjoy reading them and hope you do too. His wit and irreverence that was so loved (well, most of the time anyway), shines through. TF
Healthcare Repositories – Their Care and Feeding
Dr. Ken Pool
It was in those days that there came a decree from the leader of the free lands that all providers shall submit records of their care for patients to a repository. And they shall foot the bill because we can’t find anyone else to do it (there were those who suggested that the government foot the bill but they were immediately recognized as socialist spendthrifts and were booted out one cold November day). And it was good.
And so it came to pass, in a land purchased from the Lenape Indians in a historic transaction, there was a provider Dr. William Robert who decided he could be his own repository (there being no provision against it, the assumption was it must be legal). He bought (with his own money) computers, hard drives, cabling, and other stuff too technical to be listed here. With these he established the required security and confidentiality controls and voilá it was done. And it was good (according to applicable state and federal regulations in effect at the time but subject to change without notice).
In the land of the Super Bowl (as it was known at that time) there lived a provider Dr. Billy Bob. Dr. Billy Bob wasn’t technically proficient (he only liked to see patients and care for them) so he googled to find an organization named Healthcare Repositories Be Us. They offered to store his contributions to the healthcare records for $1/MB/month. That is, each megabyte of data he submitted would be kept available for a month for only $1. If at any time he no longer wanted to keep those data available he could cancel and they would kindly delete the data from the repository. They even had an option to automatically deduct the payments from his bank account each month. And it was good (good enough to satisfy meaningful use which was all that seemed to matter at the time).
In the land of the Great Fault there lived Dr. Willy Robert (the “t” was silent). Living in the constant threat of breaking off and being shoved into the Pacific Ocean, the local repository (Cool Dude Repositories) had adopted a more long-term perspective for the pricing of their services. They charged a one-time fee in exchange for which they would store the record and make it available forever (or until an Act of God should make forever meaningless). They offered this at the rate of $10/MB but finance options were available. And it was good (and it is expected that the bankers that had been forced to leave the east and settled in this area would arrange for a new financial instrument called a healthcare derivative to resell those financed data).
As time passed, there came a day when all three of our providers reached the mandatory age for retirement. When our friend in New York retired he turned off his computers and (after scrubbing the hard drives to preserve confidentiality) donated them to a local charity (amazingly his tax return suggested they seemed to be worth more at that point than they had originally cost). Our friend in Texas closed his office and his bank account taking the cash and heading for Bermuda. As for the third, they say there is an old guy who looks a lot like him who now has a small agricultural concern in Humboldt County.
From that day on, the people in California were healthier and spent less on healthcare than in any other state. It is said that this might stem from the fact that they still have access to their healthcare records but that is mere speculation. Some would say that the only rational model for healthcare repositories is that they should be other than the provider and should be priced as a one-time fee. But what do they know?
I know dear reader, you are saying “but wait, give me more!” Be patient.