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Charles Heisterkamp, M.D., Chairman
Subcommittee on Computers,
Council on Computers,
Council on Medical Economics, Pennsylvania Medical Society
20 Erford Road
LeMoyne, PA 17043
January 5, 1985
Re: The Charge to the Subcommittee
You and I have talked in the past about the need for the Society to have its computer horizons raised by the handful of physicians who have made computer horizons a personal interest. In creating this subcommittee, I think we have an opportunity to show what all that means, although we have many difficulties to overcome.
Like all Society activities, this one has to depend on the spare-time activities of a few physicians (mainly the chairman), and the ongoing activities of a few physicians time are limited, and the staff time is not unlimited, we have to be careful to be realistic about what we attempt. I believe the two most important things we can accomplish are 1) to make a favorable early impression by cherry-picking a few easy projects and 2) to write a "white paper" describing what would be possible if we had more money, experience, time, and energy. The white paper is essential as a way of educating the staff and trustees as to what in the world we are talking about, and enlisting their enthusiasm. Without their enthusiasm, very little will happen.
A "blue-sky" essay is not convincing. Rather, we need to make preliminary explorations of a number of near-term potential projects, bringing out for the staff and trustees a description of the realistic nature of going further. It will not be necessary to describe "star wars" of the distant future; if we work on the near-term ideas, the star war ideas will start to come back from our audience.
Let's take some example. I believe, for example, that an inventory of existing resources should be made. You and I recently saw that the resource of the society are greater than we had imagined. You and I have both found that there is a need to identify the physicians and staff members who might already have an interest or aptitude. You and I have both had experience in scrounging help from universities, government departments, and hackers. Like all frontiers, the computer frontier is populated by many good-hearted souls who enjoy helping other people. Like all frontiers, it also has a fair number of phonies and drifters who can cost you a lot of time and money if you misjudge them.
We need to evaluate the present plans of the existing resources since we will need to know whether it is at all likely that we can expect help from those directions. It does not matter if we have a resource, if at the same time that resource has a plan for the next thousand years, or is itself obviously totally incapable of conquering existing problems without even considering new ones. We may be able to draw attention to an under the supported area and help them out occasionally, you find someone who is grateful to you for doing so.
It is my understanding that the Welfare Department is willing to turn over to us the entire data file of the MAMIS program. I believe we need to evaluate the potential of using this data for Society purposes, we need to discount its error content, appraise its timeliness, and consider whether we should lobby to have additional data elements added, or lobby to remove existing elements. Having done so, we would be in a much better position to decide whether the Welfare Department is justified in its insistence on a unique invoice sheet. Even if it is, we ought to be able to maintain as much of the HCFA 1500, A format as we can, for at least a moderate amount of convenience and consistency. We might you know, it is always possible possibly discover that the Welfare sheet is superior in some ways to the HCFA form, and make useful suggestions to the AMA. This would certainly be a great face-saver for the Welfare Department. One more thing: it is possible that the demand for a unique sheet grew out of political turf problems, an that Blue Shield might have useful things to tell us.
We should look into the claims processing systems of Blue Shield and the Welfare department, acting as the providers' representative. How bad are their processing backlogs? How high are their costs? To what degree is "quick and dirty" claims processing costing our members serious money?
How receptive are the carriers to paperless processing? What are the prospects for direct bank-to-bank transfers of payments? What in the world motivates Blue shield to charge the provider for the "privilege" of paperless claims transmission? Or am I wrong, and the advantage of paperless claims submission lies with the provider, not the carrier? What does it cost Blue Shield to process duplicate claims? What is their error rate? What does their competition say about them?
How is the data system of the PRO? Where are the system flaws, the error rates, the processing delays, the analysis inadequacy> How much coordination with the PRO is there with the malpractice carrier information in PMSLIC? Who stands to benefit in what ways if confidentiality and political issues could be resolved? How should we advise the Society to throw its weight?
Since we are the Council Medicare Economics, how much information about the state and national economic scene might be available in a magnetic form for use on our machines? My guess is that there is so much available that we could only hope at first to create a library of available resources, and then look around for universities and research groups to work with it. There might even be some hope of creating research fellowships or small grants if the cost/benefit ratio looked favorable of utilizing this method of getting some things done which the Society would like to do. You can get an awful lot of mileage out of some enthusiastic kids working to write a research paper; a $500 grant might get you thousands of man-hours of work, and it might later be a good recruiting method if the Society comes to expand its in-house activities.
Should the Society start a users group? Should we start a telephone chat-session? I think so since this would be a quick way to identify who is out there who would like to join our crusade. Maybe we should evaluate software, if only by making the chat available to inquiries. It seems to me there is a tremendous demand for information exchange. maybe AMANET is the way t go; maybe CompuServe, Source.
I think we might ask whether there is room to start a third-party system between practitioners' office and laboratories. Not only is there a tremendous problem of equipment incompatibility and protocol idiosyncrasy, but there is also a secrecy and security issue (pregnancy tests in the unmarried, for example, and Wassermann's in anybody else). It seems attractive to consider that if the society started (?sponsored?) laboratory results in a mailbox with a fixed format and protocol, then all laboratories could send their results there and all doctors could pick it up at their leisure, or on demand. The third-party system would need to have a million phone lines, but it would save everyone else from getting into the big time. If we got there first, we would preempt the field, and I think it would be a big money-spinner. And if we don't, then the bigger laboratories will do it one by one, making themselves incompatible with the rest in order to preserve market share.
What are other state societies doing in this field? We don't have a monopoly on good ideas.
Well, Charles that's my laundry list for now. I feel an urgent need to thrash out this and other lists and assign tasks to people. many of done by doctors. But the great need is for someone to pick up the ball, and start running with it.