Bold, entrepreneurial idea to transform the health care system from within...

[EtherBunny]

As a subspecialist in private practice, I've become increasingly frustrated by the absurdly inefficient, corporatized, and downright illogical health care system in the United States. It's safe to say that the focus of the system has drifted far away from the previously sacred doctor patient relationship in the direction of corporate profits, especially among insurance conglomerates. In fact, the large insurance companies nationwide have consistently reported insane profits annually--ironically, the implementation of Obamacare has been a financial windfall for these companies. I'm so sick of the ridiculous nuances of level 3 vs. level 4 coding, PQRS, insurance denials for medically necessary care, etc. I know I'm not alone in this respect. Just about every physician in private practice that I've spoken to about this subject expresses the same frustrations.

And the frustration extends well beyond physicians. Patients are extremely dissatisfied with the overall direction of the health care system. Premiums and deductibles keep going up every year, and yet mysteriously networks for physicians keep shrinking and denials are increasing in frequency.

It's an absolutely ridiculous system that doesn't benefit physicians or patients in the long term. Which brings me to an idea...

With so many disgruntled physicians and patients--I would venture to say in the MILLIONS--why hasn't anyone taken the bold step of creating an entirely novel system? As physicians, we have tremendous power to effect change, yet no one is DOING ANYTHING ABOUT THIS MESS! Why can't we launch a startup company that is an entirely novel take on health care insurance, one that overhauls the dynamics among patients, physicians, and third party payers?

The way I envision the system is the following:
--all patients enrolled in the insurance plan are essentially signing up for catastrophic care (i.e., coverage that will prevent financial ruin from medical illness). What's the appropriate limit on catastrophic care? That of course is subject to debate, but I would support a threshold that is income dependent (on a sliding scale). Obviously, a multimillionaire has a different threshold for financial ruin than a patient who makes $30,000/yr.
--all care up to the aforementioned threshold is out of pocket and involves a DIRECT transaction between the patient and his/her physician
--all elective care prices are advertised and transparent to promote healthy competition among providers and keep pricing to a minimum (ideally)
--mandated usage of generic drugs and generic medical devices to keep costs to a minimum, but if patients truly fail to respond to generics, then it's up to the doctor and his/her patient to make the decision about escalating to a proprietary drug (not up to some stupid bureaucrat in an insurance company for "prior authorization")
--forbid financial relationships between industry and doctors in the plan
--elimination of all the bureaucratic excess in the system. There will be no need for huge billing departments, because essentially the lion's share of all financial transactions will be DIRECTLY between providers and their patients. Only "catastrophic care" would require billing and closer oversight. This change alone would dramatically improve the efficiency of the system and reduce cost overall.
--implementation of a novel EMR that isn't focused on satisfying absurd billing requirements by insurance companies but rather on excellent patient care and research, with the potential to link the EMR to artificial intelligence software such as Watson. The EMR will be intuitive and aesthetically pleasing with an interface that physicians actually enjoy. The EMR should facilitate workflow and face time with patients rather than hinder these things.
--the insurance company as a whole is truly nonprofit. None of this craziness with the insurance executives pulling in MILLIONS of dollars in compensation.

I'd like to move forward with this idea. Maybe I'm being too idealistic but somebody needs to step up to the plate and CHANGE THE SYSTEM. We sure as hell cannot rely on the incompetent/corrupt politicians to overhaul the system, and insurance companies are making far too much money to even be willing to do the "right" thing for patients and physicians. The only people who can effect change are patients and physicians. We're at the heart of the health care system, and it's our responsibility to heal what is fundamentally broken.

Any interest on this forum? Any MD/MBAs with a similar vision and interest? If so, send me a PM. I have connections in various places, including a family member who is a hospital CEO and a family friend who is a president of one of the largest health care insurance networks in the country, along with many different colleagues/friends in various specialties.

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[digitlnoize]

I agree with literally everything you've listed. That's the perfect system, IMO. It's actually most similar to the car insurance system. You don't activate your car insurance every time you need your oil changed, right? So primary care is out of pocket and relatively inexpensive, and catastrophic occurrences are covered by your insurance.

The problem with this is that it's extremely idealistic. I admire your ambition, but in the current political climate (i.e. oligarchy), this just isn't going to pass. You're talking about essentially abolishing the entire insurance industry, or at least radically changing it and reducing their profits. They are a huge lobby with billions of dollars in the system. They aren't going anywhere until we get money out of politics. Period.

Also, speaking as a psychiatrist, there will always be a segment of the population who can't afford to pay even the out of pocket costs. Many of my patients, especially the schizophrenics, are on full disability and can't maintain the type of income needed to pay for an out of pocket CBC or EKG.

My advice, if you want to change the system, is actually to start with the mental health system, which should be a universal health care system due to the cost of the drugs/tests (MRI's and EEG's for all new psychosis workups, for example) and the functional ability of the patients. Insurers are trying to get out of the mental health business right now. They're all insultingly lowballing psychiatrists, trying to get us to stop taking insurance, which most of us have. I'm talking offering 20-40% less than MEDICAID! It's literally insane. If no one takes Aetna then Aetna doesn't pay for mental health care. No one wants this market.

Let the government sweep it up, show how much better the system could be as like a pilot program, include some PCP's who opt in for a pilot program under your type of system. Gradually phase in more and more doctors until it's a fairly robust system, SHOW THAT IT WORKS on a small scale, then pull the trigger with huge public support and evidence and you MIGHT stand a chance. But if you don't start with mental health, nothing else will work because there's too much money involved in those other markets .

 

[EtherBunny]

I agree with literally everything you've listed. That's the perfect system, IMO. It's actually most similar to the car insurance system. You don't activate your car insurance every time you need your oil changed, right? So primary care is out of pocket and relatively inexpensive, and catastrophic occurrences are covered by your insurance.

The problem with this is that it's extremely idealistic. I admire your ambition, but in the current political climate (i.e. oligarchy), this just isn't going to pass. You're talking about essentially abolishing the entire insurance industry, or at least radically changing it and reducing their profits. They are a huge lobby with billions of dollars in the system. They aren't going anywhere until we get money out of politics. Period.

Also, speaking as a psychiatrist, there will always be a segment of the population who can't afford to pay even the out of pocket costs. Many of my patients, especially the schizophrenics, are on full disability and can't maintain the type of income needed to pay for an out of pocket CBC or EKG.

My advice, if you want to change the system, is actually to start with the mental health system, which should be a universal health care system due to the cost of the drugs/tests (MRI's and EEG's for all new psychosis workups, for example) and the functional ability of the patients. Insurers are trying to get out of the mental health business right now. They're all insultingly lowballing psychiatrists, trying to get us to stop taking insurance, which most of us have. I'm talking offering 20-40% less than MEDICAID! It's literally insane. If no one takes Aetna then Aetna doesn't pay for mental health care. No one wants this market.

Let the government sweep it up, show how much better the system could be as like a pilot program, include some PCP's who opt in for a pilot program under your type of system. Gradually phase in more and more doctors until it's a fairly robust system, SHOW THAT IT WORKS on a small scale, then pull the trigger with huge public support and evidence and you MIGHT stand a chance. But if you don't start with mental health, nothing else will work because there's too much money involved in those other markets .

The initial startup would not destroy the entire insurance industry. The goal would be to create a viable, common sense alternative to the existing system. If we could structure it the way that I described, I imagine physicians and patients would join in droves. We could easily pitch this to various businesses in the community as a way to reduce their costs on providing employer health insurance. In turn, this would have an enormous impact on existing insurance companies. They would be forced to either change their profit driven practice model or go out of business.

Either way, the key thing is that physicians and patients effectively win.

I agree 100% with you on the mental health front. It's absolutely ridiculous how illogical the prioritization of financial resources is in our current health care system. For my field, mental health is absolutely essential, yet insurers don't seem to understand the strong link between psychological well-being and chronic pain, despite the massive amount of ongoing and prior research on this very subject. Again, this is a classic example of why things need to change. Bureaucrats in insurance companies, government, and large hospitals don't have any experience taking care of patients. They didn't go to medical school and complete a residency. They didn't earn board certification in a specialty. Yet, these are the people dictating how we should take care of patients. Really? This is the BEST that America can do as a health care system?

As for the cost of tests...I sincerely believe that the cost of current tests is markedly inflated. Physicians and hospitals should not profit from tests. EKGs, labs, imaging, and "facility fees"--all of these things should be delivered at true cost. Look at the concierge practice model for primary care. These docs don't charge $100 for a chest x-ray. They charge what it actually costs, without any profit margin. Correct me if I'm wrong, but I think the actual cost of an EKG is $0.40. This is an enormous cost savings that can be passed on to the patient. The key is for physicians to own the equipment for the tests.

We, as physicians, are trained to be leaders. We need to take the initiative and overhaul the system. We can't accomplish it through legislation. We won't be able to change existing insurance companies' practices. We don't have to get anything "passed." This is the equivalent of an ambitious startup. A novel business. The only thing we can do is start a new system, an alternative that is fundamentally superior to the existing model in nearly every respect, with the notable exception of profit margins for people not involved in patient care.

 

[michaelrack]

Correct me if I'm wrong, but I think the actual cost of an EKG is $0.40. This is an enormous cost savings that can be passed on to the patient. The key is for physicians to own the equipment for the tests..

It depends on what you include in the cost of the EKG- 40 cents would only cover the cost of the paper. What about the time spent by the nurse/asst who does the ekg?? And how are physicians going to own all of the equipment? (and if they do, they will need to charge enough to pay for it)

 

[EtherBunny]

It depends on what you include in the cost of the EKG- 40 cents would only cover the cost of the paper. What about the time spent by the nurse/asst who does the ekg?? And how are physicians going to own all of the equipment? (and if they do, they will need to charge enough to pay for it)

Physicians can purchase equipment just like hospitals and any other practice. In my field, physicians routinely own a c-arm, a lab, and an mri. Some practices own far more. Yes, the price for the tests has to cover the cost, but no more. eventually the cost for patients becomes trivial. Once an ekg machine is paid off, the cost is just the sheet and maybe 5 minutes of work by a tech. Pretty cheap. Certainly not the ridiculous prices that hospitals charge.

 

[michaelrack]

Physicians can purchase equipment just like hospitals and any other practice. In my field, physicians routinely own a c-arm, a lab, and an mri. Some practices own far more. Yes, the price for the tests has to cover the cost, but no more. eventually the cost for patients becomes trivial. Once an ekg machine is paid off, the cost is just the sheet and maybe 5 minutes of work by a tech. Pretty cheap. Certainly not the ridiculous prices that hospitals charge.

so what do u propose- charging more for the test until the machine is paid off, and then charge less???? (that was a rhetorical question). You need to keep charging the same price so you have enough cash to buy/repair the machine when it breaks. YOu also need to get a reasonable return on capital- otherwise why would a doctor put his money at risk to buy an ekg machine or a CT scanner? Remember that practices sometimes fail/close down and a doctor/practice is taking a risk by buying/leasing equipment.

I say this as someone who has done (and is still doing) a combination of private practice, employed work, and contract work; and someone who has been sued over an equipment lease that he guaranteed for a healthcare company that went bankrupt.

 

[digitlnoize]

The initial startup would not destroy the entire insurance industry. The goal would be to create a viable, common sense alternative to the existing system. If we could structure it the way that I described, I imagine physicians and patients would join in droves. We could easily pitch this to various businesses in the community as a way to reduce their costs on providing employer health insurance. In turn, this would have an enormous impact on existing insurance companies. They would be forced to either change their profit driven practice model or go out of business.

If patients join in droves it would destroy the current insurance industry because Aetna (for example) would no longer get millions of patient's insurance premiums. I agree it would help the small businesses and reduce costs, but it would obliterate existing insurance companies. They won't let this happen and will continue to lobby Congress (and others) to prevent it.

As for the cost of tests...I sincerely believe that the cost of current tests is markedly inflated.

Yes.

Physicians and hospitals should not profit from tests.

What? Disagree. We should profit from whatever we want to profit from. Within reason.

Look at the concierge practice model for primary care. These docs don't charge $100 for a chest x-ray. They charge what it actually costs, without any profit margin.

This isn't true. They charge less than hospitals, yes, but they make money off tests. For example, Access Healthcare in Apex, NC have had a number of high profile articles written about their pioneering approach to concierge medicine and their ability to offer quality primary care at affordable prices. http://www.acchealth.com/ They charge $20 for an office visit, and $34 for a lipid panel. Reasonable, but likely more than cost.

Correct me if I'm wrong, but I think the actual cost of an EKG is $0.40.

You're wrong. EKG machines are expensive. Lead pads are expensive. Maintenance is expensive. Someone to work the thing is expensive. Then there's power, rent, and other overhead. All put together the "cost" of an EKG is far, far more than $0.40. Watch: An average, low-end EKG machine is ~$1500. $1500/0.40 = 3,750. You'd have to perform 3,750 EKG's to break even if you're only charging $0.40 each. How many EKG's does a PCP office do in a year? 200? 500? At 500 EKG's per year (which I think is an overestimate) it would take an office 8 years to break even on just the machine. Will the machine even last 8 years.

The cheapest EKG pads I could find were $7.50 for 50 electrodes. This is $0.15 per electrode. You need 12 of them for each EKG. $0.15 x 12 = 1.80 per EKG, just for the leads.

The average salary for an EKG tech is around $13/hr x 40h/wk x 50 wk/yr = $26k. Or you have your nurse do it, but that's more money too.

You get the idea. You're massively low-balling the true cost of an EKG. $40-50 seems more reasonable to me, which is more what I hear concierge practices charge for an EKG.

Physicians can purchase equipment just like hospitals and any other practice. In my field, physicians routinely own a c-arm, a lab, and an mri. Some practices own far more. Yes, the price for the tests has to cover the cost, but no more. eventually the cost for patients becomes trivial. Once an ekg machine is paid off, the cost is just the sheet and maybe 5 minutes of work by a tech. Pretty cheap. Certainly not the ridiculous prices that hospitals charge.

Again, you've underestimated the costs. You need the machine, the paper, the pads, the tech, the tech's health care insurance, the tech's dental insurance, the tech's vision insurance, the tech's other benefits, the electricity used to power the machine, the office space, and the maintenance of the machine (repairs, calibration, etc), your malpractice insurance to perform the test, and the portion of the rest of your office overhead it takes to service that patient for that visit. It adds up.

 

[EtherBunny]

If patients join in droves it would destroy the current insurance industry because Aetna (for example) would no longer get millions of patient's insurance premiums. I agree it would help the small businesses and reduce costs, but it would obliterate existing insurance companies. They won't let this happen and will continue to lobby Congress (and others) to prevent it.QUOTE]

I think you misunderstood me on this one. I said that the implementation of the new insurance COULD result in obliteration on existing insurance companies, but not necessarily. The alternative is tremendous pressure to change their practices. Either outcome is a win for patients and their doctors.



[What? Disagree. We should profit from whatever we want to profit from. Within reason.]

I hope you don't sincerely mean this. Yes, physicians are entitled to earn a good living, but we should get paid for our skills and knowledge, not from passive revenue on tests, etc. That passive revenue inevitably gets passed on to our patients.


[You're wrong. EKG machines are expensive. Lead pads are expensive. Maintenance is expensive. Someone to work the thing is expensive. Then there's power, rent, and other overhead. All put together the "cost" of an EKG is far, far more than $0.40. Watch: An average, low-end EKG machine is ~$1500. $1500/0.40 = 3,750. You'd have to perform 3,750 EKG's to break even if you're only charging $0.40 each. How many EKG's does a PCP office do in a year? 200? 500? At 500 EKG's per year (which I think is an overestimate) it would take an office 8 years to break even on just the machine. Will the machine even last 8 years.

The cheapest EKG pads I could find were $7.50 for 50 electrodes. This is $0.15 per electrode. You need 12 of them for each EKG. $0.15 x 12 = 1.80 per EKG, just for the leads.

The average salary for an EKG tech is around $13/hr x 40h/wk x 50 wk/yr = $26k. Or you have your nurse do it, but that's more money too.

You get the idea. You're massively low-balling the true cost of an EKG. $40-50 seems more reasonable to me, which is more what I hear concierge practices charge for an EKG.]

Again, I think you missed the bigger point here. It's all relative. Even if direct care practices charge for the true cost of tests, it's still light years ahead of what various hospitals and unethical practices charge. Jesus, some hospitals charge several hundred dollars for an EKG (or more). Do you seriously think that's ethical and good for patients? If a concierge practice charges $60 for an EKG, that's still an enormous cost savings for patients.

The bottom line is that all of the third party payers in existence today provide no value to the health care system. They only INCREASE overall cost of care by introducing tremendous bureaucracy and inefficiency. The ONLY role that insurance companies should play is in catastrophic care. Plain and simple. The current model is completely ******ed and devoid of the even a shred of common sense.

 

[beekle]

This would be why doctors are not fit to fix healthcare.... "Doctors and hospitals should not profit from tests" .... ?
"They charge what it actually costs, without any profit margin " ... ? Come on these are both just common sense.
Of course you can't just charge what it costs! If you charge what it costs you earn nothing, and if you earn not only are you not sustainable, you won't get paid back for the risk you took to set up in the first place! (assuming costs are objectively determinable - which they are not in any case)

I know many of us went into medicine as idealists - but at some point we should come back down to planet earth. We're craftsmen - don't mistake yourself for a businessman just because you have a 140 iq. If the solution was simple some hard charging MBA would have figured it out and exploited it years ago. It's a messy complicated problem with no easy answers. If we fix it at all it will be with thousands of small incremental changes driven by policy at the top. We're talking about turning the titanic here.

 

[EtherBunny]

This would be why doctors are not fit to fix healthcare.... "Doctors and hospitals should not profit from tests" .... ?
"They charge what it actually costs, without any profit margin " ... ? Come on these are both just common sense.
Of course you can't just charge what it costs! If you charge what it costs you earn nothing, and if you earn not only are you not sustainable, you won't get paid back for the risk you took to set up in the first place! (assuming costs are objectively determinable - which they are not in any case)

I know many of us went into medicine as idealists - but at some point we should come back down to planet earth. We're craftsmen - don't mistake yourself for a businessman just because you have a 140 iq. If the solution was simple some hard charging MBA would have figured it out and exploited it years ago. It's a messy complicated problem with no easy answers. If we fix it at all it will be with thousands of small incremental changes driven by policy at the top. We're talking about turning the titanic here.

This exemplifies my frustration with so many physicians in practice today--there's a sort of learned helplessness and inability to "think outside the box" when it comes to health care delivery. Yes, the American health care system is enormous and complex, but it can be changed, and it starts with physicians and patients. Physicians need to start opting out of the absolutely ridiculous insurance system that we have in place right now. There are several models that can be implemented--concierge/membership fees, cash based fee for service, and even hybrid models. It just depends on the nature of your specialty. If you're a surgeon, obviously you can't opt for a membership fee, you would have to opt for the cash based fee for service model. For doctors who treat chronic illnesses on a long term basis (htn, CAD, DM, etc.), a membership model is ideal. Businesses need to transition to self-funded insurance with stop loss coverage.

I just spoke with one of the leaders in the direct pay model movement in primary care, and it was an eye opener. The model WORKS! Much better than the existing system. It's so refreshing to talk to physicians who have the courage to venture outside the boundaries of conventional health care.

As for the profit margin comment, you're not thinking outside the box. The source of profit for physicians should come from the knowledge and skill set that we acquire over years of training, not from medications and tests. If you were a patient, what would you prefer? Would you be Ok with your physician--the person you're supposed to trust with your health--marking up the cost of medications and tests to turn a profit? I mean, for Christ's sake, are we used car salesmen or doctors? We're supposed to always have our patient's best interest in mind. Medicine is supposed to be an inherently selfless and noble profession. Making a profit on medications and tests is just flat out wrong, and (as it turns out) unnecessary for physicians to earn a great income.

Even if you charge for medications and tests at cost, you can still earn a very healthy living. Don't believe me? Do the math with a membership model for primary care. If the PCP has 400 patients enrolled in a practice with a $75/month fee and 30% overhead (which is typical for direct pay practices), the gross revenue is $360,000/yr and the take home for the doc is $240,000/yr. Not bad, considering that the doctor is completely divorced from the absurd prior authorization and denials game with insurance company, the onerous documentation requirements with private insurers and CMS, etc. And, mind you, this is a model in which all medications and tests are provided to patients AT COST. I didn't make these numbers up. These are from an actual direct pay model primary care practice in a large city.

The bottom line is that physicians CAN make an excellent living and take fantastic care of patients WITHOUT playing the stupid game with insurance companies or marking up the cost of medications and tests.

 

[dozitgetchahi]

This exemplifies my frustration with so many physicians in practice today--there's a sort of learned helplessness and inability to "think outside the box" when it comes to health care delivery. Yes, the American health care system is enormous and complex, but it can be changed, and it starts with physicians and patients. Physicians need to start opting out of the absolutely ridiculous insurance system that we have in place right now. There are several models that can be implemented--concierge/membership fees, cash based fee for service, and even hybrid models. It just depends on the nature of your specialty. If you're a surgeon, obviously you can't opt for a membership fee, you would have to opt for the cash based fee for service model. For doctors who treat chronic illnesses on a long term basis (htn, CAD, DM, etc.), a membership model is ideal. Businesses need to transition to self-funded insurance with stop loss coverage.

I just spoke with one of the leaders in the direct pay model movement in primary care, and it was an eye opener. The model WORKS! Much better than the existing system. It's so refreshing to talk to physicians who have the courage to venture outside the boundaries of conventional health care.

As for the profit margin comment, you're not thinking outside the box. The source of profit for physicians should come from the knowledge and skill set that we acquire over years of training, not from medications and tests. If you were a patient, what would you prefer? Would you be Ok with your physician--the person you're supposed to trust with your health--marking up the cost of medications and tests to turn a profit? I mean, for Christ's sake, are we used car salesmen or doctors? We're supposed to always have our patient's best interest in mind. Medicine is supposed to be an inherently selfless and noble profession. Making a profit on medications and tests is just flat out wrong, and (as it turns out) unnecessary for physicians to earn a great income.

Even if you charge for medications and tests at cost, you can still earn a very healthy living. Don't believe me? Do the math with a membership model for primary care. If the PCP has 400 patients enrolled in a practice with a $75/month fee and 30% overhead (which is typical for direct pay practices), the gross revenue is $360,000/yr and the take home for the doc is $240,000/yr. Not bad, considering that the doctor is completely divorced from the absurd prior authorization and denials game with insurance company, the onerous documentation requirements with private insurers and CMS, etc. And, mind you, this is a model in which all medications and tests are provided to patients AT COST. I didn't make these numbers up. These are from an actual direct pay model primary care practice in a large city.

The bottom line is that physicians CAN make an excellent living and take fantastic care of patients WITHOUT playing the stupid game with insurance companies or marking up the cost of medications and tests.

Bravo. If subspecialty training and being a specialist doesn't end up paying the bills in the long run, I fully intend to go concierge. Some people from my residency class are doing it. Their preliminary numbers sound good but I want to see if it actually works out for them.

Almost anything would be better than the overregulated, overwrought bureaucratic disaster that government/insurance funded American healthcare has become.

 

[beekle]

As physicians we spend our formative years in school and residency - years where others ("the suits") are learning to run organizations. By the time we finish residency, our college classmates who entered the business world have gained years of experience learning to lead and manage. We have chosen a trade - a noble and lucrative one- but a trade nonetheless. We are technicians. This is not to say we can't become managers, leaders, and entrepreneurs - only that we have chosen to spend our formative years training in a very particular skill set which does not translate well to seeing the bigger picture. As a dagger in the heart of the aspiring physician entrepreneur, we will lose money by chasing leadership opportunities as a physician. Our per-hour salary, with few exceptions, will never be higher than it will if we simply practice medicine. If we want to learn to be entrepreneurs and start businesses, we'll have to seek out our own experiences and do so at an initial financial loss, because we won't be getting that skill set during med school or residency.

 

[zeloc]

As you've pointed out, everyone know how illogical the system is - certainly attendings, but also patients. But it isn't the case that this is an intractable problem that no one has solved. There are plenty of possible systems that would solve, or at least greatly improve, every aspect of the current system, and improve care while reducing cost by billions or hundreds of billions. The problem is that the government (ie, elected congresspeople), receives huge amounts of money by lobbyists from the insurance companies and other powerful organizations who profit from the gross inefficiencies in healthcare. I have met physicians who are world experts in their field, and who have been on congressional committees, met with congresspeople, and given specific instructions on what to do on a particular issue or bill, and invariably the congress votes for the opposite. Even worse, legislation has passed (in other words, is law in the US), that actually obstructs progress in improving the healthcare system, which were passed at the behest of well-funded special interest groups. I do not see any way for what you propose without convincing our legislators to change, or to elect new ones.

But beyond that, what you are proposing is fantastically complicated. I could spend a huge amount of time discussing just one of your points, the EMR. For someone to create this novel EMR would take a large team years of full-time work and would cost at least tens of millions of dollars, and there is no guarantee it would meet anyone's standards. Since I have a background in informatics, I have had several physicians come up to me and tell me what the "ideal" EMR would look like, yet each person has a completely different picture of what that ideal is.

If you want to get involved, I would choose a small project and complete it. Eg, I started a successful company in the health IT space, which has since been acquired. Even the smallest possible idea turns out to be exceedingly complicated in implementation.

 

[cpants]

The biggest cost of the EKG which no one is mentioning is the expertise and liability of the person reading it. Sure it would cost 40 cents to print out an EKG. But its just a scribble on a piece of paper without a physician.