Further, the money mentioned above has already been spent. It is "water under the bridge." Now the issue is money for the years ahead. Now the Commission wants not only EHR, but IEHR or Interoperable Electronic Medical Records, records which, when produced in one country, can be read in any EU member country. Because when you break your leg while skiing in the Alps, a doctor in Austria may need data from your EZK.
A person might naturally expect that the EU would order the necessary software and distribute it to all Member States. But commissions do not think like people, and so the EU commissioned an "EHR IMPACT study." In only 50 pages it defines and analyzes the "conceptual framework" of different EHR systems, including our own Czech one. Each member country is developing its own system. And this March, Brussels will hold a big big conference about how to use e-health technology intelligently .
(DMP) dossier médical personnel should cost 10 trillion €. That includes software for medical offices, distributed free of charge. The French health card has a chip, and it would appear that French are ahead of the game, but do not jump to conclusions. "Chip technology is obsolete. "
says MD Hronek of IZIP in the Medical Tribune and explains:
"When we got this idea, expectations were focused on smart cards. But the Internet has opened a new dimension and allows the patient to participate in the game. In any case, we were the first in the world .. ," Not only were they first, but they were also wise enough to have their idea, which is to "save all the data in a central database," patented. Here is that patent from the year 2002 (in Czech)
The IZIP company thus owns a patent, and based on it's idea, is developing a system of health booklets, EZK, for the insurance company VZP.
In contrast to VZP, whose the board is appointed by the government and parliament, IZIP is a private company whose objective is profit. What would happen if their products and services were offered to other insurance companies?
Protecting Investments
VZP wants to protect its investment and gain control of IZIPs "intellectual property." To this end, the head of VZP, MD Horak, is planning to buy another 30% to 35% of the shares of IZIP.Could it be too late to be thinking about getting control now, after they invested over a billion CZK into the project for just 5% of shares?
MUDr. Pašek, CEO of IZIP, said
"I have 2.5 million users, I have a market value of three billion. Why I should want VZP insurance to take a third of the shares de facto for free? (i.e. for nominal price) " But he is willing to consider the sale anyway. How nice to see that "among us doctors" fair dealing and gentlemen's honor still exist. The sale may indeed take place for a nominal price, while IZIP's market value, according to the audit, is between 1.5 to 3 billion CZK But, what about Czech citizens who use other insurance companies? Clients of other insurance companies may, in various marketing promotions, try EZK free of charge. After one year, the clients can decide whether they want to give up EZK, or become insured with VZP - General Health Insurance Company.
If shares of IZIP can be obtained at a nominal price, it could be a great bargain. If the other insurance companies wanted to use the patented EZK, they would have to pay, and IZIP and VZP could charge higher fees than lucky VZP clients would pay. Actually, clients can get the VZK for free, but VZP pays IZIP some 84 CZK per person per year, which right now comes out to some 300 million CZK annually.
Indeed, if VZP bought control of IZIP using money they had received from the state to use for its insured patients, certainly not all of the profits would be to paid in remuneration for the board and shareholders of IZIP. Perhaps the lucky VZP patients could even be given CZK 30 every time they visited the doctor, instead of the paying the 30 CZK copay as it is now. Something must, as U.S. President Ronald Reagan used to say, "trickle down" to ordinary people, right?
The other insurance companies could not simply develop different EHR systems, or get one from the EU, because the system of storing medical data in a database and accessing them via the Internet is "a patented idea." IZIP owns the patent and VZP would control IZIP. These other insurance companies and their policyholders will protest, but a patent gives its owner a legal monopoly. When enough EZK booklets have been issued, the government might just decide to make their use mandatory. No point spending another milliard.
The Czech Republic would thus end up like France and the UK, with one EHR system. However, it would not be owned by the state, but by one of the nine health insurance companies the Czech Republic has. That's because here we have smarter businessmen and politicians who have wisely kept nine insurance companies to compete.
Because insurance companies are stock companies, they can do business. The state pays for pensioners and employers pay for the workers. But who bears the risk and who is entitled to the profits? The insured, the state, or the Board of Directors which chose the brilliant entrepreneurs?
Consider the potential
It's not just the eight Czech insurance companies which may have to pay. A patent is a patent. It means we were "the first in the world." When in the 1960's Professor Wichterle invented the "soft contact lens," millions of dollars poured to Czechoslovakia from all countries, including Japan, USA etc. Can we expect the same for IZIP?"Is there a similar project somewhere in the world ?" asks Dr. Hronek, chief IZIP in the Health newspaper. And he elaborates: "In any case, we were the first in the world. Today, there are similar projects in other countries. The European project EpSOS , the British NHS, individual projects of some European countries, as well as the planned introduction of RHR by Barack Obama, who does not hide the fact that Europe inspired him. It all just shows that ours is the right way. "
It is true that both the EU and the USA went on a quest for the holy grail of the computerization of health care records and health care.
The US budgets
$ 1.2 billion on EHRs. Add to it the money budgeted by the EU member states.
It seems that the whole world will need our patent!
This looks like an "once in a lifetime" opportunity ! where can one buy shares of IZIP?
In America health is done differently than in Europe. Many companies are developing software for doctor's offices, surgeries, clinics, and hospitals, using there own capital. This software does everything: patient records, medical prescriptions, accounting and interfaces for specialized equipment and laboratory tests. These EHR (or EMR) systems and interfaces for different insurance companies are just another feature added to medical office systems.
The American NASADQ is something like a bursa for small technology companies. These are the ones that can grow into giants like Google, and make millionaires of its shareholders.
Here is the list of companies listed on NASDADQ that make the EHR software There are 274 of them. In USA they have several insurance companies, but this Americans did not copy Czechs, but rather we copied it from them. These are fully private insurance companies, even though Obama wants to regulate them, which some consider to be unamerican. Software companies are also private, having their own capital and investors. They can bid on government orders, however and that may be on the increase if Obama's plan will survive.
So, these firms compete, and the main battle field is the doctor's office.
Doctors, do not like forms and little boxes, in which you must enter some number. That is, they do not like filling them out themselves. Patients, there as here, always get a long questionnaire about their medical history, allergies, etc., which they must fill out whenever they visit a new doctor or specialized clinic. But American doctors themselves do not want even to type on a keyboard. So, many EHR systems allow them to just speak into the microphone, or to scribble on a 'tablet.' Typist or computer transcribes these records.
That's why the battlefront is in doctor's offices. Doctors will decide which software is suficiently 'user friendly' and that is what their office will buy.
Now consider the risks too
Czech Republic invented "business without risk," in solar power plant affair. There is no risk to the entrepreneur. When things go bad, the consumer pays more. Czech government says that the "EU made them do it". with some "directive," we have doubts. What can go wrong with EHRs? What if "the imperialists" , I mean some U.S. companies, are reluctant to pay the royalties that are due IZIP for their patented idea? A patent is a global issue. Either IZIP were the world's first, and then they have a valid patent, or they have nothing. If U.S. would not pay, then probably even France and England would be reluctant. And if France and England would not pay, then probably even our other insurance companies might refuse.We would have to sue. The US has the rule of law. How much would such a lawsuit in the US cost? In the US each side always pays its own costs, and suits can take years. Are we looking at hundreds of law suits? Sounds like a risky business. IZIP has no such money. Could IZIP issue more shares? Or will the Czech government or VZP's insured clients be asked to pay for the lawyers?
Inconvenient truth
When one reads the statements of MDs Hron, Pasko, Horak and others, statements like"Any misuse of data is absolutely impossible," one wonders whether they have at least one experienced programmer there. He would have tell them not to say things like that, not to underestimate security. Absolutely secure computer network was not been invented as yet. We are still working on that one.
Experienced programmer could also tell them about the American company called Healtheon, formed to keep the EHR in a central database and make it available to authorized persons over the Internet. It was founded by James Clark, who put $ 16 million of his own money into it. Clark was a "serial entrepreneur." He founded a company, waited until it got listed on the stock exchange, then he sold his shares, collected his millions, and went on. That $16 million was made as the founder of his previous company, called Netscape. It was the company that developed the first commercial browser. It is part of Internet lore, of which older IT professionals have fond memories.
This new idea of his, "to use the Internet for the EHR," was not as successful as his previous ideas. The company had a complex history. In 1999 it merged with WebMD, took that name, and in 2003 finally began to show slight profits. It added other activities, but is still doing EHRs. Here is chart of their stock price . It's still registered on the NASDAQ. The Healtheon Corporation was founded in 1995. The plan was the same as that as described in the patent of our Czech wise men in 2002.
| .. So their patent is invalid? In America? Is it invalid also in the Czech Republic and elsewhere? |
| You can not invent something that's already been used somewhere. Even if you do not know about it. |
| .. But why were they issued the patent? They surely did a search? |
| That happens quite often. Especially for software patents. Many issued patents will not stand up in court. |
| .. So what now? |
| My guess is it's, "Will sell shares! Cheap!" Hurry, before everyone knows! |
The march of technology can not be stopped. We do not want to stop it. Health and medical science are making great strides, and IT technology already plays a major role. That role is growing and will grow even faster.
To see one example showing the potential of IT technology and EHR, at the end of this article click on the TED talk on geo-medicine: not only your childhood measles, but also information about where you lived in different years, will be part of your EHR. Not only you will not have to fill this info for each clinic, but you will not have to fill it out at all. Already there are applications for Android cell phones which record the locations created by using GPS, but only if you allow it, of course.
With these new devices and applications, no IT company, small or large, will have a monopoly.
The software which will win the race and form the basis on which computerized medicine will be probably be "open source" software. Such software allows continuous improvement by many cooperating contributors
One wonders if it would make sense, for nine Czech companies to build nine different systems, instead of one national system.
But then, does it makes sense for 27 member countries of EU to build 27 different national systems?
That why there will big the conference on Inter-operability in Brussels, this March, mentioned on the beginning. EU will select from existing ISO norms and also from standards of the international
professional organizations in the field of medical informatics, or e-health.
Increasing the complexity of the task, the EU is also negotiating with the American Institute of Health (NIH) Institute of Health ( NIH) , which will be giving out grants and publishing standards.
Conclusion
If you are a Czech insured by VZP, but do not want to participate in the gamble, potential gains and risks, you have two avenues open:The Czech sage Cimmerman would likely say : "Citizens do not be sheep : Burn your health books." If a solicitor, stops you on the street to recruit you for 'free' EZK, your do not give him fake data. You can "just say no"; Without sheep-citizens, these "unique and patented electronic service health books (EZK)" which are becoming "standard of professional public health" can not happen.
But there is another avenue, which is using that 'engine of capitalism'. Competition. In a free society customer, the customer, in this case the physician, selects software which best performs the task. It is not selected by a bureaucrat, who may have a conflict of interest. The patient select the physician. But patient can also select insurance company. Patients also can say, "Thank you, we're leaving" and go to another insurance company.
They can thus be safely beyond the reach of MD. Horak's entrepreneurial talent.
The Association of insurance companies ( SZP) lists all nine health insurance companies .
There are instructions on transfers and patient fora, which can give you an idea how satisfied patients are. Choose carefully: Not all companies are nationwide and you should check that your doctor has a contract with new insurance company. You can change insurance company once every year at the beginning of any quarter.
The companies other then VZP have their Board of Directors elected by wider circle of stakeholders, by employers and trade union representatives. Such "more direct" governance makes them less likely to gamble with their funds. They do what they were created for, to collect premiums and pay for treatment and medicines. They certainly will certainly computerize their records, but first they will gain acceptance of doctors and the standards and rules of game will be agreed upon.
TED Talks (video)
- Geo-medicine The place where you live can affect your health.
Of course, there are no geo-pathogenic zones, or dangers from microwaves, but
just in case they existed, this application would find them. Of course, there are some unhealthy and contaminated areas we need to deal with. - Introduction of EHR in the country can cost a lot of money, such as it did in Canada, or almost nothing, as is proven by the Foundation Baobab Health Trust for Malawi. There, TED Fellow Gerry Douglas has done it for $ 1 per person. Not $1 on annual or monthly basis. This is one dollar and keep it. He used already-developed systems and the EU should look how he did it.
This article is published under a license "creative commons" Therefore you can print it, distribute copies, and even display it on your website as long as you say where you got it and share alike.
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