As a medical doctor, I'm concerned about many aspects of the changes taking place in heath care.
But I'm also excited, because we have the opportunity to make health care a lot better. It's a chance to change to a system of keeping individuals healthy, rather than performing procedures for payment. We can improve individuals' health by creating a smarter health care system that uses comprehensive information technology.
Things need to improve. U.S. health care spending has risen sharply, adding up to nearly $2.6 trillion in 2010, which is 10 times more than we spent in1980 and more than 50% higher than any other country. The costs threaten to make the U.S. uncompetitive.
And all that spending isn't buying great results. The Commonwealth Fund's third national health care scorecard last year found that the U.S. ranks last out of 16 developed countries when it comes to deaths that could have been prevented by effective medical care.
One reason is that the U.S. is behind in information technology systems for health care, according to the Commonwealth Fund's research. Even though the U.S. is the world's leader in computer systems and software, our huge health care system lacks sophisticated electronic systems.
The nation's health care system has had difficulty in developing seamless interaction among computer systems because of multiple physicians, hospital systems, government and private insurers. Rivalries among payers and suspicions by care-givers sometimes discourage open sharing.
The situation needs to get better. And we're talking about how to do so at the Healthcare and Information Management Systems Society Conference Conference, which is holding its annual meeting in Las Vegas now through Feb. 24.
The push to adopt electronic medical records by 2015 could bring big improvements. When a comprehensive record is accessible to any doctor who sees a patient, the result should be fewer unnecessary tests and fewer cases of prescribing medicine that could dangerously interact with a patient's existing prescriptions.
The creation of regional health information exchanges will also allow better sharing of clinical health information. After all, 90 percent of healthcare is delivered locally.
Patients must also become part of the information stream. There are plenty of easy-to-use, low-priced monitors for blood sugar and blood pressure. Connecting patients' information to computer systems could provide much more detailed information about chronic conditions.
If doctors were paid for keeping patients healthy rather than for office visits, they would have more incentive to encourage remote monitoring. They might find it cost-effective to e-mail with their patients.
New technology that can interpret the content and context of human language and analyze massive amounts of data will help. IBM Watson was developed as a sophisticated question and answer system to compete on Jeopardy! But now, IBM Watson is at work in healthcare.
The nation's largest health insurance company, WellPoint, is working with oncology experts at Cedars-Sinai in Los Angeles on a pilot. The system could even help doctors determine which treatment methods are covered by a patient's insurance plan.
As we change the health system, I hope that we won't lose the great things about American medicine. We as a nation lead in medical research. Many patients in the U.S. have deep relationships with skilled, caring physicians. We don't want to lose the best things about health care in the U.S. But being smarter about securely sharing health information could make health care more effective in its primary mission. It will make people healthier.
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We need to change the system to eliminate the profit motive. Too bad if you're in it for thre money; go be a banker or such. We need to pay doctors for keeping people healthy and make that determination as real health & wellnes factors not the elimination of symptoms.
Paris and Germany have excellent systems also In Paris if you have cancer you do not work but the whole body is treated. Stress is an enemy of cancer.In this country you have to worry about working and keeping your job plus hope your health care will cover all your treatments as they are far more costly here.
ER 's give the best care cause they do the test and find your problem right away. Your doctor who treats you often treats your symptoms withouts test and according to your own medical history and drugs.
That database will most likely assure you who is or is not covered by insurance. Besides its dangerous also if you look up and see a patient has asthma and treat the patient for that and instead had fluid on the lungs and was drowning.
Facilitate a simple intervention that can enormously decrease the rate of heart attacks and strokes: switching ACE-I's / ARB's to bedtime dosing. For diuretics facilitate switching from HCTZ to Chlorthalidone. Thus chronotherapy and awareness of RCT results in the types of meds that are dosed and the timing of the dosage could save billions in health care dollars per year.
So:
1) data drive the encounter note into lists of information (eg, Problem List, Medication List, Allergy List, Observation List, Intervention List, Contemplated Intervention List...etc)
2) use a time oriented database coupled with a chronologically aware clinical practice guideline rule base system to generate clinical reminders
3) allow the clinician to do "form filled hypertext" where answering questions smartly posed leads to smart: documentation, medical classification, order entry & smart annotation (dated of course) of the smart problem list
4) "dump" these data into HealthShare and facilitate the sharing of these data between sites.
Disease is divided into onset, progression and recovery.
Outcome Factors impact at onset, progression and recovery and define level of wellness that is possible.
Onset of Disease
Risk Factor, if present, increases the probability of Onset of Disease
Protective Factor, if present, decreases the probability of Onset of Disease
Progression of Disease
Stress Factor (mental or physical, as in all Factors), if present, increases the probability of Progression of Disease
Resistance Factor, if present, decreases the probability of Progression of Disease
Recovery from Progressed Disease
Antagonistic Factor, if present, decreases the probability of recovery ("bounce back") from Progressed Disease
Resilience Factor, if present, increases the probability of bounce back from Progressed Disease
In the division of labor between Watson and the Physician, Watson should try to help handle the "nasty" (negative) Outcome Factors - Risk, Stress, Antagonistic Factors.
Watson should help define for the Physician ALL Outcome Factors and for the positive Outcome Factors (Protective, Resistance, Resilience Factors) Watson should encourage "motivational discussion" between the Physician and Patient pertinent to self-care
Monopolies never work. Deregulate Medicine, throw standards of care out the window since
they bankrupt everyone !
Medicine should go back to the 50's on business model.
Actually in the USA we can not only look at some examples of success globally but even here in the USA systems like the VA, Kaiser, Marshfield. stack up as some of the best in the world. I love this video that just came out that give some great examples. http://video.pbs.org/video/2198039605 PBS U.S. Health Care: The Good News - The Good News in American Medicine
I really like what is happening in Vermont to improve health Under the Blue print for health started by Republican gov and being followed through on under a Democrat.
If we created the inter-state highway system of Healthcare IT. Cost control can done through IT automation. By creating a public-private open-source Healthcare Information Technology process between HHS and the Healthcare Industry. Using the best evidence based-medicine from around the world come up with “Best Medical Practices (BMP)” diagnostic and treatment interactive-electronic-medical-workbooks using: XML, XML schema, XForms, Dita and web-services which are IETM Class V compliant documents that when each step is filled out is checked for accuracy and completeness in real-time and saved to one of the telecoms (third-party).
Savings former OMB Director Orszag's 700b a year using BMP, since your insurance is based on BMP it could be fully automated, savings Senator Sanders 400b a year in administrative costs, since the workbook format is public the HHS like the IRS could offer rewards to independent programmers savings 60b a year in fraud. Like Newt Gingrich has said if you're using BMP, a malpractice case should never go to court savings 100b a year. Your personal EHR is also at the telecoms secure with bio-metrically audited access and no name or address attached, from anywhere in the world.
The DOD, IBM, and many others are already using these technologies. Now there is no Healthcare or Medicare deficit.
Now we've fixed the delivery system and the home medical office is a possibility.
References
EHR http://en.wikipedia.org/wiki/Electronic_health_record
XML http://en.wikipedia.org/wiki/XML
XML schema http://en.wikipedia.org/wiki/XML_schema
XForms http://en.wikipedia.org/wiki/Xforms
web-services http://en.wikipedia.org/wiki/Web_service
IETM Class V http://en.wikipedia.org/wiki/IETM
DITA http://en.wikipedia.org/wiki/Darwin_Information_Typing_Architecture
A
presentation by IBM using DITA
IBM http://dita.xml.org/sites/dita.xml.org/files/IDCMSBlue.pdf
Cloud Computing http://en.wikipedia.org/wiki/Cloud_computing
SaaS http://en.wikipedia.org/wiki/Software_as_a_service
An excellent article from a Brookings Institute Study from a medical standpoint http://www.brookings.edu/reports/2009/0901_btc.aspx
The first is a way to E-Mail either a physician or nurse practitioner who actually knows me when I have a question. Right there would save tons of money in unnecessary office visits.
The second is a microchip. I don't want to have to keep track of paper--especially in 20 years when I might not even remember what I had for breakfast. A nurse should just be able to wave a piece of equipment over a part of my anatomy and get my entire medical history or update my file.
Only with the elimination of fees for services and a change in views of medicine. Currently Americans feel that more care means better outcomes. If an x-ray rules out something, then an MRI will rule it out ever more betterer. Give it to me or I will sue the doctor and the hospital and the county! I will sue everybody!
Technology is hugely important in medicine, but it is not the solution. Changing social understanding of medicine is of much greater importance.