HEALTH CARE TECHNOLOGY

1. HEALTH CARE TECHNOLOGY 27 February 2009 KATHARINE C RATHBUN MD

2. COSTS • MONEY • TIME • LABOR • PAIN • INDEPENDENCE • LOVE

3. HOW MUCH IS YOUR LIFE WORTH? • YOUR MONEY, TIME, ETC • SOMEONE ELSE'S • SOCIETY’S

4. HEALTHY WORKER EFFECT • THE EMPLOYMENT PROCESS SELECTS FOR PEOPLE WHO ARE HEALTHY • THERE IS NO HEALTHY PERSON EFFECT ON BEING ALIVE • THERE USED TO BE

5. CAUSES OF DISABILITY • SAVING ADULTS OFTEN INCREASES NUMBERS ON DISABILITY • SAVING BABIES MAY BE WORSE

6. LIFE EXPECTANCY / DISABILITY • 1965-1999 LIFE EXPECTANCY ROSE 2.7 YEARS • DISABILITY FREE YEARS PROJECTED TO DECLINE BY 7.3 • 2080 PROJECTIONS – 90 years of life

7. MORTALITY • EVERYONE IS GOING TO DIE • EVERYONE HAS TO DIE OF SOMETHING

8. TECHNOLOGIC IMPERATIVE • HAVE STATE-OF-THE-ART TECHNOLOGY • USE THIS TECHNOLOGY AT EVERY OPPORTUNITY

9. TECHNOLOGIC IMPERATIVES • HEALTH INSURANCE • MEDICAL SPECIALIZATION • MEDICINES • TESTS

10. SPECIALTY VS PRIMARY CARE • 1940 - ALL DOCTORS ARE TRAINED AS GENERALISTS • 1970 - 41% PRIMARY CARE • 1996 – 34% PRIMARY CARE • 2003 – 41% PRIMARY CARE

11. PUSH FOR SPECIALIZATION • PAY MORE • BUY EQUIPMENT • ADDS PRESTIGE • WON’T HIRE GENERALISTS • ADVANCED PRIVILEGES • PEOPLE HAVE BEEN TAUGHT TO DEMAND SPECIALISTS

12. PUSH FOR PRIMARY CARE • LIP SERVICE • LOWER PAY AND PRESTIGE • DENIED PRIVILEGES • WORK UNDER A SPECIALIST • HAND-ME-DOWN FACILITIES AND EQUIPMENT • GATEKEEPERS FOR SPECIALISTS

13. CLASSES OF DRUGS • OVER THE COUNTER DRUGS • PRESCRIPTION DRUGS • SCHEDULED DRUGS - NARCOTICS • SUPPLEMENTS

14. DECIDING WHICH DRUG TO USE • DRUG MANUFACTURERS • DOCTORS IN PRACTICE • DOCTORS IN TRAINING • VIOXX VS IBUPROFEN

15. TESTS • SENSITIVITY – True Positives • SENSITIVE TESTS FOR SCREENING – Fewer false negatives • SPECIFICITY – True Negatives • SPECIFIC TESTS FOR CONFIRMATION Fewer false positives

16. TELEMEDICINE • STORAGE AND TRANSFER OF INFORMATION • ISOLATED DOCTORS • READING THINGS AT A DISTANCE • MONITORING

17. ALTERNATIVE THERAPIES • Faith vs Science • Everyone will die • Nature vs Technology • Arsenic, Cyanide, Strychnine • 50% of women die in childbirth • 50% of children die before age 6 • DDT and HIV in breast milk

18. OUTCOMES • GEOGRAPHIC COMPARISONS SHOW THAT DIFFERENT TECHNOLOGIES MOSTLY DO NOT CHANGE OUTCOMES • CONTROLLED FOR RACE, AGE, OCCUPATION, ETC

19. TECHNOLOGY FALLACIES • DECISIONS ABOUT TECHNOLOGY ARE ABOUT QUALITY OF CARE • SENSITIVE SCREENING TESTS ARE GOOD

20. COST CONTROL FALLACIES • UNNECESSARY TESTING/CARE • OLDER PHYSICIANS HAVE MORE INAPPROPRIATE ADMISSIONS • DRG’S RUNNING OUT • OUTPATIENT VS INPATIENT • CERTIFICATE OF NEED • COMPETITION

21. FUNDING FALLACIES • MERGE WITH OTHER PROVIDERS • OBTAIN MANUFACTURER SUPPORT • BECOME A DEMONSTRATION SITE • BECOME A SERVICE CENTER • PONZI SCHEMES

22. MEDICALIZATION • Epidemic of Diagnoses • unhappy vs depressed • Epidemic of Treatments • screening for disease in healthy people

23. THE FUTURE • PHYSICIAN/PATIENT RELATIONSHIP IS STILL FUNDAMENTAL • IT STILL TAKES 9 MONTHS TO MAKE A BABY

24. INFORMATION SYSTEMS • ALL THE USUAL PROBLEMS • HIGHLY IDIOSYNCRATIC INFORMATION • HIGHLY “TECHNICAL” INFORMATION • HIPPA

25. ADVANTAGES OF EMR • Access from multiple sites • Reduced offline storage costs • Improve quality & coherence of process • Automated clinical guidelines • Support research and quality improvement • Easier reporting of all types • Portability – disaster response

26. DISADVANTAGES OF EMR • Scores of incompatible data sources • Duplicate information and effort • Obtaining information from physician • Physician as clerk/typist • Confidentiality • No reduction in support staff • Transfer to next provider