Monday, July 21, 2008

FUTURE OF HEALTH CARE

A DISMAL OUTLOOK?

The American Economist web site offers this pessimistic view on what is happening to our health care system.

My response is at the end.

"If you haven’t read Alvin Toffler’s book, Powershift, you probably have no idea what has happened to us in the last decade with regards to the information era. In this historic book, Toffler talks about the “Powershift” which is the information era and how knowledge and information will be the most valuable currency in the world. While traditional economic transformation progressed from agrarian to industrialized societies, the next wave was the information era. “Third World” economies could actually leapfrog the industrialized economy from a rural/agrarian one to an informational society with the advent of computer networks and the internet.

In the healthcare system, such a “powershift” is occurring within the walls of hospitals. Archaic hospital systems are using paper charts and paper prescriptions. Physicians must hand sign an order book which then gets faxed to the pharmacy. A courier then runs up the medicine to the patient’s room. All charting is done on paper and record keeping rooms are enormous. Medical transcriptions are done on a typewriter and placed in the patient’s paper chart.

In the second wave of medical informatics, the electronic network came about. Orders were allowed to be filled electronically. Medical transcriptions of dictations were outsourced to transcription companies who typed these out and they appeared electronically. Physicians could edit, verify, and sign electronic records and transcriptions. Computerized vending machines on the hospital floors could electronically document the use of supplies for the indicated patient. The second wave of medical informatics cuts costs and dramatically improved things and brought us out of the dark ages.

It appears that we are starting the third wave of medical informatics. “Going Live” is the concept where the electronic record is completely “live” and “online” and always being edited. Laboratory and diagnostic results appear real-time; doctors dictations, nurses notes, medical orders, and prescriptions are all done online and appear real-time. Transcription software allows the physician to dictate his note which uses voice recognition and speech transcriptions software to transcribe the note instantaneously where the physician can edit. If he so desires the doctor can electronically type his notes if he likes. There is no paper chart.

“Going Live” is the third wave of medical informations. Gone are the outsourced medical transcription companies. Gone are the paper charts. Gone are the electronic notes that indicate that a dictated note is “pending.” There are no gaps in the care or documentation of the care of the patient. The laptop or PDA-toting physician is here to stay.

As in the global powershift, hospitals and healthcare systems who “Go Live” early on will win more business and thrive. They will be more profitable and be more efficient and thus more effective in the delivery of healthcare.

If you’re interested in other works by Alvin Toffler, read Greg Beatty’s review of Revolutionary Wealth: How It Will Be Created and How It Will Change Our Lives by Alvin and Heidi Toffler.

medical informatics, health care economics, health care, alvin toffler, powershift, electronic medical records, electronic health records, medical IT, health care IT, health care informatics

Tags: electronic health records, medical industry, medical informatics

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One Response to “The Future of Healthcare Is Here”
  1. 1 Gary Levin M.D., on July 21, 2008 at 10:00 am, said:

    Alvin Toffler also authored “Futureshock”, the story of how human beings and society can only absorb certain rates of change, then become overwhelmed and dysfunctional leading to deterioration of coping mechanisms.

    We see this occuring in health care for the past 20 years, some of it driven by technology innovations, but much of it from outside bureaucracy in it’s mis-directed attempts to control cost escalation. Managed care has been a misnomer for managed costs, and control of health care by non medical personell (ie, physicians). Physicians have been wrongly held accountable for ordering too many tests, too many treatments,while paradigm shifts occured without benefit of careful evaluation by physicians of their net effect, other than to reduce reimbursements, decrease access,, increase administrative paperwork and overhead.

    Health information technology is the next “Pandora’s Box” currently being promulgated by political leaders, insurance companies and the massive bureaucracy now surrounding your visit to the provider’s office (used to be called..doctor’s office)….Patient’s are now called “consumers”.

    Most physicians remain highly skeptical of Health IT.
    Most younger providers look forward to adapting it to their practices, because they have grown up in a school system that now promotes IT for everything, examinations, applications, research, The word processor has replaced script. Email and the web are replacing the telphone call to make an appointment at the office. Economics and time factors are credited with this new shift.

     

    Economic change is driven by these evolutionary and revolutionary sea-changes..

 
 
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3 comments:

Anonymous said...

I'm a career federal government employee and I know that depending on the Federal government to fix the National Healthcare System is a non-starter. I've never been in the medical profession but I'm a Technoprogressive and a Futurist and I believe that by bringing to bear a LOT of advanced IT, and other medical technologies towards these issues we have a shot at creating a cost-effective and efficacious National Healthcare System with universal access. The model I have in mind involves combining pushing the vast majority of primary care down into the "Home Care" environment. I feel that by employing Telemedicine technology in the home, combined with Personal Electronic Medical Records, that'll enable & empower the average healthcare consumer to monitor their own health and to manage injuries, chronic diseases and comply with healthy behavioral, dietary and lifestyle changes in a more cooperative manner. By taking advantage of the amount of households in this nation have PC's and Internet access, the average household can access a vast array of healthcare related information and websites with all sorts of tools and plans and management protocols that can be easily modified for individual households, and families. Care plans for individual persons within a household can be implemented and compliance can be monitored through numerous telemedicine peripheral devices. Telemedicine can allow individuals to monitor their own health in the privacy in their own homes and also provide their clinicians with a surveillance capability so that they can keep an eye on their patients health (subject to their patience compliance with the reporting protocol). I feel that instead of all of the classical solutions that are currently being offered, that what's needed is to reengineer the entire infrastructure so that all care except various types of intensive care, trauma & surgeries that can't be performed on an outpatient basis are pushed out into the community on a much more extensive basis than they are currently. The model that I've been developing envisions care being rendered in an inverted pyramid with telemedicine in the home at the bottom, at the next highest level of care would involve receiving a homecare visit from a trained caregiver, at the next highest level of care would be referrals to outpatient clinics, express clinics in Malls (or big box retailers like Walmart or Kmart) or MRI/CT centers, Ambulatory SurgiCenters/Day SurgiCenters or specialty care clinics and at the highest level of abstraction within the health care system, care would be rendered in hospitals that render services only in an intensive, acute care setting. Hospitals would also host the central telemedicine control centers from which primary care would be rendered remotely direct into the homes of patients. All other care would be rendered at a lower (but appropriate) level of abstraction within the healthcare system. In this way, a great deal of the physical infrastructure (and its associated costs) that currently constitutes our national healthcare system can be disintermediated. In addition, all of the clinics and SurgiCenters, and the hospitals can be networked on high-speed backbone that can also support the telemedicine system so that vast amounts of data and images can be shared effortlessly. Rendering as much Primary care in the home as is practicable thru the use of telemedicine combined with homecare visits will facilitate the implementation of preventative healthcare protocols & comprehensive chronic disease management protocols. The way I see it, if you can push the "healthcare system" down into individuals homes, and use it to promote healthier, wellness lifestyles with a preventative theme, then that should lesson the necessity of so many ER visits & re-hospitalizations or the (load) that is placed on the healthcare system. If the load is lessened, then that should provide opportunities for disintermediating brick & mortar healthcare infrastructure.

Gary M. Levin said...

Very interesting and creative approach. How would you organize this effort and can it be placed in a business model. Would providers be reimbursed in some way. Who would fund the network, or would it just be open source?
Contact me again.

Anonymous said...

EMR Software and electronic medical records keep private information safer, more secure, and increases medical office efficiency thus reducing wait times