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Friday, April 23, 2010

Back to The Future



Sorry for the absence. It's been a bit hectic while the Health Train travelled from Georgia to Southern California. (from green to brown)....from bugs to lizards and snakes.

I am on a sabbatical and expect to post much more from here.

I now have an internet connection and am able to catch up on some of my favorite bloggers,  KevinMD, Dr Wes, Edwin Leap, Medinnovation, and more, most of whom are listed on sidebar, with their links.

I admit I have been blog and healthcare reform fasting. I am not totally in 'remission' yet. I am weighing whether to continue my avid interest and advocacy for continuing health reform. I feel I need to contribute to bettering our health system.

The next ten years will see radical changes in health care delivery.

Some of what was once thought of as 'unethical' by practitioners will become commonplace.

See full size image

The rise of retail medical clinics will continue unabated, and the scope of their practice will extend to management of hypertension, diabetes mellitus in addtion to other common maladies of body and spirit.

To survive, primary care practices will need to adopt electronic information systems, not just to increase efficiency, but to satisfy insurance and governmental requirements to obtain complete reimbursements, without penalties.

Retail medical clinics already employ these systems and are an integral part of their operations.

Physicians will either adapt or be swept aside. We must prepare the next generation for what they will deal with once they are finished with medical school.

Medical education itself is undergoing a transformation in funding.  The federal government has bypassed private banks for funding undergraduate medical education.  This will allow the federal government to specify who will get financial assistance,as well as  possible later waivers on loan repayment.  Medical students may be required to sign a contract agreeing to serve in underserved communities or less desirable practice locations. Perhaps it may be year for year.  These students will become civil servants.  They will be required to develop multi-cultural skills, and to demonstrate their literacy and verbal skills in Spanish.

The lack of enrolling minority groups, African American and/or Latino will encourage the federal government to aid schools by forcing them to accept lesser qualified candidates for acceptance to medical schools.  This does not appear to be a problem for Asian students who mostly excel in secondary and undergraduate colleges.

The "cell" generation will generate a strong market pressure to allow developers to build EMRs that will run on smartphone, such as the iPod.  These systems will integrate almost seamlessly with the office EMR  and/ PM systems.

Patients will no longer use a yellow page listing to find providers, they will utilize the internet, and at times find poor providers. Ths will drive state and federal officials to require documentation to be listed on internet search engines.  Commercial web sites such as healthgrades will not be a credible source for paid listings.

Despite the evolution EMR and Health IT, it will be found to not  save money or enable providers.  In fact it will reduce provider efficiency unless they are radically designed to be user friendly as a priority over meaningful use.  The term meaningful use will have been discarded, to be replaced with "Specialty specific Design. Meaningful use with be specific for each specialty.

Remote telemedicine and monitoring will become commonplace. The Federal and State governments will adapt their reimbursement method to pay for most of these costs when an analysis reveals that remote monitoring reduces inpatient admissions drastically,  and reduces the number of outpatient visits. 

All  of the home devices will be wireless and connect automatically to the home network and the specified instrument monitoring service. For those without broadband, dial up will be an alternative.  Just as providers now are required to have a national provider identification number, patients will also be assigned one at birth or on the occassion of their next birthday. The number will be unique to the medical system for a number of important security issues, and prevention of fraud.

Written signatures for consents, hospital admission and discharge and medical office registraton will be supplanted by biometric identification, either infrared fingerprint recognition or iris recognition.  It will no longer be necessary to provide an insurance identification card to a provider or hospital. 

Freedom of choice will be reduced for most patients.


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