The Future of Computer Applications in Biomedicine

HIM 3000

Ch 24

Looking back?

Computerized records 1980s & 1990sElectronic records 2000 +

National Research Council 1997 ‘We envision the day when citizens no longer will have multiple records of their health care encounters scattered throughout the offices of numerous physicians & hospitals. Instead their records will be linked electronically over the Internet so that each person has a single “virtual health record” distributed, but unified, summary of all the health care they have received in their lives.’

How Do We Bridge The Gap And Deliver How Do We Bridge The Gap And Deliver The Promise?The Promise?

Agreement On Healthcare Goals

What results/outcomes are valued?

Metrics/Measurement Systems

How do we collect and

share data between

stakeholders?

Compensation Plans

How do we align incentives to secure delivery of the outcomes we value?

“Without electronic medical records, healthcare is doomed to incremental improvements at best.” Dr. George Halvorson CEO, Kaiser

Foundation Medical Group

Health Information Technology It’s About The Information,

Not The Technology The enhanced use of healthcare information

technology is a means to an end—a critical tool to: Collect data and provide decision support tools,

especially at the point of care Share data between healthcare providers, payers,

policy makers, and consumers The end is more effective and more efficient

healthcare purchased on the basis of value and outcomes rather than just unit cost

The Critical Importance Of HIT

As healthcare starts to shift from an input driven to an output driven model, outcomes assessment tools become critical to drive meaningful changes in provider compensation systems

If “empowered” consumers don’t have quality/value information readily available, it is likely that they will buy healthcare services solely on a price basis

Emerging Federal Approach To Nurturing HIT

Focus on improving patient safety and biopreparedness

Legislative and executive-branch efforts underwayFederal Health Architecture (FHA)

• Consolidated Health Initiative (CHI)National Health Information Infrastructure (NHII)EHR functional model (in conjunction with private

sector)e-Prescribing

Telemedicine

Using computers and telecommunications equipment to deliver medical care at a distance.

-telepsychiatry

-Teleoncology

-Teledermatology

-Teleradiology

Remote Patient Monitoring Technologies Are Beginning To Mature

Health Hero Network To Support Remote Glucose Monitoring

Radio Shack Introduces NewProduct Line To Support

Consumer Health

Yahoo, Medem , WebMD Enter DiabetesMonitoring Market

Health Hero Network AnnouncesConnectivity With Weight Scales,

Blood Pressure CuffsHigh Tech Underwear Could

Help Heart Patients

Diagnosis And Medicine In A Pill

“So What?” New technologies will allow HIT to go

places it has seldom/never been beforeExam roomsPatients’ homes

More information means we have a “movie” instead of a “photograph” on how patients are doing, thereby improving quality of care by detecting changes in health status early

Where HIT Needs To Be

I/P LabSystem

RadiologySystem

Hosp. BillingSystem

Pt. Registration System

Hospital Interface

I/P Pharmacy System

O/P PharmacySystems

Home Health System

O/P LabSystem

Elec. Med.Record

Office Billing System

MD Office Interface

Pt. Reported Data (On-Line Dx) (QOL Data) (Compliance)

MasterInterfaceEngine

Balancing Cost and Value

Hosp.

MD OtherRx

“How much am I paying?”Focus on: componentcostsLever:forced ratesetting

Hosp. MD OtherRx

“What am I buying?”Focus on: overall valueLevers:Creating/sharing info.

RESULT:Uncoordinated careAdversarial relationships

RESULT:Coordinated careCollaborative relationships

Forces affecting the Future of Medical Computing

Legal considerations Health care financing Changes in the background of health

professionals

Assignment question 2.

Answer question 2 in text.

Imagine that you are a patient visiting a health care facility at which the physicians have made a major commitment to computer-based tools. How would you react to the following situations?

(A)Before you are ushered into the examining room, the nurse takes your blood pressure and pulse in a work area and then enters the information into a computer terminal located in the nursing station adjacent to the waiting room.

(B)While the physician interviews you, he or she occassionally types information into a computer workstation that is facing the physician; you cannot see the screen

(C)While the physician interviews you, he or she occasionally uses a mouse-pointing device to enter information into a computer workstation located such that, when facing the physician, you cannot see the screen.

(D)While the physician interviews you, he or she occasionally uses a mouse-pointing device to enter information into a computer workstation located such that you both can see. While doing so, the physician explains the data being reviewed and entered.

(E)While the physician interviews you, he or she enters information into a clipboard sized computer terminal that responds to finger touch and requires no keyboard typing.

(F)While the physician interviews you, he or she occasionally stops to dictate a phrase. A speech-understanding interface processes what is being said and stores the information in a medical record system.

(G)There is no computer in the examining room, but you notice that between visits the physician uses a workstation in the office to review and enter patient data.

2.

Now imagine that you are the physician in each situation. How would you react in each case? What do your answers to these questions tell you about the potential effect of computers on a patient-physician rapport? What insight have you gained regarding how interactive technologies could affect the patient-physician encounter? Did you have different reactions to scenarios c & d? Do you believe that most people would respond to these two situations as you did?