The Technological Imperative in United States Healthcare How emerging technology is addressing the issue

Sarah Herhold – James Madison UniversityResearch for NSF REU Program at the Univeristy of Virginia, 2007

What is a technological imperative

The pursuit of the most

advanced technology and the

desire to implement it without

regard to cost.

Arguments for its existence in U.S. Health care

Healthcare Spending and Costs:• In 2005, the US spent 16% of its

gross domestic product on healthcare

• Per capita spending is 53% higher than any other country

• Elevated cost is partially due to higher incomes, but is largely attributed to healthcare in the U.S. being simply more expensive.

Arguments for its existence in U.S. Health care

Even though U.S. medical care is the

world’s most costly, its outcomes are

mediocre compared with other

industrialized nations.

“The U.S. health care industry is

arguably the world’s largest,

most inefficient information

enterprise.”

Proposed Effects of the Imperative

High-tech does not always translate to

high quality.

• Service expansion vs. meeting actual patient needs

• Provider induced demand

• Focus on treatment technology

Proposed Effects of the Imperative

• Medical students are shying away from primary care, choose instead to specialize

• Leads to a disproportionate burden placed on limited number of primary care practitioners

• Further increases focus on treatment and technology as opposed to prevention and quality

Differences in scope

Primary Care:

Focus on holistic health of patient,

continual care, and overall health

maintenance through prevention

Specialty Care:

Focus on single aspect of patient health,

episodic care, and treatment based

The problem

• Increased costs without reciprocal quality return

• Skewed focus on treatment as opposed to prevention

• Overburdened primary care leads to decreased efficiency in accessing the rest of the health care system

• Not the fault of technology itself that these problems exist

The Emerging Solutions

Health Information Technology (HIT)

• HIT can be used to describe a wide range of services

• Benefits include reduced medical errors, improved communication between clinicians, reduced healthcare costs, and increased patient and physician satisfaction with the quality of care delivered

The Emerging Solutions

Health Information Technology (HIT)

The key component to HIT systems is

an electronic medical record infrastructure.

Electronic Medical Records (EMRs):

Typically store patient information such as

immunization tracking, previous visit history,

test results, allergies, and diagnosis.

The Emerging Solutions

Health Information Technology (HIT)

“By computerizing health records, we can

avoid dangerous medical mistakes, reduce

costs, and improve care.”-President George W. Bush, State of the Union Address

2004

The Emerging Solutions

Health Information Technology (HIT)

National Incentives:• Department of Health and Human

Services has defined a medical vocabulary

• Funding for EMRs in government care• Adoption plans for 2014• “Office of the National Coordinator for HIT”• Allocation of $100 million for

demonstrations

The Emerging Solutions

Health Information Technology (HIT)

• Despite the government sponsored initiatives, shift from paper records to an electronic alternative has been slow

• Current estimates of physician use of EMRs range between 10 to 25%

The Emerging Solutions

Health Information Technology (HIT)

HIT implementation examples:

• Use of EMR systems

• Having computers placed in examination rooms

• Physician use of portable digital assistants (PDAs)

The Emerging Solutions

Health Information Technology (HIT)

While EMR adoption has been slow, the U.S.

has adopted other HIT components at rates

comparable to other industrialized countries.

The cost of implementing HIT systems limits

adoption to large hospitals or financially

secure practices. When in place, physicians

and residents who have most recently

graduated from medical school are the most

likely to use the technology.

The Emerging Solutions

Telemedicine Programs

Telemedicine is heavily dependent on HIT

infrastructure, sometimes considered a

subcategory of HIT itself.

Defined:Rapid access to shared and remote

medical expertise by means of

telecommunication and information

technologies, no matter where the patient

or relevant information is located

The Emerging Solutions

Telemedicine Programs

Programs are used to provide health care

services to rural populations, geriatric

patients, military employees and veterans

Generally differentiated as either asynchronous

“store-and-forward” communication or as a live

conference communication

The Emerging Solutions

Store-and-Forward Telemedicine

Allows patients to query physicians via email and

attached images or video.

The emerging solutions

Store-and-Forward Telemedicine

Once the physician receives the email, several

recommendations can be made:

• Seek immediate help from emergency care clinic

• Schedule an appointment for checkup as soon as convenient

• Suggest over the counter solution

• Take no action, concern is unwarranted

This allows triage for patient concerns

The Emerging Solutions

Live Conference Telemedicine

Synchronous communication between the patient

and the physician.

Typical Set Up:

• Large Regional Hospital acts as the “hub”

• Satellite clinics are setup in an underserved area, and these sites link back to the hub

Almost all medical specialties have made use of this type of communication, including psychiatry, rehabilitation, cardiology, pediatrics, obstetrics, gynecology, neurology, and geriatrics.

The Emerging Solutions

Live Conference Telemedicine

The Emerging Solutions

Benefits of these programs

Benefits of these programs:

• Satisfaction with quality of patient-physician communication

• Access to continual care

• Patients can obtain access to healthcare in settings they are most comfortable

• Reduced costs

• Increased Efficiency

Current Barriers to Progress

HIT: Electronic Medical Record Adoption

Initial implementation costs are preventing a

large proportion of practices from adopting the

technology.

– Only 2% of gross healthcare industry revenues are invested in IT

– Profit from implementation not necessarily seen by clinics

– Learning curve– Interoperability

What can be done

HIT: Electronic Medical Record Adoption

Initial implementation costs are preventing a

large proportion of practices from adopting the

technology.

– If healthcare invested the same 10% as other industries, productivity could increase by as much as 6-8%

– National incentives to offset costs– Younger generation of doctors will be more

comfortable with the technology– Interoperability – matter of time

Current Barriers to Progress

Telemedicine: Lack of Reimbursement

Challenge lies in finding a way to compensate

small traditional clinics and community based

practices for adopting technologies that improve

healthcare delivery and quality.

Reimbursement is available for Medicare and

Medicaid in specified underserved areas, as well

as in military and veteran care.

Current Barriers to Progress

(Continued)

• Concern that programs will negatively impact patient-physician relationship

• Licensing issues

• Interoperability

What can be done

(Continued)

• Patient-physician relationship often improved by telemedicine

• Movement for national licensing program

• Interoperability

The Potential of These Technologies

HIT and telemedicine programs are proving

that an imperative for improved technology

does not necessarily exacerbate current

healthcare problems, and that it can in face

be used to address them.

Acknowledgements

Dr. Alf Weaver, Dr. Christopher Nye,

Dr. Mark Williams, Dr. Karen Rheuban,

Dr. Scott Strayer, Linda Rose, REU mentors.

FIN.