HEALTH CARE TECHNOLOGY

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HEALTH CARE TECHNOLOGY

• 27 February 2009
• KATHARINE C RATHBUN MD

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COSTS

• MONEY
• TIME
• LABOR
• PAIN
• INDEPENDENCE
• LOVE

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HOW MUCH IS YOUR LIFE WORTH?

• YOUR MONEY, TIME, ETC
• SOMEONE ELSE'S
• SOCIETYS

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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

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CAUSES OF DISABILITY

• SAVING ADULTS OFTEN INCREASES NUMBERS ON
  DISABILITY
• SAVING BABIES MAY BE WORSE

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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

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MORTALITY

• EVERYONE IS GOING TO DIE
• EVERYONE HAS TO DIE OF SOMETHING

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TECHNOLOGIC IMPERATIVE

• HAVE STATE-OF-THE-ART TECHNOLOGY
• USE THIS TECHNOLOGY AT EVERY OPPORTUNITY

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TECHNOLOGIC IMPERATIVES

• HEALTH INSURANCE
• MEDICAL SPECIALIZATION
• MEDICINES
• TESTS

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SPECIALTY VS PRIMARY CARE

• 1940 - ALL DOCTORS ARE TRAINED AS GENERALISTS
• 1970 - 41 PRIMARY CARE
• 1996 34 PRIMARY CARE
• 2003 41 PRIMARY CARE

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PUSH FOR SPECIALIZATION

• PAY MORE
• BUY EQUIPMENT
• ADDS PRESTIGE
• WONT HIRE GENERALISTS
• ADVANCED PRIVILEGES
• PEOPLE HAVE BEEN TAUGHT TO DEMAND SPECIALISTS

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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

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CLASSES OF DRUGS

• OVER THE COUNTER DRUGS
• PRESCRIPTION DRUGS
• SCHEDULED DRUGS - NARCOTICS
• SUPPLEMENTS

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DECIDING WHICH DRUG TO USE

• DRUG MANUFACTURERS
• DOCTORS IN PRACTICE
• DOCTORS IN TRAINING
• VIOXX VS IBUPROFEN

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TESTS

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

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TELEMEDICINE

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

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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

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OUTCOMES

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

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TECHNOLOGY FALLACIES

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

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COST CONTROL FALLACIES

• UNNECESSARY TESTING/CARE
• OLDER PHYSICIANS HAVE MORE INAPPROPRIATE
  ADMISSIONS
• DRGS RUNNING OUT
• OUTPATIENT VS INPATIENT
• CERTIFICATE OF NEED
• COMPETITION

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FUNDING FALLACIES

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

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MEDICALIZATION

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

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THE FUTURE

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

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INFORMATION SYSTEMS

• ALL THE USUAL PROBLEMS
• HIGHLY IDIOSYNCRATIC INFORMATION
• HIGHLY TECHNICAL INFORMATION
• HIPPA

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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

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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