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HEALTH CARE TECHNOLOGY

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THE EMPLOYMENT PROCESS SELECTS FOR PEOPLE WHO ARE HEALTHY. THERE IS NO HEALTHY PERSON EFFECT ON ... VIOXX VS IBUPROFEN. TESTS. SENSITIVITY True Positives ... – PowerPoint PPT presentation

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Title: HEALTH CARE TECHNOLOGY


1
HEALTH CARE TECHNOLOGY
  • 27 February 2009
  • KATHARINE C RATHBUN MD

2
COSTS
  • MONEY
  • TIME
  • LABOR
  • PAIN
  • INDEPENDENCE
  • LOVE

3
HOW MUCH IS YOUR LIFE WORTH?
  • YOUR MONEY, TIME, ETC
  • SOMEONE ELSE'S
  • SOCIETYS

4
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

5
CAUSES OF DISABILITY
  • SAVING ADULTS OFTEN INCREASES NUMBERS ON
    DISABILITY
  • SAVING BABIES MAY BE WORSE

6
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

7
MORTALITY
  • EVERYONE IS GOING TO DIE
  • EVERYONE HAS TO DIE OF SOMETHING

8
TECHNOLOGIC IMPERATIVE
  • HAVE STATE-OF-THE-ART TECHNOLOGY
  • USE THIS TECHNOLOGY AT EVERY OPPORTUNITY

9
TECHNOLOGIC IMPERATIVES
  • HEALTH INSURANCE
  • MEDICAL SPECIALIZATION
  • MEDICINES
  • TESTS

10
SPECIALTY VS PRIMARY CARE
  • 1940 - ALL DOCTORS ARE TRAINED AS GENERALISTS
  • 1970 - 41 PRIMARY CARE
  • 1996 34 PRIMARY CARE
  • 2003 41 PRIMARY CARE

11
PUSH FOR SPECIALIZATION
  • PAY MORE
  • BUY EQUIPMENT
  • ADDS PRESTIGE
  • WONT HIRE GENERALISTS
  • ADVANCED PRIVILEGES
  • PEOPLE HAVE BEEN TAUGHT TO DEMAND SPECIALISTS

12
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

13
CLASSES OF DRUGS
  • OVER THE COUNTER DRUGS
  • PRESCRIPTION DRUGS
  • SCHEDULED DRUGS - NARCOTICS
  • SUPPLEMENTS

14
DECIDING WHICH DRUG TO USE
  • DRUG MANUFACTURERS
  • DOCTORS IN PRACTICE
  • DOCTORS IN TRAINING
  • VIOXX VS IBUPROFEN

15
TESTS
  • SENSITIVITY True Positives
  • SENSITIVE TESTS FOR SCREENING Fewer false
    negatives
  • SPECIFICITY True Negatives
  • SPECIFIC TESTS FOR CONFIRMATION Fewer false
    positives

16
TELEMEDICINE
  • STORAGE AND TRANSFER OF INFORMATION
  • ISOLATED DOCTORS
  • READING THINGS AT A DISTANCE
  • MONITORING

17
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

18
OUTCOMES
  • GEOGRAPHIC COMPARISONS SHOW THAT DIFFERENT
    TECHNOLOGIES MOSTLY DO NOT CHANGE OUTCOMES
  • CONTROLLED FOR RACE, AGE, OCCUPATION, ETC

19
TECHNOLOGY FALLACIES
  • DECISIONS ABOUT TECHNOLOGY ARE ABOUT QUALITY OF
    CARE
  • SENSITIVE SCREENING TESTS ARE GOOD

20
COST CONTROL FALLACIES
  • UNNECESSARY TESTING/CARE
  • OLDER PHYSICIANS HAVE MORE INAPPROPRIATE
    ADMISSIONS
  • DRGS RUNNING OUT
  • OUTPATIENT VS INPATIENT
  • CERTIFICATE OF NEED
  • COMPETITION

21
FUNDING FALLACIES
  • MERGE WITH OTHER PROVIDERS
  • OBTAIN MANUFACTURER SUPPORT
  • BECOME A DEMONSTRATION SITE
  • BECOME A SERVICE CENTER
  • PONZI SCHEMES

22
MEDICALIZATION
  • Epidemic of Diagnoses
  • unhappy vs depressed
  • Epidemic of Treatments
  • screening for disease in healthy people

23
THE FUTURE
  • PHYSICIAN/PATIENT RELATIONSHIP IS STILL
    FUNDAMENTAL
  • IT STILL TAKES 9 MONTHS TO MAKE A BABY

24
INFORMATION SYSTEMS
  • ALL THE USUAL PROBLEMS
  • HIGHLY IDIOSYNCRATIC INFORMATION
  • HIGHLY TECHNICAL INFORMATION
  • HIPPA

25
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

26
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
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