HEALTH CARE TECHNOLOGY

27 February 2009

KATHARINE C RATHBUN MD

COSTS

• MONEY

• TIME

• LABOR

• PAIN

• INDEPENDENCE

• LOVE

HOW MUCH IS YOUR LIFE WORTH?

• YOUR MONEY, TIME, ETC

• SOMEONE ELSE'S

• SOCIETY’S

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

CAUSES OF DISABILITY

• SAVING ADULTS OFTEN INCREASES NUMBERS ON DISABILITY

• SAVING BABIES MAY BE WORSE

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

MORTALITY

• EVERYONE IS GOING TO DIE

• EVERYONE HAS TO DIE OF SOMETHING

TECHNOLOGIC IMPERATIVE

• HAVE STATE-OF-THE-ART TECHNOLOGY

• USE THIS TECHNOLOGY AT EVERY OPPORTUNITY

TECHNOLOGIC IMPERATIVES

• HEALTH INSURANCE

• MEDICAL SPECIALIZATION

• MEDICINES

• TESTS

SPECIALTY VS PRIMARY CARE

• 1940 - ALL DOCTORS ARE TRAINED AS GENERALISTS

• 1970 - 41% PRIMARY CARE

• 1996 – 34% PRIMARY CARE

• 2003 – 41% PRIMARY CARE

PUSH FOR SPECIALIZATION

• PAY MORE

• BUY EQUIPMENT

• ADDS PRESTIGE

• WON’T HIRE GENERALISTS

• ADVANCED PRIVILEGES

• PEOPLE HAVE BEEN TAUGHT TO DEMAND SPECIALISTS

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

CLASSES OF DRUGS

• OVER THE COUNTER DRUGS

• PRESCRIPTION DRUGS

• SCHEDULED DRUGS - NARCOTICS

• SUPPLEMENTS

DECIDING WHICH DRUG TO USE

• DRUG MANUFACTURERS

• DOCTORS IN PRACTICE

• DOCTORS IN TRAINING

• VIOXX VS IBUPROFEN

TESTS

• SENSITIVITY – True Positives

• SENSITIVE TESTS FOR SCREENING – Fewer false negatives

• SPECIFICITY – True Negatives

• SPECIFIC TESTS FOR CONFIRMATION Fewer false positives

TELEMEDICINE

• STORAGE AND TRANSFER OF INFORMATION

• ISOLATED DOCTORS

• READING THINGS AT A DISTANCE

• MONITORING

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

OUTCOMES

• GEOGRAPHIC COMPARISONS SHOW THAT DIFFERENT TECHNOLOGIES MOSTLY DO NOT CHANGE OUTCOMES

• CONTROLLED FOR RACE, AGE, OCCUPATION, ETC

TECHNOLOGY FALLACIES

• DECISIONS ABOUT TECHNOLOGY ARE ABOUT QUALITY OF CARE

• SENSITIVE SCREENING TESTS ARE GOOD

COST CONTROL FALLACIES

• UNNECESSARY TESTING/CARE

• OLDER PHYSICIANS HAVE MORE INAPPROPRIATE ADMISSIONS

• DRG’S RUNNING OUT

• OUTPATIENT VS INPATIENT

• CERTIFICATE OF NEED

• COMPETITION

FUNDING FALLACIES

• MERGE WITH OTHER PROVIDERS

• OBTAIN MANUFACTURER SUPPORT

• BECOME A DEMONSTRATION SITE

• BECOME A SERVICE CENTER

• PONZI SCHEMES

MEDICALIZATION

• Epidemic of Diagnoses– unhappy vs depressed

• Epidemic of Treatments– screening for disease in healthy people

THE FUTURE

• PHYSICIAN/PATIENT RELATIONSHIP IS STILL FUNDAMENTAL

• IT STILL TAKES 9 MONTHS TO MAKE A BABY

INFORMATION SYSTEMS

• ALL THE USUAL PROBLEMS

• HIGHLY IDIOSYNCRATIC INFORMATION

• HIGHLY “TECHNICAL” INFORMATION

• HIPPA

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

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