Component 1: Introduction to Health Care and Public Health in the U.S.

1. Component 1: Introduction to Health Care and Public Health in the U.S. 1.1: Unit 1: Introduction to modern healthcare in the US 1.1 c: Paradigm Shifts in Medicine

2. Core values in US healthcare • Patient centricity and individual choice • Interdisciplinary care • Technology and innovation drive healthcare • Cost of healthcare • Options for financing healthcare • general revenue • social health insurance • voluntary or private health insurance • out-of-pocket payments • internal donations • Health care expenditure • $253 billion in 1980 • $714 billion in 1990 • $2.3 trillion in 2008 (16.2% of GDP, $7681 per resident) • Need for cost containment! Health IT Workforce Curriculum Version 1.0/Fall 2010

3. Paradigm shifts in medicine:Physician-centric to Patient-centric Care • The old model: patient care options were determined by the provider -- patients were offered few opportunities to make decisions • The new model: cultural shift towards giving patients greater responsibility in their care • Shift from paternalism to patient autonomy Health IT Workforce Curriculum Version 1.0/Fall 2010

4. Paradigm shifts in medicine:Physician-centric to Patient-centric Care • Patient Self-Determination Act,1990 • Requires health care organizations to give adult individuals certain information about their rights including • the right to participate in and direct their own healthcare decisions • the right to accept or refuse medical or surgical treatment • the right to prepare an advance directive • information on the provider’s policies that govern the utilization of these rights • Providers, organizations and healthcare systems have become more responsive to patient needs Health IT Workforce Curriculum Version 1.0/Fall 2010

5. Paradigm shifts in medicine:Individual to Team-Based Care • Historically, patient care provided by an individual clinician • With the increasing complexity of healthcare and patients, there has been an evolution towards collaboration between healthcare • An interdisciplinary team is a “…group of individuals with diverse training and backgrounds who work together as an identified unit or system” • Examples: intensive care units, hospice care, primary care outpatient settings Health IT Workforce Curriculum Version 1.0/Fall 2010

6. Paradigm shifts in medicine: Individual to Team-Based Care • The Patient Centered Medical Home - term introduced by the American Academy of Pediatrics in 1967, now endorsed by numerous organization including the AAFP, ACP, and the AOA • Hallmarks of the patient centered medical home include: • Personal physician • Physician directed medical care • Care is coordinated • Emphasis on quality and safety • Enhanced access to care Health IT Workforce Curriculum Version 1.0/Fall 2010

7. Paradigm shifts in medicine:Physician-kept records to Personal Health Records • The first medical records were maintained by physicians as notes • First individual patient medical records - 1907, at the Mayo Clinic in Rochester, Minnesota • Advances in technology have led to the electronic medical record, but these are still usually created, maintained and updated by the provider or system • Current trend is towards the personal health record, which is created and maintained by the patient Health IT Workforce Curriculum Version 1.0/Fall 2010

8. Paradigm shifts in medicine: Dominance of technology in healthcare delivery • Health information technology (HIT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers • HIT can: • improve health care quality and prevent medical errors • increase the efficiency of care provision • reduce unnecessary health care costs • increase administrative efficiencies and decrease paperwork • expand access to affordable care • improve population health Health IT Workforce Curriculum Version 1.0/Fall 2010