The Technological Imperative in United States Healthcare

1. The Technological Imperative in United States Healthcare How emerging technology is addressing the issue Sarah Herhold – James Madison University Research for NSF REU Program at the Univeristy of Virginia, 2007

2. What is a technological imperative The pursuit of the most advanced technology and the desire to implement it without regard to cost.

3. 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.

4. 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.”

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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.

11. 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

12. 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

13. 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%

14. 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)

15. 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.

16. 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

17. 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

18. The Emerging Solutions Store-and-Forward Telemedicine Allows patients to query physicians via email and attached images or video.

19. 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

20. 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.

21. The Emerging Solutions Live Conference Telemedicine

22. 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

23. 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

24. 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

25. 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.

26. Current Barriers to Progress (Continued) • Concern that programs will negatively impact patient-physician relationship • Licensing issues • Interoperability

27. What can be done (Continued) • Patient-physician relationship often improved by telemedicine • Movement for national licensing program • Interoperability

28. 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.

29. Acknowledgements Dr. Alf Weaver, Dr. Christopher Nye, Dr. Mark Williams, Dr. Karen Rheuban, Dr. Scott Strayer, Linda Rose, REU mentors. FIN.