Introduction to Health Care and Public Health in the U.S.

1. Introduction to Health Care and Public Health in the U.S. Introduction to and History of Modern Health Care in the U.S. Lecture d This material (Comp 1 Unit 1) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

2. Introduction to and History of Modern Health Care in the U.S.Learning Objectives - 1 • Define key terms in health care and public health (Lectures a, b, c, d) • Describe components of health care delivery and health care systems (Lecture a) • Discuss examples of improvements in public health (Lecture b)

3. Introduction to and History of Modern Health Care in the U.S.Learning Objectives - 2 • Define core values and paradigm shifts in U.S. health care (Lecture c) • Describe the technology used in the delivery and administration of health care (Lecture d)

4. Electronic Health Records - 1 • Potential advantages over paper records • Remote access to patient data • Record is legible • Confidentiality is better handled than paper records • Improves patient safety • Integrated with other resources and data • Integrated with decision support and knowledge-base resources

5. Electronic Health Records - 2 • Some disadvantages • Cost of installation, maintenance and upgrading • Requires training and changes in clinical workflows • Lack of interoperability • Depersonalizes the doctor-patient relationship

6. Personal Health Records - 1 • 1980s - Patients keep their own records • One study gave patients their records to read when in the waiting room • Patients reacted positively • Older patients tended to avoid reading their notes • Few inaccuracies and unpleasant reactions • Advantages • Tailored information • Cost (for patient and physician)

7. Personal Health Records - 2 • Types (Tang, 2006) • Tethered – connected to the EHR of a single health care organization • Well-known example is myHealtheVet from VA • Integrated – able to integrate data from many health care and other organizations • Very few in existence • Standalone – not connected to any data source • Patients enter their own data

8. Personal Health Records - 3 • Some concerns • Significant privacy concerns • Who owns the data? • Patient grants access – to whom? • Will physicians accept access to patient information on a “need to know” basis? • What does the patient do if their PHR vendor is sold to a different entity, becomes insolvent, or ceases to exist?

9. Technology in the Medical Office • Billing software • Insurance claims processing • Accounting • Computer assisted surgery • CAD/CAM technology in medicine

10. Telemedicine • Remote delivery of health care using telecommunications and teleconferencing equipment • Very useful where interpretation of images/visual data is required • Tele-radiology • Tele-dermatology • Can link doctors and patients remotely • Remote patient monitoring

11. Pharmacy • Safety improvement in drug dispensing • Bar code systems can verify the patient, medication, and the dosage • 2006: FDA mandated hospitals use bar codes for administering medications • Clinical decision support • Reminders and alerts • Checks for interactions between drugs • Reviews orders • Scans for inconsistencies

12. Dentistry • Electronic dental record • Similar advantages to the practice of dentistry as EMRs have to the practice of medicine • Computer modeling and CAD/CAM • Assist in endodontics • Technology aids dental diagnosis • Imaging • Use of electrical conductance properties to diagnose cavities

13. Radiology • Advances in imaging techniques have led to incremental degrees of sophistication • 1895 X-rays were first developed • Computerized tomography (CAT or CT scans) • Computer processes X-ray images and generates a 3-dimensional image

14. Other Technology • Other technology • Ultrasound • Magnetic Resonance Imaging (MRIs) • Positron Emission Tomography (PET scans) • Radionuclide imaging techniques

15. Rehabilitation Medicine • Branch of medicine which aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. • Examples of assistive technology • Audio books and text-to-speech • Voice recognition software • Prosthetics • Wheelchairs • Ambulatory devices

16. Health Care Education • Expert systems help in developing diagnostic reasoning skills • Online resources provide a readily available knowledge base that can be accessed on-demand • Simulation technology helps in training

17. Introduction to and History of Modern Health Care in the U.S. Summary – Lecture d • Many significant technological advancements in the delivery of medical care • Imaging, diagnosis and surgical procedures • Electronic and Personal Health Records • Positive effects include: • Accuracy, confidentiality, patient safety, more integrated care, broader access for care team and patient, patient education

18. Introduction to and History of Modern Health Care in the U.S. Unit Summary • Different types of health care and health care delivery • Public Health has affected control of infectious diseases and contributed to improvements in data collection, training and infrastructure • Multi-level care and technological advances reflects complexity of diseases and management • There have been many significant paradigm shifts in the delivery of health care

19. Introduction to and History of Modern Health Care in the U.S. References – 1 – Lecture d References Baldry, M., Fisher, B., Gillett , M., & Huet, V. (1986). Giving patients their own records in general practice: experience of patients and staff. BMJ, 292, 596-598. Bar Code Label for Human Drug Products and Biological Products; Final Rule. (2004). In Federal Register (69 ed., Vol. 38, pp. 9119-9171). Bates, D. W., Gawande, A. A., & Gill (2003). : Improving safety with information technology. New England Journal of Medicine, 348, 2526-2534. Coleman, V. (1984). Why patients should keep their own records. Journal of Medical Ethics, 10, 27-28. Jones, R., Pearson, J., McGregor, S., Gilmour, W. H., Atkinson, J. M., & Barrett, A., et. al. (1999). Randomized trial of personalized computer based information for cancer patients. BMJ, 319, 1241-1247.

20. Introduction to and History of Modern Health Care in the U.S. References – 2 – Lecture d References Powsner, S. M., Wyatt, J. C., & Writght, P. (1998). Opportunities for and challenges of computerization. The Lancet, 352, 1617-1622. Sittig, D. (2011). Data collection in private practice and implementation with electronic medical records. Retrieved January 19, 2017, from ClinfoWiki website: http://clinfowiki.org/wiki/index.php/Data_collection_in_private_practice_and_implementation_with_electronic_medical_records. Smith, D. G., & Burgess, E. M. (2001, May). The use of CAD/CAM technology in prosthetics and orthotics— Current clinical models and a view to the future. Journal of Rehabilitation Research and Development, 38(3), 327-334. http://www.rehab.research.va.gov/jour/01/38/3/pdf/smith.pdf. Tang, PC, Ash, JS, et al. (2006). Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. Journal of the American Medical Informatics Association. 13: 121-126.

21. Introduction to Health Care and Public Health in the U.S.Introduction to and History of Modern Health Care in the U.S.Lecture d This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001.