Comp1_unit1d_audio_transcript.doc



Introduction to Healthcare in the US: Introduction and History of Modern Healthcare in the US

Audio Transcript

Slide 1

Welcome to Introduction to Healthcare in the US: Introduction and History of Modern Healthcare in the US This is Lecture d.

The component, Introduction to Healthcare in the US, is a survey of how healthcare and public health are organized and services are delivered in the US

Slide 2

The Objectives for Introduction and History of Modern Healthcare in the US, are to:

• Delineate key definitions in the healthcare domain

• Explore components of healthcare delivery and healthcare systems

• Define public health and review examples of improvements in public health

• Discuss core values and paradigm shifts in US healthcare

Describe in overview terms, the technology used in the delivery and administration of healthcare

Slide 3

This lecture will discuss the role of technology, and the advantages and disadvantages of these advances, in several aspects of healthcare delivery.

We will begin this discussion by focusing on the most obvious facet of technology in clinical medicine, the electronic health record or E-H-R. We know that the EHR has significant advantages over paper records. It allows clinicians to access patient data remotely. In contrast to paper records, the electronic record is legible. Confidentiality can be protected in a more sophisticated fashion than can be achieved with paper records. The EHR improves patient safety. For example, computerized physician order entry - when physicians enter their own orders rather than writing them out on a paper chart and relying on someone else to enter orders into the system - reduces transcription errors. The EHR can be integrated with other resources and data and also can be integrated with decision support and knowledge-based resources which are described later in this lecture.

Slide 4

EHRs do have some disadvantages. The cost of installation, maintenance, and upgrading EHRs can be quite substantial. Implementation of an EHR requires training and also is often associated with changes in clinical workflows. There is also often a lack of interoperability between EHRs that are supplied by different vendors. And clinicians sometimes feel that the presence of the EHR in the examination room de-personalizes the doctor-patient relationship. Having said this, the advantages of EHR appear to outweigh the disadvantages.

Slide 5

One trend that has been growing in popularity over the last few years is the availability of personal health records. The idea that patients can keep their own records has been around since the 1980s: for example, researchers who conducted one study gave patients their records to read when they were waiting to see their clinician. Patients reacted positively and most of them were familiar with the information in their charts. Interestingly, older patients tended to avoid reading their notes. A few inaccuracies were noted, and there were some unpleasant reactions, but overall, there weren’t many problems and patients received the idea of reviewing and maintaining their own records quite well.

There are some advantages associated with personal health records. The information is tailored and patient-centric. And there are reductions in cost for both the patient and the physician when patients maintain their own health records.

Slide 6

There are some concerns about personal health records, (PHRs) [P-H-Rs]. There are significant privacy concerns, especially when the personal health record is stored by an independent entity and might even be stored offshore. There are also questions about data ownership. Who owns the data in a personal health record? Is it the personal health record vendor, the patient, or the clinician?

Patients have the opportunity to grant access and different levels of access to different clinicians. So who does the patient grant full access to, and which clinicians have curtailed access, and how does the patient decide? Is curtailing access to clinicians in the patient’s best health interest when it comes to treating their illnesses? Will physicians accept access to patient information on a need to know basis? And we’re not quite sure what the patient does if their personal health record is sold to a different entity, becomes insolvent, or ceases to exist. And one concern is the fact that personal health records may be sponsored by advertising and if that’s ethical.

Slide 7

But technology in the medical office extends beyond the electronic health record or personal health record. Technology is everywhere in healthcare delivery, whether it be in billing software, in insurance claims processing, or in accounting.

Another example of technology in clinical medicine is computer-assisted surgery where a robot may assist a surgeon in performing complex and delicate surgical procedures.

Yet another example is the use of CAD CAM (Computer-Aided Design/ Computer-Aided Manufacturing) techniques in medicine, such as in the design and manufacture of prosthetics.

Slide 8

Technology is also important in telemedicine which is the remote delivery of healthcare using telecommunications and teleconferencing equipment and interactive audio-visual experience. This is very useful where interpretation of images or visual data is required.

For example, in tele-radiology, a radiologist sitting in a remote location is able to review x-rays. In tele-dermatology a picture of a skin lesion on a patient can be transmitted to a dermatologist from a remote location. The dermatologist then reviews the image and provides a diagnosis.

Telemedicine can link doctors and patients remotely and is useful in rural or remote locations. Another example of telemedicine is remote patient monitoring. For example, a patient can wear a Holter monitor, which is an electronic device that records heart rhythms, and these can be transmitted using telemedicine to cardiologists who can review the rhythm and provide a diagnosis.

Telemedicine can also help monitor patient’s blood pressure or weight at home.

Slide 9

Technology can help the pharmacist and improve patient safety by reducing errors. For example, in drug dispensing, bar code systems can identify the National Drug Code or NDC for products and can verify the patient, the medication, and the dosage. This reduces the possibilities of errors, so much so that in 2006 the Food and Drug Administration, the FDA, mandated that hospitals use bar codes for administering medication.

Clinical decision support is another example of safety improvement. Decision support tools can provide reminders and alerts, check for interactions between drugs, review orders, scan for inconsistencies, and provide advice regarding alternative medications that may have a better safety profile for that particular patient.

Slide 10

Technology is playing an increasing role in the healthcare delivery of dental care. The electronic dental record offers similar advantages to the practice of dentistry as electronic medical records, EMRs, have to the practice of medicine. Computer modeling and CAD CAM (Computer-Aided Design/ Computer-Aided Manufacturing) techniques assist in endodontics [en-doh-don-ticks], for example performing a root canal. Technology also aids in dental diagnosis. For example, x-rays and CT (computed tomography [tuh-maw-gruh-fee) scans are now extensively used in dental practice. And tools that apply electrical conductance properties can be used to diagnose cavities.

Slide 11

Let us now turn our attention to the role of technology in healthcare delivery in the field of radiology. Now radiology is a discipline that is strongly driven by technology. Advances in imaging techniques have led to incremental degrees of sophistication. For example, in 1895 William Roentgen began studying the properties of x-rays and took the first x-ray picture of his wife’s hand. This technology progressed and advanced, leading to computerized tomography, also known as the CAT or CT scan, which uses a computer to process x-ray images and generates a three-dimensional image from a number of axial two-dimensional x-ray images.

Other technology-driven radiologic imaging methods include ultrasound, magnetic resonance imaging or MRIs, positron emission tomography or PET scans, and radionuclide [radio-new-klide] imaging techniques.

Slide 12

Rehabilitation medicine is a branch of medicine which aims to enhance and restore functionality and quality of life to those with physical impairments or disability. Technology has significantly advanced rehabilitation in medicine and its delivery. Assistive technology helps patients with physical impairments or disability lead relatively normal lives.

Examples of assistive technology include audio books and text-to-speech which converts normal language text into speech, voice recognition software, prosthetics, wheel chairs, and ambulatory devices.

Slide 13

Technology has been responsible for innovations in the delivery of healthcare education. Expert systems, which are a type of clinical decision support tools, help in developing diagnostic reasoning skills and decision-making skills in clinicians.

Online resources provide a readily available knowledge base that can be accessed on demand. Just a few decades ago, if a physician was looking for a particular piece of information, for example, an article, they’d have to go into a library, look at a physical index or consult with a librarian, order the article, and wait for it to show up via the postal service. Now all they have to do is to turn on a computer.

Another growing field is simulation technology which helps in training clinicians. For example, medical residents practice procedures using a simulated environment rather than practice procedures on real patients. This helps with patient safety, improves student’s clinical skills, and helps in healthcare education.

Slide 14

This concludes Lecture d of Introduction and History of Modern Healthcare in the US.

In summary, there have been significant advancements in the delivery of medical care, from advances in imaging, diagnosis and surgical procedures to Electronic Health Records, Personal Health Records and the use of technology to better inform both practitioners and patients.

While there are advantages and disadvantages to technology in healthcare, there are many positive impacts, the most significant being increased patient safety, whether it be through integrated electronic patient records, more accurate drug prescriptions or more accessible health information and education for patients.

Slide 15

This also concludes Introduction and History of Modern Healthcare in the US.

In summary, there are many different types of healthcare delivery, ranging from in-patient facilities which include hospitals and short- and long-term care facilities to out-patient facilities where patients visit for specialty care and laboratory work.

Public Health has significantly impacted the control of infectious diseases, such as typhoid, small pox and goiter, and helped identify nutritional deficiencies and contributed to a greater understanding of diseases. It has also supported improvements in data collection, training and infrastructure.

The emergence of multi-level care accompanied by significant technological advances reflect the increasing complexity of diseases and their management. This progress has, in part, driven a dramatic increase in healthcare costs, containment of which is at the forefront of patient concerns.

Finally, there have been significant changes in healthcare in response to patient core values, including from physician to patient-centric centered care; from individual to team-based care; from paper-based management of medical information to a dominance of technology in the management of medical information and the delivery of healthcare.

Slide 16 (Reference slide)

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