01-01d - introduction to healthcare and public health in the us - unit 01 - introduction and history...

Introduction to Healthcare and Public Health in the US

Introduction and History of Modern Healthcare in the US

Lecture dThis material (Comp1_Unit1d) was developed by Oregon Health and Science University, funded by the Department of Health

and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.


Learning Objectives

2

• Delineate key definitions in the healthcare domain (Lectures a, b, c, d)

• Explore components of healthcare delivery and healthcare systems (Lecture a)

• Define public health and review examples of improvements in public health (Lecture b)

• Discuss core values and paradigm shifts in US healthcare (Lecture c)

• Describe in overview terms, the technology used in the delivery and administration of healthcare (Lecture d)

Health IT Workforce Curriculum Version 3.0/Spring 2012

Introduction to Healthcare and Public Health in the US Introduction to modern

healthcare in the US Lecture d

Role of Technology in Healthcare Delivery: Clinical Medicine

3Health IT Workforce Curriculum Version 3.0/Spring 2012



• The Electronic Health Record (EHR) has significant 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


• Some disadvantages of EHRs:– Cost of installation, maintenance and

upgrading– Requires training and changes in clinical

workflows– Lack of interoperability– Depersonalizes the doctor-patient relationship

• Advantages outweigh disadvantages?




Role of Technology in Healthcare Delivery: Clinical medicine




• Personal Health Records• Patients keep their own records - idea has been around

since the 1980s– One study gave patients their records to read when in the waiting

room– Patients reacted positively– Older patients tended to avoid reading their notes– A few inaccuracies and unpleasant reactions but overall, not

many problems

• Advantages– Tailored information– Cost (for patient and physician!)

Role of Technology in Healthcare Delivery: Clinical medicine

• Some concerns about Personal Health Records (PHR)s– 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 is sold to a

different entity, becomes insolvent, or ceases to exist?– Will PHRs be sponsored by advertising?





• Technology in the medical office • Billing software• Insurance claims processing• Accounting

• Computer assisted surgery• CAD/CAM technology in medicine




Role of Technology in Healthcare Delivery: Telemedicine

• Telemedicine – remote delivery of healthcare using telecommunications and teleconferencing equipment

• Very useful where interpretation of images / visual data is required • Teleradiology• Teledermatology

• Can link doctors and patients remotely• Remote patient monitoring




Role of Technology in Healthcare Delivery: Pharmacy

• Safety improvement in drug dispensing – barcodes– Bar code systems can verify the patient, the medication, and the

dosage– In 2006 the FDA mandated that hospitals use bar codes for

administering medications

• Clinical decision support – Reminders and alerts– Checks for interactions between drugs– Reviews orders – Scans for inconsistencies




Role of Technology in Healthcare Delivery: Dentistry

• Electronic dental record– Similar advantages to the practice of dentistry

as EMRs have to the practice of medicine• Computer modeling and CAD/CAM• Technology aids dental diagnosis, for

example– Imaging– Use of electrical conductance properties to

diagnose cavities10Health IT Workforce Curriculum

Version 3.0/Spring 2012



Role of Technology in Healthcare Delivery: Radiology

• Advances in imaging techniques have led to incremental degrees of sophistication– For example, X rays were first developed in 1895– As technology advanced, this led to computerized tomography

(CAT or CT scans)–a computer processes X-ray images and generates a 3-dimensional image

• Other technology driven radiologic imaging methods include • Ultrasound• Magnetic Resonance Imaging (MRIs)• Positron Emission Tomography (PET scans) • Radionuclide imaging techniques




Role of Technology in Healthcare Delivery: Rehabilitation

• Rehabilitation medicine: a 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 and ambulatory devices




Role of Technology in Healthcare Delivery: Healthcare 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




Introduction and History of Modern Healthcare in the US Summary – Lecture d

14

• Many significant technological advancements in the delivery of medical care– Electronic Health Records– Personal Health Records– Other Areas

• Positive impacts include:– Accuracy, confidentiality, patient safety, more integrated

care, broader access for care team and patient, patient education

Health IT Workforce Curriculum Version 3.0/Spring 2012




Summary• There are different types of healthcare and healthcare

delivery• Public Health has greatly impacted the control of

infectious diseases and contributed to improvements in data collection, training and infrastructure

• Multi-level care and technological advances reflect the complexity of diseases and management

• There have been many significant paradigm shifts in the delivery of healthcare





References – Lecture dReferences• 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. • 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

December 6, 2011, 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. Retrieved from http://www.rehab.research.va.gov/jour/01/38/3/pdf/smith.pdf.




http://clinfowiki.org/wiki/index.php/Data_collection_in_private_practice_and_implementation_with_electronic_medical_records

http://clinfowiki.org/wiki/index.php/Data_collection_in_private_practice_and_implementation_with_electronic_medical_records

http://www.rehab.research.va.gov/jour/01/38/3/pdf/smith.pdf

01-01d - introduction to healthcare and public health in the us - unit 01 - introduction and history...

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