Technology and Diagnosis

First of all, I would be uncomfortable, to say the least, to convey that I think the biggest fish to fry in getting a healthier nation is the advancement of technology. Is it important? Yes, and very beneficial, but our biggest problems we bring upon ourselves. If we could get more people to say "where's the gym" versus "supersize me", we could curb many of our ills. As others have pointed out, technology can really be a two edged sword. Now, instead of eating right and exercising, people seem to be more willing to pop a pill to control their blood pressure, or 10mg of a statin drug to lower their cholesterol, etc. etc. But since we're asked to keep this to technology, and many other excellent concepts have already been discussed, let me suggest that perhaps we could develop better diagnostic tools and software. I watch a LOT of "Mystery Diagnosis" types shows, documentaries, etc. and I'm amazed at how many times people go undiagnosed or misdiagnosed, sometimes for years. Needlessly suffering both physically and financially, and having endless trips to the E.R. And then finally, through some series of events, another doctor sees the symptoms and immediately recognizes what the problem is. And these aren't always just rare and difficult conditions to diagnose. Perhaps a comprehensive, collaborative software effort could be made to create better diagnostic tools. Let me put it this way - if you can think it, it can go into a computer and have decision making software guide you into possible diagnoses, or at least different ways of thinking. I'm not suggesting this is a replacement for having a doctor diagnose an issue, but it could, over years, evolve to be a great tool. But no one single entity could really provide this - I think it would have to be a large scale collabarative effort. Perhaps that, and not the technology, is the biggest hurdle. As I inferred (and countless others have for generations) before: man's greatest enemy is himself.

Patien't perspective on technology

Over the past few decades the rapid advances in technology have significantly benefited patients. These advancements have not only enabled patients to receive a higher quality of care, but it has also served the purpose of dispelling some of the apprehension.

Before the newer technology became available physicians were restricted, to a certain extent, in their ability to make a thorough diagnosis. Some of the equipment available to them at that time was somewhat cumbersome and limited in the amount of information that it could provide. It served the purpose it was intended for but did not compare to the technology that is available today.

There was a point in time where individuals viewed a visit to the doctor’s office and possible hospitalization as a last resort. Patients did not have the resources that are available today. And were of the mindset that they could use various home remedies before paying the physician a visit. Unfamiliarity with X-ray and other equipment also played a role.

Technology today is so sophisticated and the various pieces of equipment provide such a wealth of information that physicians are able to better identify a problem. As a result of the gathered information they can make a more informed plan of treatment.

Due to these advances patients are more receptive to treatment for two reasons. The equipment no longer intimidates most patients because it will more accurately diagnose a problem. And if surgery is required the actual procedure as a result of advanced technology, can be done in such a way that the period of recovery can be greatly reduced.

Some patients shy away from taking advantage of this technology. In some instances an insurance company may not cover the procedure. In others they may not have coverage and are unable to pay for the treatment.

While having a test or procedure may be costly the benefits of enabling yourself with a higher quality of life outweigh any immediate concerns.

There are a number of resources and wellness education is becoming more available in the community. Taking advantage of these resources will only make you more informed.

Technology could be saving health care costs.

Incredible technological advances have occurred in medicine over the last two decadesIn the not so distant past patient fractures were diagnosed by x-ray. Many times the x-ray didn't reveal the extent of the fracture. Do to the missed diagnosis of the injury many complications could have occurred. People could be walking on legs that had a fracture that wasn't shown on x-ray. The complications from walking on a unknown fracture could be anything from pain to displacement of the fracture. If displacement of the fracture occurred, surgery would be needed to repair the fracture. Thus the invention of the CAT scan revolutionized fracture recognition. Cat scanners are able to reveal, layer by layer and angle by angle, the affected bones and diagnose precisely the scope of the injury. Shortly after the CAT scanner was the newest diagnostic tool, a new scanner called MRI was introduced to further aid with diagnosis of injuries. This MRI would be used to diagnose soft tissue problems. The scanner is able to identify injuries such as ACL and MCL tears. In the past these injuries were only identified by symptoms. There was no ability to know the extent of the injury until surgery was performed. Surgery was performed without knowing what was actually needed. An incision could have been made and there was nothing abnormal discovered during the surgery. This unnecessary surgery could have complications such as blood clots and infection. These complications could have been prevented by not having the surgery in the first place.Current new technology in surgical practice is laparoscopic surgery. This technique uses laparoscopic tubes to enter the body at points needed to perform the correction. Physicians are able to repair the problem by looking thru the scope and correcting the problem thru the laparoscope. This technology has improved recovery time for patients who require surgery. There isn't a long incision and not as much manipulation in the body cavity, thus less pain for the patient. There's less potential of post operative infection due to the quickness and less invasive the surgery is.Newest on the market is robotic assisted surgery. The "robot" enables a surgeon to perform precise moves in very delicate structures in bodies. Robotics are currently being used in brain surgery, heart surgery, and prostrate surgery. This type of surgery allows precise movements, to designated areas, therefore lessening the chance of accidental movement that could mean grave consequences for the patient. The robotic surgery has lessened the chance of stroke, bleeding difficulties, residual paralysis, and many other complications usually associated with these types of surgeries.

All the above technological advances have cost millions to develop. However when I see the benefits of this technology in diagnostics and interventions, I believe health care has been improved by better diagnose and decreasing the complications that cause long hospital stays. It has been more cost effective in the treatment of patients then prior to these new technologies.

Health Records, a solution or just a piece of the puzzle?

I have been working in health care for 30 years. Simplified access to patient records will surely improve efficiencies in certain situation for a given patient. However there is a void in the continuity of this information based on the fact the the trail of information stops when a patient is discharged. Even if this patient has nurse visitations there are many gaps in the data.

Why are these gaps critical? Rarely does a patient suffer an event while hospitalized. It occurs at home when there is no form of record keeping leaving this enormous gap in critical information.

If it is believed that this effort to streamline health care though the development of an automated record keeping system it would follow that the continuity of the data is critical. The current gaps in how and when the data is collected needs to be changed to gather meaningful cause and effect information.This information can also be beneficial for faster diagnosis in the future for other patients.

This being said. It seems that heavily relying on this initiative is a very small part of what is needed for reform. Ask yourself if automated health care records existed today how would this provide access to health care for people who currently have none? How will this change the mind set of the self insured who do not see their doctors because each time they do their monthly premium is increased? How do you practice preventative medicine in an environment where this "RECORD" now implies you are predisposed and therefore considered a risk? In this scenario these great records would not work in the favor of the patient but certainly help risk managers within the insurance companies.

Health care has been ignored. It is in many ways the same as Wall Street....making bets based on probabilities by insures relative to outcomes, versus making bets on stocks,commodities etc. Insures deny applications,deny claims and increase premiums to earn money on there bets an toss all the non income generating assets on to the taxpayer and keep the low risk money makers one their balance sheets.

The big difference is on Wall Street the carnage is a loss of capital and the bad bets the insures result in the loss of human lives. Now the government sits back and talks about record keeping when it's a small part of the problem and a long term return on investment and this investment is not without risk.

The dollar needs to be followed very closely to find the waste and develop a meaningful plan to solve this problem. We failed to do it with the collapse of the Financial Markets.Why not do it with Health Care rather than throwing a records program at the wall to see if it sticks?

Zig Ziglar: "Success is where preparation meets opportunity"

Let's prepare for success on this very critical opportunity.


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