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.


Red

Reform Proposal

As a member of the technology group I will be proposing reform on electronic or e-health in the United States. The current U.S. system deters doctors and patients from embracing technology online. With online record keeping on a national scale patients records could be accessed by any doctor anywhere. This would allow for a greater mobility for aging or chronically ill patients. This would also allow the patient to access and update their status and health condition, allowing for more efficient treatment. According to a survey of health care consumers, “57% of American consumers want a secure Internet site to access medical records, schedule appointments, refill prescriptions and pay medical bills (…).”

The fears that are holding back progress on this are due mainly to privacy and patient privilege issues stemming from the lack of security of online records. With even the government pushing for a complete transition to e-record keeping, critics denote that there must be an option to opt out if a patient does not want his medical data to be stored electronically. Another large problem is the fact that the startup cost per provider office is between 10,000 and 50,000 dollars. Along with the fact that many providers are paid per visit, this has deterred many physicians from the adoption of this system.

This technology eliminates many of the problems resulting from a system of paper records kept by a single provider. By letting patients access the system at will, they will be able to update their status when feeling ill and not have to recall symptoms from memory. Moreover, “it would cut down on mistaken and unnecessary procedures and give doctors faster access to more accurate information about patients' medical histories and drug regimens.” The providers that have incorporated this technology into their practice have reaped the rewards by being able to see more patients at once. This has in fact increased their profits while increasing their effectiveness. As taxpayers we should begin to examine the current healthcare system and ways to improve it through our use of technology and e-record keepings seems to be worth a second look.

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Jennifer Gamberini

In my opinion, I think a new approach should be taken to reform health care. Measures are already being brought forth in this direction, but I think the aspect of prevention is one that is key. Much money is spent developing new technology, and while I believe that is great, I think it we would be much more productive and able to save a lot more money if preventative measures were increased.
Injuries are a great example of this. When a person gets injured, costs quickly escalate as doctors work to diagnosis it; tests are run, and imaging equipment is used to examine the patient. And as degree of severity has an infinite range, so does reason for injury. Athletic injuries, in particular, can be more frequently prevented with the help of proper training. Beginning in early gym classes, children should be taught proper exercise, stretch and training techniques. If these values can be instilled early on, it will be easier to carry on throughout life and one can incur less injury. For instance, upon developing agility skills, children should be taught appropriate jumping and landing skills, in conjunction with side-to-side motions. Learning and practicing this correctly will reduce the risk of damage, such as tearing a muscle or ligament (ACL).
In addition to athletic injuries are vehicle-induced accidents. Driving limitations, restrictions and revocations should be enforced in full, in particular with regard to drunk driving. Not only should people fear a first offense, but multiple offenders should be unheard-of. Care most definitely should be provided for victims of such a crime, but the cost to provide the care can skyrocket with ambulances, hospital stays, medical exams and potential further rehabilitation. If prevention in this area could be effective, much money could be saved; plus, lives themselves could be saved and protected.
Last, I think lifestyle is a key factor. For many people who have poor health, it is due to their unhealthy lifestyle. Smoking predisposes a person for lung cancer and requires the use and development of equipment and technology to treat it. Obesity predisposes a person to diabetes and requires the use and development of equipment and technology to treat it. Unprotected and multiple-partner sex predisposes a person to STIs and requires the use and development of equipment and technology to treat it. The list continues, but this root lies within lifestyle. If people can be better educated and given better opportunities to make beneficial choices, much disease, injury and cost can be eliminated. The money saved from this unnecessary spending could then be channeled toward more complicated and effective technology and research for things that we don’t have as much control over.


Delivering Health Care In America, Leiyu Shi & Douglas A. Singh

Technology- Reform Proposal 1

Now days, because we rely so much on technology to find and diagnose medical problems in the human race, we wonder why access to it can be so difficult. Something that is so steadfast and capable of doing what the human eye cannot do should be easily available to the population. It’s not though; majority of reason being, the cost.
It is not only the people who do not have health insurance either. Our U.S. health care system is struggling to find a way to make medical costs efficient. For example, many hospitals and clinics exceed the amount of machines necessary to treat patients. This is inefficient for two reasons. One being that the place of practice has increased what they pay for their medical equipment, and two being patients are told to receive multiple scans (MRI, PET, etc.) which may be unnecessary because it most likely does not help the doctors diagnoses.
Over the last five years, medical technology spending has included about twenty percent of the rise in U.S. health care costs. Cutting on medical technology health care costs is easier said than done because of how accurate these machines really are. As stated earlier, they are capable of seeing what the human eye cannot; therefore people’s health has/will increase. Another question we would like to raise is, why is it that in the United States, an MRI, for example costs around one grand for the patient and in other countries, Japan for example the price only is around ninety dollars? Being the most developed country on the globe, we should be able to come up with ways to make our health care more cost efficient. Granted it would take time do so, we don’t expect a price change in the blink of an eye. But with the resources we have, we believe it is possible for the U.S. health care system to come up with ways to proficiently reduce the costs of medical technology both for the caregiver and caretaker with out compromising the innovation of our machines used. It seems as though innovation is the biggest reason for the increase in medical technology costs. Everyone is too scared to find ways to lower the costs because that would mean our technology would not be up to par, or so they think. Our country is not about to take steps backwards in the world of technology because of price cuts. This can be done; it’s just a matter of time and willingness.

Kelsey Katarow

"U.S Health Care's Technology Cost Crisis." (28. Feb. 2009): 28 Feb. 2009. http://www.strategy-business.com/enewsarticle/enews033104?pg=1.


Shi, L, & Singh, D (2008). Delivering Health Care in America: A Systems Approach.Sudbury: Jones and Bartlett Publishers.