July 30th, 2008 by Dr. Val Jones in Expert Interviews, Health Policy
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I recently interviewed former Congresswoman Nancy Johnson about her views on health information technology (IT). She described her vision of an ideal IT solution, and what it should be able to do for physicians and patients. For the full interview, please check out my post at Medpolitics.com
Dr. Val: What would the ideal IT system look like?
Ms. Johnson: It would offer continuously updated evidence-based guidelines at the point of care for physicians. It would give patients clear information about what they should expect. It would enable physician social networks to promote learning and experience sharing with one another. It would promote continuous improvement of care practices, and track outcomes and results to continue refining healthcare delivery. Patients should be given check lists and preventive health guidelines, and be asked to provide feedback on any complications or unanticipated events.
If we could aggregrate deidentified patient information we would gain powerful insight into adverse drug events (or unanticipated positive effects) at the very earliest stages. It could be useful in identifying and monitoring epidemics or even terrorist incidents. This could advance medical science faster than ever before. Until we have all this information at our finger tips, we can’t imagine all the potential applications.
Dr. Val: Are you describing a centralized, national EMR?
Ms. Johnson: Not necessarily. But if systems are interoperable, it could function as one. I imagine it as a series of banks run by local administrators, but with the capability of sharing certain deidentified data with one another.
Dr. Val: Do you think the government should design this information system?
Ms. Johnson: No. You don’t want the government doing it alone. As much as I love the government and have been working in it for decades, it’s simply not good at updating and modernizing systems. You have to have a public-private partnership in this. The government should be involved to protect the public interest, and the private sector should be involved so that the system can be innovative, nimble, and easily updated.
Technology will bring us extraordinary new capabilities to manage our health, prevent illness, minimize the impact of disease on our lives, improve the ability of physicians to evaluate our state of health, allow us to integrate advances in medicine in a timely fashion, and quantify the impact of new inventions and procedures. All this, and IT will help us to promote prevention and control costs associated with acute care.
We have a high quality system now, but because it’s so disorganized, the patient doesn’t receive the quality they should. The incredible advances in technology that we have created should be available to all who need it. Unfortunately that’s not the case now.
If you look at Canada’s use of the specialist and specialist equipment along the US’s border with Canada, it says a lot about government run healthcare.
*See full interview at Medpolitics.com*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 28th, 2008 by Dr. Val Jones in Expert Interviews
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At the recommendation of my dear friend and fellow blogger, Dr. Ramona Bates, I attended a lecture entitled, “Limb Labs: Getting Amputee Soldiers Back to Work After World War I.” The lecture was held at the National Museum of Health and Medicine on the Walter Reed campus in Washington, DC. Both lecturers (Beth Linker and Jeffrey Reznick) did a wonderful job of transporting the audience back in time, outlining the cultural beliefs and historical context of the day. This is what I gleaned from their commentary:
Roughly 100,000 men became amputees as a result of injuries from the American Civil War (1861-1865). At the time there was no government-sponsored program to fit amputees with prosthetic limbs, so veterans were on their own. Prosthetists catered to the middle and upper classes who paid cash for their custom prostheses. Veterans of lesser means could only afford a peg leg, and some would sell photos of their stumps (like baseball cards) to support themselves. Many veterans were not effectively reintegrated into the work force after their injuries, and were considered “charity cases” by the American public.
By the time World War I began, there was significant social stigma associated with amputation. Peg legs and hook arms were synonymous with “blood thirsty villains” like Captain Ahab from Moby Dick, and Captain Hook from Peter and Wendy. As America braced for a fresh round of young amputees, the government prepared occupational rehabilitation programs in an attempt to reduce deliquency among injured veterans. An entire PR engine was developed to set expectations that veterans would become “active workers, not charity cases.” And authors like John Galsworthy, began describing the vocational reintegration of war heroes as “sacred work.”
Around the turn of the 20th century, technology had advanced to allow mass production of various goods. Factories were created to produce large quantities of standardized items like clothing, and the corresponding reduction in cost revolutionized the standard of living for many poor and middle income Americans. Not surprisingly, enterprising individuals looked for ways to mass produce costly, custom products – and be the first to market with a new, affordable option.
Seizing on the opportunity that World War I created (i.e. a new market for prosthetic limbs), a couple of orthopedic surgeons recognized an opportunity to take over the prosthetic limb market by creating a “one size fits all” solution that they could sell to the government. The government was eager to avoid the costly mistakes of the Civil War (i.e. not having a plan for reintegrating young men into the work force), but couldn’t afford the prosthetist’s fee of $200 per custom prosthetic limb. The “E-Z leg” was born, and at a cost of only $20 per prosthesis, it seemed like a steal.
The E-Z leg solved a few problems for the government – 1) it allowed injured veterans to walk off the ships (instead of being carried on stretchers) that brought them home from Europe, thus minimizing the public appearance of the toll of war 2) it allowed them to offer cosmetically appealing prostheses, rather than peg legs, to amputees 3) it increased the vocational rehabilitation potential of veterans.
Of course, the “E-Z leg” didn’t have the best marketing ring to it, so it was rebranded the “liberty leg” and hailed as a triumph of modern technology. In reality, though, it wasn’t much of a functional improvement over a peg leg. In prosthetic design, a “one size fits all” approach ensures that no one gets a truly good custom fit. But psychologically, the veterans were pleased to have a cosmetically appealing limb, and most had no idea how much better a custom limb could be. The public was satisfied by the government’s generosity, not realizing that the government had actually budgeted $75/amputee at the beginning of the war. What happened to the $55 savings? We’ll never know.
One thing’s for sure, the orthopedist owners of E-Z leg made out like bandits. John Galsworthy became so disillusioned with his push for “sacred work” that he wrote, “Empty promises and rhetoric of heroism… The war killed the self-importance, faith and idealism in me.” He never spoke of vocational rehabilitation for war veterans again.
***
As I watched the NBC nightly news yesterday, I noted an interview with a young Marine recovering from bilateral leg amputations (caused by an IED explosion in Iraq) at Walter Reed. When asked if he was worried about walking again he simply replied, “I don’t worry about that. With the artificial legs they have these days, I’ll probably be better than ever.”
And I thought to myself, “the more things change, the more they stay the same.”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 14th, 2008 by Dr. Val Jones in Expert Interviews, Health Policy
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I had the chance to speak with John Rother, Executive Vice President of Policy and Strategy for the AARP about the intersection of online health, information technology (IT), and the baby boomer generation. Find out what America’s most powerful boomer organization thinks about the future of healthcare in this country.
*Listen to the podcast*
Dr. Val: Recent studies suggest that Americans age 50 and older are more Internet savvy than ever before. How are AARP members using the Internet to manage their health?
Rother: People over the age of 50 are the fastest growing set of online users, and healthcare is the major reason why they’re going online. They’re looking for health related news, help with diagnosis, and finding appropriate healthcare providers.
Dr. Val: What role can online community play in encouraging people to engage in healthy lifestyles that may prevent chronic disease?
Rother: Our experience is that online communities can be extremely helpful in several ways. First, it provides emotional support for people who have a shared experience, whether it’s as a caregiver, or being recently diagnosed with a disease or condition. Second, people seem to feel more comfortable asking questions of others with their condition than they do their own physicians. And third, online communities can reinforce needed behavior change. Whether it’s weight loss, exercise, or quitting smoking – online communities can be just as effective in encouraging behavior change as a face-to-face community.
Dr. Val: Tell me a little bit about the communities on the AARP website.
Rother: Currently our communities are organized around medical topics, but in the future I think the communities will become more geographical. An online community designed to serve the needs of people in a given location can facilitate information sharing about how to navigate a particular hospital system, for example, instead of just general information about coping with a disease or condition.
Dr. Val: Intel just announced that it has FDA approval for its “Intel Health Guide.” The unit enables caregivers to provide their patients with more-personalized care at home, while also empowering patients to take a more-active role in their own care. What do you think of this technology?
Rother: I think information technology is going to have all kinds of beneficial applications for people with health challenges. Personal health records and this Intel Health Guide are very well suited to the needs of individuals with chronic health conditions, and I expect to see more Internet based tools developed to help people to make appropriate decisions and change their behavior.
General information is helpful, but personalized information is the key. The more these technologies allow you to have your own individual information at your fingertips and allow that to be the basis for recommendations and decision support, the more powerful it’s going to be. This is all very promising technology – the next question is, can people afford it and will the people who need it be able to use it?
Dr. Val: In your opinion, what role does health IT have in reducing healthcare costs and improving access to care?
Rother: Health IT can support almost every aspect of healthcare. It can decrease costs by reducing duplication. Many people with chronic conditions see different doctors – and if you have to go through the same set of X-rays or CT scans every time you see a different doctor, that can get very expensive. A good, common medical record system is critical in reducing costs and improving care.
IT can also reduce the cost of health insurance, in the way that online car insurance has reduced car insurance premiums. If we reform our health insurance market, this could offer substantial savings to individuals.
People often use the Emergency Department inappropriately – for minor issues instead of true emergencies. A good decision support system that helps people to figure out when they need to go the ER could be helpful in reducing costs.
Dr. Val: What are the AARP’s major health-oriented initiatives?
Rother: The AARP is very focused on healthcare because our members tell us that it’s their top priority. The cost, quality, safety and accessibility of healthcare are important to us, so we are involved in a broad spectrum of initiatives.
First of all, extending coverage to all Americans, regardless of their age or health condition, is a top priority for the AARP. Second, In terms of health quality, it varies quite broadly among hospitals in the US. If we could get everyone to copy the best hospital practices, we’d have a much more manageable problem.
Dr. Val: What needs to happen to America’s healthcare system in order for it to serve the needs of baby boomers on its limited budget?
Rother: We spend almost 2.5 trillion dollars for healthcare in the United States, so I don’t think of it as a limited budget, but quite an expansive budget. There is enough money in the system to fully respond to the needs of the population. It’s just that we’re not organized very well and the system has become fragmented.
The healthcare system needs to be organized in a more person-centered way, and we need it to shift from a focus on acute care to a chronic care model. We need a different system of health delivery – one that relies more on nurses and other physician extenders. People need to join support groups to modify their behaviors and risk factors and rely on IT to help them make appropriate decisions.
So you put that all together and you have a pretty big agenda for change. I don’t know if we can achieve this all at once, or if it will occupy us for several years. The upcoming election gives us the opportunity to do this at the Federal level, though there are many private sector initiatives that are currently making important contributions.
Dr. Val: Can you give me an example of someone in the private sector who’s making an important contribution to improving healthcare?
Rother: The AARP just met with the leadership of the Mayo Clinic, one of the most outstanding medical institutions in the country. They provide excellent care at a cost that is less than most other parts of the healthcare system – and with improved outcomes. We asked them about their secret to success.
Mayo has an electronic medical record and all their patients have their information online. The physicians are on salary, so there’s no incentive to order unnecessary tests or procedures, and Mayo has an ethic of patient-centered care, with a long history of attracting the best people and rewarding them.
If Mayo can do it, why can’t everyone else? The AARP believes that the potential is there for most communities to have excellent care – we must emulate the care delivery of institutions like the Mayo Clinic, and put in place payment and information systems that will coordinate care management better. It’s a big job and will take some investment, but we have many opportunities to do a better job than we’re doing today.
*Listen to the podcast*
*Learn more about preventing chronic disease*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 11th, 2008 by Dr. Val Jones in News
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Intel just received FDA approval for their new in-home monitoring devices. The press release notes:
The Intel Health Guide enables caregivers to provide their patients with more personalized care at home, while also engaging and empowering patients to take a more active and positive role in their own care.
Intel said the interactive guide integrates vital sign collection, patient reminders, multimedia educational content and feedback and communications tools such as videoconferencing and e-mail. It can connect to specific models of wired and wireless medical devices, including blood pressure monitors, glucose meters, pulse oximeters, peak flow meters and weight scales.
Now this is a good idea – imagine how much pain and suffering we can alleviate by intervening in illnesses before they become acute? For example, when a patient with CHF begins to decompensate, physicians can intervene before the patient experiences severe shortness of breath and requires a hospital admission via the ER. What about catching a hyperglycemic episode early on? What about a hypertensive emergency that has no symptoms until very late in the game?
Avoiding the hospital can reduce exposure to infections, medical errors, insomnia, stress, and disorientation. Early intervention in disease keeps people out of the ER, and saves money and resources – while improving quality of life for the patients. The data gathering tools not only empower patients to be as independent as possible for as long as possible, but they empower physicians to care for their patients more effectively.
Unlike services that are aimed at replacing physicians, this one is designed to make them more efficient and effective. One day I imagine that a primary care physician will be able to keep an eye on her patients on one web page – with input from all the terminals combined into a dashboard. Alerts can be set at customized levels for different patients, and with a glance of an eye the physician will be able to see which patients may need help.
This is a brave new world of real-time health communication, and with technologies like this one, we may be able to bridge the gap between growing care needs and decreasing care resources while actually improving quality to boot.
Personal, affordable, telemedicine for the chronically ill. Bravo, Intel.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 3rd, 2008 by Dr. Val Jones in Expert Interviews
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If you or your friends or family have a disability, there’s no reason you can’t enjoy a vacation at Disney World. This post is a continuation of my interview with Bob Minnick, the Technical Director of Global Accessibility and Facility Safety at Walt Disney Parks and Resorts. He explained to me how Disney theme parks are committed to providing access to guests with disabilities. I’ve captured some highlights from our discussion here, and then summarized the services offered to guests with disabilities.
Dr. Val: Why is Disney so committed to universal access?
Minnick: Walt was all about guest service – he wanted the place to work for everybody, even guests who have unique needs. Our mantra is “guest service,” not “compliance.” We do things because it’s the right thing to do. For example, we were building wheelchair-accessible rides long before the ADA (Americans with Disabilities Act) became law. Also, we won’t patent a ride vehicle design because there are only so many ways to make rides accessible. If we invented a great idea and patented it, then nobody else could use it. Since we’re about creating access for everybody, we don’t mind if people use the idea or approach to improve the world we live in for people with disabilities.
Dr. Val: This must cost a lot – what’s the business case for it?
Minnick: I’m truly blessed to work for a company that “gets it.” We want to bring our guest service amenities to everybody. It’s the right thing to do, and it’s the Disney brand. For us, it’s worth the investment to give everyone the opportunity to experience the joy and magic of Disney parks. All the senses are stimulated at Disney – scents, sights, sounds, and touch and we want to enable as much of the sensory experience as we can for all our guests.
Dr. Val: Do any of your competitors go out of their way like you do to accommodate guests with disabilities?
Minnick: Many in the industry are doing a great job accommodating their Guests with disabilities. We have some unique services that many of them don’t offer. For example, the reason why we provide hearing and visual aids is that our rides are designed to tell a story. You can build an iron roller coaster to create a “motion” experience of being turned upside down and thrown about. But we tell a story with our rides and we want to bring that story to life for everybody.
Services for Guests with hearing disabilities
Sign language interpretation is provided at many shows, 2 days a week at all of the parks (except Animal Kingdom).
Assistive listening service (ALS): amplified audio and captioning technologies are bundled into a Blackberry-sized device that is free of charge and may be carried throughout the parks.
Services for Guests with visual disabilities
Audio Description: Visually impaired individuals can listen to a description of what’s happening on stage or in the shows in between the audio narrations. It is also equipped with a GPS module so that as the guest walks around the park, it offers a way of finding information and tells you where you are.
Braille is available on most park maps. There are Braille guide books available as well.
Services for the Guests with mobility disabilities
Seated parade viewing – special roadside sections exist for guests in wheelchairs so that they get a clear view of Disney parades without other guests standing in front of them.
Zero grade entrance to pools. Gentle slopes (rather than stairs) lead in to all water attractions. This facilitates wheelchair entry and is safe for young children.
Aquatic wheelchairs are provided as needed.
Accessible golf carts are available. They are designed to allow the seated rider to be raised up to standing level so they can swing a club more easily.
Special design features of rides. Many rides are designed so you can’t tell if a guest is in a wheelchair (this normalizes the experience, especially for kids). A special “spur track” feature takes the coaster car offline so that the guests with disabilities can take as long as they need to get in. Then the car rejoins the next line of coasters and enters the ride stream. Toy Story Mania is an innovative ride that provides an optional, closed-captioning service with a shooting mechanism designed for people who can push a button but can’t pull a trigger.
Practice vehicles are available just outside the entrance to various rides. Guests can practice transfers, and getting in and out of the ride vehicle before getting on the actual ride. They can even have pictures taken in the model vehicle.
General Services
Guest Assistance Cards are available to customize services to the needs of individual guests. Customized cards include requests for shade while waiting to enter a ride, the ability for parents to use strollers in lieu of wheelchairs for young children with disabilities, a front row seat pass, a pass to enter attractions via special entrances, and a green light pass for the Make-A-Wish Foundation participants.
Alternate entrances are available for all attractions so that guests with special needs may be ushered in discretely as needed. This design feature is particularly useful for guests with cognitive disabilities who cannot tolerate waiting in lines.
Dietary accommodations are made by Disney chefs trained to prepare food to accommodate special dietary needs.
Make-A-Wish Foundation is a partner of Disney’s. Children with terminal illnesses whose last wish is to go to Disney World are offered special accommodations and service, free of charge.
Emergency medical services are available at all theme parks in case a guest has an immediate medical need. EMS staff arrive within minutes of any distress call.
Bob Minnick summarizes it this way: “Walt Disney World is a place where everybody gets to be a kid. It levels the playing field for children with disabilities – even 60 year olds wear Goofy hats. Everyone’s having fun and acting funny, so it really normalizes the experience for guests with disabilities – because no one stands out or feels different from others.”
*For more information, visit the Disney guests with disabilities website.*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
