HSOP - Technology

Payment for services

A lack of checks and balances to determine the appropriateness of high-cost care The influence of patients in demanding technology (sometimes the bang for the buck isn't felt due to third party payers) Payment models that tend to curtail the use of high-tech procedures haven't been widely used in the US delivery system

Medical training and practice

A system that favors specialization and the use of technology Specialists utilize more health care technology in the care they provide Medical training provides unique opportunities and exposure to an array of specialties and advanced technology

Food and Drug Administration

Agency of the US Department of health and human services Responsible for ensuring that drugs and medical devices are safe and effective for their intended use Has authority to premarket review devices, which fall under three classes - class 1, 2 and 3

Cultural beliefs and values

Capitalism and resistance to government intervention promote innovation (minimal presence of supply side rationing, high investment in medical R&D) Americans have high expectations of major advances (e.g. finding cures) through science and technology Americans favor the most advanced technologies be made available regardless of cost (the "technological imperative")

Cost-effective technology

Cost effectiveness/cost efficiency are beyond the determination of efficacy and safety Technology is cost effective when the benefits exceed the costs How do you measure the cost? In a monetary figure? How do you add it up? in lives? what is the value of someone's life? Cost effectiveness is typically determined using economic models Not every technology provides substantial benefits

Why is the US a tech leader?

Cultural beliefs and values Medical training and practice Payment for services Competition

Role of Technology

Dramatic increase in life expectancy Costly to develop Can dramatically increase the cost of health care

EMRs

Electronic Medical Records The original term used Primarily considered as the digital version of a medical chart

Assessing technology

Evaluation of medical technology to determine efficacy, safety and cost effectiveness The objective of technology assessment is to establish the appropriateness of medical technology for widespread use

Technology and access to care

Geographic access can be improved New mobile equipment or communication technologies allow remote access to centralized equipment and specialized personnel Telemedicine allows for medical diagnosis and patient care when provider and patient are separated by distance

Big data and personalized medicine

Health care analytics: "the big data revolution"... unlocking population health management, detecting fraud and abuse, reaching predictive and prescriptive care As technology progresses, medicine will be more tailored to the genetic specifics of the individual patient... maximizing precision in individual treatments (e.g. cancer care); regulations, reimbursement, structures haven't kept pace

Health Information Technology

Includes clinical information systems, administrative information systems, decision support systems and internet/e-health

Technology and bioethics

New ethical questions and serious ethical dilemmas are raised as technological advances continue - gene mapping, cloning, stem ell research

PHRs

Personal health records Includes the same information as EHRs, but managed by the patient

Common EHR complaints

Poor usability Hard to navigate interfaces Difficult to learn/implement Poor interoperability Not ideal for sophisticated reporting Workarounds are common Poor support for workflow Decision support is clunky

Technology and quality of care

Quality is enhanced when new procedures can: Prevent or delay the onset of disease Provide a better diagnosis Make faster and more complete cures possible Increase the safety of medical treatment Minimize undesirable side effects Promote faster recoveries Increase life expectancy Increase quality of life

Technology and quality of life

Quality of life indicates a patient's overall satisfaction with life during and after medical treatment with medical technology, this could include the ability to improve quality of life during treatment (minimally invasive surgery that painlessly removes kidney stones) and after treatment (better outcomes and faster recovery time following an advanced surgical procedure)

Technology and safety

Safety considerations are designed to protect patients against unnecessary harm from the use of technology Primary benchmark: benefits must outweigh any negative consequences Efficacy and safety typically are evaluated in clinical trials

Technology and medical costs

Technology has contributed to rising health care costs (capital, labor, insurance and training costs) BUT technology has also reduced costs in some aspects (replacement of treatments with less expensive ones, reduced hospitalizations or LOS due to new therapies/improved outcomes, better and quicker diagnoses)

Competition

The "medical arms race" Attracting specialists and (insured) patients with high tech offerings (specialty hospitals, specialty units, etc.)

Impact of technology

The effects of medical technology are far reaching and pervasive It is difficult to pinpoint the impact of technology on the delivery of health care - new technology, new routines, potentially more errors... learning curve based on an individual's skills... new technology does not equal higher quality evaluate impact in terms of quality of care, quality of life, cost, access, bioethics

EHRs

Used interchangeably with EMRs as a term Intended to go beyond EMR functions and include more than clinical data Four basic components: -collection and storage of health information on individual patients -access to information for authorized users -knowledge and decision support to enhance quality, safety and efficiency of care -support the efficiency of other health care processes

Technology and efficacy

efficacy is the health benefit to be derived from technology or how effective technology is in diagnosing or treating a condition if a product or service actually produces some health benefits, it can be considered efficacious or effective

Meaningful use

focuses on effectively using certified EHR technology to improve care quality in meaningful ways Three key components- the use of a certified EHR in a meaningful manner, such as e-prescribing; the use of certified EHR technology for the electronic exchange of health information to improve the quality of health care; the use of certified EHR technology to submit clinical quality and other measures