Guest Author: Student

I was asked, as a student of UW-La Crosse, to give my opinion on the current health care reform, and in particular, my opinion regarding the role of technology in health care. Since I am a sociology/ criminal justice major, I must admit that I do not know a ton about the health care reform bill- however, after reading the previous reform statements by the blog authors, I can tell you what I agree with and what I disagree with.

I definitely agree that there should be a huge push towards preventative care. I was amazed at the huge cost of a colonoscopy. My grandpa had colon cancer so my Dad just recently got his first colonoscopy, and from what I can imagine it does not sound like a pleasant procedure. Luckily, we had insurance to cover the cost. I am very thankful for that fact that we have insurance, but even more I am thankful that the technology is available to my family to have a colonoscopy. I know many people do not have this privilege.

However, I also agree that preventive medicine can sometimes go way too far. Because of this, I agree with the Technology Reform Proposal 1 that states that many physicians perform numerous expensive and unnecessary tests to basically cover their butt if they were to get sued later on down the road. I think that something definitely needs to be done about the high costs of premiums for malpractice insurance, and there should also be a limit as to how much one can sue for. I know from experience that when a family member dies, a way of coping with your sadness and grief can be blaming their death on somebody else. All too often, the blame is put on the physician in charge of the deceased person’s care. Something needs to be done to put the money hospitals have been wasting on malpractice insurance to good use.

After reading these blogs, there is one thing I would like to point out that has been only mentioned briefly. Even though I am all for spending money on technology that can provide better diagnosis, quicker cures, and a better efficiency- I think that overspending could happen very easily. I would say that many people would want the latest and greatest technological procedure done – even if it is not any more beneficial than a standard, inexpensive procedure. Therefore, I think an important part of the reform should be an analysis of each technological procedure to see if the benefits really outweigh the costs.

Overall- I think that as Americans we should be proud of the efforts that we have put into technology and continue to provide the best healthcare for the most people possible. I agree that we need to cut money somewhere- but technology is just not the place to do it in my eyes.

- Jacob Lucey

Guest Author: Health Care Patient

I agree that a universal paperless medical records system should be a key component to healthcare reform. The ability for a medical provider to quickly access your complete and detailed medical records could be critical to your health, and help reduce cost by limiting redundant testing.

At the age of 53 I have witnessed the progression of my personal medical records from a hard copy paper file, to a detailed paperless system currently used by my medical provider. During medical checkup visits as few as 8 years ago my Doctor would finger through a one-inch thick paper file to try to quickly get up to speed on my history. It was apparent that it was critical that I kept a mental track of my own medical history regarding previous medical conditions or treatments so you could bring the Doctor up to date. Since then the large medical group that I go to has developed their own paperless system that I believe has greatly help in my care.

I have diabetes, and with this chronic medical condition come frequent doctor visits, numerous lab tests and several changes in my medications. Now during my visits the Doctor pulls up my detailed medical records on their computer which summarizes my long medical history. The system shows my medications, previous treatments, and a history of my lab results. With a click he can drill down into the system and pull up detailed records from years ago. He pulls up graphs showing my blood sugar history to review the changes base on various medications, and makes adjustments to the medications. The system allows him to explain the treatments and affects from visit to visit. As I have visited other specialists within the same medical group my records followed me. The specialist Doctor starts my visit by pulling up my medical records electronically and has complete access to my history. I believe the tools provided in this medical records system has significantly improved my care.

Unfortunately this system is not universal, and not available to medical providers outside this specific medical group. With a uniform universal medical records system a provider anywhere across the country could access my records and provide care based on my history. With the continually increasing mobility of our society it becomes more important that our medical history can follow us.

A universal medical records system would obviously improve the quality of care for patients that travel or those that move frequently. However, a universal system would also provided savings by greatly limiting the redundant testing.

If you had to visit an emergency room in another state, quickly access your history would be a great advantage to the medical provider. Your medical history could allow the doctor to eliminate some of the lab tests or treatment procedures that he would normally need to perform for someone with an unknown history. The system would result in a better quality of care and a reduction in the cost of you treatment. Based on the number of emergency room and walk-in clinic visits the quality of care and savings in reduced testing would be a significant improvement to the current system.

For the poor and homeless in our country, who have had only limited access to medical treatment due to the costs or their transient life style, an accessible medical history could have a dramatic improvement on the quality of the little health care they do receive.

With all the various proposals for medical reform, I believe that a universal paperless medical records system would have a direct positive impact on the health care quality and costs. With the current and constantly improving technology the implementation of the system is possible at a relatively low cost, and would be easily paid for by the savings in the reduction in inappropriate or redundant testing.

Mark, Health Care Patient

Guest Author: Student

As a student, I am very aware of the money I spend on Health Care. I am in a situation where my parents own their own business, so they must buy private health insurance. Since the deductibles are so high, we usually only go to the doctor when absolutely necessary. However, when I do go to the doctor, technology is a huge part of deciding on the hospital I want to go do.

After reading the reform proposals, I am at an agreement with the authors of this blog. Technology is definitely something that deserves major funding. For example, I think having all health care records electronic is not only cost effective in the long run, but extremely efficient. I have spent way too much time at the doctor’s office filling out endless sheets of past medical history, most of which I don’t remember. I am actually more comfortable with all my information in a computer, rather than on a piece of paper floating around the doctor’s office. This may be a generation opinion since my generation tends to be more comfortable and trusting of technology versus the older population.

I also agree with the authors that preventative medicine should be pushed and rewarded. I spend a semester in Ireland, and though my experience I have realized that preventive medicine should be a priority for Americans. Technology plays a huge rule in preventative medicine. It offers the ability for early detection of heart disease, diabetes, cancer, and other life threatening diseases.

Like I said, I don’t go to the doctor much, but when I do, I expect the technology to be up to date and reliable. Just a few months ago, my sister had her first baby and she picked her hospital, out of all the hospitals in the Green Bay and Appleton area, primarily because it had a Neonatal Intensive Unit that could provide the best care for her baby. She wasn’t expecting any problems or a premature birth, but just having the technology available is extremely comforting. I know that if I or anyone in my family had a life threatening disease, I would make sure to go the hospital with the best technology to treat that disease, despite of the high costs. I know many people would do the same thing.

I will say that the health care system problem is complex. It is hard to find the perfect program, which might not even exist, but we should look for better solutions and try to implement them. I understand that the main objective for proposing a health care reform care propose is to cut down on costs, but I strong agree with the authors that technology is not an area where costs should be cut.

- Ross E.

Guest Author: Health Care Worker

As a healthcare provider, the topics discussed in this Technology Blog ring true for the most part. I would like to address a few key points posted on this blog. Without question, having an electronic medical record keeping system that is universal would be ideal for all of the reasons stated by the authors here. However, from recent experience in my own medical center, I have learned that the transition to an electronic system is not without its drawbacks. In May of 2009, my large facility made the transition to electronic medical record keeping. The cost of doing so is astronomical, estimated at 12 million dollars…and that’s just for the technology and support. The endless hours spent by healthcare providers to learn how to use the new system added substantially more. There was much frustration among the doctors and nurses who were trying to find ways to chart things, but it often times was like fitting a round peg in a square hole. Getting customized reports is a challenge as well, vs. the pre-configured reports the system is programmed to generate. Flexibility is the biggest drawback of electronic charting, along with the ability of older healthcare providers to manage the computer technology (vs. younger providers who were raised on technology). On the subject of scanning and treatment technology advances, the more the better! The problem is that our healthcare industry is profit-based…based on capitalism. Companies that conduct research and develop such technologies want to make money on their products, and don’t want to be told (by government) how much they are going to be paid for its use. This is the primary disconnect in trying to use technology to lower healthcare costs. The government’s wiliness to step in and mandate fee caps has been minimal, in fear of suppressing competition and development. Its much the same in the Pharmaceutical industry…people can’t afford medications because the drug companies want to make the most money they can on what they invent. On the subject of access, clearly, those without health insurance at all place a huge burden on society and the healthcare providers themselves. Medicare reimbursement rates are dismal in the Midwest, but the cost of healthcare is still pretty high. Universal healthcare is a bad word these days in many circles, but unless there is some sort of acceptable baseline healthcare for everyone, hospitals will continue to lay off workers or keep reducing the quality of the personnel/care provided to save money and survive. This is especially true in the “critical access” hospitals of the rural states…some only have 25 beds. This means they cannot purchase expensive, cutting edge technology to keep up with other institutions, or pay the salaries of top notch healthcare providers…so they go practice somewhere else. Finally, the blog’s point about tort reform is right on. Healthcare providers make mistakes…they are human, not machines. Lawsuits drive the practice of medicine, and are responsible for medically unjustified procedures and tests in every hospital in every state. People should be held responsible for their mistakes, but plaintiff/punitive awards are out of control. FEMA estimated the average value of a human life lost during Hurricane Katrina at roughly $5.7 million dollars. If FEMA can do it, so can others.

Technology Reform Proposal 2

Technology has the ability to both improve and provoke health care costs, quality and access in the reformed US health care system. The unnecessary use of technology can increase costs while patients receive the same quality and outcome of care as they would with the absence of the highly technical procedure. When technology can aid to improve quality and outcomes of medical procedures, it can be more cost effective in the long run. We have come up with some ideas on how we would like to see technology used appropriately in both aspects.

As mentioned in our first proposal, we feel that having a universal paperless system could be beneficial in many ways. According to chief medical officer Harry Greenspun, "The more data you have, the greater your ability to make better decisions." Most health care providers would agree that it would be beneficial for the provider to have a full medical history of the patient. With appropriate privacy regulations, a universal paperless system could be shared among health care providers across the US containing a complete health care background on patients. A thorough background could lead to higher quality treatment and also help reduce the need for unnecessary procedures. Providers could have access to past test results or scans, for example, and perhaps avoid re-running tests or re-assessing patients. This could also save time and make health care more efficient. This way, we can utilize technology with universal access to electronic health records as well as avoiding the use of unnecessary, repetitive technology such as expensive scans and lab tests.

According to HIMSS, the increased spending in healthcare over the years can directly correlate with the prevalence of chronic diseases like hypertension and diabetes. It is estimated that the 45% of Americans suffering from chronic diseases account for nearly 75% of health care spending and 70% of deaths. We believe that a health care reform should focus much more of its spending on preventative means for these chronic conditions and, in turn, less spending on the management of them. Technology can aid in the prevention process just as well as it has previously aided in the management process.

To help reduce health care spending on the management of chronic diseases, the government should increase investments in grants for the research and development of preventative health care. Currently, preventative care includes early detection procedures such as pap smears, mammograms and colonoscopies. The problem with our current preventative health care lies within the cost, quality and access of the procedures.

Due to the high costs of these procedures, many Americans, especially the uninsured, simply cannot afford a procedure for a condition they may or may not have. A colonoscopy, for example, can cost anywhere from $2,010 to $3,764. Even with insurance, there are many limitations to how and when one can receive preventative procedures. For example, most insurance companies will not cover the costs of a colonoscopy until a person reaches a certain age. With the technological development of more cost effective procedures, more people can utilize procedures and perhaps have better insurance coverage.
Many Americans do not utilize our current preventative procedures due to the quality of them. A colonoscopy is not a pleasant procedure. The evasiveness and risks alone would scare off even the insured from receiving, for some people, a life saving procedure. With the development of a higher quality, less evasive procedure that didn’t require anesthesia, more people would be willing to utilize certain preventative procedures.

Lastly, many Americans simply do not have access to preventative procedures. In order to receive a procedure such as a mammogram or colonoscopy, they have access to a primary care physician or clinic. However, the 46 million uninsured Americans are likely to be turned away at a primary care clinic due to inability to pay and therefore do not have access to most preventative procedures. They usually do not receive any health care unless their condition is bad enough to send them to the emergency room where doctors are obligated to give them care, which defeats the purpose of preventative health care all together.

We believe that with the development of cost efficient preventative procedures as well as universal access to them, chronic diseases could be greatly prevented and health care costs much reduced. With appropriate government grants, research and development of new procedures can aid in the reform of our health care system by focusing on preventative cares rather than management cares.

- Leigh Manske

References:

1. Cervical Cancer: Prevention and Early Detection. American Cancer Society. 2009.
http://www.cancer.org/docroot/CRI/content/CRI_2_6x_cervical_cancer_prevention_and_early_detection_8.asp?sitearea=PED


2. Colonoscopy Cost. Costhelper. 2010. http://www.costhelper.com/cost/health/colonoscopy.html


3. Sternstein, Aliya. Technology and the Business of Government. Next Gov. 2009. http://www.nextgov.com/nextgov/ng_20090803_8322.php


4. HIMSS. Enabling Healthcare Reform Using Information Technology. Arlington, Virginia. December, 2008. www.himss.org/2009calltoaction/HIMSSCallToActionDec2008.pdf


5. Shi, Leiyu, and Douglas A. Singh. Delivering Health Care in America A Systems Approach. Sudbury: Jones and Bartlett, 2007. Print.

Technology Reform Proposal 1

Health Care Reform Proposal 1
We believe that the impact technology has on the quality of medical care received by Americans is significant enough for Congress to consider while passing new legislation. Technology provides new procedures that provide better diagnosis, quicker cures, and an overall increase in efficiency and precision in the medical field. This new legislation should provide the right amount of emphasis on the importance of technology within the field of medicine. We believe that if Congress does this successfully, the quality of care will continue to increase, costs of care will decrease, and accessing medical care information will become more efficient between providers. Our first proposal suggests that Congress pass new legislation that reforms the malpractice system and implements electronic records for all health care settings.
It is fair to say that most health care providers go through their work day thinking about how to protect themselves from lawsuits. To avoid such situations, providers practice defensive medicine. One example of defensive medicine that pertains to our topic of technology is the overuse of unnecessary diagnostic tests. Performing tests such as MRI’s, CT scans, and PET scans are just a few examples of some technological procedures that could have been otherwise avoided in some diagnostic cases. However, because the provider was afraid of a malpractice lawsuit, the tests were ordered anyways and the costs of care just increased significantly.
In the case of defensive medicine, technology has the ability to hurt the cost and quality of health care. We believe that to turn this situation around, Congress should lower the cost of premiums for malpractice insurance and put strict caps on the cost of damages received by patients, so the amount of damage actually done is compensated for appropriately. According to the Wall Street Journal, if defensive medicine was eliminated, the United States could save 200 billion in health care costs annually. This money saved could help instead of hurt the health care system by using it for useful clinical trials and medical research.
The second part of our proposal is for Congress to implement paperless medical records. The Healthcare Information and Management Systems Society (HIMSS) defines health information technology as “ the use of computers and computer programs to store, protect, retrieve, and transfer clinical, administrative, and financial information electronically within and between health care providers.” We believe that electronic records will improve the overall efficiency and effectiveness of our health care system. We also believe that it will provide more privacy and safety with patient’s health care records. To achieve this, Congress must pass legislation that allows the Office of the National Coordinator for Health Information Technology (ONC) to coordinate health information technology programs across the United States. So far, ONC has not had the proper authority to coordinate such activities because it has not yet been codified into law. However, if passed into legislation, using electronic medical records could save the United Sates $81 billion each year.
Another important issue we propose Congress address is electronic processing of payments and claims. According to the HIMSS, 60% of all claims payments are paper-based and the health care system consumes more than 15% of its total expenditures on processing payments. Also, it costs approximately eight dollars per item for paper-based claims and this high cost of transmitting paper-based claims could easily be exempt through a revised legislation. If we increase the rate of electronic payment of claims to 90%, the United States could save around six billion dollars.
Overall, this health reform proposal aims at decreasing the two trillion dollars spent on health care last year by using the benefits of technology, and using them wisely. Congress can achieve this by implementing a reform on the malpractice system and give the ONC the authority to coordinate electronic health care records and payment systems. According to the Wall Street Journal, 83% of Americans agree with our proposed plan that Congress needs to change the medical malpractice system. A compromise needs to be made within the system of our government to reform malpractice in a way that will help, not hurt, the health care quality and costs of Americans. Lastly, putting into practice an electronic medical records and payment system will not only make it easier for employers to handle, but it will be more efficient and decrease the costs of health care.

-Andrea Hartley

References:

1. Shi, Leiyu, and Douglas A. Singh. Delivering Health Care in America A Systems Approach. Sudbury: Jones and Bartlett, 2007. Print.

2. Howard K., Philip. Why Medical Practice is Off Limits. Wall Street Journal, October 15, 2009. http://online.wsj.com/article/SB10001424052970204488304574432853190155972.html?mod=googlenews_wsj

3. HIMSS. Enabling Healthcare Reform Using Information Technology. Arlington, Virginia. December, 2008. www.himss.org/2009calltoaction/HIMSSCallToActionDec2008.pdf

4. Medpac. Report to the Congress: New Approaches in Medicare. Information Technology in Health Care. June, 2004. http://www.medpac.gov/publications%5Ccongressional_reports%5CJune04_ch7.pdf

5. Kaiser. CBO: Medical Malpractice Reform Would Save $54 Billion Over 10 Years. Kaiser Health News. October, 2009. http://www.kaiserhealthnews.org/Daily-Reports/2009/October/09/Tort-Reform.aspx

History and Overview

Imagine you are a soldier in the 16^th century. While on the battlefield, you are shot in the leg and carried to a wooden bench. Your surgeon has the same educational background as your barber, and he is attempting to remove the bullet from your leg. The pain is unbearable and there are no anesthetics available, so the nurse offers you some whiskey to drown the pain. The surgeon pours boiling water over your wound in an effort to remove any infection, unaware that this process does more harm than good. After a few unsuccessful tries to remove the bullet, he decides amputation is the only option, and in a few gruesome minuets later your right leg is completely gone.

Now imagine you are solider in Iraq in 2010 with the same gunshot injury. You are carried to a chemical and biologic protective shelter and immediately given anesthesia. Your trained and licensed doctor takes a radiograph of your leg to see where the bullet is, and it is quickly and painlessly removed using a bacteria-free technique. Because of the technology that was available to you, in just a few months you are walking again.¹

The growth of medical advancements in the last couple hundred years is astounding. Mostly because of new technological advancements, the life expectancy in America has grown from 41 in 1900 to 77 in 2010.² This had been made possible by improvements in drugs that can stabilize chronic conditions, vaccines that can eliminate potential epidemics, and machines that can provide doctors with valuable information on how to cure a disease. We feel that when it comes to health care reform, advancements in health care technology should not be compromised in order to reduce health care costs.

Improvements in health care technology definitely do come with a large cost. According to Delivering Healthcare in America: A Systems Approach, technological innovations are the leading cause of medical cost inflation in the 2^nd half of the 20^th century.³ In 20 years, the total cost of our nation’s medical care has increased from less than $50 billion to over $500 billion.⁴ Much of this cost increase is due to advancements in technology. When new technology is implemented in a hospital, many costs come along with this including trained professionals, new facilities, and an increased demand from both consumer and providers to use the technology.

We feel that instead of concentrating only on the huge price tag that comes along with new technology, one must also consider the value of medical advancements. The impact on quality of care that comes along with a better diagnosis, faster cures, and preventative care is astounding.⁵ Many American’s agree with us that the quality of care received because of advancements in technology is worth the cost. According to a random telephone pole, 63 percent of Americans agreed that they are willing to pay a modest tax increase in order to fund medical research.³

Although technology has opened many doors in the medical field, millions of people do not have access to the improved quality of care. This may be because they live in a geographically remote area or simply because they lack health insurance.³ According to an article written at Santa Clare University, over 37 million Americans, including 12 million children, do not have any health insurance at all and therefore are at a disadvantage to take advantage of technological advancements that could improve the quality or even save their life.⁴ This article brings up a lot of examples of the ethical dilemmas that come along with the fact that not all Americans have access to health care.

Certainly, high-tech health care is an inflator of health care costs. At the same time, we feel that providers can make investment decisions based on their community’s best interest by using technology appropriately. The quality of health care that is possible because of technological growths is something that should be of value to all Americans, and going along with this we want to ensure that all American’s have access to any technology that will improve their quality of life. When considering options for health care reform, it is essential that enough money is allocated to cover technology in the medical field.

Works Cited

1. 1. Peoples, George. The New England Journal of Medicine. “Caring for the Wounded in Iraq.” 2004.

http://content.nejm.org/cgi/content/full/351/24/2476

2.2 2. Life Expectancy. World Bank, World Development Indicators, 2010. http://www.google.com/publicdata?ds=wbwdi&met=sp_dyn_le00_in&idim=country:USA&dl=en&hl=en&q=life+expectancy+trends

3. 3. Shi, Leiyu, and Douglas A. Singh. Delivering Health Care in America A Systems Approach. Sudbury: Jones and Bartlett, 2007. Print.

4. 4. Unhealthy Delimas. The Markkula Center for Applied Ethics. 2008.

5. 5. Frank, Ryan. “Medical Technology and 5 Significant Advancements.” http://www.goarticles.com/cgi-bin/showa.cgi?C=1717059