$19.2 billion in Recovery Act funding has been designated to modernize the health care system by promoting and expanding the adoption of health information technology, but what is going to happen? Like it or not, all health professionals will be significantly impacted by the Health Information Technology for Economic and Clinical Health Act, or HITECH, and we will all have to change the way we work.
A carrot and stick approach has been taken with HITECH, with incentive payments for implementing electronic medical records (EMR) starting in 2011 averaging $44,000 per physician who achieves “meaningful use” of EMR’s, and reductions in patient payments from 2017 for those who don’t. It is not sufficient for EMR’s to be installed or available – they have to be in demonstrable routine “meaningful” use.
The Centers for Medicare and Medicaid Services has released a 555 page document that outlines the requirements for “meaningful use”. The proposal contains 25 measures for physicians and 23 measures for hospitals.
Let’s examine some of these.
At least 80% of all unique patients seen per provider must have demographics, an up-to-date problem list of current and active diagnoses and an active medication and allergy list recorded electronically, while clinical summaries must be provided to patients for at least 80% of office visits. Computerized Physician Order Entry must be used for at least 80% of all orders, the functionality for drug-drug, drug-allergy and drug-formulary checks must be implemented and at least 75% of all prescriptions written per provider are to be transmitted electronically.
The other measures, many of which require interoperability with other data systems for public health purposes, are detailed on the HITECH website.
It is evident that achieving “meaningful use” will significantly change the way much of American medicine is practiced. Dr David Blumenthal, National Coordinator for Health IT, has agreed that the proposed rules aim to “stretch” the health care community, but not “break” it. This is an exciting opportunity to radically improve patient care, underpinned by informatics expertise, and is one that we should welcome and support.
A video version of this post is available on www.youtube.com and at www.ucdmc.ucdavis/informatics
Thursday, February 25, 2010
Monday, December 21, 2009
Can your doctor read your mind?
There is considerable research being undertaken on new ways of communicating. And I don't just mean communicating with each other as we talk, sing, shout or cry. I mean ways of communicating with other objects, such as cars, computers and other electronic devices. I also mean communicating with people who are in other parts of the world, and who we may or may not know. And I also mean communicating with animals, with people who are deaf and blind, or who are profoundly physically or mentally disabled.
We all know of many examples of our unconscious mind seemingly taking over and informing us of events occurring before they do actually happen - we call it "déjà vue." I will never forget my first memory of this. I was watching a soccer game on television, and I suddenly "knew" that a goal was about to be scored in a certain way, by a particular player, and within a couple of minutes exactly what I "knew" happened.
There are many other examples of the unconscious mind influencing us, our behavior, or our decisions over the ages, and books have been written, societies and religions formed and history influenced on multiple occasions by the strength of our unconscious and the many unconscious or inexplicable communications that occur in our world.
But how will the power of our unconscious mind be influential in healthcare? And will it be somehow linked with the research on communication that is occurring around the world at this time? Will it occur in tandem with research that is trying to define our moods, and which uses electrical currents through our bodies to predict, for instance, suicidal intent?
Let's move to a more mundane form of communication. This article was written with the aid of a voice recognition system. I spoke into a microphone and words appeared on the screen, mostly accurate, but needing some corrections. I also now write my patients notes using a similar system - straight into their electronic records, which I can also control with the voice system. So we are certainly starting to use voice control systems in everyday life, even if they are not yet perfect. But what is the natural extension of these sorts of activities, and how might they be used in the field of healthcare?
We all know that we can communicate just by looking at people. We also know that we can tell what another person is thinking, particularly if that person is very close or important to us. I know that I and my wife often realize that we are thinking the same thing at the same time - and much more frequently than should occur just by coincidence, or because we are in the same environment.
So will be able to eventually use these extra powers of communication with our doctors? Will it be possible for our doctors to literally "read" our minds - to download our thoughts straight into our electronic medical records? It is certainly possible for humans to use their minds to control other objects, without even needing to talk. A number of experiments have shown that our electrical brainwaves can be trained and used to control other objects, be they an artificial limb, or a computer joystick, and these experiments offer substantial hope to severely disabled people.
I think the answer is certainly "yes". But with a caveat. This will not occur soon. And we will have to have considerable ethical debates before any such programs are introduced into clinical practice. But it should be possible. After all, a doctors primary diagnostic skill is pattern recognition - we see simple, and often unusual patterns in massive amounts of data collected from patients, and equate these patterns with a diagnosis. So why should we not be able to extend this often unconscious skill in pattern recognition to include the power to "read" our patients more accurately. All doctors know certain colleagues who are frequently regarded as superior diagnosticians who already almost seem able to do this. So I suspect that in future, as we discover more about the interaction between the mind, the brain and the environment, that we will develop physical means of "mindreading". I wonder how that will affect the doctor-patient relationship?
Peter Yellowlees MD has recently published "Your health in the Information Age - how you and your doctor can use the Internet to work together" - available at most online bookstores.
We all know of many examples of our unconscious mind seemingly taking over and informing us of events occurring before they do actually happen - we call it "déjà vue." I will never forget my first memory of this. I was watching a soccer game on television, and I suddenly "knew" that a goal was about to be scored in a certain way, by a particular player, and within a couple of minutes exactly what I "knew" happened.
There are many other examples of the unconscious mind influencing us, our behavior, or our decisions over the ages, and books have been written, societies and religions formed and history influenced on multiple occasions by the strength of our unconscious and the many unconscious or inexplicable communications that occur in our world.
But how will the power of our unconscious mind be influential in healthcare? And will it be somehow linked with the research on communication that is occurring around the world at this time? Will it occur in tandem with research that is trying to define our moods, and which uses electrical currents through our bodies to predict, for instance, suicidal intent?
Let's move to a more mundane form of communication. This article was written with the aid of a voice recognition system. I spoke into a microphone and words appeared on the screen, mostly accurate, but needing some corrections. I also now write my patients notes using a similar system - straight into their electronic records, which I can also control with the voice system. So we are certainly starting to use voice control systems in everyday life, even if they are not yet perfect. But what is the natural extension of these sorts of activities, and how might they be used in the field of healthcare?
We all know that we can communicate just by looking at people. We also know that we can tell what another person is thinking, particularly if that person is very close or important to us. I know that I and my wife often realize that we are thinking the same thing at the same time - and much more frequently than should occur just by coincidence, or because we are in the same environment.
So will be able to eventually use these extra powers of communication with our doctors? Will it be possible for our doctors to literally "read" our minds - to download our thoughts straight into our electronic medical records? It is certainly possible for humans to use their minds to control other objects, without even needing to talk. A number of experiments have shown that our electrical brainwaves can be trained and used to control other objects, be they an artificial limb, or a computer joystick, and these experiments offer substantial hope to severely disabled people.
I think the answer is certainly "yes". But with a caveat. This will not occur soon. And we will have to have considerable ethical debates before any such programs are introduced into clinical practice. But it should be possible. After all, a doctors primary diagnostic skill is pattern recognition - we see simple, and often unusual patterns in massive amounts of data collected from patients, and equate these patterns with a diagnosis. So why should we not be able to extend this often unconscious skill in pattern recognition to include the power to "read" our patients more accurately. All doctors know certain colleagues who are frequently regarded as superior diagnosticians who already almost seem able to do this. So I suspect that in future, as we discover more about the interaction between the mind, the brain and the environment, that we will develop physical means of "mindreading". I wonder how that will affect the doctor-patient relationship?
Peter Yellowlees MD has recently published "Your health in the Information Age - how you and your doctor can use the Internet to work together" - available at most online bookstores.
Thursday, December 3, 2009
Guidelines for videoconferencing in mental health
I am very pleased that the guidelines on videoconferencing in mental health published by the American Telemedicine Association are finally available. A large number of people contributed to these guidelines, but the core writing group for them was myself, Jay Shore MD, Lisa Roberts PhD, with a lot of input from a number of others, including Barb Johnston, who had worked with me on an earlier version published by the California Telemedicine and eHealth Center, and Brian Grady MD, Eve-Lynn Nelson PhD and Kathleen Myers MD.
Writing guidelines is an exhaustive process. It is not the sort of thing an individual can do, and requires input from large numbers of people, especially people with different perspectives. Unfortunately in medicine, it is rare to find a single view on a clinical process, and this was as true for these guidelines as it is for the many other sets of guidelines available in other areas.
I know that all the authors are pleased with the result here - for several reasons. First of all the guidelines are relatively short, usable and practical. They do not have the failing of many other guidelines that are 50 pages or more long, or only apply to a very specific group of patients or settings. These guidelines are really generic, and can be used by any mental health provider with any type of patient. They also have a lot of overlap with non-mental health areas, and would be usable, for instance, by providers in primary care, geriatrics and many areas of internal medicine. They also apply to adults, children and the elderly, as well as to emergency and non-emergency situations. And they have information about clinical, educational and technical issues and approaches - all in just a few pages. They are designed to be downloaded and could easily be taped to videoconferencing machines so that they are easily available for use "stat" by any provider undertaking consultations using videoconferencing. So let's hope that that is how they are used, and that they are helpful. It would be good if a number of the American specialist colleges, such as the American Psychiatric Association, and the the American Psychological Association, could adopt these guidelines for their own use, rather than attempting to rewrite them completely. Let's see if that happens.
In the meantime, I strongly suggest that, if you are a provider of mental health services, that you download a copy and go through it, so that you can undertake telepsychiatry consultations in the best possible way. The guidelines are available at the American Telemedicine Association. http://www.atmeda.org
Writing guidelines is an exhaustive process. It is not the sort of thing an individual can do, and requires input from large numbers of people, especially people with different perspectives. Unfortunately in medicine, it is rare to find a single view on a clinical process, and this was as true for these guidelines as it is for the many other sets of guidelines available in other areas.
I know that all the authors are pleased with the result here - for several reasons. First of all the guidelines are relatively short, usable and practical. They do not have the failing of many other guidelines that are 50 pages or more long, or only apply to a very specific group of patients or settings. These guidelines are really generic, and can be used by any mental health provider with any type of patient. They also have a lot of overlap with non-mental health areas, and would be usable, for instance, by providers in primary care, geriatrics and many areas of internal medicine. They also apply to adults, children and the elderly, as well as to emergency and non-emergency situations. And they have information about clinical, educational and technical issues and approaches - all in just a few pages. They are designed to be downloaded and could easily be taped to videoconferencing machines so that they are easily available for use "stat" by any provider undertaking consultations using videoconferencing. So let's hope that that is how they are used, and that they are helpful. It would be good if a number of the American specialist colleges, such as the American Psychiatric Association, and the the American Psychological Association, could adopt these guidelines for their own use, rather than attempting to rewrite them completely. Let's see if that happens.
In the meantime, I strongly suggest that, if you are a provider of mental health services, that you download a copy and go through it, so that you can undertake telepsychiatry consultations in the best possible way. The guidelines are available at the American Telemedicine Association. http://www.atmeda.org
Monday, November 2, 2009
Health Informatics specialists are essential to reform and transform our health system
Much of the American health system is outdated, inefficient and excessively expensive. Many have written about what is wrong with our system, and how important is the process of health reform. But relatively little has been written about what is required to improve the care of all Americans, and how we are to arrive at comprehensive solutions that both disrupt our current system of care, and replace it with improved approaches. One thing we can be certain about is that any changes that we make will be dependent on our capacity to harness information technology, and to use computerized systems intelligently to reform and transform our patient care environments and processes.
Clayton Christensen, in a recent ground breaking book, has argued that disruptive innovation is now necessary in our health industry and that this consists of three elements. The first requirement is for sophisticated technologies to simplify healthcare processes, the second is for business models that deliver more affordable and patient focused solutions, and the third is a commercial and information infrastructure to act as a value-added network.
For this vision to be implemented at a practical level, his model requires strong leadership and the training of substantial numbers of health informatics and change implementation specialists to take up transformative roles within our healthcare system.
Let's look at how this model might work for the average American academic medical center currently trying to provide a full range of sophisticated medical services while using our antiquated and exponentially increasing fee-for-service cost model, and running a series of regional primary care clinics.
The first element is to implement sophisticated technologies to simplify healthcare processes. This includes a full electronic medical record, accessed by patients and clinical staff, available anytime anywhere, sharing data with competitors systems, fully available for research and clinical trials and including a sophisticated set of decision rules to assist all users. This academic center would have extensive telemedicine and internal and external communications systems, online platforms for all types of continuing education, and an active virtual community profile and social networking program. All of the technologies would be continuously improved and evaluated by a team of health informatics specialists, part of whose role is to train their colleagues and the next generation of change implementation specialists.
The second element is to transform the clinical and cost-approach taken by the medical center which will need to focus on specialized areas of internally acknowledged strength to become, as Christensen notes, a "solution shop" in its areas of strength, while no longer providing a full range of all types of medical and surgical services. This may mean dropping certain types of care completely, and negotiating for such specialist services to be delivered at another hospital instead. It may mean creating specialist community clinics with capitated payment models. It will certainly mean doing more of what it does well, and less of what it does not see as core clinical activities. It means taking on services that are already efficient and technologically supported, and adding value to these services through technological and clinical innovation. This second element requires both business and technological expertise.
The third element in the model is developing what Christensen calls "facilitated networks" which he defines as enterprises in which people exchange things with each other. This is where the academic center might decide to partner with previous competitors, promote pre-paid preventative health approaches, support health savings accounts linked to employer groups and encourage all patients to have personally controlled health records. All of these activities are underpinned by the need to have extensive expertise in health informatics - the discipline that is, above all others, required to transform American healthcare.
So the question is, can a modern academic medical center in the USA afford to be without a strong health informatics program as it moves forward in this era of health reform?
And the answer?
A resounding "No".
Peter Yellowlees MD has recently published "Your health in the Information Age - how you and your doctor can use the Internet to work together" - available at most online bookstores.
Clayton Christensen, in a recent ground breaking book, has argued that disruptive innovation is now necessary in our health industry and that this consists of three elements. The first requirement is for sophisticated technologies to simplify healthcare processes, the second is for business models that deliver more affordable and patient focused solutions, and the third is a commercial and information infrastructure to act as a value-added network.
For this vision to be implemented at a practical level, his model requires strong leadership and the training of substantial numbers of health informatics and change implementation specialists to take up transformative roles within our healthcare system.
Let's look at how this model might work for the average American academic medical center currently trying to provide a full range of sophisticated medical services while using our antiquated and exponentially increasing fee-for-service cost model, and running a series of regional primary care clinics.
The first element is to implement sophisticated technologies to simplify healthcare processes. This includes a full electronic medical record, accessed by patients and clinical staff, available anytime anywhere, sharing data with competitors systems, fully available for research and clinical trials and including a sophisticated set of decision rules to assist all users. This academic center would have extensive telemedicine and internal and external communications systems, online platforms for all types of continuing education, and an active virtual community profile and social networking program. All of the technologies would be continuously improved and evaluated by a team of health informatics specialists, part of whose role is to train their colleagues and the next generation of change implementation specialists.
The second element is to transform the clinical and cost-approach taken by the medical center which will need to focus on specialized areas of internally acknowledged strength to become, as Christensen notes, a "solution shop" in its areas of strength, while no longer providing a full range of all types of medical and surgical services. This may mean dropping certain types of care completely, and negotiating for such specialist services to be delivered at another hospital instead. It may mean creating specialist community clinics with capitated payment models. It will certainly mean doing more of what it does well, and less of what it does not see as core clinical activities. It means taking on services that are already efficient and technologically supported, and adding value to these services through technological and clinical innovation. This second element requires both business and technological expertise.
The third element in the model is developing what Christensen calls "facilitated networks" which he defines as enterprises in which people exchange things with each other. This is where the academic center might decide to partner with previous competitors, promote pre-paid preventative health approaches, support health savings accounts linked to employer groups and encourage all patients to have personally controlled health records. All of these activities are underpinned by the need to have extensive expertise in health informatics - the discipline that is, above all others, required to transform American healthcare.
So the question is, can a modern academic medical center in the USA afford to be without a strong health informatics program as it moves forward in this era of health reform?
And the answer?
A resounding "No".
Peter Yellowlees MD has recently published "Your health in the Information Age - how you and your doctor can use the Internet to work together" - available at most online bookstores.
Wednesday, October 28, 2009
A scary story - the public option?
Why is Congress so afraid of the public option? Why are politicians getting so worked up about a system that every other Western country already has, and which works so well in all of them? Why do they not want to extend Medicare, a widely supported and valuable system that even the most ardent republicans are now praising? Why are they afraid of a competitive system that will force insurance companies to be more honest and keep their premiums reasonable? Why do they want to seemingly continue with our current broken expensive inefficient health system?
Is the public option really that scary?
Of course not.
So let's look at this question? What are the reasons?
Doubtless some politicians have strong philosophical views that preclude them supporting the public option - that is fair enough, and at least they can tell their constituents without any health insurance in perfect honesty that they would like them to remain in the same uninsured state for the foreseeable future.
Others are clearly in the pockets of the insurance companies, and have listened to too many industry lobbyists giving positive presentations containing inaccurate data. They have taken contributions from the companies, and feel a sense of alignment as a consequence. They may even have some of these companies based in their states, allowing them the self-deception that they are helping retain jobs in their own states by opposing the public option.
But most of them are scared. They are scared of making decisions. They are scared of change. They are scared of losing their seats, and their power and influence. They are scared of upsetting their current position. They would prefer to retain the status quo, and are afraid of a different world.
We need to examine why this is the case. What will make them less scared. What will give them the courage to stand up and promote change, when it is so patently needed?
Members of Congress need to understand that if they can identify this fear, as fear of change, that they will be able to conquer it and move forward. Congress is well known as a slow moving place, where change happens at a glacial pace, so it is hardly surprising that our representatives are suddenly scared of the rapid pace of potential change, and are frightened.
And it is true that some of them have much to lose. They may be up for re-election and feel considerable pressure from advocacy groups and funders. But they have to make a decision. Do they stand up for themselves, and do something right? Do they make a vote to save lives? Do they try and help save the life of the many people currently dying needlessly in our wonderful land of plenty? Do they take the advice of 70% of doctors, like myself, who support the need for a public option to help keep the health system more honest?
Fear of change can be overcome. Remember that a life without change is often boring and monotonous. Think how much more fulfilled our Congressmen will feel for having done the "right thing" and voted to implement change, and a public option in healthcare. Change is essential in our lives. It opens up new vistas and opportunities. When you face change, and overcome it, you can then go on and face more changes in your life and successfully overcome them. And enjoy your life more.
Our politicians need to overcome their fear. The public option is not really a scary story. Change must be embraced. They need to do the right thing for themselves, for their constituents, and for their country. This way they will grow, and will become bigger and better people. For that is what happens when you embrace change and move on and overcome your fear.
Peter Yellowlees MD has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is available at www.InformationAgeHealth.com and most online bookstores.
Is the public option really that scary?
Of course not.
So let's look at this question? What are the reasons?
Doubtless some politicians have strong philosophical views that preclude them supporting the public option - that is fair enough, and at least they can tell their constituents without any health insurance in perfect honesty that they would like them to remain in the same uninsured state for the foreseeable future.
Others are clearly in the pockets of the insurance companies, and have listened to too many industry lobbyists giving positive presentations containing inaccurate data. They have taken contributions from the companies, and feel a sense of alignment as a consequence. They may even have some of these companies based in their states, allowing them the self-deception that they are helping retain jobs in their own states by opposing the public option.
But most of them are scared. They are scared of making decisions. They are scared of change. They are scared of losing their seats, and their power and influence. They are scared of upsetting their current position. They would prefer to retain the status quo, and are afraid of a different world.
We need to examine why this is the case. What will make them less scared. What will give them the courage to stand up and promote change, when it is so patently needed?
Members of Congress need to understand that if they can identify this fear, as fear of change, that they will be able to conquer it and move forward. Congress is well known as a slow moving place, where change happens at a glacial pace, so it is hardly surprising that our representatives are suddenly scared of the rapid pace of potential change, and are frightened.
And it is true that some of them have much to lose. They may be up for re-election and feel considerable pressure from advocacy groups and funders. But they have to make a decision. Do they stand up for themselves, and do something right? Do they make a vote to save lives? Do they try and help save the life of the many people currently dying needlessly in our wonderful land of plenty? Do they take the advice of 70% of doctors, like myself, who support the need for a public option to help keep the health system more honest?
Fear of change can be overcome. Remember that a life without change is often boring and monotonous. Think how much more fulfilled our Congressmen will feel for having done the "right thing" and voted to implement change, and a public option in healthcare. Change is essential in our lives. It opens up new vistas and opportunities. When you face change, and overcome it, you can then go on and face more changes in your life and successfully overcome them. And enjoy your life more.
Our politicians need to overcome their fear. The public option is not really a scary story. Change must be embraced. They need to do the right thing for themselves, for their constituents, and for their country. This way they will grow, and will become bigger and better people. For that is what happens when you embrace change and move on and overcome your fear.
Peter Yellowlees MD has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is available at www.InformationAgeHealth.com and most online bookstores.
Saturday, October 17, 2009
Questions for your doctor?
I had a rewarding experience last week when one of my patients asked me a range of excellent questions about their condition. I had just diagnosed them as having an anxiety disorder. This patient was clearly concerned about possible medication side effects, having had difficulties with these in the past, and wanted to know in detail about the type of psychotherapy that would be most likely to help them. I recommended that they read about the illness on the handouts that I printed out for them, and on a number of websites I suggested, before coming back to see me again to decide on a course of treatment. It was pleasing to have a good open discussion about their best therapeutic options, to not need to simply prescribe and undertake a treatment program immediately, and to be able to take the time for the patient to do their own research, and then come back and make a joint decision on the best therapy together. This is the way medicine, in non-emergency situations, should be practiced.
Unfortunately this is not the usual way that physicians practice, partly because it takes more time to communicate and arrive at a mutually agreed treatment plan, but also because most patients still do not really plan in advance what questions they should ask. This leads to doctors still having to second guess what patients want to know when they give them an opinion, and of course they therefore often omit telling patients key information of particular importance to that individual.
Most doctors like patients to ask appropriate relevant questions about their health condition. Two way information flow is a key component in any doctor-patient relationship. It is just as essential that patients ask questions of doctors about their diagnosis and treatment, as it is for doctors to ask patients questions to help them decide what tests are necessary, and what treatments are best.
Think about the last time you bought a major consumer item, such as a television, computer or an expensive piece of furniture, or even something cheaper, such as a cell phone or new clothing. What research did you do? Did you go online and compare all sorts of products? Did you go to various stores and compare prices, availability and replacement guarantees? How much time did you spend on your research before making your purchase?
What about when you last went to see your accountant or your lawyer? Did you think through what issues might come up beforehand and plan some possible questions? Did you think of several potential scenarios that might occur, and try and work out what your response would be to those?
Now compare this with the last time you went to see your doctor. Did you check out various different hospitals if you needed surgery? Did you read up on a variety of possible medications if you needed drug therapy? Did you confirm your diagnosis by reading about your disorder and all possible treatment modalities? Did your doctor tell you what he or she thought was wrong, and then offer information to help you make a decision on what to do next?
The Agency for Healthcare Research and Quality has been running an excellent public campaign called "Questions are the Answers". This campaign encourages patients to create their own list of questions whenever they visit the doctor, or need to have any sort of medical procedure. The campaign consists of both print and internet resources, as well as television advertisements. The Agency has created all sorts of lists of questions which I would encourage any patient to use, and has sorted them by a number of differing situations and encounters that commonly occur in the health field. Examples of some of the core questions are "What is this test for?", "How many times have you done this?", "Are there any alternatives to surgery?" and "How do you spell the name of that drug?" These may all sound like very simple questions but it is astonishing how often patients, when confronted with a potentially life changing or serious diagnosis, have very few questions at the time of the doctor's consultation. Of course people often think of questions afterwards, and will then hopefully read up on their condition and arrange another appointment to ask their doctor about these issues, but not all do, leading to people receiving all sorts of medications and surgeries for reasons that they simply do not understand.
So do help your doctor, and plan your questions as much in advance as much as you can. Most doctors will be appreciative of your questions, and will be happy to answer them so that your treatment can progress with your full understanding.
Peter Yellowlees MD has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is available at www.InformationAgeHealth.com and most online bookstores.
Unfortunately this is not the usual way that physicians practice, partly because it takes more time to communicate and arrive at a mutually agreed treatment plan, but also because most patients still do not really plan in advance what questions they should ask. This leads to doctors still having to second guess what patients want to know when they give them an opinion, and of course they therefore often omit telling patients key information of particular importance to that individual.
Most doctors like patients to ask appropriate relevant questions about their health condition. Two way information flow is a key component in any doctor-patient relationship. It is just as essential that patients ask questions of doctors about their diagnosis and treatment, as it is for doctors to ask patients questions to help them decide what tests are necessary, and what treatments are best.
Think about the last time you bought a major consumer item, such as a television, computer or an expensive piece of furniture, or even something cheaper, such as a cell phone or new clothing. What research did you do? Did you go online and compare all sorts of products? Did you go to various stores and compare prices, availability and replacement guarantees? How much time did you spend on your research before making your purchase?
What about when you last went to see your accountant or your lawyer? Did you think through what issues might come up beforehand and plan some possible questions? Did you think of several potential scenarios that might occur, and try and work out what your response would be to those?
Now compare this with the last time you went to see your doctor. Did you check out various different hospitals if you needed surgery? Did you read up on a variety of possible medications if you needed drug therapy? Did you confirm your diagnosis by reading about your disorder and all possible treatment modalities? Did your doctor tell you what he or she thought was wrong, and then offer information to help you make a decision on what to do next?
The Agency for Healthcare Research and Quality has been running an excellent public campaign called "Questions are the Answers". This campaign encourages patients to create their own list of questions whenever they visit the doctor, or need to have any sort of medical procedure. The campaign consists of both print and internet resources, as well as television advertisements. The Agency has created all sorts of lists of questions which I would encourage any patient to use, and has sorted them by a number of differing situations and encounters that commonly occur in the health field. Examples of some of the core questions are "What is this test for?", "How many times have you done this?", "Are there any alternatives to surgery?" and "How do you spell the name of that drug?" These may all sound like very simple questions but it is astonishing how often patients, when confronted with a potentially life changing or serious diagnosis, have very few questions at the time of the doctor's consultation. Of course people often think of questions afterwards, and will then hopefully read up on their condition and arrange another appointment to ask their doctor about these issues, but not all do, leading to people receiving all sorts of medications and surgeries for reasons that they simply do not understand.
So do help your doctor, and plan your questions as much in advance as much as you can. Most doctors will be appreciative of your questions, and will be happy to answer them so that your treatment can progress with your full understanding.
Peter Yellowlees MD has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is available at www.InformationAgeHealth.com and most online bookstores.
Tuesday, October 6, 2009
Jobs in health informatics are becoming plentiful
The way most doctors and health care professionals do their jobs has hardly changed over the past thirty to forty years. Contrast this with the enormous changes in, say, transport, manufacturing and telecommunications!
But hang on to your stethoscopes! Despite the fact that some doctors still have their heads buried firmly in the sand, the winds of change are blowing and most doctors are now using electronic communication technologies, if not enthusiastically, then at least regularly. The combination of technological change, the demands of business and the rise of consumerism are causing radical changes in the way healthcare is practiced around the world. Health Informatics experts are poised to revolutionize health practices by implementing the enormous changes needed in the health system, that have already occurred in other industries. These professionals typically have backgrounds in either healthcare, such as nurses and doctors, or information technology, and then receive cross-training so as to be able to work across both areas in the newly emerging electronic health systems of today and tomorrow.
The changes in healthcare will be the 21st century’s equivalent of the public health initiatives of sanitation and nutrition which revolutionized health care in the twentieth century. Integration of online technologies will see doctors and patients working together on electronic health records with patients having much more say in their treatments. The development of widely available broadband networks and video mail will bring electronic health into everyone’s home. Patients and doctors will work collaboratively on the internet as parters with the agreed mutual objective of health improvement.
Look at how fast the average adolescent can send messages on their phone – gone are the days when a telephone was just an audio device. The way we interact with communication systems is radically changing the way we behave and think in ways that are impossible to predict. And the computer literate children of today - the millenials and succeeding generations - will drive these changes. How many doctors want to interact with patients using instant messaging? Not many today, but the doctors of the millennial generation will probably think nothing of this approach. And these sorts of systems will be developed by experts who have been trained in health informatics, and who understand how to apply information technologies of all sorts to change and improve the way that we deliver patient care.
Knowledge has never been as important - and as accessible - as it is today.
Technology, and in particular, Internet technology, is transforming the academic medical landscape. A large number of institutions are moving to digital-only radiography and full electronic medical records. I no longer write any notes on paper – all my clinical work is electronically recorded. Residents now come to rounds armed with a vast array of reference information stored in hand-held personal digital assistants. The iPod is now a platform for lectures presented either as "podcasts" and “videocasts” and is also used as a mobile x-ray image viewer. Continuing medical education is increasingly available through the Internet. The digital revolution has greatly altered how academic health systems pursue education, research, and clinical care, and this is spreading through the rest of the health system.
The provision of clinical care is changing rapidly as health informatics technologies become increasingly used and accepted, with a move away from episodic care to concentrating on continuity of care, especially for patients with chronic disease who will create the greatest disease burden in the future. Care is gradually moving away from a focus on the service provider to that of the informed patient and from an individual approach to treatment to a team approach. Increasingly, less focus is placed on treating the illness and more is placed on wellness promotion and illness prevention: the model of the”Information Age care” first described by Dr Tom Ferguson MD. To move to this future of information age healthcare, the availability and use of information must be strengthened to facilitate changes in health service delivery, and a much greater focus must be placed on developing and refining the information technology infrastructure, and on training experts in health informatics who can create and develop the electronic clinical environments needed by both patients and doctors.
This is all occurring at a time of difficulty in our economy, but America is known for its capacity to thrive on challenges, and to rapidly change its industrial practices in the face of adversity. The health system needs large numbers of experts in health informatics, and training programs are being rapidly expanded. The University of California Davis Health Informatics graduate program, for instance, has doubled the number of Masters Health Informatics students in one year, and has enrolled 76 new students in a fully online Health Informatics certificate program within the last three months. The Obama Administration is putting billions of dollars into health informatics implementation and training with funds from the American Recovery and Reinvestment Act and increasing numbers of jobs in health informatics are already appearing. The jobs website, CareerBuilder has just marked health informatics as it's number one emerging industry job opportunity, and is highlighting a number of jobs in areas as diverse as telemedicine, nursing information officers, clinical information technology liaisons, programmers, analysts, data integration experts and health service managers.
So, as healthcare continues to change and become more electronically enabled, watch out for this whole new generation of professionals trained in Health Informatics, and how they will facilitate the changes in healthcare, and eventually contribute to improving the health of all of us.
Peter Yellowlees MD has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is available at www.InformationAgeHealth.com and most online bookstores.
But hang on to your stethoscopes! Despite the fact that some doctors still have their heads buried firmly in the sand, the winds of change are blowing and most doctors are now using electronic communication technologies, if not enthusiastically, then at least regularly. The combination of technological change, the demands of business and the rise of consumerism are causing radical changes in the way healthcare is practiced around the world. Health Informatics experts are poised to revolutionize health practices by implementing the enormous changes needed in the health system, that have already occurred in other industries. These professionals typically have backgrounds in either healthcare, such as nurses and doctors, or information technology, and then receive cross-training so as to be able to work across both areas in the newly emerging electronic health systems of today and tomorrow.
The changes in healthcare will be the 21st century’s equivalent of the public health initiatives of sanitation and nutrition which revolutionized health care in the twentieth century. Integration of online technologies will see doctors and patients working together on electronic health records with patients having much more say in their treatments. The development of widely available broadband networks and video mail will bring electronic health into everyone’s home. Patients and doctors will work collaboratively on the internet as parters with the agreed mutual objective of health improvement.
Look at how fast the average adolescent can send messages on their phone – gone are the days when a telephone was just an audio device. The way we interact with communication systems is radically changing the way we behave and think in ways that are impossible to predict. And the computer literate children of today - the millenials and succeeding generations - will drive these changes. How many doctors want to interact with patients using instant messaging? Not many today, but the doctors of the millennial generation will probably think nothing of this approach. And these sorts of systems will be developed by experts who have been trained in health informatics, and who understand how to apply information technologies of all sorts to change and improve the way that we deliver patient care.
Knowledge has never been as important - and as accessible - as it is today.
Technology, and in particular, Internet technology, is transforming the academic medical landscape. A large number of institutions are moving to digital-only radiography and full electronic medical records. I no longer write any notes on paper – all my clinical work is electronically recorded. Residents now come to rounds armed with a vast array of reference information stored in hand-held personal digital assistants. The iPod is now a platform for lectures presented either as "podcasts" and “videocasts” and is also used as a mobile x-ray image viewer. Continuing medical education is increasingly available through the Internet. The digital revolution has greatly altered how academic health systems pursue education, research, and clinical care, and this is spreading through the rest of the health system.
The provision of clinical care is changing rapidly as health informatics technologies become increasingly used and accepted, with a move away from episodic care to concentrating on continuity of care, especially for patients with chronic disease who will create the greatest disease burden in the future. Care is gradually moving away from a focus on the service provider to that of the informed patient and from an individual approach to treatment to a team approach. Increasingly, less focus is placed on treating the illness and more is placed on wellness promotion and illness prevention: the model of the”Information Age care” first described by Dr Tom Ferguson MD. To move to this future of information age healthcare, the availability and use of information must be strengthened to facilitate changes in health service delivery, and a much greater focus must be placed on developing and refining the information technology infrastructure, and on training experts in health informatics who can create and develop the electronic clinical environments needed by both patients and doctors.
This is all occurring at a time of difficulty in our economy, but America is known for its capacity to thrive on challenges, and to rapidly change its industrial practices in the face of adversity. The health system needs large numbers of experts in health informatics, and training programs are being rapidly expanded. The University of California Davis Health Informatics graduate program, for instance, has doubled the number of Masters Health Informatics students in one year, and has enrolled 76 new students in a fully online Health Informatics certificate program within the last three months. The Obama Administration is putting billions of dollars into health informatics implementation and training with funds from the American Recovery and Reinvestment Act and increasing numbers of jobs in health informatics are already appearing. The jobs website, CareerBuilder has just marked health informatics as it's number one emerging industry job opportunity, and is highlighting a number of jobs in areas as diverse as telemedicine, nursing information officers, clinical information technology liaisons, programmers, analysts, data integration experts and health service managers.
So, as healthcare continues to change and become more electronically enabled, watch out for this whole new generation of professionals trained in Health Informatics, and how they will facilitate the changes in healthcare, and eventually contribute to improving the health of all of us.
Peter Yellowlees MD has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is available at www.InformationAgeHealth.com and most online bookstores.
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