1. Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture d This material (Comp1_Unit1d) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

2. Introduction and History of Modern Healthcare in the US Learning Objectives 2 Delineate key definitions in the healthcare domain (Lectures a, b, c, d) Explore components of healthcare delivery and healthcare systems (Lecture a) Define public health and review examples of improvements in public health (Lecture b) Discuss core values and paradigm shifts in US healthcare (Lecture c) Describe in overview terms, the technology used in the delivery and administration of healthcare (Lecture d) Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction to modern healthcare in the US Lecture d

3. Role of Technology in Healthcare Delivery: Clinical Medicine 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction to modern healthcare in the US Lecture d The Electronic Health Record (EHR) has significant advantages over paper records: –Remote access to patient data –Record is legible –Confidentiality is better handled than paper records –Improves patient safety –Integrated with other resources and data –Integrated with decision support and knowledge-base resources

4. Role of Technology in Healthcare Delivery: Clinical Medicine Some disadvantages of EHRs: –Cost of installation, maintenance and upgrading –Requires training and changes in clinical workflows –Lack of interoperability –Depersonalizes the doctor-patient relationship Advantages outweigh disadvantages? 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction to modern healthcare in the US Lecture d

5. Role of Technology in Healthcare Delivery: Clinical medicine 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction to modern healthcare in the US Lecture d Personal Health Records Patients keep their own records - idea has been around since the 1980s –One study gave patients their records to read when in the waiting room –Patients reacted positively –Older patients tended to avoid reading their notes –A few inaccuracies and unpleasant reactions but overall, not many problems Advantages –Tailored information –Cost (for patient and physician!)

6. Role of Technology in Healthcare Delivery: Clinical medicine Some concerns about Personal Health Records (PHR)s –Significant privacy concerns –Who owns the data? –Patient grants access – to whom? –Will physicians accept access to patient information on a “need to know” basis? –What does the patient do if their PHR is sold to a different entity, becomes insolvent, or ceases to exist? –Will PHRs be sponsored by advertising? 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction to modern healthcare in the US Lecture d

7. Role of Technology in Healthcare Delivery: Clinical Medicine Technology in the medical office Billing software Insurance claims processing Accounting Computer assisted surgery CAD/CAM technology in medicine 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction to modern healthcare in the US Lecture d

8. Role of Technology in Healthcare Delivery: Telemedicine Telemedicine – remote delivery of healthcare using telecommunications and teleconferencing equipment Very useful where interpretation of images / visual data is required Teleradiology Teledermatology Can link doctors and patients remotely Remote patient monitoring 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction to modern healthcare in the US Lecture d

9. Role of Technology in Healthcare Delivery: Pharmacy Safety improvement in drug dispensing – barcodes –Bar code systems can verify the patient, the medication, and the dosage –In 2006 the FDA mandated that hospitals use bar codes for administering medications Clinical decision support –Reminders and alerts –Checks for interactions between drugs –Reviews orders –Scans for inconsistencies 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction to modern healthcare in the US Lecture d

10. Role of Technology in Healthcare Delivery: Dentistry Electronic dental record –Similar advantages to the practice of dentistry as EMRs have to the practice of medicine Computer modeling and CAD/CAM Technology aids dental diagnosis, for example –Imaging –Use of electrical conductance properties to diagnose cavities 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction to modern healthcare in the US Lecture d

11. Role of Technology in Healthcare Delivery: Radiology Advances in imaging techniques have led to incremental degrees of sophistication –For example, X rays were first developed in 1895 –As technology advanced, this led to computerized tomography (CAT or CT scans)–a computer processes X-ray images and generates a 3-dimensional image Other technology driven radiologic imaging methods include Ultrasound Magnetic Resonance Imaging (MRIs) Positron Emission Tomography (PET scans) Radionuclide imaging techniques 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction to modern healthcare in the US Lecture d

12. Role of Technology in Healthcare Delivery: Rehabilitation Rehabilitation medicine: a branch of medicine which aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. Examples of assistive technology –Audio books and text-to-speech –Voice recognition software –Prosthetics –Wheelchairs and ambulatory devices 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction to modern healthcare in the US Lecture d

13. Role of Technology in Healthcare Delivery: Healthcare Education Expert systems help in developing diagnostic reasoning skills Online resources provide a readily available knowledge base that can be accessed on-demand Simulation technology helps in training 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction to modern healthcare in the US Lecture d

14. Introduction and History of Modern Healthcare in the US Summary – Lecture d 14 Many significant technological advancements in the delivery of medical care –Electronic Health Records –Personal Health Records –Other Areas Positive impacts include: –Accuracy, confidentiality, patient safety, more integrated care, broader access for care team and patient, patient education Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction to modern healthcare in the US Lecture d

15. Introduction and History of Modern Healthcare in the US Summary There are different types of healthcare and healthcare delivery Public Health has greatly impacted the control of infectious diseases and contributed to improvements in data collection, training and infrastructure Multi-level care and technological advances reflect the complexity of diseases and management There have been many significant paradigm shifts in the delivery of healthcare 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction to modern healthcare in the US Lecture d

16. Introduction and History of Modern Healthcare in the US References – Lecture d References Baldry, M., Fisher, B., Gillett, M., & Huet, V. (1986). Giving patients their own records in general practice: experience of patients and staff. BMJ, 292, 596-598. Bar Code Label for Human Drug Products and Biological Products; Final Rule. (2004). In Federal Register (69 ed., Vol. 38, pp. 9119-9171). Bates, D. W., Gawande, A. A., & Gill (2003). : Improving safety with information technology. New England Journal of Medicine, 348, 2526-2534. Coleman, V. (1984). Why patients should keep their own records. Journal of Medical Ethics, 10, 27-28. Jones, R., Pearson, J., McGregor, S., Gilmour, W. H., Atkinson, J. M., & Barrett, A., et. al. (1999). Randomized trial of personalized computer based information for cancer patients. BMJ, 319, 1241-1247. Powsner, S. M., Wyatt, J. C., & Writght, P. (1998). Opportunities for and challenges of computerization. The Lancet, 352, 1617-1622. Sittig, D. (2011). Data collection in private practice and implementation with electronic medical records. Retrieved December 6, 2011, from ClinfoWiki website: http://clinfowiki.org/wiki/index.php/Data_collection_in_private_practice_and_implementation_with_electronic_medi cal_records. http://clinfowiki.org/wiki/index.php/Data_collection_in_private_practice_and_implementation_with_electronic_medi cal_records Smith, D. G., & Burgess, E. M. (2001, May). The use of CAD/CAM technology in prosthetics and orthotics— Current clinical models and a view to the future. Journal of Rehabilitation Research and Development, 38(3), 327- 334. Retrieved from http://www.rehab.research.va.gov/jour/01/38/3/pdf/smith.pdf.http://www.rehab.research.va.gov/jour/01/38/3/pdf/smith.pdf 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction to modern healthcare in the US Lecture d