Tuesday, January 24, 2006

Enabling the Paradigm Shift in Healthcare

Birthing a New Healthcare System

In order for an emerging paradigm in healthcare to overtake the currently established healthcare system, enabling technologies are required. What we see as our healthcare crisis is , at times, the painful birth of a radically different way of delivering healthcare. Throughout the internet discussion groups, websites and blogs and on out to the hallways, lounges and lecture halls of hospitals and clinics I hear the cry for a paradigm shift. Well, here's a newsflash; it's already here. We are experiencing it right now. What we are witnessing is the initial rollout of the long awaited paradigm shift everyone, ok maybe just some of us, have been demanding. The Digital Revolution enabled the Information Age , and now both are in the process of creating a Healthcare System the likes of which will alter our entire approach to medicine. When it is up and fully operational we will know it when we see it. As Thomas Kuhn, who coined the all too often quoted phrase "paradigm shift" said, it is "always better, not just different."

Artificial Intelligence and the Virtual Provider

The patient-physician relationship is the cornerstone of the current Healthcare System model and I believe will be a focal point of change for the emerging Healthcare System. Physicians have acted as gatekeepers to the Healthcare System for patients and as a cornerstone of that system have performed their role admirably over the years. Times are changing and with those changes we must ask ourselves, can this role be, in part or even completely fulfilled by an alternative source? I think we know the answer to that question already. The alternative source comes in the form of Nurse Practitioners (NP) and Physician Assistants (PA) that are already at work in places like Minute-Clinic. In time Artificial Intelligence (AI) with highly developed algorithms embedded in their software will assume these roles as well. I think people will be initially attracted by the convenience, low-cost and accessibility to the services provided by AI. Over time as these technologies prove themselves with patient satisfaction as well as improved outcomes society will demand that they be incorporated into the more complex levels of the emerging Healthcare System. I don't' think people will be interacting with a laptop or even a Hal 9000 but are more likely to engage a provider in a virtual reality setting. Patients will choose the type of provider they prefer based on their unique style. This will include things like age, sex, ethnicity, and personality. A virtual provider could even be some futuristic being from Star Wars like "Dr. Yoda" or if your mood prefers, try paging "Dr. Moe, Dr. Larry or Dr. Curly". Then again, I wouldn't recommend their ear exam. Nyuck, Nyuck, Nyuck.

Standardized Medical Record

Access, connectivity and storage of healthcare information will play a key role in the emerging paradigm of our Healthcare system. The current "Medical Records Department" approach to storing and communicating patient health information needs to go. Health records are slowly, and I might add painfully, transitioning to an electronic format. A standardized way to electronically exchange data will be an essential step. Hospitals and Clinics will no longer need to ask the same old questions for each visit. Standardizing the format of the electronic medical record and storing it at an off-site facility will make life easier for patients and providers. It will no longer be locked-up in the basement of St. Elsewhere's Medical Record Department; it is the patient's permanent record and is accessible from anywhere in the world. Think of the advantages of portability. The recent hurricane season taught us important lessons regarding the emergent need to move hundreds of thousands of people whose medical records are now permanently lost. Off-site storage and back-up of electronic medical records is becoming the answer to national disasters and patient portability.

National Health Information Network

Recent efforts to accomplish this in the form of Regional Health Information Organizations (RHIO's) have been slow to develop. There has been local resistance to this approach as hospitals and independent health networks are more interested in developing their own version of an Electronic Health Record (EHR) and do not have any outside incentive to share data. This will be changing in the near future as the Department of Health and Human Services recently awarded four contracts for the development of a prototype National Health Information Network (NHIN). Dr. David Brailer the National Coordinator for Health Information Technology said, "Eventually physicians and hospitals will buy electronic medical records software with the network connectivity tools embedded." Patients will provide access to their medical record at the point of care.

Will The Thought Police Patrol This Highway?

A single, unified and standardized system is where it is headed. It is reminiscent of what was done for the National Highway System. This started out as a grassroots effort which was developed by the state and local authorities. It eventually grew and prompted the Interstate Highway Act in 1956. By assuming the responsibility of the interstate highway system this allowed local governments to focus on other priorities. I know what your thinking, "Terry are you out of your mind? This is the beginning of Big Brother and Socialized Medicine." I don't think so. While I am hesitant to turn over that amount of data about the personal aspects of our health histories to the federal government some degree of involvement on the part of the feds is going to be needed to encourage the local health care entities to make our records electronically portable and secure. The National Highway System became critical for our economic, defense and transportation sectors and I think a National Health Information Network will play just as important a role in the healthcare sector. It will have its own share of problems but I believe it will move us forward. If this is truly a paradigm shift it will not only look different but more importantly it will be better. That is how we will know if is the real thing or not.

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