The May general meeting was heavily publicized and well attended—it generated DACS’s highest attendance in several years. It was designed to promote John Patrick’s important new book, Health Attitude: Unraveling and Solving the Complexities of Healthcare. John received a doctorate in healthcare administration last year. One thing the book tries to explain is how the Internet and mobile devices are going to change healthcare in the United States.
John started the meeting with an overview of the health care system in this country. A big problem is cost. Factoring into this is fraud—payer systems that are being billed for procedures not performed. Doctors may order unnecessary tests and procedures, although sometimes this is due to the risk of being sued. Costs are twice as high in the U.S. compared to other developed countries, indicating inefficiency in our system. “Big Pharma,” the nickname for the vast pharmaceutical industry and its lobbying group, charges prices in this country way beyond what they charge in other countries, and it’s illegal to buy drugs from overseas.
John offered solutions in three areas, which are covered in more detail in his book. The first is that a change in attitude is required. Patients need to take more responsibility and ask questions about their medications and procedures that are ordered. Of course they have a role in developing healthful habits, to prevent problems from developing in the first place. Attitudes of physicians are already changing, but the system needs to change so that it compensates for wellness and not just sickness. Payers need to provide motivations for cost savings. Politicians’ attitudes need to change as well, but John admitted he didn’t have time to go into that area.
Technology is a key area that will help change the healthcare system. The Cray supercomputer developed in the 1970s filled a large room and cost $5,000,000, but smartphones today are 150 times more powerful. The motion coprocessor on recent iPhones can constantly monitor your steps, position, and posture, and the Health app in iOS 8 on your iPhone has 900 apps that feed information to it. Attachments to a smartphone camera can analyze a blood test strip for cholesterol. Electronic health records (EHRs) can be tied into the Health app and monitor, for example, heart irregularities, potentially alerting a physician. A CellScope is an iPhone otoscope that can take a picture and detect an infection in someone’s ear. Another sensor attachment can provide a 30-second EKG. The Isabel differential diagnostic tool can ask a few questions about symptoms and come up with some probable diagnoses, prior to coming in for a doctor’s visit. The new field of regenerative medicine is doing experiments where tissues can be 3D-printed from pluripotent stem cells and used to repair organs.
The last area is policy. Big data and analytics can look at population health. The accountable care organization (ACO) concept means payers pay based on population health, which breaks the old model.
After John’s introductory talk, the meeting moved on to a panel discussion moderated by Tom Zarecki, adjunct professor in the Communication and Media Arts department at Western Connecticut State University. The panelists were:
- Dawn Myles, APRN, Vice President , Quality and Patient Safety at Western Connecticut Health Network
- Aparna Oltikar, MD, Chairman of the Department of Medicine for Danbury and New Milford Hospitals
- Cary Passik, MD, Chief of Cardiothoracic Surgery at The Praxair Regional Heart and Vascular Center at Danbury Hospital
- John Patrick, DHA, President, Attitude LLC
Tom started off with a question, “How do you measure the quality of health care?”
Panelist answers were—
- the best possible outcome for a patient
- Did the patient get what they came for?
- longitudinal tracking of quality, across time—not just the initial outcome
- the quality of life for both patient and family. (John mentioned Atul Gawande’s book Being Mortal: Medicine and What Matters in the End.)
Dr. Oltikar explained her role as a hospitalist—a specialist who manages a patient’s inpatient care.
The panelists mentioned communication between doctors as a problem, and John mentioned ways to automate communication, e.g. using a tool as simple as e-mail. However, until we move to an accountable care model, physicians are not compensated for their time spent reading e-mails or making Skype calls. Dr. Passik mentioned the distraction of typing in patient notes into an EHR during a patient visit. John asked why we couldn’t capture voice recordings and have the system translate them so data is properly entered in the electronic health record. The discussion next veered into the problem of so many different systems being incompatible, sometimes requiring the entry of the same data multiple times.
John contrasted the health care systems in Europe with that in the United States. Doctors in Europe do not have to pay for the liability insurance that American doctors must have, and they don’t have the huge medical school debts to pay off that American doctors do. Administrative costs are lower overseas, but not because they have a single payer system. Germany has 200 payers. Canada with thirteen provinces has thirteen payers.
Other topics brought up by the panelists ranged from minimally invasive procedures, telemedicine (robots examining a patient, controlled remotely by a physician), and physician training that involves practicing procedures on patient simulators as well as practicing communication with patients. Hospitals are experimenting with hospitalizing patients in their own homes. Touching on policy, John mentioned the United States is the only developed country that doesn’t pay for health care for everyone. Dr. Passik mentioned that everyone wants access to health care, but no one wants to pay for it. Our taxes pay for police, fire, schools, and a military, so why not health services? Also what is the responsibility of people for their own health, with the health habits they choose?
The meeting concluded with a question and answer session with audience members who were either physicians or who shared their experience as patients. Some of the questions and topics were:
- Why is the U.S different from Europe?
- How patient care can transition from being focused on physician efficiency to being patient centered.
- Defensive medicine practiced to defend against possible lawsuits.
- The cost of drugs. It’s a felony to buy drugs more cheaply overseas and resell them.
- Direct to consumer—We’re the only country in the world that permits advertising drugs to consumers
The entire meeting was videotaped and it is expected to be broadcast on Charter cable systems, possibly Comcast, and made available online. Watch for future announcements on the DACS website.