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.
Introduction and History of Modern Healthcare
in the US
Learning Objectives
• 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
2
Role of Technology in Healthcare Delivery:
Clinical Medicine
• The Electronic Health Record (EHR) has
significant advantages over paper records:
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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
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
• 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?
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
4
Role of Technology in Healthcare
Delivery: Clinical medicine
• 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!)
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
• Some concerns about Personal Health
Records (PHR)s
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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?
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
6
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
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: 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
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: 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
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Reminders and alerts
Checks for interactions between drugs
Reviews orders
Scans for inconsistencies
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: 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
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: 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
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Ultrasound
Magnetic Resonance Imaging (MRIs)
Positron Emission Tomography (PET scans)
Radionuclide imaging techniques
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: 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
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Audio books and text-to-speech
Voice recognition software
Prosthetics
Wheelchairs and ambulatory devices
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: 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
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
Introduction and History of Modern
Healthcare in the US
Summary – Lecture d
• 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
14
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
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
References – Lecture d
References
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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.
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Bar Code Label for Human Drug Products and Biological Products; Final Rule. (2004). In Federal Register (69 ed.,
Vol. 38, pp. 9119-9171).
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Bates, D. W., Gawande, A. A., & Gill (2003). : Improving safety with information technology. New England Journal
of Medicine, 348, 2526-2534.
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Coleman, V. (1984). Why patients should keep their own records. Journal of Medical Ethics, 10, 27-28.
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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.
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Powsner, S. M., Wyatt, J. C., & Writght, P. (1998). Opportunities for and challenges of computerization. The
Lancet, 352, 1617-1622.
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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.
•
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), 327334. Retrieved from http://www.rehab.research.va.gov/jour/01/38/3/pdf/smith.pdf.
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
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