A Win for HIT

BIT 5564 students (anonymized for privacy)

 

 Jun 28, 2012 1:51 PM 

We have been talking quite a bit about the upcoming (and now announced) ruling from the Supreme Court on the health care act, so I thought that I would change things up a little and post this interesting article that I found.

http://www.engadget.com/2012/06/28/first-synthetic-laryngotracheal-implants/
The article discusses the successful implanting of two "synthetic sections of larynx" that restored normal breathing and talking "straight after surgery".  With some of the difficulty in finding donors (and the horror stories posted for the medical errors thread we had a week or so ago) finding more alternatives for major organs would be a big win for HIT.  Besides, who wouldn't want to be the next Steve Austin (6 Million Dollar Man) :)

Two Myths about Healthcare

BIT 5564 Blog (Anonymized for privacy) Jun 25, 2012 5:34 PM Here are the 2 myths I continue to hear and completely disagree with: "Why should I be forced by the government to purchase health insurance when I don't want it or need it." My opinion - Everyone will get sick and die at some point and require healthcare. Unless they have a salary or wealth in the millions they will most likely not be able to afford it out of pocket. A single ER visit is in the $1000s even if you are only treated for a few hours and sent home. Due to the"The Emergency Medical and Treatment Labor Act (EMTLA)" anyone who has an illness cannot be turned away from a public hospital, so they should have health insurance "The government cannot force me to purchase anything". My opinion - I am quite certain a percentage of my paycheck is removed every pay period for both social security and medicare/medicaid that I have never opted in for and cannot opt-out of. (I am not against this) Healthcare is a global issue and a global solution is needed. I feel people need to stop feeding into the health insurance companies lobbying and expensive commercials against helping the common man.....

Re: 2 myths of healthcare law Jun 26, 2012 11:11 AM I have to agree with you. As America continues to debate on Obama's healthcare plan other countries around the world are already starting to provide medical insurance to all citizens. In the US 15% of citizens lack healthcare coverage and internationally the drive for healthcare for everyone is leaving the US behind. Mexico for example a decade ago only covered less than half of its population and with recently completing an eight year drive for universal coverage has dramatically increased life saving treatments for diseases such as leukemia and breast cancer. Sadly, today the US is among the richest nations who is not providing healthcare coverage to all citizens. More on this topic can be found in this article: Global push to guarantee health coverage leaves U.S. behind found at: http://articles.latimes.com/2012/may/12/nation/la-na-global-health-reform-20120512

Re: 2 myths of healthcare law The issue of "forcing someone" to purchase something needs to be in context. The government is not mandating that everyone buy a product or service. It is mandating something that it is very likely everyone will need. The case for it here can be made mainly because healthcare is not a natural market with conventional economic functions at play. For instance if a person wants to purchase a computer that is $1000 and comes to find out the price for that type of computer has risen to $3000 they are likely to not purchase it anymore. The 300% increase would be enough for the person to decide on another item.  Now suppose this is applied to a scenario where a son or daughter needs a medical procedure. If the family is ready to pay $1000 and the price is later changed to $3000 the family will likely pay for the critical procedure. The family would pay if it were $10,000 or more. The normal market forces do not apply to health care. Situations like this occur too frequently and the bills cripple the finances of unprotected families. These families are then burdened by debts and unable to consume other goods in the market as they would have been able to otherwise.  When considering consumption is the main economic driver for the US economy the affect of crippling debt is exacerbated. The truth is the US population already has a social medical welfare program, medicare. The mere fact that even examining taking this program away is politically detrimental goes to show how critical it is in out society. There is certainly room for improvements in terms of efficiencies and efficacy of its programs. That is where the focus should be and not whether people in a country of our means should be precluded from a right that many poorer countries do much better. Re: 2 myths of healthcare law  Jun 26, 2012 8:27 PM

I agree...it's amazing that this is even a debate in our country.  It saddens me because it's become so politicized that the true focus, ensuring that everyone who needs it has access to affordable healthcare, has been lost.  But if the choice is pay or perish, you hit the nail on the head - we will pay, no matter the costs.  And the individuals and corporations that profit from allowing the cost of healthcare and insurance to rise unchecked, can't seem to see past the dollars.

HIT and Diabetes

BIT 5564 Student (Anonymized for privacy) If you have diabetes, what's your main problem? It’s that you don't want to have to carry around a bulky glucose meter that is not only annoying but also a constant reminder that you are ill. Come to think of it, how sweet and easy it would be if your doctor had already received the information from a tiny device built into your cell phone, wallet, or undershirt? This kind of device could fundamentally change healthcare, you can't just hide vitals from your doctor—it's all there, recorded. The fact that Wearable computing facilitates a new form of human-computer interaction comprising a small body-worn computer (e.g. user-programmable device) that is always on and always ready and accessible is a special technological advancement toward healthcare. Surprisingly glucose sensor and bio sensor added to wearable computer will enable patients to gain real time information about their vital signs, glucose levels and other data bearing upon their health condition. Diabetic patients need to determine their blood sugar levels and manage their medication accordingly. Wearable computer is able to monitor diabetic patients’ health condition and glucose levels through the glucose sensor and biosensor. The design of this unique device is incredibly wonderful. Bio-Tex, a European firm developed bio-sensors for inclusion in wearable fabric or textile. These bio-sensors in a textile patch can analyze body fluids as small as tiny drop of sweat and provide an excellent assessment of someone’s health indicators. Bio-Tex probes using PH levels that are detected by a portable spectrometer device and that cause an indicator to change color. These PH sensors are used to monitor people with obesity and diabetes as well as athletes. Finally, new methods to monitor blood glucose levels are now available without the pain of finger poking to draw blood. With the new method, blood glucose levels are monitored using glucose sensing bio-implants and noninvasive technologies. In glucose sensing bio-implants, the sensor is embedded into the skin through a minor surgical implantation. There are several methods that usethese non-invasive technologies: urine glucose monitoring measuring the infra-red radiation emitted by the body, applying radio waves to the finger tips using ultra-sound and checking the thickness of fluids in tissue underneath the skin.

Web-based application for patient’s liability estimation in real time to deliver cost-savings

As Consumer directed health care (CDH) plan products continue to gain traction with employers, patient payment as a percentage of out-of-pocket expenses and providers' review will rise further. Health plans are strong proponents of transparency in pricing because of the belief that it is essential to engaging consumers in health decisions. Although providing an estimate on the cost of care before the care begins sound like a relatively easy task, providing real time, accurate patient liability information considering patients' insurance benefits, specific medical conditions and expected care is a lengthy and complex process. There is a need for a solution that not only provides accurate patient liability estimate but also information in real time using a web-based tool. This web-based tool will be a model used for estimating cost of care and member liability at the points of a service, from scheduling to check-out. The solution will generate patient liability estimates in real-time, based on payer specific details, care provider pricing and historical claims data. Let me give an example here. A patient is referred to the healthcare provider for acute abdominal pain experts and stays overnight for some blood work and other medical examination. During the 72 hours of stay, he is repeatedly surprised by visits from not only a gastroenterologist, but a neurologist, a cardiologist, and a psychiatrist. He also undergoes several tests including X-rays and an MRI. These surprises are nothing compared with his shock of receiving a bill of these services. Explanation of his liability of $15,000 after the fact does little to manage the patient’s shock. The need for patient liability calculation in real-time is clear here and urgent for patients and healthcare providers. Patients want to know upfront what charges they can reasonably expect to pay for a medical intervention. Providers also want to know how and when they will be paid. Re: Web-based application for patient’s liability estimation in real time to deliver cost-savings I can totally understand how having this done in real time would be beneficial. There was a time when I visited the doctor and payed $45 copayment per visit. Even after paying a total of $90 for 2 visits, I still got a bill in the mail for $100 which is calculated after the insurance. The doctor’s office said that I still had yet to meet my deductible. I thought this was a bit overkill considering that I was spending a total of $290…what was the point of the appointment anyway? It would have helped me to know exactly my liable price balance without any surprises. I am sure that people with an 80/20 PPO health benefits plan would love to know in real time what their expected costs are before leaving. If a web based tool is going to be considered, then it is important to confirm that the application is heavily tested. This pertains from an IT security standpoint and also from a confidentiality, integrity, availability standpoint. Having the patient data properly protected and costs calculated accurately is necessary for the goodwill and trust of the patient. This should also be applied to dental offices. There have been too many times in which I had to overpay for their “estimated” costs. Then weeks later, I receive my dental insurance benefits statement only to learn now that my dental office actually owes me money for overpayment...sometimes more than $100. It makes it hard to trust some practices because you don't know if this is a common mistake or them trying to milk your wallet. I look forward to an industry accepted application that will help mitigate this concern.

HIT and Celiac Disease

Adopted from BIT 5564 students' forum (anonymized for privacy) Celiac's is an auto-immune disorder that damages the intestinal villi when there is a negative cross-reaction with one of several gluten proteins. These gluten proteins can be found in products made from the common grains wheat, barley and rye. The damage caused to the intestinal villi impact the body's ability to absorb nutrients and can therefore lead to a wide range of potentially serious health concerns. One of the most surprising facts that I have found is the relative difficulty that exists in diagnosis. The wide range of symptoms and health impacts often lead to Celiac's being misdiagnosed or going unnoticed for long periods of time. Patients are often treated for Irritable Bowel Syndrome, Iron-Deficiency, and Chronic Functional Abdominal Pain before a Nurse Practitioner recommends that the tests for Celiac's be administered. A not so surprising fact is that the only known treatment of Celiac's is to avoid all gluten proteins in one's diet and it is a lifelong approach to treating the disease. Another surprising fact about the condition is the wealth of information that is already available via smart-phone technology. There are at least three effective iphone apps that are currently used to help manage the condition (although admittedly the restaurant guide for Celiac's more than the others). Note that Celiac should not be mistaken with gluten (wheat) allergy. A common wheat allergy does not involve the immune system agents and damage the intestinal lining like Celiac's disease does. Wheat allergies are more akin to other allergies and can cause asthma, hives, hay fever, and sometimes more serious allergic reactions such as anaphylactic shock.

Effects of HIT on Healthcare Education

Technology is rapidly changing the way students learn. In a recent study it was found that the average college graduate spends less than 5,000 hours of their lives reading, but over 10,000 hours playing video games. Not only is HIT and technology in general shaping the future of businesses but it is also having a profound impact on the learning styles of future students. With this we are seeing a divide of people who have grown up with technology (Digital Natives) and those who are migrating into understanding technology (Digital Immigrants). This divide is forcing us to re-evaluate teaching strategies that Digital Immigrants have always known and come up with new innovative ways to better educate these Digital Natives.

The second interesting fact I found surprising was the amount of technologies that are becoming available for education on HIT and the funding that is available. Some of the technologies available are low/high fidelity, serious games, virtual reality, social media tools, and educational EHRs. However, with these tools come costs and many schools cannot afford to implement such systems for education. There is though many new grants that are becoming available such as HITs designed by the National League for Nursing (NLN) that offer funding for schools who have innovative ideas for successfully integrating such technologies into their programs.

Overall, healthcare education is not something that can be overlooked with the rapid evolution of HIT. With so many tools and new methods of funding available, a good first step to successfully improve patient safety, quality of care, and efficiency of healthcare is to effectively educate our future healthcare providers.
 

Re: Effects of HIT on Healthcare Education
Jun 20, 2012 12:15 AM

I must admit that I am one of those graduate students who plays a lot of video games. It is always appealing seeing just how far technology continues to push the limits towards reality. As funny as it sounds, it is quite therapeutic in getting me away from the stresses of life and late college nights. Now of course, I had to cut that habit down drastically in order to focus on my education.

As for learning styles, I believe that time will filter out what you consider the Digital Immigrants up to the point where the majority of Digitial Natives dominate. I do not think there need to be a re-evaluation of teaching strategies regarding technology. This is why having prerequisite courses are important. They help establish a foundation of technologies that are built upon through progress and advancement.

I think that healthcare education will become more popular with time, and our HIT course module is an example of such. One constant challenge with education (in general) is that there is so much funding (grants, scholarships, internships) available to support, but too many students are not aware that these options exist…and if so, then where? I think healthcare education should be considered, but I would suggest that course subjects such as organizational management or IT security become course prerequisites due to the overlap of some content.

Re: Effects of HIT on Healthcare Education
Jun 20, 2012 6:45 PM

I disagree. I think the point about the way Digital Immigrants learn vs Digital Natives is perfectly valid. In some fields such as IT, there may not be as much of a disconnect between those who grew up with it and those that didn't because both sets are continually adapting to new innovations as they come out. But in fields such as healthcare where many of the clinicians interact with IT changes on a less frequent basis, there is more likely to be a learning curve especially for those who didn't grow up with it. Age is not the only factor here though. Many older people have adopted strong IT skills to facilitate their hobbies. These people will gradually become more like Digital Natives. For educational purposes, I think it is important to look at the target audience based on both their background and use of technology in daily life to assess how they might learn best. Both sets can learn from the other's ways of doing things as well as innovative uses of teaching with IT.

Re: Effects of HIT on Healthcare Education
Jun 20, 2012 8:15 PM

I've heard some arguments over the past couple of years about Digital Natives and one of the things that bother me a little bit about it is a general assumption that people seem to take from it. Digital Natives grew up with technology, they've had phones, computers, internet, xBox, etc. their whole lives. They are integrated with technology. That means that they are better able to interact with technology and that they have a better understanding of it; therefore, we can assume that the technology itself is no barrier to Digital Natives.

I know that it is an over-simplification of that point but it seems to be what people talk about most with much relish. I disagree. Mostly with anecdotal evidence but reviewing some of the literature there are a number of people pushing back on the idea. The use of technology is more widespread but the understanding if it is less.

One of the common misconceptions that a large portion of students make is that what you see displayed on your monitor is exactly how another monitor will display it. If you go with them to Wal-Mart and look at LCD TV, most of them will be able to tell which has the best image on it and which is the worst (putting aside any issues of tweaking displays to sell the high end ones). So while they can easily see and explain how one LCD TV looks better than another, they can't extrapolate that information to a computer LCD monitor. Then they print out the images and the black colors aren't a true black. I ask the question, well did you make the color black (RGB: 0-0-0)? They have all learned about colors, they’ve had to mix paints to create images long before they learned to use Photoshop to design an image and their response is "well it looked black so I don’t understand why it didn’t print that way". It is a somewhat specialized thing and calibrating screens to colors, and printers to colors can be much more difficult, but the basic idea that colors are combined to create other colors doesn’t see to hold true in the digital world. I like to think of the following example (and I hope people can comment if it’s not correct).

Automobile natives. Let's take the average American. Most people in America were born after the advent of the automobile. Most of them have ridden in cars. Many have driven a car and have been licensed to do so. The history of the United States through the 20th century was greatly impacted by the car; Route 66, muscle cars, garages, drive-in's, and drive-thrus are all examples of how our culture adapted to the automobile. I'd say that everyone born in the United States today is an Automobile native. Now, that being said think about how we approach cars today. How many of us wash the car every weekend? It keeps the car clean and the paint in good shape and makes the finish last longer. How many of us actually change the oil every 3000 miles (or at whatever level they say) or every 3 months? How many of us change the oil ourselves? How about the filters? Belts? Brake pads? Spark plugs?

Now there are a lot of reasons in the development of cars such as computers and hybrids and so on but the fact remains that most people would rather take the car to the shop and have someone fix it and probably can't answer the month of the last oil change. It's not a bad thing and in many cases its best to let the professionals handle these things.

The point is that we don't have a deeper understanding of the automobile than previous generations because we were born with them. We have changed the way we teach about cars; no more shop class working on motors but I'd say it has less to do with the cars themselves than a shift in our culture and an increase in disposable income. The challenge with Digital Natives is to engage them in ways that will keep their interest with so many distractions but I dare say that that has always been the case.