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A Radical and "Disruptive Innovation" Reshaping Medical Care and Public Health for an "Outcomes-Oriented" Prevention Emphasis: Enabled by Available Information Technology (pdf)
 
Submitted By:
Bruce M. Brock, Ph.D., MPH
Sr. Research Scientist
Applied Research Services, LLC
Abstract:
Medical care today is unlikely to do “prevention”, and risk factor control successfully or cost-effectively. A radical innovation is required to reassign such responsibilities from medical care to Public Health’s doman, implementing “best prevention intervention practices” recommended by the CDC.
Transformation of the health and medical care system, is enabled by health IT and communitywide “shared” electronic medical records, to reduce preventable morbidity and mortality associated with risky health practices and the underutilization of clinical preventive services.
LHDs should be responsible for providing case management and follow-up services for adults and children to maximize optimal patient, family, and community-wide “health”.
Chronic Care at Home: Crumbs from the eHealth Table? (pdf)
Submitted By:
Deborah Randall, Esq.
Health Care and Aging Services Consulting
Abstract:
eHealth initiatives for remote monitoring of the chronically ill have failed to move forward with the rapidity predicted five years ago. This trend persists despite vast unmet need in the care of the chronically ill.
Disease management research is attempting to demonstrate improved outcomes and cost efficiencies to skeptical payers. This paper proposes collateral political and regulatory factors may be slowing eHealth: persistence of acute medical models in homecare; tightened payment for Medicare homecare, diminishing dollars for agencies’ hardware and software deployment; Congressional focus on rural health funding; and concern about medical equipment fraud, and mistrust of the homecare industry.
Solo Endocrinologist's six-year experience running an "Electronic Medical Office" (pdf)
Submitted By:
Arvind R. Cavale, MD, FACE, FACP
Arvind R. Cavale, MD, LLC
Abstract:
This paper documents experiences of a solo Endocrinologist in implementing and progressively improving an “electronic medical
office”. The fact is that vast majority of community medical care is provided by small practices. Such practices are least likely to
implement IT due to an overwhelming number of forces working against them. Therefore, any initiative to expand use of IT in
healthcare must focus on getting such small practices involved in designing a process which will incentivize small practices to
implement technology successfully over the coming years. Some of eHI’s member organizations may need to reassess their
policies to further this effort.
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Comments: |
| Submitted by: Emily Welebob |
9/10/2008 11:46:51 AM |
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| After reading these three papers: 1) preventive health practices / health maintenance still requires focus, implementation,and clinical decision support; 2) public health depts need the clinical data to be the focal point for prevention; and 3) continue to struggle with interoperability in order to to reach #1 and #2 |
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| Submitted by: Bruce Brock |
9/14/2008 8:30:28 PM |
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| I would greatly appreciate any feedback concerning my paper, above (A Radical and "Disruptive Innovation" Reshaping...) whether positive or negative. I firmly believe that with the millions of dollars spent by the feds (e.g., AHRQ) and many states and foundations, we have amply demonstrated that there are a wide variety of solutions to "interoperability" across the broadest array of community health and medical care providers... (from my perspective best enabled by web-based "shared" electronic medical records). From my reading of federal funding priorities, the emphasis seems to have shifted from "can we connect"... “to what are the outcomes we can achieve with IT”. The issue I would love to see discussed is whether readers believe that medical care should give up its "prevention responsibilities" to public health, given IT can enable it to happen. When I think about the benefits primary care clinicians accrue by having their patients' risk factors reduced to the extent possible by public health, I would think there would be a huge positive change in the adoption of EMRs by clinicians, since they benefit from healthier patients (which should translate into measurable reductions in risk factor related morbidity and mortality within the community). Make sense? |
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| Submitted by: Arvind Cavale, MD |
9/20/2008 8:26:13 PM |
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Dr. Brock: Very thoughtful paper. A few comments:
1) It would be better to view the concept of "prevention" in its true perspective, i.e. prevention can be primary (disease prevention), secondary (complication prevention) and tertiary (co-morbidity prevention). Hence, restricting prevention to one dimension would be an underutilisation of available resources and would miss a large portion of the population.
2) The concept of LHDs would only work in communities if there is no direct cost to users (patients).
3) Sharing of EMRs is an idea that will only happen if the cost is not transferred to the end-user of EMRs (physicians) and IT companies figure out a way to do it without finger-pointing.
Overall, great ideas. |
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| Submitted by: Michele M |
10/16/2008 12:59:35 PM |
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| Dr. Brock puts forward an elegantly simple solution and entirely plausible approach to a complex problem. We simply must figure out a way to make progress on the lifestyle and chronic disease management and prevention issues that drive costs in the health care system. Public health is uniquely positioned to take this role. With a mechanism for reimbursement for preventive followup services, this idea would get upstream to prevent premature morbidity and mortality in a way that our current system hasn't been able to achieve. |
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| Submitted by: A.Waller |
11/3/2008 1:24:33 PM |
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| Dr. Brock has long been a visionary about the potential offspring of the marriage/cohabitation of public health and medicine, as well as an incisively clear thinker regarding the problem solving necessary regarding these complex issues. |
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