A strong argument can be made that the health care field is one of the most information-intensive sectors in the U.S. economy and avoidance of the rapid advances in information technology is no longer an option. Consequently, the study of health care information technology and systems has become central to health care delivery effectiveness. This course covers the modern application of information technology that is critical to supporting the vision and operational knowledge of the health care leaders in managing the health care organization. Heath care decision-makers have to meet head-on the dynamic challenges of health care delivery quality, cost, access, and regulatory control. Additionally, this course integrates the Healthcare Information System as integral to the Quality Assurance Tracking Programs including measurement of systems inputs, processes, and outputs with special emphasis on systems outcomes research and organizational accountability to its various stakeholders, not the least of which are government regulators.
Module 1: Interview: Bruce Darrow with Wen Dombrowski (Part 2)
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En provenance du cours de Icahn School of Medicine at Mount Sinai
Health Care IT: Challenges and Opportunities
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À partir de la leçon
A Patient’s guide to the Doctors’ Secret World of technology
Rencontrer les enseignants
Bruce J Darrow, MD, PhDSENIOR VICE PRESIDENT MSHS IT | ASSOCIATE PROFESSOR of Cardiology & Population Health Science and Policy
Cardiology
Nicholas G Genes, MD, PhDASSOCIATE PROFESSOR | Emergency Medicine ASSOCIATE PROFESSOR | Genetics and Genomic Sciences
Emergency Medicine
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So, I love your example about the Lego's.
And knowing that you and this friend of yours, and the birthday and the Lego's.
And I'm interested if I can expand on that sort of example?
You work with many health care systems when they want to use technology
to improve their patient care.
When you work with them do you find that they want to know more about
their patients so that they can offer them Legos, metaphorically?
Or do they bring you in, because they need to drive their market share and
their profit sector?
>> That's a great question.
So it depends on the health care system.
So there are some organizations that are truly committed to patient-centered care.
And they're undergoing a lot of overspace models where basically,
instead of them getting paid for every test and every hospitalization,
these hospitals are getting paid one lump sum in a year.
And they're trying to do everything they can to try to improve the care
of the patients without spending too much money in the year.
Now in this scenario what happens is
that these organizations have to be very judicious about how they spend the money.
And usually the strategy is that they try to find, using data,
who are the sickest patience or the patience most likely to be become sick.
And then they reach out to them with different interventions.
And the best case- >> Those are the green Lego patients as
opposed to- >> I guess so, yes.
And- >> The purple Lego patients.
>> And I would say in a best case scenario,
the more sophisticated organizations, they're using they're data to find,
not just who didn't have their mammograms, or colonoscopies.
But really on a very micro-segmentation level, understand
which patients have cancer and kidney disease and are on a certain medication.
And perhaps it's a nurse that calls him or perhaps it's a text message or
email that reaches out.
And either asks follow-up questions or
gives him a specific piece of advice about what they specifically should be doing.
So it's an example of where people often say,
doesn't technology make care less human?
But I actually think technology gives us the ability to scale and
look at a large group of patients.
But gives us the ability to look at a large group of patients at once, but
then be able to drill down to the individual patient level, and
offer the individual patient what they need at the time they need it.
Another related example is instead of sending postcards to
every patient in your health care system, a postcard for their flu shot.
If you go and look at the database and
find out who hasn't got the flu shot and only contact these people.
And not just contact them, but if your system knew do they prefer phone call,
do they prefer text messaging, do they prefer email.
Do they prefer postcard or
do they prefer a gorilla suit coming knocking on their door?
Knowing this level of preference is what I am about, learning from
the marketing side of things, and really understanding how do you use data.
How do you collect data to understand what each individual's needs are and
how to best reach out to them in terms of what
their personality prefers in terms of outreach and communication interaction.
So now, you had also asked about a lot of hospitals they just want to try to
get market share, so I have seen that scenarios as well.
There are number of hospitals that are actually dabbling in the value base
care and the new payment models.
But at their core, their revenue is really focused on continuing what I would say
the status quo of medicine which is fee for service medicine.
And for those people who are not familiar with fee for service medicine, it's
basically when a hospital or doctor gets paid for every surgery that they've done.
For every hospitalization, for every possible patient that has come through,
for every test that they've run.
That is fee for service medicine.
And that's not always in the best interest of patients,
because if a patient only needed an EKG.
But then if a hospital or doctor said well,
I'm going to make a lot of money if I order an echo cardiogram, and
a cardiac cath, and a brain scan, and a full body scan.
Then that's money that the hospitals can be making, but
that's money that the patient and the insurance companies are losing.
And yes, the insurance companies are paying for a lot of the health care.
But at the end of the day, insurance premiums are ultimately paid for
by patients and consumers, either through their copays or
through the less pain they would otherwise get as an employee.
One of the things about this fee for
service approach that I'm very concerned about is there are a lot of health care
systems right now in the US that are using health care reform and the ACO trends.
Not actually to improve care, but
really to use it as legal protection to have market share monopolies
to try to cover a large geography, and grab a lot of patients.
And funnel these patients into their testing centers and their procedure
centers, but not necessarily improve the underlying patient experience and
the patient's journey.
>> Do you think that this is something where over the next five
years the payment models, the technology offering,
and what patients are asking for.
Are they going to converge at the same place, or
are they always going to be a little bit apart from each other?
>> So I think that the consumer demand is growing.
The consumer demand for better and easier care, more convenient care,
more accessible care, cheaper care.
That demand has already been growing in the last few years and
will continue to rapidly grow.
And that demand really opens up a lot of opportunities for
non-traditional health care providers to meet their needs.
Because it used to be if you got sick,
you would drive to the hospital down the street.
But nowadays if someone is sick and they don't feel like driving to the hospital,
can they get their care online through a video visit?
Or can they talk to a robot?
Or can they just call their best friend or go to a chatroom?
These are already existing options and alternatives for patients.
And I really think that as more and
more people are exposed to technology in their day to day life.
So not technology for health care, but technology that they're using at work,
at school, to manage their own family calendars.
As people get more used to using web calendars and
mobile phone apps and things like that.
They're going to expect the same level of easiness of service in their care needs.
What I'm seeing with health care organizations is that the leadership is
very uncertain about what direction payment policy is going to go in the next
few years.
There's a lot of political instability in our country at the federal and
state level.
And a lot of hospitals and insurance companies and other health care
organizations are really wondering about what's going to be paid for
in a year or in five years?
How are they going to be paid, and how much they're going to be paid?
And honestly a lot of leaders are feeling like it's a gamble in terms of whether
they should invest in technologies or whether they should just continue their
current mode of business with paper forms and phone calls and things like that.
But one- >> So
you think even in five years we'll still have papers in our lives.
>> I think we're still going to have paper in our lives,
because organizations tend to be slow to change.
But one of the factors that I'm seeing that's going to accelerate the change,
is that consumers are demanding more.
And when I say demand, I don't mean that in a pejorative sense,
I mean that consumers and patients- >> They're expecting more.
>> They're expecting more.
They are expecting life to be easier, to have everything at
the tip of their fingertips, whether it's on their phone, or on a website.
To be able to contact the people that they do business with, to be able to
see their schedules, to be able to communicate across different stakeholders.
This is what they're already doing in their day to day lives,
whether it's at work, or whether they're in school right now.
There's a lot of people I know they manage their family calendars for
soccer practice and piano practice and all this in online and mobile tools.
And yet we don't have this in health care in most organizations right now.
One thing I think is a big opportunity for health care leaders to really both improve
their organization's bottom line as well as improve the experience for patients.
Is to really look at how to adopt technologies that
streamline the patient experience.
And not just the patient's experience within the four walls of a hospital, but
really what is the whole health care and
the health overall of these individuals and families in their community setting.
>> With regards to technology, one of the things that I've noticed in health care is
there's a certain asymmetry due to the fact that a lot of health care
spending and use and demand is
towards older population.
Maternity services, pediatric services aside, a lot of people don't
ask that much of health care until they are into their 40s, 50s, 60s, and older.
And so the demands for things like streaming Netflix video
and make a reservation, order online tickets to the basketball game.
Or restaurants skewed towards older, but
also younger population whereas health care tech demands can be older.
Do you think that impacted the adoption of technology in health care and if so how?
>> So I'm a geriatrics physician.
So my specialty is working with older adults and
understanding what their pain points are.
Especially my experience has been doing house calls and
really seeing how do people live in their homes.
And how do they manage to get by in their homes,
even if they have a severe level of disability, for example.
So one of the things I'm seeing is that, personally, I believe that the slowness
of adopting technology in health care really is at a health care leaders level,
in terms of them understanding what are the current technology and market trends.
What are the other industry best practices?
And how to actually adopt this and apply this into a health care context.
Sometimes people ask me, well my grandma is 60 years old or 80 years old,
I don't think she's using an iPad or iPhone.
But the statistics are showing that older adults are one of the rapidly growing
groups that is adopting things like mobile phones, iPhones, and
social media like Facebook.
A common example that I hear is that a lot of grandparents have gone onto Facebook,
so they can watch their grandkids photos and videos and updates about that.
So that's a natural reason why they're using technology.
It's not because it was forced on them.
It wasn't like, here's a login.
Please log in and- >> They don't need a family portal.
>> Do all this work.
Yeah they don't need a family portal.
Facebook is already a natural social network where there's exciting and
interesting content that keeps them feel connected to their family's and
their communities.
And there's also what I'm seeing is that for the very,
very old patients, even if they're not on technology.
Often times if they're very sick their not actually managing their own care.
They're relying on their adult children or grandchildren.
So if you have, for example an 80 year old person,
if they're not tech literate, they're 60 year old child or
40 year old relative is often the one that's coordinating their care.
And they are looking for
and relying on technology tools to make things easier for them.
And when I say technology tools, I don't mean 101 apps to log when they ate and
when they feel pain.
because there's a lot and lot of apps out there that create more burden for,
both patients and clinicians.
It just generates more work and
is not actually providing any helpful information, beyond the effort you put in.
But what I'm saying, in terms of technology tools that are useful is,
how do we simplify and automate what used to be complicated processes just
to make everything easier for both the families as well as for the clinicians.
These type of design considerations are currently available.
This is not science fiction.
There are a number of experts out there that are focused on user experience design
and design thinking.
And If more health care organizations, as well as the technology vendors,
would leverage these design principles,
it would really create much better, easier care for families.
Now, looking forward to, not even the far future, but
in the near future, I don't know if you've heard of products like
Amazon Echo- >> Yeah.
>> And even something like Siri, where the what's called a
>> A voice recognition type technologyies.
>> Exactly, there's voice recognition technologies.
And there's currently a lot of technologies that are being
developed that are going beyond having a tablet or a touchscreen.
Where people have to look and touch and type to input and get the information.
So things like voice recognition, speech processing,
even image analysis, gesture and motion analysis type of sensors.
These are all ways that older adults and
younger adults will be interacting with computers in the very near future.
And, one example that I really like, that I've heard on social media
is there is a family member who is very worried about her mom, who is older.
And bought them an Amazon Echo, and
was given permission to have a log in to look at the search
results from within the Amazon Echo web portal.
And so an the Amazon Echo for those of you if you're not familiar, it's basically
a little electronic that sits at home, and it listens to you talk to it.
And you can talk to it and say, I would like to buy toilet paper, or
what's the weather outside today?
And using this consumer electronic device the family member was able to tell from
a different city from far away, what time does mom always wake up in the morning?
What is she normally ask about?
Is she asking about the weather?
Is she asking to tell jokes?
Is she asking for stories?
What is she looking up?
And based on these patterns this family was also able to see if mom normally
asks about the weather every morning at 6 o'clock.
But then suddenly you know she didn't wake up til 10 o'clock on some days,
is there something wrong?
Is she not feeling well?
Should I call her or should I have someone check on her?
And this is the beginning of simple consumer electronic that's widely
available for very inexpensive price.
That I think we can use to help people both provide better self care of
themselves and their families.
But also there's opportunities to integrate that into the entire health care
ecosystem with providers, clinicians, and health care organizers.
To really think about, how do we provide care outside the four walls of a hospital?
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