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 3)
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Из курса от партнера Icahn School of Medicine at Mount Sinai
Health Care IT: Challenges and Opportunities
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A Patient’s guide to the Doctors’ Secret World of technology
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Bruce J Darrow, MD, PhDVICE PRESIDENT MSHS | President's Office ASSOCIATE PROFESSOR | Medicine, Cardiology ASSOCIATE PROFESSOR | Population Health Science and Policy
Cardiology
Nicholas G Genes, MD, PhDASSOCIATE PROFESSOR | Emergency Medicine ASSOCIATE PROFESSOR | Genetics and Genomic Sciences
Emergency Medicine
[MUSIC]
When you think about these exciting technologies that are coming along for
patients and for their caregivers, when you talk to physicians about this.
This is what's coming, this is what our patients are asking for and expecting and
demanding.
How much do you see from the physicians in terms of excitement
versus terror and what sort of balance do you see there?
>> That's a great question.
So I see a mixed of reactions of physicians when they hear about these new
technologies that are really transforming the way we provide care for patients.
So on the one hand there are some physicians that I know who've always been
frustrated of how the current health care system is not efficient and things fall to
the cracks and their patients are not getting the optimal care they should need.
And they're very excited about learning new ways to do things and learning about
new tools to help them ultimately improve the lives of their patients.
On the other hand, I meet many physicians who are scared of technology and
are unfamiliar with technology.
And they just, it's a fear of the unknown.
They really don't know what technology will do and whether technology will harm
them or harm their patients and so they're cautiously fearful.
And then there's, I would say, even a third category, or maybe a sub
category of the second category of physicians you have been making a lot.
Physicians and hospitals are making a lot of money out of the old fee for
service paradigm.
And they recognized that technology could end to those profits in terms of, if it
you used to be that you'd make a lot of money during cardiac cath but now I have
a technology that tells me which patient shouldn't be getting a cardiac cath.
Or maybe have a technology that can do a cardiac cath without so
many resources involved.
The people who are previously profiting from the old ways of providing care
are obviously going to be uncomfortable about the new ways of providing care.
But this is a discussion that we, that we as healthcare leaders and
as a society really need to have a conversation about.
Because all this talk about lowering healthcare costs,
what people aren't mentioning is that in order to lower healthcare costs,
someone's profit is eaten into.
That is by definition the flip side to cost is who was going to
be paid with those costs that is now no longer being paid is now upset about.
>> Some of these costs are somebody's income.
>> Exactly.
So yeah, so there's there's a mixture of excitement for those who really
want to improve care and see the potential for technology in improved care.
And then there's kind of more skeptical and uninformed fear.
And then there's the groups that are really
realizing that technology has the potential to change things but
it will change things in a way that might upset their income.
Now obviously, a lot of people go into healthcare because they want to make
a stable living, but what I see there is a difference between, there
are some clinicians and administrators that go into healthcare purely for
profit motive, where they want to drive a fancy car and have a big mansion.
And then there are other clinicians and
hospital administrators that are really there for the mission.
They're ultimately there to help patients.
Help them from getting sick, help them recover from being sick,
help them to have better quality of life.
And I really think that if we as a society can cultivate clinicians that really
want what's best for patients and what's best for patients and their families, then
we are more likely to have aligned inside and adoption for these essentially
altruistic physicians to be able to adopt new technologies to help patients.
And I often get asked the question of,
if we adopt all this technology is that going to make physicians lose their jobs?
And I really don't think that technology is anywhere near
replacing physicians in their jobs.
But I do think that physicians' roles will change within the next few
years in terms of what used to be.
I mean like as a clinician there is a lot of basic questions that patients come to
me, where they really don't need to be asking me, they could be asking a nurse or
they could be asking Google.
And I know Dr. Google is a very controversial topic amongst physicians but
honestly there are some questions that are so basic,
like they don't even need to see anyone,
these are things that can be provided on a self care and online resource basis.
But what I would like to see is for, as
technology helps provide more decision support to both physicians and
nurses and even community health workers and non-licensed professionals.
You can have technology provide decision resource,
in terms of what's the next best step in terms of advice, treatment, diagnosis.
And this frees up the licensed professionals to have more time to care
about their patients.
Technology is not always a barrier to the doctor or patient relationship.
Technology can actually offload all the burdens and
time consuming parts of the interaction, and allow more time for where we call
those heart to heart conversations about what is the meaning of life?
Or how is this pain impacting your day to day life and function and
your family dynamics?
Or if there are patients where, like some patients that are,
there's let's say one to 5% that are so complicated,
that the decision support algorithms are not able to understand.
This is where really utilizing the brainpower of human physicians who have
honed their clinical reasoning skills and their patient interaction skills
to really focus the time of physicians on the tough stuff.
I mean, frankly speaking the tough cases, the zebra cases,
the very medically complex and social complex cases.
>> I think that if we as healthcare leaders accept the challenges
the technology brings, that technology has the potential to
challenge us to do a better job at what we're trying to do in the first place.
I live in New York City and
I think about New York City cabs of the last 10 to 15 years.
Ten years ago there was a lot of discussion more or
less about whether or not.
All cabs should be outfitted so that they could take credit card payments.
And there was a lot of backlash from some in the cab driving community.
We don't want to do this, it's going to cut in, we'll get less in tips.
The technology will fail us, somebody will be seeing how much we're making and
it will cut into our profits.
Nowadays, when a company like Uber comes along and
says not only are we going to take credit card payments, but we're going to make it
easy and it'll come right to you and you get a receipt emailed to you.
Nowadays no cab would ever say,
well I want to take away the ability to have people paying with credit cards and
take only cash, because the technology has leapfrogged the technology that
they were fighting against in the first place because they saw it as a threat.
I think technology potentially challenges
us in healthcare delivery to think if we don't give patients what they want,
somebody else is going to come and do a better job of doing that than we do.
And they're going to go elsewhere.
So I think one of our challenges is to figure out how
to embrace the technology and recognize that change can be better.
>> Yeah, I would totally agree with that.
So I work a lot with large health systems as well as with start up and
entrepreneurs and I think that just like you said, if large health systems
are able to bend with the needs of consumers, patients and technology,
these patients will go elsewhere and will find their care in other ways.
Because there's a lot of innovative companies that are being formed in
the last few years that are trying to serve patients
outside of the four walls of the hospital.
And in order for hospitals to remain relevant in the next five or ten years,
they really, right now, need to think very deeply about their digital strategy,
their technology strategy and how they can partner with outside innovators or
bring in innovators into their own organizations to build internal
capacity to actually think about these new business models, new care models,
what is a technology that supports the business models and care models.
And I want to emphasize it's not just about technology,
it's not just about let's go out there and buy ten pieces of software and
20 apps and 50 gadgets and stick it in a room.
At the end of the day it's about what are the processes that make it easier for
clinicians and for patients to feel better, to be better, to get better?
And this takes a type of creativity that I think a lot of healthcare leaders and
clinicians had when they were a child, but
they might not have been encouraged in their current roles to really exercise
the creativity part of their brains, to really think Beyond E and M codes and
DRG's and you know the thirty minute office visit, the ten minute office visit.
The three day hospital stay.
But I think if we can collectively, collectively as healthcare leaders
pool our creative energy into really just kind of, even starting from scratch
in thinking about if I were a patient or if my mom or my kid were a patient.
How would I want care or health, even without the care part, but
just being healthy.
How would I want to be healthy without necessarily having to
go to the hospital every week, every month, every year?
>> Well, I'd like to thank healthcare leader and innovator Dr. Windor Grasky.
Thank you very much.
>> Thank you, thank you for having me.
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