Impact of Communication Technology on Healthcare Systems

Explosion of technology and the information revolution has greatly impacted our healthcare system for the better. Not just at the level of treating diseases, but the fact that a greater number of people are now inside the healthcare network is a testament to the improved and increasing presence of technology.

In the not so distant past, people still had to physically be available for consulting a doctor but information technology and communication has now made remote patient consulting and tele-medicine common place. The barriers of time & distance are increasingly shrinking in our times and this means that more & more patients can have access to quality healthcare.

Communication technologies are also greatly improving patient experiences; besides improving hospital response times. Response time is critical for emergencies, someone in distress is least likely to be willing (or be happy) if he or she is made to wait endlessly. The role of technology is not just limited to reducing response times but also towards improving overall patient-care experience.

Some of the ways wherein patient-experiences can be improved with better communications & technology are outlined below:

Provide call handlers with complete patient information to help them better response or offer advise

Send or receive multimedia files such that it is easy for the patient to send investigative reports etc.

Call forwarding or remote calling facilities to enable the same consultant to be available for a patient irrespective of his or her location.

The advancements in communications have expanded the horizons of consumer expectations are it is imperative that healthcare providers are able to embrace these technologies to better serve their patients.

Real-time connect with the patients helps provide preventive services, consultation on prevalent health hazards and nutritional information. As healthcare providers work increasingly on the preventive model of healthcare dispensation it is imperative for them to seek real-time patient information. Patients, on the other hand, need to know that the healthcare provider will be available whenever required and that all emergency situations are well-catered to.

Technology also helps create convenience and comfort resulting in an overall better patient experience. With our worlds more interconnected today than they have been ever before there is a greater convergence of the different spheres of our lives. Being able to access medical information on the go, set up doctor appointments, order medicines and consult with doctors remotely are all various facets of the ever increasing patient demands – which healthcare providers can now cater to with advancements in communication technology!

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The Norwegian Versus the American Healthcare System

America’s history is rooted so deeply in freedom of choice to either win or lose in one’s economic decisions. This can be epitomized by so many early Europeans coming to the New World in search of a new life, many of which had very little wealth in terms of personal property or education, but eventually pioneered much of the American wilderness creating farms, small communities, and big cities. From the earliest Americans that came to Jamestown Virginia to the more recent immigrants coming through Ellis Island, many of these Americans have argued for less government intervention in their lives and created a culture that keeps the government from controlling everyday choices like gun control to even universal healthcare. Even today, America does not even have a universal healthcare system, even though many other industrial nations do.

Many Americans argue that a universal healthcare system will not work in America because a large portion of Americans will simply take advantage of the system, in terms of not altering their unhealthy behavior, thus, running up the costs for everyone. Moreover, many feel that healthcare is simply not a privilege to be handed to everyone, and should be employer based to ensure everyone pays for their own healthcare, as much as possible. This seems to be a cultural issue rooted deeply in the American value of individuals being independent as much as possible from government influences. On the other hand, a country like Norway has some pure socialist practices, especially in the area of healthcare. In fact, everyone in Norway has healthcare. It is the law of the land.

Norwegians are more practical than Americans in how they spend their money, they enjoy saving money for quality health care. According to Bruce Bartlett, a Forbes Magazine columnist, on a per capita basis, Norwegians spend $4,763 per year, and covers everyone, while Americans spend $7,290. By various standards of health quality, like life expectancy or rate of preventable deaths, Norway does better than the U.S. One key measure is physicians per capita: America has 2.43 physicians compared with Norway’s 4 doctors per every 1,000 people, even though Norway spends a third less of its Gross Domestic Product on health care than the U.S. does.

Why is the cost of healthcare in Norway less than that in America? The eye catching statistic that reveals Norwegian superiority in providing lower cost healthcare is that the number of doctors in America, per capita, is actually less than in Norway. Perhaps increasing the supply of healthcare providers in America could lower overall healthcare expenditures for healthcare. Perhaps there is a deep rooted cultural reason in Norway that is helping to keep healthcare costs down. Maybe their society has a healthier population than countries like America.

Finally, it appears capitalistic and socialistic policies both can benefit a nation like America. America has the greatest GDP of any nation, but yet, does not provide a universal healthcare system for its citizens. One would think that through sheer size and because of its economic output, America could keep its healthcare costs lower for its citizens than a country like Norway. Perhaps the free market system in America will one day solve all of the demands that its citizens want, like universal healthcare. If not, perhaps a more controlled socialistic policy will be created providing universal healthcare that is similar to the one implemented in Norway. There is a school of thought for each economic approach, but the bottom line is, there is a cost to be paid, and ultimately the consumer/taxpayer will bear that cost.

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Increasing Incidence of Joint Replacements Burdens Healthcare System

With the number of joint replacement procedures growing at extraordinary rates, putting extreme pressure on already rising healthcare costs, the healthcare community must ensure that it is adequately equipped to meet the demand by preparing for the rising costs and making sure that there are enough orthopedic surgeons to handle new cases. For their part, medical device companies need to design and manufacture implants with longer life spans to avoid revision surgeries that add to healthcare costs, while exploring alternatives to traditional joint replacement procedures.

Record growth in joint replacement surgeries represents a lucrative opportunity for implant makers, but with opportunity comes the responsibility to help hold down increases in healthcare costs before they overwhelm our collective ability to pay. Medical device companies are developing new materials and procedures and working with healthcare providers on preventive measures. Even so, more needs to happen to prevent joint replacement surgeries from overburdening the healthcare system.

Joint replacements, which have been performed since the late 1960s, can be highly successful at relieving pain, repairing damage caused by arthritis, and helping people to function normally and remain active. According to the National Center for Health Statistics, about 43 million Americans, or nearly one in five adults, have some sort of arthritis pain. Knees, the largest joints in the body, are usually the most painful. Since obesity is also highly prevalent, cases of arthritis are beginning to onset at a much earlier age in overweight people.

Number of Replacements Skyrocketing

With an aging baby-boomer generation, it should come as no surprise that the number of hip and knee replacement procedures have skyrocketed. The Nationwide Inpatient Sample (NIS) shows that primary hip replacements increased by 48%, from 153,080 procedures in 1997 to 225,900 in 2004. First-time knee replacements grew by 63% from 264,331 in 1997 to 431,485 in 2004. According to HCUPNet, 228,332 patients received total hip replacements in 2006, and 496,077 patients received total knee replacements.

If these trends continue, an estimated 600,000 hip replacements and 1.4 million knee replacements will be carried out in 2015. It is estimated that by 2030, the number of knee replacements will rise to more than 3.4 million. First-time replacement procedures have been increasing equally for males and females; however, the number of procedures has increased at particularly high rates among people age 45-64 years.

According to Datamonitor’s 2006 report, the US accounts for 50% and Europe 30% of the total procedures worldwide. The 2005 revenues for hip implants in the US were $2 billion and $1.4 billion in Europe, while knee implant revenues comprised $2.4 billion in the US and $774 million in Europe.

Demand & Technology Drive Cost Increases

With the increase in demand and improved implant materials and surgical techniques, the cost of these procedures is also increasing. According to NIS, Medicare was the major source of payment in 2004 (55.4% for primary hip replacements, 59.3% for primary knee replacements). Private insurance payments experienced a steeper increase. In 2004, the national bill for hip and knee replacements was $26 billion. Hospital cost accounted for $9.1 billion, and the amount of reimbursement was $7.2 billion (28% of hospital charges or 79% of hospital cost).

Another study from Exponent, Inc. analyzed Medicare data for hip and knee replacements from 1997-2003. It was found that while procedural charges increased, reimbursements actually decreased over the study period, with higher charges observed for revisions than primary replacements. Reimbursements per procedure were 62-68% less than associated charges from primary and revision procedures. It is evident that joint replacements have the potential to be highly lucrative, but the burden on patients and our healthcare system must also be considered.

Behind the Growth Trend

An aging population and increased incidence of obesity are primary causes for the increase in joint replacements. Nearly 65% of the US population is overweight, and arthritis is highly prevalent among this group. With more patients receiving joint replacements at an earlier age, there is much higher probability they will outlive their artificial joint.

A recent study in Wales tracked joint replacement procedures since 2003 and found a revision rate of 1-in-75, which was considered to be a fairly good score. In the US, 40,000 knee revisions and 46,000 hip revisions were performed in 2004. However, knee revisions are expected to increase sevenfold, and hip revisions to more than double by 2030.

Revision surgeries are problematic for several reasons. In addition to the extra recovery time for patients, revisions are tougher operations that take longer and cost more. There is often a reduced amount of bone to place the new implant and there is a much higher complication rate.

Why Implants Fail

With hip replacements, the most common problems are postoperative instability and repeated dislocations. Surgeons must consider many risk factors before the initial surgery, including age, gender, motor function disorders, dementia and prior hip surgery. The surgical approach can also affect the risk for dislocation and leg-length discrepancy, so proper pre-operative planning is a must.

Components design and positioning may also contribute to instability. Dislocations are often caused by movement outside the normal range of motion, so it is important for patients to take the proper precautions following surgery. A study by the Mayo Clinic showed that in the case of repeated dislocations, the hospital fees for treatment and revision surgery end up costing, on average, 148% of the cost of the initial replacement. The decision to undergo a revision surgery is typically made based on repeated dislocations and the patient’s health. Patients that have undergone previous hip surgeries or have poor abductor muscles are at greater risk for failed revisions.

Revisions of knee replacements may be required when patients experience infection, osteolysis, implant loosening or misalignment, knee injury or chronic progressive joint disease. Decisions to undergo revisions are made based on previous knee surgeries, current health and radiographic examinations. Patients with poor bone quality, unresolved infection, peripheral vascular disease or poor quadriceps muscles or extensor tendons are at greater risk for a failed revision.

Preventive Measures

With the unprecedented growth in replacement procedures, measures must be taken to prevent this phenomenon from overwhelming our healthcare system. This can be accomplished through better preventive care, alternatives to total replacements, and by ensuring that primary replacements are successful. Reducing obesity and treating arthritis at earlier stages will help reduce the numbers of procedures. In addition, many have called for a national joint replacement registry such as those in Australia, Great Britain, Norway, Denmark, and Sweden, which track high failure rates associated with some joint replacement procedures.

Alternative procedures are available that have improved dramatically over the past 10 years. For example, partial replacements are less-invasive, with smaller scars and shorter healing times because only the diseased compartments are replaced. Minimally invasive procedures are available for total replacements in some patients. There are also new options available for women needing total knee replacement, known as “gender-specific” knees that are slimmer and contoured to more closely imitate the female anatomy. Hip resurfacing is another procedure gaining in popularity because it conserves more bone than a traditional total hip replacement. This type of implant will last longer than a traditional hip replacement.

New biomaterials and component designs also increase the lifespan of implants, and computer-assisted surgery can improve the success of joint replacement by allowing more accurate and precise implant alignment. Several studies have shown this type of procedure to be more cost-effective by preventing the need for revision.

Looking Ahead

For medical device companies, the record growth in joint replacement procedures presents a lucrative opportunity. However, manufacturers need to work with the medical community to help ease the burden of this epidemic by increasing the success and longevity of their implants and exploring alternatives to the traditional joint replacement procedures.

Undoubtedly, national joint replacement registries have proven useful in other countries. The medical community needs to demand that a registry be put in place in the United States, and it needs to do a better job of educating society on prevention. It is important that the medical community, including device companies, come together with a plan for preventing the potential burden this overwhelming surgical load could have before it takes a toll on our healthcare system.

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Offshoring U.S. Patients No Cure for Ailing Healthcare System

For several years now, American healthcare consumers, including many from other western industrialized nations, have heard about elective surgeries being performed in lesser-developed nations and due to cost and denial of coverage by health insurance providers have opted to go there. However, surgeries in the past were truly elective and not medically necessary procedures that largely consisted of face-lifts, tummy tucks and gastric bypasses for cosmetic purposes.

But just in the past two years, American patients are being wooed to make decisions on serious medically necessary surgeries due to their fears of excessive healthcare costs. And the decision involves traveling abroad primarily to India and Thailand in order to receive such hospital care which they require.

For those self-insured, underinsured, or not insured at all, the desperation of receiving medical care without sacrificing homes or assets in the process is plausible, since costs of similar procedures in South Asia range from 75% – 80% less than in the United States. But now U.S. based corporations have entered the arena as well by encouraging employees to go to India and Thailand via cash incentives, free airfare and hotel stays with no co-pays due on the final bill.

Yet, just as with any large purchase consumers must look beyond the fancy advertisements and read the fine print with a Buyer Beware mentality. Americans have become quite adept at learning what to look for when dealing with car dealerships when purchasing an automobile and with computer retailers when purchasing a new computer. But it has taken many years to educate consumers as to their rights and protections under the law and what to do when something does go wrong.

The term “medical tourism” has been inaccurately applied to what is essentially the offshoring of patients of the U.S. healthcare system to foreign countries, in order to appeal to potential customers who are really medical patients. The term was invented by the media and it stuck and is now being used as a marketing tool. Deceptive in its concept, it is an implication that a patient can go sightseeing before or after a serious hospital procedure in that foreign country. But for those who are more scrupulous it remains difficult to get the necessary information needed to make a reasoned decision on whether to have surgery performed, let alone halfway around the world.

There are now organizations being touted as medical tourism agencies that have cropped up throughout the U.S. in order to facilitate such care overseas for individual patients as well as to serve as a clearinghouse for corporations wishing to outsource their employees’ healthcare with them in tow. These groups include MedSolution, GlobalChoice Healthcare, IndUShealth, Planet Healthcare and Med Retreat, to name just a few.

And with more and more corporations adding select foreign hospitals as Preferred Providers to their employees’ health insurance plans, medical tourism companies handle the paperwork and travel arrangements for their employees. Other countries of destination include Costa Rica, the Dominican Republic, the Philippines, Panama, Mexico, China, Malaysia, Singapore, Turkey and South Africa.

However, it is at this point that the patient needs to start their own due diligence. There is usually a requirement by most U.S. healthcare insurance providers for patients to get second opinions for most complicated surgeries in the U.S., but not so for offshore surgeries. And the list of surgeries which are being sent offshore are indeed medically necessary but confusingly being reported to the media as elective. But you can determine for yourself whether or not the following are elective procedures: cardiac bypass, cardiac stent implantation, cardiac angioplasty, knee replacement, hip replacement, mastectomy, hysterectomy, chemotherapy, eye surgery, vascular surgery, among others.

And as the medical tourism agency is only an intermediary between the client and the hospital as well as between hotels and airlines they do not provide any liability in the event that there is a medical complication or there is a mishap at the destination hospital. Furthermore, there are fees which could arise not documented by an employer nor agency which could require additional expenses upon the patient’s arrival. And as a conduit between patient and hospital, the medical tourism business remains an unregulated industry in the U.S., without licensing requirements and with most managed by non-medical personnel.

Similarly, and unbeknownst to most U.S. patients is that the healthcare industry in India is highly unregulated. It was only in 2006 that regulations regarding the medical device industry, which includes surgical devices such as cardiac stents and orthopedic implants for use in hip and knee replacements, was mandated. Such call for regulation from the Drug Controller General of India (DCGI) only came about as the result of discovered defective drug eluting cardiac stents in 2004. And although hospitals have the option of applying for accreditation through the Joint International Commission established in 1999, a subsidiary of the Joint Commission on Accreditation of Healthcare Organizations, used for hospitals in the U.S., there is no such requirement to do so.

As of 2006 there are five hospitals in India which have JCI accreditation, renewable every three years. They include the three facilities of the Apollo Hospital group, the Shruff Eye Hospital and the Wockhardt Hospital. The Bumrungrad International in Bangkok is Thailand’s sole JCI hospital. Singapore has over a dozen JCI hospitals however, and the Philippines has one. But the JCI accreditation only applies primarily to hospital management which although includes procedures to reduce risk of infection and disease and to ensure patient safety, it has no jurisdiction over the actual physicians performing surgical procedures.

The patient is provided limited information other than an introductory phone call to the intended physician and having medical records electronically sent to the doctor or hospital via the internet by the medical tourism agency. The patient has a choice of physicians, but unlike in the U.S. where there is easy access to a doctor’s medical status by medical boards and organizations, other than knowing whether the doctor may have practiced medicine in the U.S., there is little information to come by. Without standardized protocols it is difficult for the patient to make a correct assessment.

When decisions on a patient’s health is driven primarily by cost it can impair the decision making process. There is little argument that healthcare costs in the U.S. are bankrupting corporations and labor unions and deceleration of escalation is nary in sight. With the healthcare industry being 15% of the U.S. Gross Domestic Product and having risen in cost 75% for employers and 143% for employees since the year 2000, the system is broken. High malpractice insurance fees required by both employers and physicians, hospital deregulation and class action medical litigations have only exacerbated the problem.

Such high medical costs will only encourage limited access to healthcare for the middle class and ultimately result in less preventative care costing taxpayers more in the long run. The problem is not the medical care in the U.S., still considered the best in the world, but its delivery system. It is when Medicare and the health insurance providers became the decision makers and took that power away from the physicians that the system began to unravel. Added to that is the lack of restraint of costs by the pharmaceutical industry which charges U.S. patients more for its own medications than any other country in the world.

But as expensive as healthcare is in the U.S., there are legal and safety issues which are part of the American fabric which Americans very much take for granted yet expect but are not present in the undeveloped world. For example, there are few regulatory bodies such as the Centers for Disease Control, the Food and Drug Administration, the Federal Trade Commission, various medical boards, consumer protection laws, available legal experts and the court system. All serve as a net of safeguards offering remedies. But unlike a car purchase, medical care is a complicated undertaking in which there are no guarantees, yet there are areas of compliance which must be maintained.

Once the patient is in a foreign country there is little protection for redress and once that patient leaves the country should they need follow-up care such as therapy or if complications arise even during travel, they must seek medical care in the U.S. Secondarily, if the procedure is performed overseas, insurance providers or Medicare may not honor the additional required care in the U.S. Still, patients may decide to take the risks in addition to the inherent risks of any surgery, but should not be coerced into uninformed choices in order for their employer to save costs under the guise that they are helping to reduce the costs of U.S. healthcare in the long run.

In July 2006 the U.S. Senate Committee on Aging held a hearing called “The Globalization of Healthcare: Can Medical Tourism Reduce Healthcare Costs?” Its goal was to address the subject of medical tourism, its growth, safety of patients and possible regulation of the industry itself. Its Committee Chairman, Senator Gordon H. Smith, has asked that several federal agencies such as the Department of Health and Human Services, the Department of Commerce and the Department of State create an interagency task force necessary for lawmakers to reach informed decisions that healthcare consumers themselves cannot accurately make at this juncture regarding offshoring their medical care.

And among the labor unions, the United Steelworkers Union (USW) has publicly weighed in on this issue when it learned one of its union members, employed by Blue Ridge Paper Products, was going to be sent to India for gall bladder surgery simultaneously with shoulder surgery. Leo W. Gerard, USW International President, fired off a complaint dated September 11, 2006 to Congress by contacting the following committees: the House Committee on Education and the Workforce, the House Committee on Energy and Commerce, the House Committee on Ways and Means, the Senate Committee on Finance, and the Senate Committee on Health, Education, Labor and Pensions.

The goal is not necessarily to create more legislation but to establish guidelines. Perhaps Mr. Gerard puts it best when he states, “The right to safe, secure and dependable health care in one’s own country should not be surrendered for any reason-certainly not to fatten the profit margins of corporate investors.” He also contends to the Congress that “We remain steadfast in our commitment to rebuild a domestic healthcare system.”
Let us hope that our government and healthcare providers can likewise make such a commitment by investing in the health and welfare of the American people.

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Integrated Healthcare Systems

The world of healthcare is always changing. When you think back to healthcare and health services back when our parents and grandparents were children and then compare things to healthcare today things are drastically different. One thing that has changed and developed and also continues to change and develop as we speak is what is called the integrated healthcare systems. Sometimes also referred to as multi-care providers or multi-care treatment, these systems intend on focusing on convenience for the client or patient and ease of working through the system. Typically these systems cover a wide area of travel and are operated through multiple levels. The systems also incorporate many different types of services including medical services and general health and wellness services as well. The goal is the get you healthy and to keep you that way with this type of integrated system.

A system such as Manhattan Illinois healthcare has many different offices and services connected to it. There is typically a large hospital that would be the main center and then many other clinics, offices, and even smaller hospitals that feed into and work off of or from the larger hospital. Patients can visit a doctor in a medical center or office and expect to the same level of service if they visit a different doctor, hospital, or other provider that is within the same integrated healthcare systems. There is also the benefit of having your medical records contained in the same system so that you don’t have as much trouble trying to track down a get your medical records to all your different doctors.

Information is many times also maintained in the integrated healthcare systems information center so that if you visit Monee healthcare instead of another center then your information can be located because it is all consider the same provider. In a way this is like an umbrella system that covers the patient. There can be advantages for a patient and the goal of the integrated healthcare system is to make the experience better for both the patient and for the healthcare providers as well.

This way of providing care for patients is drastically different than how the doctors and nurses may have provided care in the past but one could say that it is an attempt on a large scale to make patients feel similar. A doctor from Manteno healthcare is not likely to come to your home to provide care but the hope would be that because you are in this network of healthcare and provided quality and uniform care that you may feel somewhat like your father or grandfather felt with the doctor at their home.

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