Component 1: Introduction to Health Care and Public Health in the U.S. Unit 1: Introduction to modern healthcare in the US Paradigm Shifts in Medicine

Core values in US healthcare Patient centricity and individual choice Interdisciplinary care Technology and innovation drive healthcare Cost of healthcare Options for financing healthcare – general revenue – social health insurance – voluntary or private health insurance – out-of-pocket payments – internal donations Health care expenditure $253 billion in 1980 $714 billion in 1990 $2.3 trillion in 2008 (16.2% of GDP, $7681 per resident) Need for cost containment! Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 20102

Paradigm shifts in medicine: Physician-centric to Patient-centric Care The old model: patient care options were determined by the provider -- patients were offered few opportunities to make decisions The new model: cultural shift towards giving patients greater responsibility in their care Shift from paternalism to patient autonomy Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 20103

Paradigm shifts in medicine: Physician-centric to Patient-centric Care Patient Self-Determination Act,1990  Requires health care organizations to give adult individuals certain information about their rights including ◦ the right to participate in and direct their own healthcare decisions ◦ the right to accept or refuse medical or surgical treatment ◦ the right to prepare an advance directive ◦ information on the provider’s policies that govern the utilization of these rights Providers, organizations and healthcare systems have become more responsive to patient needs Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 20104

Paradigm shifts in medicine: Individual to Team-Based Care Historically, patient care provided by an individual clinician With the increasing complexity of healthcare and patients, there has been an evolution towards collaboration between healthcare An interdisciplinary team is a “…group of individuals with diverse training and backgrounds who work together as an identified unit or system” Examples: intensive care units, hospice care, primary care outpatient settings Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 20105

Paradigm shifts in medicine: Individual to Team-Based Care The Patient Centered Medical Home - term introduced by the American Academy of Pediatrics in 1967, now endorsed by numerous organization including the AAFP, ACP, and the AOA Hallmarks of the patient centered medical home include: ◦ Personal physician ◦ Physician directed medical care ◦ Care is coordinated ◦ Emphasis on quality and safety ◦ Enhanced access to care Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 20106

Paradigm shifts in medicine: Physician-kept records to Personal Health Records The first medical records were maintained by physicians as notes First individual patient medical records , at the Mayo Clinic in Rochester, Minnesota Advances in technology have led to the electronic medical record, but these are still usually created, maintained and updated by the provider or system Current trend is towards the personal health record, which is created and maintained by the patient Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 20107

Paradigm shifts in medicine: Dominance of technology in healthcare delivery Health information technology (HIT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 20108

Paradigm shifts in medicine: Dominance of technology in healthcare delivery HIT can: ◦ improve health care quality and prevent medical errors ◦ increase the efficiency of care provision ◦ reduce unnecessary health care costs ◦ increase administrative efficiencies and decrease paperwork ◦ expand access to affordable care ◦ improve population health Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 20109