HEALTH CARE TECHNOLOGY 25 February 2008 KATHARINE C RATHBUN MD

COSTS MONEY TIME LABOR PAIN INDEPENDENCE LOVE

HOW MUCH IS YOUR LIFE WORTH? YOUR MONEY, TIME, ETC SOMEONE ELSE'S SOCIETY’S

HEALTHY WORKER EFFECT THE EMPLOYMENT PROCESS SELECTS FOR PEOPLE WHO ARE HEALTHY THERE IS NO HEALTHY PERSON EFFECT ON BEING ALIVE THERE USED TO BE

LIFE EXPECTANCY / DISABILITY LIFE EXPECTANCY ROSE 2.8 YEARS DISABILITY FREE YEARS PROJECTED TO DECLINE BY 7.3

CAUSES OF DISABILITY SAVING ADULTS OFTEN INCREASES NUMBERS ON DISABILITY SAVING BABIES MAY BE WORSE

TECHNOLOGIC IMPERATIVE HAVE STATE-OF-THE-ART TECHNOLOGY USE THIS TECHNOLOGY AT EVERY OPPORTUNITY

MEDICAL SPECIALIZATION SPECIALTY BOARDS WERE SET UP IN THE LATE 1940’s MEDICARE AND HEALTH INSURANCE IN THE 1960’S ALSO A TECHNOLOGIC IMPERATIVE

SPECIALTY VS PRIMARY CARE ALL DOCTORS ARE TRAINED AS GENERALISTS % PRIMARY CARE 1996 – 34% PRIMARY CARE

PUSH FOR SPECIALIZATION PAY MORE BUY EQUIPMENT ADDS PRESTIGE WON’T HIRE GENERALISTS ADVANCED PRIVILEGES PEOPLE HAVE BEEN TAUGHT TO DEMAND SPECIALISTS

PUSH FOR PRIMARY CARE THIS IS GIVEN LIP SERVICE LOWER PAY AND PRESTIGE DENIED PRIVILEGES WORK UNDER SPECIALIST SUPERVISION GET HAND-ME-DOWN FACILITIES AND EQUIPMENT USED AS GATEKEEPERS TO THE SPECIALISTS

QUALITY OF CARE FALLACIES TECHNOLOGY ASSESSMENT DECISIONS ABOUT TECHNOLOGY ARE ABOUT QUALITY OF CARE SENSITIVE SCREENING TESTS ARE GOOD

TESTS SENSITIVITY – LIKELIHOOD A POSITIVE TEST INDICATES DISEASE SENSITIVE TESTS FOR SCREENING – Fewer false negatives SPECIFICITY – LIKELIHOOD A NEGATIVE TEST INDICATES HEALTH SPECIFIC TESTS FOR CONFIRMATION – Fewer false positives

OUTCOMES GEOGRAPHIC COMPARISONS SHOW THAT DIFFERENT TECHNOLOGIES MOSTLY DO NOT CHANGE OUTCOMES MUST CONTROL FOR RACE, AGE, OCCUPATION, ETC

COST CONTROL FALLACIES UNNECESSARY TESTING/CARE OLDER PHYSICIANS HAVE MORE INAPPROPRIATE ADMISSIONS DRG’S WITH REDUCED PAYMENTS OUTPATIENT VS INPATIENT CERTIFICATE OF NEED COMPETITION

CLASSES OF DRUGS OVER THE COUNTER DRUGS PRESCRIPTION DRUGS SCHEDULED DRUGS - NARCOTICS SUPPLEMENTS

DECIDING WHICH DRUG TO USE DRUG MANUFACTURERS DOCTORS IN PRACTICE DOCTORS IN TRAINING VIOXX VS IBUPROFEN

INFORMATION SYSTEMS ALL THE USUAL PROBLEMS HIGHLY IDIOSYNCRATIC INFORMATION HIGHLY “TECHNICAL” INFORMATION HIPPA

TELEMEDICINE STORING AND TRANSFERRING INFORMATION ISOLATED DOCTORS GENERALLY ACQUIRING DATA IS THE PROBLEM NOT READING IT

FUNDING TECHNOLOGY MERGE WITH OTHER PROVIDERS OBTAIN MANUFACTURER SUPPORT BECOME A DEMONSTRATION SITE BECOME A SERVICE CENTER PONZI SCHEMES

THE FUTURE IT STILL TAKES 9 MONTHS TO MAKE A BABY