1. HEALTH CARE TECHNOLOGY 25 February 2008 KATHARINE C RATHBUN MD

2. COSTS MONEY TIME LABOR PAIN INDEPENDENCE LOVE

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

4. 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

5. LIFE EXPECTANCY / DISABILITY 1966-1997 LIFE EXPECTANCY ROSE 2.8 YEARS DISABILITY FREE YEARS PROJECTED TO DECLINE BY 7.3

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

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

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

9. SPECIALTY VS PRIMARY CARE 1940 - ALL DOCTORS ARE TRAINED AS GENERALISTS 1970 - 41% PRIMARY CARE 1996 – 34% PRIMARY CARE

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

11. 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

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

13. 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

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

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

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

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

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

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

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

21. THE FUTURE IT STILL TAKES 9 MONTHS TO MAKE A BABY