A9BairdCunninghamSmith

A9BairdCunninghamSmith

To Do

• 1. please work as a group (minimum: 2 members; max: 6 members) and submit one answer as a group (clearly identifying the members of your group)
• 2. Read:
  • Chapter 8 in Ben Shneiderman's book entitled "The New Medicine: E-Healthcare" (lecture on Oct 27)
  • Chapter 9 in Ben Shneiderman's book entitled "The New Politics: E-Government" (lecture on Oct 29)

Question 1

discuss what YOU consider the two major influences of information and computer technology on healthcare with comments on how these developments have changed:

• the healthcare business
• the doctor/ patient relationship (pluses and minuses)

Question 2

assume you need to inform yourself about some medical problem or issue (e.g.: high blood pressure, hip surgery, torn ACL or Achilles tendon, obsessive compulsive disorder (OCD), attention deficit disorder (ADD), you want to travel to a country in Africa (any precautions needed?), ....) - choose one example from the list or one chosen by yourself and

• explore the WWW about it, and
• describe what you found out and did not find out?

Question 3

as elections are coming up on November 4, 2008:

• identify the major differences between elections in 1980 (before the Internet, Social Networking, blogs, ....existed) and 2008!
• which new possibilities do you personally see as positive or negative developments?

Group response

1. Members of the Group

Will Baird, Dara Cunningham, and Matt Smith

2. Question 1

The two major influences of information and computer technology on the health care industry are: 1) a desire by health care professionals and patients to improve health care costs; and 2) a desire by health care professionals and patients to increase the quality of patient care. In the United States, the health care industry has widely adopted computer technologies for devices used in patient care. Most hospital rooms are now a maze of computerized devices used to monitor and treat patients. However, when it comes to patient records, the American health care industry lags behind most other industries in terms of adoption of information and computer technologies.

While electronic medical records (or computer-based patient records) have been implemented widely in other countries (with 50-90% of physicians using them), the U.S. only has about 7% of physicians currently using electronic medical records (Wang et al, 2003). According to a recent five-year study, there are many benefits to using electronic medical records. Wang et al list these benefits in their article, "A cost-benefit analysis of electronic medical records in primary care," published in the American Journal of Medicine, as follows:
The estimated net benefit from using an electronic medical record for a 5-year period was $86,400 per provider. Benefits accrue primarily from savings in drug expenditures, improved utilization of radiology tests, better capture of charges, and decreased billing errors. In one-way sensitivity analyses, the model was most sensitive to the proportion of patients whose care was capitated; the net benefit varied from a low of $8400 to a high of $140,100. A five-way sensitivity analysis with the most pessimistic and optimistic assumptions showed results ranging from a $2300 net cost to a $330,900 net benefit.
(Wang et al, 2003)

The benefits of adopting electronic medical records are not only seen in financial terms but in better care for patients. Bates et al list some of the benefits that Australia, New Zealand, and England have seen as a result of wide adoption of electronic medical records, as follows:
Even more than improving efficiency, quality may be the greatest benefit of computerization. Computerization of reminders and prevention guidelines benefits patients. Reminders are also effective in care of chronic conditions, such as diabetes. Computerization of medication prescribing improves safety; in one study of inpatients, the medication error rate was reduced by more than 80%. Communication between patients and providers appears to represent a particular problem in outpatient care, and computerization may be helpful in this domain. Another quality improvement benefit will likely come from monitoring and tracking abnormal results and ensuring that appropriate follow-up occurs. Moreover, electronic records can be linked with public health surveillance, which may be extremely important in emergencies such as a bioterrorism attack or an epidemic.
(Bates et al, 2003)

A 2004 study regarding how the use a patient-accessible electronic medical records affects the patient/doctor relationship showed overall positive effects. Patients interviewed before and after receiving access to their records had a universally positive response. The doctors who participated in the study had initial apprehensions about allowing patients access to their records, fearing "that access to records would increase patient worry and that patients would find laboratory and x-ray reports confusing." However, by the end of the study, all of the doctors agreed that giving patients access to their medical records was empowering for the patient. They also agreed that they were in favor of giving patients access to their medical records in future. (Earnest et al, 2004)

Patients from this study identified the benefits of having access to their medical records as:

• Learning more about their condition
• Coordinating care
• Learning about medical decision-making
• Reinforcing memory
• Increasing participation in medical care
• Streamlining the flow of information
• Confirming normal results and the accuracy of the record

The only concerns these same patients had about using electronic medical records were that some of the medical jargon was confusing and about the security and privacy of having their medical records online. Although this was a relatively small study (107 patients and eight physicians), the results are promising.

References:

David W. Bates, Mark Ebell, Edward Gotlieb, John Zapp, and H.C. Mullins. (2003). A Proposal for Electronic Medical Records in U.S. Primary Care. Journal of the American Medical Informatics Association. 10: 1-10. First published online as doi:10.1197/jamia.M1097.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=150354

Mark A Earnest, Stephen E Ross, Loretta Wittevrongel, Laurie A Moore, Chen-Tan Lin. (2004). Use of a Patient-Accessible Electronic Medical Record in a Practice for Congestive Heart Failure: Patient and Physician Experiences. Journal of the American Medical Informatics Association, 11(5), 410-417. Retrieved October 25, 2008, from ProQuest Health and Medical Complete database. (Document ID: 699401611).
http://proquest.umi.com/pqdweb?index=2&did=699401611&SrchMode=1&sid=1&Fmt=4&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1224985693&clientId=18999

Samuel J. Wang, Blackford Middleton, Lisa A. Prosser, Christiana G. Bardon, Cynthia D. Spurr, Patricia J. Carchidi, Anne F. Kittler, Robert C. Goldszer, David G. Fairchild, Andrew J. Sussman, Gilad J. Kuperman, David W. Bates. (2003). A cost-benefit analysis of electronic medical records in primary care. The American Journal of Medicine - 1 April 2003 (Vol. 114, Issue 5, Pages 397-403, DOI: 10.1016/S0002-9343(03)00057-3).
http://www.amjmed.com/article/PIIS0002934303000573/fulltext

3. Question 2

When exploring the web today to find information on different disorders and diseases you can find multiple sources of information about the different things. You can also find websites that ask you about symptoms then try to diagnose you. We found multiple sites which could "diagnose" symptoms most were pay sites but some were free, which raises doubt about the accuracy of the website. If the website is wrong in diagnosing someone and the person has paid for the diagnosis, what are the terms surrounding liability. The websites did a pretty good job at telling the descriptions of the disease or disorder and explaining some ways to treat it, but just because some people show symptoms does not always mean that they have the disease or disorder because there are now hundreds of different things that share common symptoms. If a person did use one of these services offered by the internet, they would still need to see a doctor to confirm if their suspicions are correct and to receive treatment for the problem. One really good thing about these new diagnosis programs is that they allow users to get an idea of what the cause of their symptoms could be before they enter a doctors office which gives them an opportunity to help the doctor narrow down the full diagnosis and determine treatment for the problem. A bad problem, though that comes with this new information being available to anyone and with the sites "diagnosing" different things is that it does have the potential to freak people out when they look at their symptoms and see the possibly problems it could be. This leads to unneeded stress as well as sometimes can cause the person fear to visit a doctor. It can make a person think they have something they don't and if they don't have a symptom of a disease but they believe they have the disease they can trick themselves into believing the develop the symptom over time.

The new information is nice in that it empowers the patient with knowledge of what is wrong with them before going to see a doctor so they can then empower the doctor to have a direction to pursue when diagnosing. Another problem with this is if the patient comes in and says they have something and they just wants a prescription to cure it and the doctor takes their word on it and does not do proper tests to determine if the patient has what they think they have it can cause issues with quality of doctors visits. The person could have tonsillitis and think it is strep and be treated for the wrong disease, because a doctor took a short cut offered by the patient. There are pros and cons to this new system of "diagnosis" and treatment, but it has become a beneficial tool for people over all. It has helped lead to social systems for treatment for disorders that would not have developed if it weren't for people to have the resources in sharing treatments with each other via the internet.

4. Question 3

Before the Internet, the tools for campaigning were limited. They consisted of speeches, media interviews, gatherings, and marketing (radio, television, phone, and print). The first three all require the physical presence of the candidate. Therefore they are significantly limited by scheduling and logistics. Marketing could be delegated to supporters.

Elections in the age of the Internet are more transparent and accessible. Marketing can be customized to a micro scale. Information is much more effective. Campaigns can customize their message to reach out to more diverse and niche citizen groups. This is well received by these groups as they feel understood and validated. Conversely voters can research the particular topics of most interest to them as individuals. They are no longer confined by the generic campaign and media messages. Organizing, collaborating, and disseminating are more easily delegated so that supporters can contribute to the campaign very easily. On October 26, 2008, a search for Facebook groups related to "Obama" returned over 500 groups. Some were supporters - others were detractors.

The downside of the Internet on today's elections is misinformation. In fact, campaigns now designate personnel to identify, confront and mitigate harmful information (Time magazine http://www.time.com/time/nation/article/0,8599,1813663,00.html?imw=Y). The problem has been noted by today's politicians - Barack Obama has a special Web site devoted to this (www.fightthesmears.com).