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What Is the Future of Health Care?In Many Ways, the Future Is Already HereBy Jill Elaine Hughes, MA, Health Care Writer, University of Phoenix, Knowledge Network
Health care in the United States is at a crossroads. Just as rapidly advancing technology has revolutionized almost every other major industry, so will it revolutionize health care — and not in ways you might expect. One major issue is cost. The United States spends more than double the amount per capita on health care than the median spent by all other industrialized nations, yet lags behind the rest of the industrialized world on key outcomes indicators like infant mortality and life expectancy.1 “Our cost of health care is astronomically higher than other ‘industrialized nations’, and yet we have the worst outcomes,” says David Harrell, PhD, FACHE, director of strategic development-health care for the Apollo Group. Many physicians agree. “Under pay for performance, no outcomes will equal no income,” says Robert H. Haralson III, MD, MBA, a retired orthopaedic surgeon who is currently active in health care policy-making nationally. Dr. Haralson also believes that real health reform will not occur without rapid advancement in health care information technology, which much of the health care industry has been slow to embrace in comparison with other industries. “Electronic medicine is the wave of the future,” says Dr. Haralson. “Before we know it, every man, woman, and child in America will have their own portable electronic medical record (EMR) that they can take with them anywhere. EMRs are crucial to any cost-savings and improved efficiency.” Much of the new technology implementation across the health care industry is being driven by nursing, and that’s no accident. “Nursing is relationship-based. In partnership with medicine, nurses help patients navigate the health care system and are often the primary providers of information to patients,” says Tracy Chesney, RN, MSN, a nursing instructor at University of Phoenix. Nursing has embraced mobile technology in particular, both at the bedside and in the community. “Health care has moved from residential to mobile, along with society at large,” says Chesney. “We have nurses using PDAs, tablets, smartphones, [and] laptops at the bedside as well as administratively. We have nurses using mobile technology to assist in home care, we have telenursing via webcam. And it’s only going to continue to grow and expand.” “Nursing is a high-acuity environment,” says Kathy English, RN, a health care policy and technology expert for Cisco Systems. “Most use of technology in nursing centers around the patient record—placing care orders, requesting equipment, doing tests, administering medication, and so on. Nurses drive all communication surrounding the patient. That’s where EMRs are essential.” 
Services at the Cisco lifeConnections Health Center span the full health care continuum, from fitness and child care facilities to a full-fledged health center that uses the “patient-centered medical home” as a care model. Even the design of the facility is unique. The care suite is set up like a living room, and features, among other technologies, a plasma-screen TV which the physician or other care provider uses to access the patient’s electronic medical record (EMR) in full view of and in partnership with the patient. In addition, many diagnostic and communication technologies are fully integrated into the suite (See Figure 1). “There’s a real push to get nurses out of the nurses’ station and back to the bedside,” says English. “Instead of spending hours and hours at the end of their shifts catching up on charting, mobile technology really enables nurses to get back to the bedside and do all of that work in real time.”
EMRs: “A Blessing and a Boondoggle”Even though almost everyone in the health care industry believes that EMRs will help solve a lot of problems, in some ways the EMR presents an even more complex problem in and of itself. “EMRs are both a blessing and a boondoggle,” says Jane Kleinman, RN, MA, a nurse educator with Medical Simulation Design, Inc. and an expert in working with health care information technologies and training platforms for nurses. “A blessing when they are both streamlined and simple to use—which is rare in America. A boondoggle since most EMR vendors offer competing and closed formats. At present, EMR is only a site-specific partial solution.” This potentially very sticky situation exists because, unlike most developed nations, the U.S. currently has no universal standard record format or delivery system for EMRs. “My private MD uses a different EMR in her office from the ones used in the hospital she works in,” says Kleinman. “And neither my doctor nor my hospital could provide any of my EMR information to an emergency room during a critical event in another city 50 miles away.” But in nations like France, Canada, the United Kingdom, and Japan, which have government-mandated universal EMR standards (some of which have existed for decades), doing just that would require nothing more than a single keystroke on a computer terminal. Telemedicine: The Next Wave of the Future?In the past two years or so, the combination of “smart” mobile telecommunications devices like the iPhone®, along with social-networking platforms like Facebook® and Myspace® and even virtual-reality platforms like Second Life®, have revolutionized the way people, businesses, and institutions communicate. Industries as varied as retail, financial services, and even manufacturing are embracing the possibilities that these technologies bring to our new, smaller world. Can health care be far behind? It’s closer than you think. For example, Cisco Systems is already exploring the health care possibilities of current virtual-reality applications like Second Life ®, or platforms yet to be developed. “We foresee virtual reality having a place in patient care,” says Kathy English, RN. “For example, we at Cisco can visualize an application where patients can seek health care information and advice from a virtual-reality avatar, especially when they’re seeking very personal information and want it administered in a non-judgmental way, such as a teenager seeking accurate sex-education or birth control information.” 
What Will the Future of Illness (And Wellness) Look Like?The potential for advancing technology to revolutionize the health care industry is certainly vast. But what diseases will 21st-century medicine be fighting most? “Our number one health care problem in the United States is obesity,” says Dr. Harrell. “Obesity and all the diseases that accompany it—diabetes, heart disease, high blood pressure, and many cancers—are generating massive costs in our health care system today. And it’s only going to get worse.” The Centers for Disease Control and Prevention (CDC) estimates that obesity-related costs account for 9.1 percent of total U.S. medical expenditures and may have reached as high as $78.5 billion in direct and indirect costs annually.2 The CDC further predicts that if current trends continue, in 10 years, more than half of the U.S. population will be obese. Other areas of public health interest in the coming decades include epidemiology relating to “superbugs” like drug-resistant bacteria and H1N1 (“swine flu”), the use of nanotechnology and gene therapy. However the U.S. health care industry develops over the next ten years, one thing is clear: the United States needs catch up with other industrialized nations when it comes to delivering quality health care at a reasonable cost, or face the dire economic consequences. Fortunately, the U.S. is the world’s epicenter of new technology development, and new technologies will be the key to meaningful health care reform.
Reprinted with permission from the University of Phoenix Knowledge Network. Visit the Knowledge Network site or email knowledge.network@phoenix.edu.
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 PHOENIX FOCUS FEBRUARY 2010 |
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