Innovation and the Internet: The Real Leaders in Healthcare Reform

Healthcare reform is inevitable; it may be of legislative design or shaped by market forces, but there is a common thread. There will be fewer dollars in the system and a higher demand for resources. The biggest impact will be on hospitals and healthcare workers. The model of care will change very little. Routine visits and elective surgery will be directed to outpatient centers and inpatient admissions reserved for the acutely ill and traumatic injury. Early intervention in acute illness and timely treatment of injury saves lives and reduces the cost of care. Is there a new role for Emergency Medical Services in prehospital care and what new technologies might be incorporated into acute and trauma care?

Critical Factors Effecting Healthcare in the Next Ten Years

Shortage of Healthcare Workers


The demand for health services is on the rise, fueled by aging baby boomers and an epidemic of obesity and related diseases. Federal government sources estimate a shortage of 1 million nurses by 2020. Factors affecting the nursing shortage are two fold. There are not enough qualified nursing educators to train the work force and the turnover with in hospitals is very high. There are ongoing efforts by the American Association of Colleges of Nursing and federal and state governments to increase the number of nursing faculty and new nurse trainees. But, retention of experienced nurses has been problematic. In a report from Pricewaterhouse Cooper's Health Research five reasons for nursing job dissatisfaction were sited: (a) an excess amount of administrative paper work, (b) work load strain second to high acuity, (c) inadequate staffing, (d) poor compensation and (e) disruptive physicians (Pricewaterhouse Cooper, 2007).



Stretching manpower and resources is a daily struggle for healthcare administrators and staff. Thus far efforts to reduce the demands on nursing have focused on utilizing patient care extenders and improved work processes such as electronic charting. Now, a flu pandemic is looming and will exert and even bigger strain on a system struggling to retain experienced nurses.


Increase in Outpatient Programs and Home Care


President Obama's reform initiative mandates coverage of preexisting conditions. Third part payers have agreed in principle and intend to offset the cost of covering the chronically ill by dramatically increasing enrollment. Outpatient centers, home care and wellness programs will increase and continue to divert sources of revenue and labor from impatient facilities. Inpatient care will be reserved for the acutely ill or victims of trauma. Hospitals will have fewer patients but incur higher costs associated with acute care and advanced diagnostic modalities.

New Resources and Future Innovations

Inpatient Care


Hospital systems and managers will remain challenged to provide quality cost effective care. Lessons learned through implementations of computer systems into operations and patient care will be applied in continued efforts to stretch man power and resources. Plug and play modalities will be developed by medical device manufacturers to meet administrative demands for cost economies (Grifantini, 2008). Monitoring systems will interface with technologies throughout the hospital including the EMR. Telemedicine will become accepted and utilized in even more creative ways.


Prehospital Care-a Bridge Over a Widening Chasm


Knowledge gained from the flu pandemic as well as military action in the Middle East will place renewed emphasis on early intervention in acute illness and trauma. Emergency Medical Services will transform and become increasingly important in the continuum of acute care.



Emergency Medical Services in the Future


The ambulance of the future will resemble a sleek dune buggy rather than a cumbersome cargo truck and may eject a paramedic into difficult trauma fields. (Royal College of Art, 2009) Specialized Pakbots could be used for search and rescue efforts, to provide satellite communication between the Emergency Department and field personnel, as well as traffic control at the scene. Paramedics wear flexible, touch LED screens equipped with storage drive to document treatment at the scene and download into the EHR at the ED or via satellite connection (Ubergizmo, 2009).

A national health information infrastructure allow nonidentifying patient data obtained at the scene to be downloaded into a Regional Health Information Network. The RHIN will analyze and issue timely alerts on trends and sentinel events to the Center for Disease Control and Home Land Security regarding threats to public safety. In response, a revamped advanced warning system will send out a text message notifying the public to take action. (Text messaging was added as utilization of satellite entertainment and communication expanded and made the Emergency Broadcast System obsolete.)


ED's handle only acute cases enabling specialty physicians to monitor and direct patient care via satellite at the scene and facilitate patient transfer to the appropriate inpatient care unit. Ambulatory urgent cases will be directed to a specialty clinic or a mobile urgent care unit will be dispatched to evaluate, treat and release.



Intensive Care


Primary care nursing returns and efforts will focus on assistive technologies rather the addition of care technicians. On admission, patients will be placed in an automatic hyperbaric bed to promote healing and monitor vital signs and hemodynamic function through integrated, noninvasive technologies such as impedence cardiography (Cardiodynamics, 2009). Bed sensors will control room temperature and ventilation for patient comfort and sample air quality for infectious disease. Infection control data will transmit to a remote, system wide management center that will monitor patient care and issue alerts. The hospital bed will have multiple functions that assist nurses and physical therapists to move and reposition the patient.



Hospital physicians will be Intensivists and utilize the real time EHR monitoring systems rather than make individual rounds. Nurses will communicate and chart with a virtual head set that allows them to chart electronically with the assist of a flexible wrist LED screen.



Rehabilitation and discharge planning begin immediately on admission. After a complete assessment of injuries and functional abilities, nursing consults with social services and develops a virtual recovery plan. The patient's information cube (computer) will be customized with virtual healing modalities such as physical therapy, speech therapy and relaxation/stress management techniques.



An Unrealistic Dream?



When compared to current EMS procedures and acute care this scenario might seem like a model for future generations, but many of these products are in development at this time. A brief internet search yields an array of amazing technologies and applications for the net itself ready to be integrated into healthcare and new innovations appear daily.



Meaningful healthcare reform is coming. It will not come from a legislative process, but rather in technology and innovation in delivery.

References

CardioDynamics, (n.d.), Impedence Cardiography (ICG)): Technology Overview and Physician Office Appilication. Retrieved September 20, 2009 from CardioDynamics: http//www.cardiodynamics.com/PDF/OPslides.pdf

Grifantini, K. (2008, July 09). Technology Review. Retrieved September 19,2009, from Technology Review: http//www.technologyreview.com/biomedicine/21052/

PricewaterhouseCooper's Research Institute. (2007, July). Healing the Healthcare Staffing Shortage. Retrieved September 21, 2009, from PricewaterhouseCooper's:http://www.pwc.com/us/en/index.html

Royal Collegeof Art, London. (2009, April 11). EMS Innovation, Ambulances and Ejector Seats. Retrieved September 23, 2009, from MedicCast: http//www.medicast.com/blog/2009/0411/ems-ambulance-and -ejector

Ubergizmo. (2009, September 20). Ubergizmo. Retrieved September 20, 2009, from Ubergizmo: http//www.ubergizmo.com/15/archives/militry/index.html.

What is the role of Second Life in Health Care?

The current concept of virtual education is readily accepted and available in the medical community. Health professionals can train in virtual settings ranging from hands on with a linear accelerator to simpler programs such as the American Heart Association' ACLS review.

Now enter Second Life, the exciting interactive virtual world created by Linden Labs. Second Lifers obtain avatars or virtual persona to communicate with other participants and move about in a multitude of worlds or islands. Second Life has been utilized for training and communication needs in special patient populations, but can the patient-physician relationship exist in a virtual world?

Primary to the patient-physcian relationship is the exchange of verbal and nonverbal communication between parties the goal of which is to establish trust. In real life, patients may be either unable or inept at clearly conveying issues and concerns. Appearance, body language and responsive reactions are important to establishing a repore and are of as much value in diagnosis and treatment as lab values and vital signs. It is novel that a Second Life avatar can sigh or laugh but frequently when assessing a patient, observing gestures and facial expressions are key, such as evaluation of neurologic symptoms or a pain syndrome. Assessment tools such as the Wong-Baker pain scale use examples of facial expressions to assist the clinician and patient to assign a value. It is difficult to envision that a conventional, therapeutic patient-physician relationship could exist within Second Life in most cases.

But Second Life does have value in the information age. It lies in its applications in education for providers and patients and as an adjunct to conventional therapy. There are new applications for providers such as "hands on" in special procedures and sharing of knowledge between health care communities like USU's Virtual Intensive Pediatric Education Resource (VIPER).

Certainly interactive education works well with patients too. I posed the question to friend/physical therapist that perhaps a physical therapy island may be of value and she saw great potential in home therapy with cognitively impaired patients. These patients benefit from exercise to maintain balance and range of motion but it is difficult to keep them on task. She felt a visual program and some simple interactions with an avatar would be of great assistance in home therapy as well as a welcome respite for busy caregivers.

Second Life may be a tool that has some value as part of a rehabilitation/wellness program such as Cardiac Rehab. Stress management is one of the essentials of such a program. There are relaxation techniques that can transfer to virtual space. Incorporating this into an island of recovery where experiences can be shared may be safer and more convenient than the real world. Occasionally participants require an intervention and this would bring it back to the real world where the patient- physician relationship belongs.

I think that Second Life is a unique tool that has a lot of potential in health care as a resource for education, communication and new methods to deliver adjunctive therapy but the patient-physician interaction is human to human. Altering that communication to include virtual concepts is complicating an already challengeing relationship.