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.