Category Archives: Health information

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Smart cards, grad school and DoD (Doctor of the Day)

I had my presentation for one of my graduate classes this past Wednesday.  I went alright.  I think I got my point across.  I was pretty nervous during the beginning of the presentation.  A lot more relaxed once I really started to talk about the topic.  The topic was Disruptive Impacts of Smart Card Technology in Health Care.  I was planning on reading off my slides for my presentation.  The night before the presentation, I picked up my buddy, Chris, for our usual Tuesday basketball.  Chris teaches Astronomy classes at UVic, and I wanted to know how he handles teaching in front of a class.  Chris’s advice was that to talk about what you know about the topic rather than reading your slides to your audience.  Audience can read the slides later on their own if you made your point across.  Ain’t that the truth!  I took Chris’s advice and tried to make my point across in my presentation.  Smart cards will help us better manage our health information while keeping our health information safe if done properly.  It’s proven in many countries (i.e. France, Germany, Taiwan, and more) that smart card technology has a new-market disruptive impacts in health care delivery.  From a health care service provider point of view, smart cards help make patient information electronic, provide easier and more secure access to patient information and cut back paper and administrative costs in the delivery process (i.e. prescription and insurance claim forms).  As patients via smart cards, we can get educated on how to manage our health information better, receive health insurance reimbursement quicker and have fewer headaches on worrying about forgetting medical information when needed.

The first term of my graduate school adventure has been rewarding mentally and stressful physically.  I worked hard for my first assignment and realized when being interested and having curiosity on a particular subject helps learning.  Guests lectures on different professors’ research areas acted like a preview of what the school specializes in.  It was a great way for me to start thinking what I should focus on and define what particular field I want to research on.  I’m enjoying it so far.

I learned a new term from my supervisor at the MoHS this week.  The term is Doctor of the Day, or DoD.  A DoD provides the medical care required by orphaned patients including admissions to hospital and necessary physician care while in hospital.  Doctors of the Day can be any GPs and get compensated while providing available coverage for patients.  While there are no specified response times for DoD, physicians are expected to provide timely and appropriate care for patients.  Health authorities in British Columbia encourage and ensure physicians participating in a DoD program.  Physicians participating in the DoD program have obstrical privileges at the facilities where they provide services.  Here is a document came out in February 2003 to describe this program in BC.  Apparently, this Doctor of the Day concept is being implemented throughout the province right now, so we’ll see what kind of impacts it’ll have on our health care system soon.

Some definitions around innovation

Disruptive technology has been one of my main research areas for my first term of graduate school.  Disruptive innovation is an interesting and fairly new concept introduced by Dr. Clayton Christensen, a well-known MBA professor at the Harvard Business School.  In order to understand disruptive technology fully, I studied the categorization of a technology/innovation.  Here are some definitions I found from my research on innovation.

An innovation is either sustaining or disruptive to our society.  According to Clayton Christensen and Michael Raynor in their book, The Innovator’s Solution, “a sustaining innovation targets demanding, high-end customers with better performance than what was previously available.  Some sustaining innovation are the incremental year-by-year improvements that all good companies grind out.  Other sustaining innovations are breakthrough, leapfrog-beyond-the-competition products.  It doesn’t matter how technologically difficult the innovation is, however: The established competitors almost always win the battles of sustaining technology.  Because this strategy entails making a better product that they can sell for higher profit margins to their best customers, the established competitors have powerful motivations to fight sustaining battles.  And they have the resources to win.”  Within sustaining innovation, there are revolutionary and evolutionary innovations.  A revolutionary innovation creates a new market that by allowing customers to solve a problem in a radically new way, while an evolutionary innovation improves a product in an existing market in ways that customers are expecting. Automobiles were a type of revolutionary innovation in the transportation industry improving the traditional horse carriage or rail road types of transporting methods.  When fuel-injected engines came out, it created an evolutionary effect in the automobile industry.  A fuel injection system increases engine fuel efficiency and produces more power than a carbureted engine, therefore, it is an evolutionary innovation.

“Disruptive innovations, in contrast, don’t attempt to bring better products to established customers in existing markets.  Rather, they disrupt and redefine that trajectory by introducing products and services that are not as good as currently available products.  But disruptive technologies offer other benefits – typically, they are simpler, more convenient, and less expensive products that appeal to new or less-demanding customers.” (The Innovator’s Solution, p. 34, 2003)  Disruptive technology can hurt successful, well managed companies that are responsive to their customers and have excellent research and development.  Within disruptive innovation, Dr. Christensen distinguishes between low-end disruption, which targets customers who do not need the full performance valued by customers at the high end of the market, and new-market disruption, which targets customers who have needs that previously unserved by existing incumbents.  Some of the low-end disruption examples include downloadable digital media disrupts the CD and DVD market, digital cameras disrupt the film-based cameras, and plastic products disrupt the metal, wood and glass wares.  The Linux OS is the perfect example as a new-market disruptive innovation.  When the Linux OS was first introduced in 1991, it was inferior in performance to other server operating systems like Unix and Windows NT.  However, it was inexpensive compared to other server operating systems.  After years of improvements, Linux is now installed in 87.8% of the worlds 500 fastest supercomputers.

In health care, there are many disruptive technologies such as smart cards, RFID, remote monitoring, wearable computing, personal health records, genomics, bio sensing, bio informatics, etc.  My current research is on the disruptive impacts of smart card technology in health care.  Knowing the types of innovations after the previous discussion I now appreciate the fact that smart card technology should be categorized as a new-market disruption in health care.  Understanding and distinguishing the difference between various types of innovations is critical for my research.

Reference:
* http://en.wikipedia.org/wiki/Disruptive_technology
* http://en.wikipedia.org/wiki/Fuel_injection
* Christensen, Clayton M., Raynor, Michael E. (2003). The Innovator’s Solution.

Inpatient VS Outpatient

I was in a meeting yesterday, and the terms, inpatients and outpatients, were referred to numerous times.  Going back and forth with these terms, I ended up coming out of the meeting a bit confused on their definitions.  I thought I had these terms figured out pretty damn clear!  Therefore, I decided to look them up and distinguish them once and for all.  Here is what I found.

Inpatient

  • Inpatient is a patient whose care requires a stay in a hospital.
  • Inpatient care is care given to a patient admitted to a hospital, extended care facility, nursing home or other facility.  Long term care is the range of services typically provided at skilled nursing, intermediate care, personal care or eldercare facilities.
  • Inpatient hospitalization makes sense for major diagnostic, surgical or therapeutic services, where the patient’s condition or response to medication must be closely monitored.  In the case of mental health treatment, a hospital stay may make sense if the person is suicidal or self-destructive or poses a threat to others.  In the case of chemical dependency or alcohol treatment, a hospital stay may be needed during the detoxification stage to monitor symptoms during withdrawal.  Inpatient hospitalization also allows a combination of individual care, group therapy, community meetings and activities.
  • The term inpatient dates back to at least 1760.

Outpatient

  • Outpatient is a patient receiving his/her care usually not in a hospital setting, but in places like a doctor’s office, clinic, or day surgery centre.  When an outpatient is admitted to a hospital, this patient does not require an overnight stay.
  • Outpatient treatment in a doctor’s office or clinic, often supplemented by medications administered at home, remains the norm for most routine care.  Thanks to advances in treatments and technology, many tests and surgical procedures formerly conducted in the hospital can be done in an office setting.  Outpatient care also provides the norm for most mental health and chemical dependency treatment.
  • Outpatient surgery eliminates inpatient hospital admission, reduces the amount of medication prescribed, and uses the physician’s time more efficiently.  More procedures are now being performed in a surgeon’s office, termed office-based surgery, rather than in a hospital-based operating room.  Outpatient surgery is suited best for healthy people undergoing minor or intermediate procedures (limited urologic, ophthalmologic, or ear, nose, and throat procedures and procedures involving the extremities).
  • The term outpatient dates back at least to 1715.  Outpatient care today is also called ambulatory care.

Alternative terminology

Due to concerns such as dignity, human rights and political correctness, the term “patient” is not always used to refer to a person receiving health care.  Other terms that are sometimes used include health consumer, health care consumer or client.  These may be used by governmental agencies, insurance companies, patient groups, or health care facilities.  Individuals who use or have used psychiatric services may alternatively refer to themselves as consumers, users, or survivors.

In nursing homes and assisted living facilities, the term resident is generally used in lieu of patient, but it is not uncommon for staff members at such a facility to use the term patient in reference to residents.  Similarly, those receiving home health care are called clients.

Reference: Wikipedia and Google

Health Council of Canada applauds B.C. plans for primary health care reform

The Health Council of Canada applauds the British Columbia Ministry of Health Services and the B.C. Medical Association on their June 24, 2010 announcement of $137 million toward integrated primary and community care that will connect every resident with a family doctor by 2015, starting with the province’s most vulnerable citizens – high needs patients, frail seniors and patients with chronic diseases.  Reporting nationally, the Health Council has made the case based on research evidence and frontline experience, for many of the types of reform B.C. will put into action. In Beyond the Basics (2010), the Health Council shows that for Canadians with chronic conditions – one of the priority patient groups for B.C. – having a regular doctor does not guarantee the safest or most supportive medical care. Rather, doctors need also to provide the basic elements of good primary care, two of which are knowing their patient’s history and helping to co-ordinate other aspects of patients’ care.  “Co-ordination is key, and this is where collaborative health care teams also have a critical role to play,” said John G. Abbott, CEO of the Health Council of Canada. Like the proposed B.C. initiative, the Health Council’s report, Teams in Action (2009), finds clear advantages in the shift to team-based care, suggesting this should be the standard of care in particular for the growing number of Canadians with chronic conditions.   In Helping Patients Help Themselves (2010), some obvious gaps to be filled in order to better manage complex chronic care patients include asking patients about their goals for their own care and referring them to community services that might help them reach those goals. B.C. is ready to close such gaps through enhanced care planning. “The B.C. announcement talks about ‘an individualized and co-ordinated personal medical health-care plan linking together various health professionals to provide better quality care,” said John G. Abbott. “These are the types of approaches that our work supports,” he added.

The above article is taken from the CNW Group: http://www.newswire.ca/en/releases/archive/July2010/05/c2152.html

European eHealth News in 2009

If you are following eHealth and wondering what were the breaking news or the top hitters in the world of eHealth in Europe in the year 2009, this link will satisfy your urge: http://www.ehealthnews.eu/top-articles-2009.  It covers news from telehealth to pharmaceuticals, from European health insurance to home care, and from medical informatics to electronic health records.  Quite an extensive coverage.  Enjoy!

Report urges improved access to primary care

A report produced by the College of Family Physicians of Canada and the Canadian Medical Association this week promotes the goal of 95 per cent of the population having a regular family doctor by 2012.

According to a recent public opinion poll for the Canadian Medical Association, coverage currently stands at 82 per cent.

The two medical associations say there are two ways of reaching the ambitious 95 per cent target: increasing the number of physicians practicing in the country, and increasing physician’s capacity to take on more patients.

However, these two measures are unlikely to allow the goal to be reached in time. It says more medical students should be encouraged to choose family medicine. While there has been some movement in this direction, most students still opt to become specialists.

It also recommends the integration of foreign-trained physicians in the workforce, something the provinces are doing. But physicians wanting to immigrate to Canada will not benefit from a new federal-provincial-territorial accord streamlining the recognition of foreign credentials until the end of 2012.

The report largely deals with how to help physicians make their practices run more efficiently and take on more patients – not just urging them to “work harder and longer.”

It says teaching physicians to run a practice from a patient-flow point of view should start in medical school, and there are a number of techniques already being used that are bearing fruit. This includes “advance access” scheduling that leaves a physician’s schedule open for same-day appointments.

Wait times for primary care are an issue, and the reports says measuring these waits should be a priority for governments even though it is difficult to break this information down by the myriad reasons patients have for seeking an appointment.

Team-based care is another approach that is being used to improve patient care, but, as an instrument for improving access, the report says the jury is still out and more research is needed.

The two medical associations say tools to improve the timeliness of referrals to specialists also need to be enhanced. They point out that research undertaken by the Fraser Institute finds that half the total waiting time for care is the interval between when the family physician makes a referral and when the patient is actually seen by the specialist.

They say good professional relationships between family physicians and specialists should be promoted and supported in the health system.

Reference:  Health Edition – December 4, 2009. Volume 13 Issue 48

Federal audit shows progress being made on Electronic Health Records

A report released on November 4, 2009 by the Auditor General of Canda confirmed Canada Health Infoway has “accomplished much in the eight years since its creation.”  The Auditor General concluded that Infoway is making the best use of its funds for Electronic Health Record (EHR) projects, established appropriate governance mechanisms and management controls as well as a risk management strategy.

Reference:

Health care spending in Canada to exceed $180 billion this year

Health care spending in Canada is expected to reach $183.1 billion in 2009, an estimated increase of $9.5 billion, or 5.5%, since 2008, according to new figures released today by the Canadian Institute for Health Information (CIHI). This represents a forecast increase of $241 per Canadian, bringing total health expenditure per capita to an estimated $5,452 this year. The figures are included in CIHI’s report, National Health Expenditure Trends, 1975 to 2009, Canada’s most comprehensive source of information tracking how dollars are spent on health care in this country. The combination of a slowdown in the economy and a continued increase in health care spending resulted in a jump in the proportion of health care expenditure from 10.8% of Canada’s gross domestic product (GDP) in 2008 to an estimated 11.9% in 2009.

 Reference:

Putting tables from Oracle into SAS

If you are interested, the following SAS codes can help you import tables from Oracle into SAS.

 

/*get two tables from Oracle*/
rsubmit;
%macro recent(dsnin1=,dsnout1=,vars=);
proc sql stimer noerrorstop;
%include ‘~/connect.dssp’;
%put &sqlxmsg;

create table &dsnout1 as
select * from connection to ora (
select &vars
from
&dsnin1);
disconnect from ora;
quit;
%mend recent;

options nomlogic nomprint;
%recent(dsnin1=orcale_schma_name1.table_name,dsnout1=new_table_name1,vars=*);
%recent(dsnin1=orcale_schma_name2.table_name,dsnout1=new_table_name2,vars=*);

endrsubmit;

HIM?

I can’t believe how long it has been since the last post I made.  I need to write more often!

A few things have happened in the last couple of months in my life.  MHI at UVic rejected my grad school application.  That was hurting.  Anya got a raise.  Woo-hoo!  Holly had her first period and first agility class.  Both very crazy and amusing to see!  My conversation with Alex Berland had inspired me in many ways, including my passion in health care.  I registered for a couple of courses to get myself SAS certified.  Went to my second toastmaster session.  The first time was in ESL; oh, the good old ESL days.  Loving my job!  I think I’ve finally found my profession, HIM, Health Information Management.

What’s HIM you ask?  Wiki said, “[HIM is] a discipline that focuses on health care data and the management of health care information, regardless of the medium and format”.  A big part of what I do now is to provide mental health and addiction data for various purposes within the ministry of health services.  OK, maybe my job is not too much about managing health care information, but what I do is definitely a part of the data manipulating and communicating process in health services for the province.  I truely believe that the practicality of a health policy is heavily based upon how correct the data is.  Now, to automate the whole process will be our or next generation’s job to improve health care.

Will out.  Let’s see if I can keep this up 🙂

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