Reducing the cost of health care -- “Information exchange and Interoperability”

http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.10v1.pdf

Here the claim is made that going beyond simply having greater use of electronic medical records to a system with “fully standardized HIEI [health care information exchange and interoperability could yield a net value of $77.8 billion per year.” The claim is supported with data highlighting the current cost of Information exchange. It although it seems unlikely that the authors have a vested financial interest in seeing the change as previously stated many companies stand to gain by providing the services require for the switch.

Reducing the Cost of HealthCare-- preventative care

http://content.nejm.org/cgi/content/full/329/5/321

Using “preventative care” to reduce medical cost intrinsically makes sense. Reducing the number of people the number of people suffering from chronic conditions would certainly reduce costs more then any one gadget, but “preventative care” is broad vague and hard to define. This article makes the statement that “Preventable illness makes up 70 percent of the burden of illness and the associated cost.” It goes on to discuss how health promotion in the work place can help reduce costs. Information like “recent review of 28 separate studies of health promotion in the workplace emphasized the effects on documented cost reduction, with the savings generally being three or more times greater than the program costs” is given to suppose their claim.

Reducing the Cost of HealthCare -- video conferencing to reduce the amount of out patient care

http://www.jstor.org/stable/3767516

This paper “Reducing the Cost of Frequent Hospital Admissions for Congestive Heart Failure” discusses two ways to reduce costs created by out patient care for CHF. The First being the more technically advanced: using 2-way video conferencing with an “integrated electronic stethoscope” to check on patients and reduce hospital visits. The second being the simpler use of nurse phone calls to reduce the need for visits. The article states that the video conferencing saved 86% while regular telephone calls saved 84 % over the control. Their data comes from 37 CHF patients broke into three groups: one receiving care via video, the second over the phone and the third being a control with normal out patient care. The study lasted 6 months. This claim seems viable as it is accompanied by such definitive results. Although to see whether these kinds of methods could be used for cost savings in broader range of ailments would require a lot more testing.

Reducing Healthcare Costs -- New Microchip Technology Performs 1,000 Chemical Reactions At Once

Back in the vein of Individual device advances leading to a reduced cost in Healthcare. UCLA researches claim to have created a “microchip” which can perform and test “1,000 chemical reactions at once.” In theory this could help greatly in reducing costs in medical research. No direct evidence is give of this device reducing medical costs, as its still in development, but testing seems to show that it fulfills its intended purpose. The UCLA website definitely has vested interest in the discussing the success of the Universities own researchers but, as a respected institution it also has a vested interest in giving credible information so as not to undermine its other researchers.

http://newsroom.ucla.edu/portal/ucla/new-microchip-technology-performs-97160.aspx

Reducing the Cost of HealthCare -- Medical Technology 'Arms Race' Adds Billions to the Nation's Bills

http://www.nytimes.com/1991/04/29/us/medical-technology-arms-race-adds-billions-to-the-nation-s-bills.html

We were discussing this article in my writing seminar on medical technology so, i figured i would use this post to highlight the fact that the exorbitant cost of Healthcare is largely due to medical Technology. This article is from 1991 but here are two more to pretty much the same effect from this year:

http://www.nytimes.com/2009/03/02/health/02scans.html?_r=1&scp=4&sq=pet%20scanners&st=cse

http://www.cbsnews.com/stories/2009/09/24/eveningnews/main5337931.shtml

The first article discusses the progression of medical imagining technology and the rise in costs that comes with each advance. at the time it was written (and i see little reason to think that much has changed since the 90's): "Coronary bypass surgery... in the United States ... accounts for about $1 of every $50 spent on health care" even though "a study by the Rand Corporation ... found that more than 40 percent of such operations did very little, if anything, for the patients."

"magnetic resonance imaging alone is adding about $5 billion to the nation's health bill" while "90 percent of the time that neurologists order M.R.I. scans no structural damage to the patient's nervous system is detected."

The designers of medical technology always have a vested interest in seeing it used. In a filled where everyone feels entitled to the highest standard of care possible each new advance generally leads to increased costs across the board. While there is no denying the effectiveness of positron emission tomography and other highly advanced technologies; to reduce costs engineers cannot continue to always look to the most complicated solutions.

Reducing the Cost of HealthCare-“A New Concept for Medical Imaging Centered on Cellular Phone Technology”

“A New Concept for Medical Imaging Centered on Cellular Phone Technology”

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0002075

“The goal of this study is to introduce and demonstrate the feasibility of a new concept in medical imaging that is centered on cellular phone technology and which may provide a solution to medical imaging in underserved areas. The new system replaces the conventional stand-alone medical imaging device with a new medical imaging system made of two independent components connected through cellular phone technology.”

This paper represents the concept of engineering a device not with the intent of improving its effectiveness over previous devices but instead aiming to improve affordability and ease of use. The idea is that costs would be reduced by using a single centralized Data Acquisition and viewing device which would be fed information from small portable scanners.

This is a very believable claim and one on which the authors state they have already done some successful testing. They many have a vested interest in seeing there produce succeed but no more so then the companies that are currently producing the more expensive stand alone versions.

Reducing the Cost of HealthCare--Electronic Medical Records

It is certainly logical that we would progress towards almost entirely electronic records in this digital age. They provide cost savings in that they take up no space and have great ease of access. They can also be used to study broad medical trends more easily, reducing the cost of large scale research. Many people do have a vested interest in seeing the change to electronic Records. With the government dumping 18 billion dollars in stimulus money to aid the transition and the expectation that billions more will be needed companies who proved this service, like Dell, IBM and GE(as mentioned in the New York Times article), stand to profit tremendously. Although many have a vested financial interest in seeing the change, the fact that large profit driven medical groups like Kaiser Permanente have already successfully made the switch proves that the upfront costs of purchasing this readily available technology are easily outweighed in the long run.

http://www.nytimes.com/2009/09/10/technology/10records.html?_r=1&scp=1&sq=electronic%20medical%20records&st=cse

http://www.itbusinessedge.com/cm/blogs/bentley/electronic-medical-records-can-do-more-than-increase-efficiency/?cs=36186

Reducing the Cost of Medicine--Mimics

http://www.rdmag.com/News/2009/09/General-Sciences-Engineering-Team-To-Design-And-Study-Liver-Mimics/

http://www.boston.com/business/healthcare/articles/2009/09/07/liver_cells_may_aid_drug_safety_studies/Developing new drugs can cost hundreds of millions of dollars; primarily do, to the extensive testing that must be done before they can be brought to market. These two articles discuses the creation of Liver Mimic to be used to test for drugs toxic effects in vitro. Currently problems with many drugs “may not turn up until companies have embarked on expensive clinical trials.” By building body structures in the lab and using them to rule out dangerous drug early on a great deal of money can be saved.

Can you imagine technologies that might help us to better manage things at Penn?

The best course of action for the University of Pennsylvania is to reduce the spread of the flu. A the CDC states “people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose.”(http://www.cdc.gov/h1n1flu/qa.htm). The University could take steps to make sure objects touched by large numbers of people, such as door handles and railings, remain free of the virus. The low tech solution of cleaning all touched surfaces multiple times daily could be implemented. Although considering the frequency of cleanings that might be required to be effective perhaps surfaces that kill viruses on contact could be used in these high traffic areas.

If there were only 500,000 swine flu shots available this fall, who should get them?

The CDC recommends “pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months and 24 years old, and people ages of 25 through 64 years of age who are at higher risk” (http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm) receive the swine flu vaccine but, in a country of over 300,000,000 getting down to 500,000 would take far more specific parameters. In the New England Journal of Medicine (September 2009) Hancock K, Veguilla V, Lu X, Zhong W, Butler EN, Sun H, Liu F, Dong L, Devos JR, Gargiullo PM, Brammer TL, Cox NJ, Tumpey TM, Katz JM reported that 34% of people born before 1950 “had a titer of 80 or more” of antibodies cross reactive to 1976 and todays H1N1 so perhaps we could limit the amount of vaccine given to the elderly. One could try and limit vaccinations to health care workers but the fact that alone the number of registered nurses in America stands a 2.9 million means 500,000 would be nowhere near enough to cover them and the myriad other medical professionals. Although people who are 25 to 64 are “at higher risk” this group encompasses tens of millions of people. Pregnant woman would certainly be a go choice but it must be kept in mind that the CDC states that the FluMist not recommended for them as well as people over 50, or who have asthma or heart disease so only the injected vaccine could be used.

Should i get swine flu vaccine?

Approved by the FDA on September 15 after only a few short months of development it seems impossible that we can know the long term effects of mass H1N1 Vaccination as such I do not feel the benefits of getting a swine flu vaccination out weigh the risks. The 1976 outbreak of swine flu was combated with similar vaccination attempts and although occurrence were rare the 1976 vaccine has been associated with the debilitating auto-immune disorder Guillain-Barre Syndrome. Thomas J. Safranek, Dale N. Lawrence, Leonard T. Kuriand, David H. Culver, Wigbert C. Wiederholt, Norman S. Hayner, Michael T. Osterholm, Peter O'Brien, James M. Hughes^, and Expert Neurology Group reported in "Reassessment of the Association between Guillain-Barré Syndrome and Receipt of Swine Influenza Vaccine in 1976–1977: Results of a Two-State Study "(1991) in the American Journal of Epidemiology “excess cases of Guillain-Barré syndrome during the first 6 weeks attributed to the vaccine was 8.6 per million vaccinees in Michigan and 9.7 per million vaccines in Minnesota.” Certainly 9.7 in a million is not a very large occurrence of severe side affects but the must be compared against the virulence of the disease and the fact that the efficacy of the vaccine cannot be guaranteed in all cases. The World Health Organization reports 3486 death out of 296471 cases world wide (http://www.who.int/csr/don/2009_09_18/en/index.html) but, when compared to the 36,000 people who die of seasonal flu each year, as reported by the National Institute of Allergy and Infectious Disease (http://www3.niaid.nih.gov/topics/Flu/understandingFlu/DefinitionsOverview.htm) these number hardly sound menacing. In a press release yesterday the US department of Health and Human Services (http://www3.niaid.nih.gov/news/newsreleases/2009/H1N1PedTrial.htm) reported that in a group of 25 children 24% showed no strong immune response meaning at least one in four vaccines administered will have no effect. In a younger group of children 3-9 64% showed no strong immune response after being given a dose of the vaccine.

i) Why did you pick Bioengineering?

I’ll start by saying that I’m taking BE100 as a member of the Penn school of Nursing but, as someone who is yet to find a set direction in life the broad and rapidly evolving field of Bioengineering seems as good a place as any to look. Starting out as an EMT, an aspiring nurse and a would-be computer scientist it seems likely that I’ll be able to find something that has great deal of resonance to me and my interests.

ii) What do you think Bioengineers do?

I certainly can’t say I have complete grasp of all disciplines and sub-disciplines of Bioengineering but Bioengineers seem tasked with things as diverse as isolating specific genes in hopes of understanding their purpose, replicating enzymes and proteins found in living organisms for use in pharmaceuticals to the more mechanical branches of designing orthopedic implants and creating new medical equipment like the EKGs and AEDs we carry on our ambulances. The overarching theme being the application of engineering principles to solve medical and biological problems as such a bioengineer stand at the confluence of several different fields of engineering.

iii) If you had a chance to go back in time and work on some biomedical technology – to be part of history – what would you choose? (And, of course, e

The Human Genome project’s quest to map the genes which connect us all as human beings would certainly be a defining and exciting moment in history to be part of. The progression in the understanding of genetics and the coming together of engineers and scientists around the world to do so just feels momentous.

iv) What would you like to learn about?

I’m very interested in the creation of new medical technology and their implications to emergency medicine

v) What would you like to learn how to do? That is, is there a skill you would like to learn?

I’m not sure I could give a specific skill I was hoping this course could help me answer that question in showing what is available to me.

vi) Find a news article (loosely defined) about bioengineering/biomedical technology and blog about that.

“Cost of Decoding a Genome Is Lowered” interesting in seeing just how far we have come in the last few years bring the cost to sequence someone’s genome down to $50,000 from $500,000 and how far the field will progress by the time I graduate in 2013.

http://www.nytimes.com/2009/08/11/science/11gene.html