Monday, July 14, 2008

Steal these slides

I just stumbled across the "attic" of Tom Ferguson MD, who was the "George Washington of patient empowerment," as CNN put it this month, citing his work since 1975 to create a world of freedom and power for patients.

(That's you, in case you didn't notice. Thank him.)

Those familiar with the e-patient blog know about the white paper DocTom's team completed after his death in 2006. But I didn't know some of his earlier writings are around on, a modest web site. It includes a few old slide shows, sans speaker notes. But the good stuff is the images: you can get the drift.

My favorites (above) are #88 and #89 from his 2003 slides. Here's my narrative:
In the industrial age, the means of production and ability to create value were centralized in massive facilities. If you didn't own the factory, you didn't have freedom and power.

In the information age, those with access to information have access to power and can create value.
Those slides were made in 1995, when the Web had just been born, but they hit the nail on the head: today we have access to tremendous resources, and that empowers and enables us.

Please don't interpret these slides as meaning that in the world of the future there will be no doctors. That's idiotic. Rather, Tom's vision is that "we the people" have a lot more ability to contribute than was once thought. And both costs and quality can improve as a result.

Compelling evidence to support this was collected into the white paper (above). Further independent evidence from around the world is provided by the Patient Centered Primary Care Collaborative, about which I wrote in May.

Steal Tom's slides. Show them to others, put them in your decks when you give talks. And re-view the PCPCC slides, with their data on cost and quality. It's a new world out there - feed your head!

1 comment:

  1. Electronic Medical Health Records And Medical Homes: Innovation In Medicine

    These innovative patient care records are progressively being adapted by those involved with the health care profession. The criticism of the existing health care system- expressed by others such as the Institute of Medicine, have caused others to consider the benefits of these health care records. Known often as EHRs, there are those who have understandable concerns regarding a patient’s personal information now in a digital format that can be accessed over a network. However, the advantages of this new innovation can potentially reduce medical errors as well as cost. The health care providers and their staff are now allowed to be more efficient as they promote standardization of care due to this new paradigm of accessibility that makes patient information easily obtained by the caregivers. Also, these new EMRs may improve billing accuracy for various medical establishments. In addition, these EHRs may likely decrease the possibility of performing duplicate ancillary services that occur in large part because of other health care providers understandably are unaware of the patient's history relevant to this mistake, perhaps. Needless to say, the handwriting of the well-educated will no longer vex readers who attempt to read what may be unreadable thanks to the advent of EHRs.
    Yet still, presently only about 10 percent of medical institutions and health care clinics have a fully integrated system regarding EHRs. However close to half of all health care providers have and use these EHRs. Electronic Medical Health Records have advantages, yet have not been adopted by many involved with patient care for a variety of reasons. EMRs supplement what is known as pay for performance initiatives for health care providers. This relatively new and controversial standard being implemented by payers of reimbursing those in the health care system that rewards those providers who deliver superior health care financially for meeting or exceeding variables established by those who reimburse providers. Some argue that this protocol of reimbursement to health care providers may not be in the best interest of patients- and the variables, some say, are not clearly defined yet. The reimbursement method is based on how providers demonstrate performance and outcomes data regarding patient care. This removes the focus on treating the individual patient- and the P4P initiative does not allow for variables associated with different specialties in medicine that allow for necessary deviations from a structured system such as this.
    Also, those who do have EHRs in their medical clinics utilize only a fraction of what these electronic digital devices are capable of providing. As stated already, this data includes factors that describe performance and outcomes of the care given to patients. So if EHRs are utilized by health care providers, they should perhaps strive to maximize the sharing of data, as this potentially enhances and promotes the quality of health care delivery, according to others.
    The functions of electronic health records include the following:
    -storage and transmission of health care information and data improved, along with reporting functions
    -the management of ordering procedures for patients, and results from diagnostic testing
    -enhanced connectivity and communication offered by EHRs
    -enhanced support of patients, and the decisions regarding their care

    Interoperatibility is the exchange of information due to the ability to access and deliver this data to compile knowledge at the point of care. This is also considered a significant benefit with EHRs that is often mentioned by those who utilize EHRs in their medical facilities. Big words sound impressive, do they not?
    One exception to the overall lack of adaption to the concept of EHRs is that this system was implemented with the Veteran's Administration- which consists of over 150 hospitals and nearly 100 medical clinics. Their EHR system, called VistA, is fully functional and beneficial for those who care for others at these facilities. The Army is considering the utilization of EHRs as well at some locations they are giving them a try in the beginning of 2009. If successful, maybe further growth will occur with EHRs.
    The new administration in the United States appears to support the benefits of EHRs as a prominent factor for health care reform, as well as large managed care organizations, according to reports by others. Others who consider EHRs critical to their concept of patient care models are the resurrection of what are known as Medical Homes- somewhat as a result of the shortage of primary care physicians combined with the progressive concern regarding caring for the chronically ill patients.
    Medical Homes was first suggested as an ideal way to care for those in need of health care by the American Academy of Pediatrics over 40 years ago. The premise behind the medical home is that, if properly implemented, it will result in continual care for patients with a personal physician. This model will result in better health outcomes as well as assuring the health care services needed are provided for certain patients. Components of the medical home model are the following:
    -A personal relationship between the health care provider and the patient.
    -A multi-talented team approach providing ongoing patient care
    -A comprehensive approach that expands the scope and content of health care provided
    -Coordination to enhance communication between the doctor and the patient as well as assuring availability of the health care provider, instead of the episodic care that exists.
    -Electronic health records as well as implementing evidence-based medicine to assure improvements with the quality of care delivered, as well as the safety of the care given to the patient
    Medical homes are believed to be a model that provides increased value by maximizing the potential of the health care system, which may result in saving up to 70 billion dollars a year, according to others.
    Presently, primary care physicians care for approximately 2500 citizens in a certain community, which results in about 5000 patient visits lasting 15 minutes each is a doctor’s office. Medical homes should expand the scope as well as the content of health care given to others.

    Dan Abshear


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