This article, Advancing Health Care the Old-Fashioned Way, was first published by Healthcare Innovation News on February 8, 2015.
“Nothing recedes like progress.” — Edward Estlin (e.e.) Cummings
Though cutting-edge technology serves as the foundation for modern American healthcare, an accurate measure of progress must consider the occasional conflict between society and science. Even as yesterday’s medical miracles give way to what are now considered “state of the art” practices, it is the duty of health care providers to remain mindful of both sides of the equation, balancing the capabilities of today’s technologies with the needs of today’s patient. If society and science are not in sync, patient care will suffer, and sometimes we can only advance healthcare through old-fashioned methods. For example, radiology information systems (RIS) and picture archiving and communication systems (PACS) collaborate to deliver dynamic and brilliant medical images to any healthcare provider around the globe with access to a desktop computer or mobile device. And yet, if these technologically advanced tools of the trade fail to employ the appropriate methods of encryption as they transmit digital health information to a doctor’s iPad as he or she vacations on the island of Tristan da Cunha, or worse, send this sensitive information to the hard drive of any one of the island’s 297 permanent residents living in the recesses of the Atlantic Ocean, a data breach occurs. This is no small matter for the hospital of today, and could easily result in a series of fines that could force the shutting of its doors for a single infraction.
Likewise, the modern technique of delivering medication placed inside microscopic bubbles of fluorocarbon gas injected into a patient’s bloodstream, set to dispense a strong narcotic upon the release of a high-energy ultrasound pulse, does little to protect the attending physician from the misplaced wrath of a patient in a hypnagogic state, that period just before falling asleep. This is the state of health care today, where the miracles of modern technology are forced to work their magic by providing what all patients want most – quality health care – in the last place anyone wants to be – a hospital. Bringing innovation to the forefront of healthcare can at times be as challenging as drawing the number six while making clockwise circles with one’s legs. In matters of life and death, however, healthcare is all too familiar with the need to overcome adversity, and innovation will always fight to find its place so that the system can flourish.
Remember the Basics in Advancing Health Care
A 640-slice computed tomography (CT) scanner can digitally capture an image of the human heart in less time than it takes that heart to beat, while also aiding in the evaluation of strokes, pulmonary embolisms, abdominal illness and sinus headaches. In the hands of an inept clinician, however, the results of this $2.5 million technological masterpiece can be just as unhelpful as the once lauded but now discredited pneumoencephalography study, an antiquated medical procedure which involved draining cerebrospinal fluid, replacing it with oxygen or helium and then filming the results by x-ray. Not surprisingly, Sir William Osler, a founding professor of Johns Hopkins Hospital who was also known as the “Father of Modern Medicine, pioneered the notion that a complete medical diagnosis must also include a thorough physical examination. Although Osler died 95 years ago, his legacy has endured and remains inextricably connected to the use of any 640-slice CT scanner.
Remember the Patient
Naturally, the idea of robotic surgery can leave certain patients unnerved, especially if the doctor behind the computer terminal is wearing an Atari hoody. And yet, when viewed in the proper context, the medical advantages of robotic surgery in certain common procedures, such as gallbladder removal, hysterectomy, kidney transplants and hip replacement, still outweigh the aversion experienced by some when facing high-functioning, if inanimate, healthcare providers.
Whether viewed as a legitimate response to an unnatural trend or a glorified form of pupaphobia (fear of puppets), meaningful discussion with the patient before employing robotic surgery is yet another fundamental aspect of the physician/patient relationship. While there are many ways to capture a patient’s written consent before attempting such modern surgical procedures, only through one-to-one communication can such a directive be meaningful.
The same analogy applies to a physician’s bedside manner. To be sure, the quantity of patient health information existing on a doctor’s iPad can be astounding, and if used correctly should ultimately lead to better diagnoses based upon clinical results. But no matter how impressive the capabilities of the iPad mini 3 may be, it cannot take the place of the provider delegated to that hospital bed. Such technology can, however, remind the clinician that making regular eye contact with the patient during an examination goes a long way toward establishing trust and creating a much-needed bond between patient and provider.
Remember to Budget
When it comes to healthcare, new equipment does not come cheaply, and the costs for most technological advances do not end with acquisition. Radiological modalities, for example, require service agreements and an integrated process by which information can be shared, stored and most importantly, viewed. Sometimes the price tag of such accouterments exceeds the cost of the acquisition itself, and proper institutional budgeting must accommodate both.
Remember to Integrate
Efficiency is the key to survival for the modern healthcare provider, and this is particularly true of hospitals. A hospital’s revenue cycle must depend upon an accurate and expedient calculation of the sum of all clinical departments. As the push toward electronic health records and meaningful use dominates today’s healthcare news, the question of how well pharmacy charges reconcile with nursing documentation and clinical laboratory results impacts any hospital’s ability to bill and collect faster. Any deployment of hospital-wide technological advances must be tempered by a commonality of systems, which presents an obvious challenge for any hospital looking to provide automated pharmacy services, a PACs system and a way for an attending physician to peruse a patient’s vital statistics in “real time” from any location.
Remember to Train and Educate
Perhaps the most advanced radiological modality on television made its debut circa 1966, on the original Star Trek series. With his twenty-third century bedside manner and degree from University of Mississippi, Dr. Leonard H. “Bones” McCoy’s tool of choice was the tricorder, a handheld device used to diagnose disease and collect information about a patient’s body. An invaluable medical device for any qualified physician, the necessity for proper training and education on its use underscored the reason that Bones alone was capable of using the tricorder for the medical purposes it provided.
As health care research and development push forward, each new innovation requires proper training and education for the clinician who uses it. Training courses in PACs administration can take up to a week and cost an institution more than $5,000 for each pair of employees. It may take another week and further $10,000 to learn how to use a 640-slice CT Scanner. For those interested in familiarizing themselves with the operation of a sophisticated robotic platform designed to make surgeons better and scars smaller, there are more than 1,000 hours of procedure videos to support education on the da Vinci Surgical System.
Remember that Innovation Itself Grows Outdated
Any hospital able to afford the 3 Tesla Digital magnetic resonance imaging (“MRI”) scanner for digital broadband MRI imaging, a CyberKnife for robotic radiosurgery, digital subtraction angiography equipment or even a shockwave lithotripter should not get too comfortable with its conquering of the health care tech market. Much as Apple personal computers from 1984 have evolved from the Macintosh 128k to the 3.7GHz processor, 15GB 1600MHZ memory of today’s MacBook Pro, medical technology and innovation evolve at an astounding rate. Although computed tomography successfully scanned the human brain a decade before Apple’s first Macintosh, the difference between a 1-slice and 640-slice CT Scanner is beyond comparison. In the medical specialty of cardiology, some experts believe that a 64-slice scanner sufficiently captures the image of an entire heart, while critics state that a faster scanner such as a 320-slice or 640-slice is imperative, so that the entire heart can be imaged within a single heartbeat. If given a lineup of images from modalities of sufficient difference (16, 64 and 256 slice, for example), most radiologists can immediately identify the fastest scan, though even within certain thresholds, a high definition 64-slice CT produces images up to 100 times faster than the standard 64-slice CT.
At the same time, a physician’s approach to diagnosis is just as important as the technology with which results can be achieved. A positron emission tomography (“PET”) scan identifies anomalies in the human body by tracing an injection of fluorodeoxyglucose. A radiologist may work closely with an oncologist as the pair searches for tumor metastasis, the success of which depends as much on the physicians as on the accuracy of this radioactive modality.
It may seem unfortunate that the greatest scientific achievements are still beholden to the ordinary doctor, nurse or technician working in a local hospital at any given time. The relationship between entity and individual, and more specifically between hospitals and physicians, can be erratic and/or symbiotic on any given day. To be sure, most doctors prefer an institution with a strong commitment to capital innovation, and in the area of health care technology this proclivity is even more pronounced. At the same time, if CT modalities could speak, they may wish to have a word or two with the professionals tasked to review and interpret the results. For health care to excel, the whole must truly be greater than the sum of its parts, and for this reason health care’s version of the idiom “keeping up with the Joneses” must include not only the ability to afford innovation, but also to maintain it and train the appropriate staff to utilize the new technology. The challenge to ensure that today’s practitioners integrate with innovation may ultimately determine the fate of tomorrow’s health care.
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