Annual expenditure on medical device technology in the U.S. is around $150 billion. This is a large amount of money, but the devices save lives. Furthermore, thanks to medical device translation, the U.S. exports this vital technology around the world.
Glide Scope
Paramedics often attend patients who are having problems breathing. To provide help, they place breathing tubes down patients' throats. This is an awkward procedure. The risks include damage to the vocal chords.
The Glide Scope makes the procedure far easier and quicker. The device has a tiny video camera and monitor. As a paramedic inserts the breathing tube, he or she can see exactly where it is going. In this way, the paramedic can avoid harming the vocal chords and can ensure the tube is in position without delay. Paramedics who have used the technology report positive results.
Blood Pressure Management
Abdominal aortic aneurysms are a major cause of death in the U.S. High blood pressure can swell an artery in the abdomen. If the artery ruptures, it leads to uncontrolled internal bleeding. Because an increase in blood pressure can result in such a rupture, it's important to monitor the pressure, and therefore the size of an aneurysm, regularly.
The traditional way of doing this is with a costly CT scan. A cheaper and faster alternative is the Endo Sure Wireless A Pressure Management System. This takes a different approach to CT scans. Surgeons implant a tiny measuring device inside the patient. This device sends a wireless signal to a monitor. Doctors can then find out the level of blood pressure in the aneurysm sac. Knowing exactly what this pressure is can save lives.
The Endo Sure was initially tested in Argentina, Brazil and the U.S. Medical device translation helped ensure everyone involved understood the use of the Endo Sure and its potential.
Trauma Pod
A major issue facing troops in war zones is IEDs (improvised explosive devices). Soldiers wounded by an IED may bleed to death while their comrades transport them to the nearest field hospital. Although the trauma pod is still in development, it promises to be a remarkable piece of medical technology that helps solve this problem.
The trauma pod is a surgical field unit. Instead of human surgeons, it has robots. These treat soldiers immediately by staunching wounds and opening airways.
The robots in the pod also run CT scans. The scans provide information for diagnosis and further treatment. Surgeons in the field hospital control the trauma pod process remotely.
Monday, 10 October 2011
Sunday, 25 September 2011
Ethical Issues in Healthcare Systems
Healthcare and affordable healthcare, at that, is important to everyone. Healthcare insurance, as a system, has to be doable, for the healthcare provider as well as the member. The benefits offered must provide adequate medical coverage to the member, and must be affordable and also available, without the problem of pre-existing condition requirements.
Benefits must, also provide an adequate range of services within the local, state, and national guidelines for the particular plan offered. They must be affordable, and yet inclusive enough, to service the needs of its members, and they should be flexible. Healthcare insurance is a commodity, that must be made available to all American citizens, irregardless of age, economic status, locality or previous medical conditions.
The recent healthcare legislation passed by Congress, and introduced by, President Obama's administration, has, for the first time offered most Americans, employed, and unemployed a chance to get adequate healthcare benefits at affordable premiums. They can save money by choosing a higher deductible, thereby, lowering monthly premiums. States not offering certain benefits, can allow the insured to build a coverage package, normally called a plan that works within the insured's guidelines, and needs.
I am not certain which Southern East coast states offer limited benefits coverage in some instances, I will be writing an updated article,' after doing more research on this topic, Limited Coverage, or No Coverage in Some States.
What does constitute ethical healthcare benefit coverage opportunities?
I would venture to say:
* Benefits that are available under conditions that are opened to most potential members
* No restrictions as to number of members, for example, group coverage as relates to small business, self-employed, group employee benefits coverage, requirements.
* No pre-existing condition requirements, causing a block as far as potential members being approved for benefit coverage.
* Healthcare benefits offered at an affordable cost all American citizens.
Other Options Available Within the Healthcare Industry
The great vanguard: opportunity, being at the right place, right time, a chance of a lifetime idea offered to those wishing to locate a niche in today's economy, for persons really wanting to offer a worthwhile service to all, is answered --- by becoming involved in the 'Healthcare Industry'.
Becoming involved in a self-employment venture which promotes and refers, others to providers (businesses that provide medical insurance coverage for its members).
Because of the fact, that there are about 70 million persons nationally, that are uninsured or underinsured, provides, a niche market available to entrepreneurs willing to accept the challenge.
Benefits must, also provide an adequate range of services within the local, state, and national guidelines for the particular plan offered. They must be affordable, and yet inclusive enough, to service the needs of its members, and they should be flexible. Healthcare insurance is a commodity, that must be made available to all American citizens, irregardless of age, economic status, locality or previous medical conditions.
The recent healthcare legislation passed by Congress, and introduced by, President Obama's administration, has, for the first time offered most Americans, employed, and unemployed a chance to get adequate healthcare benefits at affordable premiums. They can save money by choosing a higher deductible, thereby, lowering monthly premiums. States not offering certain benefits, can allow the insured to build a coverage package, normally called a plan that works within the insured's guidelines, and needs.
I am not certain which Southern East coast states offer limited benefits coverage in some instances, I will be writing an updated article,' after doing more research on this topic, Limited Coverage, or No Coverage in Some States.
What does constitute ethical healthcare benefit coverage opportunities?
I would venture to say:
* Benefits that are available under conditions that are opened to most potential members
* No restrictions as to number of members, for example, group coverage as relates to small business, self-employed, group employee benefits coverage, requirements.
* No pre-existing condition requirements, causing a block as far as potential members being approved for benefit coverage.
* Healthcare benefits offered at an affordable cost all American citizens.
Other Options Available Within the Healthcare Industry
The great vanguard: opportunity, being at the right place, right time, a chance of a lifetime idea offered to those wishing to locate a niche in today's economy, for persons really wanting to offer a worthwhile service to all, is answered --- by becoming involved in the 'Healthcare Industry'.
Becoming involved in a self-employment venture which promotes and refers, others to providers (businesses that provide medical insurance coverage for its members).
Because of the fact, that there are about 70 million persons nationally, that are uninsured or underinsured, provides, a niche market available to entrepreneurs willing to accept the challenge.
Saturday, 10 September 2011
Universal Health Care - Ethical Issues in Health Care Reform
Universal health care seems to be a hotly debated topic whenever health care reform in the United States is discussed.
Those who maintain that health is an individual responsibility do not want a system that requires them to contribute tax dollars to support fellow citizens who do not act responsibly in protecting or promoting their own health. They argue that they want the freedom to choose their own physicians and treatments, and suggest that government cannot know what is best for them. These people argue that preserving the current system with improvements to provide better insurance coverage for citizens who remain uninsured or under insured for their medical care needs is the only reform that is needed.
Those who believe health care is an individual right support a universal health care system with the argument that every citizen deserves to have access to the right care at the right time and that a government's responsibility is to protect its citizens, sometimes even from themselves.
Two opposing arguments arising from two opposing ideologies. Both are good arguments but neither can be the supporting argument for implementing or denying universal health care. The matter must be resolved through an ethical framework.
Examination of the ethical issues in health care reform would require consideration of much different arguments than those already presented. Ethical issues would center on the moral right. Discussion would begin with not "What is best for me?" but rather "How should we as a society be acting so that our actions are morally correct?"
Ethics refers to determining right and wrong in how humans relate to one another. Ethical decision making for health care reform then would require human beings to act in consideration of our relationships to each other not our own individual interests.
Examination of some of the common ethical decision making theories can provide a foundation for a different perspective than one that is solely concerned with individual rights and freedoms.
Ethical decision making requires that specific questions be answered in order to decide on whether intended actions are good or morally correct. Here are some questions that could be used in ethical decision making for health care reform.
* What action will bring the most good to the most people?
* What action in and of itself is a good act and helps us to fulfill our duties, obligations, and responsibilities to each other?
* What action in and of itself shows caring and concern for all citizens?
As the answer to all these questions, universal health care can always be considered the right thing to do.
The United States is in the most advantageous position there is when it comes to health care reform. They are the only developed country without a national health care system in place for all citizens. They have the opportunity to learn from the mistakes that have been made by all the other countries that have already gone down the universal health care road. They have an opportunity to design a system that can shine as a jewel in the crown of universal health care systems everywhere.
However, all ethical decision making is structured around values. In order for universal health care to be embraced by all citizens in the United States, they will first have to agree to the collective value of equity and fairness and embrace the goal of meeting their collective responsibility to each other while maintaining individual rights and freedoms. That may prove to be the most difficult obstacle of all.
Those who maintain that health is an individual responsibility do not want a system that requires them to contribute tax dollars to support fellow citizens who do not act responsibly in protecting or promoting their own health. They argue that they want the freedom to choose their own physicians and treatments, and suggest that government cannot know what is best for them. These people argue that preserving the current system with improvements to provide better insurance coverage for citizens who remain uninsured or under insured for their medical care needs is the only reform that is needed.
Those who believe health care is an individual right support a universal health care system with the argument that every citizen deserves to have access to the right care at the right time and that a government's responsibility is to protect its citizens, sometimes even from themselves.
Two opposing arguments arising from two opposing ideologies. Both are good arguments but neither can be the supporting argument for implementing or denying universal health care. The matter must be resolved through an ethical framework.
Examination of the ethical issues in health care reform would require consideration of much different arguments than those already presented. Ethical issues would center on the moral right. Discussion would begin with not "What is best for me?" but rather "How should we as a society be acting so that our actions are morally correct?"
Ethics refers to determining right and wrong in how humans relate to one another. Ethical decision making for health care reform then would require human beings to act in consideration of our relationships to each other not our own individual interests.
Examination of some of the common ethical decision making theories can provide a foundation for a different perspective than one that is solely concerned with individual rights and freedoms.
Ethical decision making requires that specific questions be answered in order to decide on whether intended actions are good or morally correct. Here are some questions that could be used in ethical decision making for health care reform.
* What action will bring the most good to the most people?
* What action in and of itself is a good act and helps us to fulfill our duties, obligations, and responsibilities to each other?
* What action in and of itself shows caring and concern for all citizens?
As the answer to all these questions, universal health care can always be considered the right thing to do.
The United States is in the most advantageous position there is when it comes to health care reform. They are the only developed country without a national health care system in place for all citizens. They have the opportunity to learn from the mistakes that have been made by all the other countries that have already gone down the universal health care road. They have an opportunity to design a system that can shine as a jewel in the crown of universal health care systems everywhere.
However, all ethical decision making is structured around values. In order for universal health care to be embraced by all citizens in the United States, they will first have to agree to the collective value of equity and fairness and embrace the goal of meeting their collective responsibility to each other while maintaining individual rights and freedoms. That may prove to be the most difficult obstacle of all.
Wednesday, 10 August 2011
The Long Term Care Industry Is Under Attack!
The industry is under attack! The long term care industry is under attack! There is no doubt that the long term care industry is going to experience major changes in the next 2-5 years. What are you going to do about it? Yes, you... I am talking to you. What are you going to do about it? Many of the people I talk to in the industry are saying there is nothing that we can do; we have to just wait and see what happens. I say that is... well I better not say what I was thinking, let's just say I strongly disagree. I think that we should prepare to battle. Right now we are under attack and we have no counter-attack, no plan. We are just asking them nicely to "please stop picking on us." And that tactic is never going to work.
First we need to face that fact that the current system is broke. We can't provide the level of care that people deserve now, so we definitely can't provide better care with less money... or can we? At the state level I have been asking legislators to put a 10-year moratorium on Long Term Care Medicaid cuts. This gives the industry 10 years to test, discover and implement a new (and hopefully) better system. I am working on establishing relationships with Congress on the national level to take this campaign to Washington, DC.
I spend dozens of hours every week brainstorming different scenarios and ideas for a new system, and to be completely honest... I am not as close as I need to be, but I do know what we need to achieve. We really need to accomplish only 2 things... Better Care & Lower Cost.
If we achieve that... we win! Actually if we achieve that... everybody wins! But it is pretty lonely over here in this corner, because most people think that this is impossible. I am willing to admit that it might be, but I am not sure enough to quit fighting. Whenever I wonder if it is possible, I consider the government created alternative... and that is not an option, it is a dead-end road.
You have two choices... sit back and see what happens or step forward and help make the changes. The changes that need to be made must be made by people inside the industry and not people who are trying to win political votes. Because if you walk through the halls of a nursing home you will likely find someone who was directly responsible for helping build America, you will likely find someone who was willing to fight a fight for the greater good. As a country, we can't turn our backs on the people whose backs built this country.
Cory Geffre is an author, speaker, trainer & thought leader in the Long Term Care industry. Cory works with Long Term Care Administrators, Assistant Administrators, Directors of Nursing, Assistant Directors of Nursing, Human Resource Directors/Managers, & Staff Educators helping them in Extracting Excellence and Unlocking Maximum Potential from their people, their organizations & themselves.
First we need to face that fact that the current system is broke. We can't provide the level of care that people deserve now, so we definitely can't provide better care with less money... or can we? At the state level I have been asking legislators to put a 10-year moratorium on Long Term Care Medicaid cuts. This gives the industry 10 years to test, discover and implement a new (and hopefully) better system. I am working on establishing relationships with Congress on the national level to take this campaign to Washington, DC.
I spend dozens of hours every week brainstorming different scenarios and ideas for a new system, and to be completely honest... I am not as close as I need to be, but I do know what we need to achieve. We really need to accomplish only 2 things... Better Care & Lower Cost.
If we achieve that... we win! Actually if we achieve that... everybody wins! But it is pretty lonely over here in this corner, because most people think that this is impossible. I am willing to admit that it might be, but I am not sure enough to quit fighting. Whenever I wonder if it is possible, I consider the government created alternative... and that is not an option, it is a dead-end road.
You have two choices... sit back and see what happens or step forward and help make the changes. The changes that need to be made must be made by people inside the industry and not people who are trying to win political votes. Because if you walk through the halls of a nursing home you will likely find someone who was directly responsible for helping build America, you will likely find someone who was willing to fight a fight for the greater good. As a country, we can't turn our backs on the people whose backs built this country.
Cory Geffre is an author, speaker, trainer & thought leader in the Long Term Care industry. Cory works with Long Term Care Administrators, Assistant Administrators, Directors of Nursing, Assistant Directors of Nursing, Human Resource Directors/Managers, & Staff Educators helping them in Extracting Excellence and Unlocking Maximum Potential from their people, their organizations & themselves.
Sunday, 10 July 2011
Understanding Ethics And Bioethics Of Medical Assistants
These days, people still have high respect for hospital staffs. When the children are down with fever, their parents would call their trusted pediatrician to seek for medical help. Most businesses and multinational corporations today even have their own industrial nurses or physicians to help the employees with their medical issues.
Currently, one of the most important members of the medical team is the medical assistant. Their role in health care are becoming more versatile and dynamic. They are now given more duties and responsibilities. Since they have so many tasks to care about, it is only vital that they understand what their profession demands. This is to avoid incidence of lawsuits and other dilemmas.
Yes, people trust their health care professionals. People trust them with their lives. It is important that they master the different medical terms and treatment procedures performed in their medical area. Also, they should know how to follow the different laws and bio ethical standards concerning their profession.
Since this article is about ethics and bio ethics of medical assistants, it is important to differentiate the two. First, let us discuss what ethics is. Ethics is a set of rules or guidelines. These rules are used to determine if the person is acting properly or not. Medical ethics are part of professional ethics. It governs the behavior and conduct of the health care professionals. To work ethically, the health care professional must remain truthful and fair.
Bio ethics on the other hand, is about life preservation. In the past, most medical decisions are made solely by doctors and physicians or legal professionals. But with the advancement of technology, patients are given more choices and medical alternatives. Since medical assistants are performing more active roles in health care, they should know how to attack different situations in a moral and ethical way. No one is perfect. Anyone can commit mistakes like giving the wrong medications or medical procedures. However, in the medical industry, a mistake can be detrimental. Yes, accepting and telling the main physician about the mistake is not easy, but it can save life.
Role Of The American Association Of Medical Assistants
In the medical assisting field, the AAMA or the American Association of Medical Assistants is responsible for setting the guidelines for ethical and moral conduct. They see to it that their members are always striving for excellence.
Certainly, one of the most promising industries today is health care. It can provide several opportunities and career advancements. However, it is not an easy job. Medical assisting is a popular health care profession. Like any other medical professionals, they too are facing many challenges in their career. Thus, knowing the different laws and bio ethical guidelines concerning their profession can help them a lot to becoming proficient and qualified health care staffs.
Currently, one of the most important members of the medical team is the medical assistant. Their role in health care are becoming more versatile and dynamic. They are now given more duties and responsibilities. Since they have so many tasks to care about, it is only vital that they understand what their profession demands. This is to avoid incidence of lawsuits and other dilemmas.
Yes, people trust their health care professionals. People trust them with their lives. It is important that they master the different medical terms and treatment procedures performed in their medical area. Also, they should know how to follow the different laws and bio ethical standards concerning their profession.
Since this article is about ethics and bio ethics of medical assistants, it is important to differentiate the two. First, let us discuss what ethics is. Ethics is a set of rules or guidelines. These rules are used to determine if the person is acting properly or not. Medical ethics are part of professional ethics. It governs the behavior and conduct of the health care professionals. To work ethically, the health care professional must remain truthful and fair.
Bio ethics on the other hand, is about life preservation. In the past, most medical decisions are made solely by doctors and physicians or legal professionals. But with the advancement of technology, patients are given more choices and medical alternatives. Since medical assistants are performing more active roles in health care, they should know how to attack different situations in a moral and ethical way. No one is perfect. Anyone can commit mistakes like giving the wrong medications or medical procedures. However, in the medical industry, a mistake can be detrimental. Yes, accepting and telling the main physician about the mistake is not easy, but it can save life.
Role Of The American Association Of Medical Assistants
In the medical assisting field, the AAMA or the American Association of Medical Assistants is responsible for setting the guidelines for ethical and moral conduct. They see to it that their members are always striving for excellence.
Certainly, one of the most promising industries today is health care. It can provide several opportunities and career advancements. However, it is not an easy job. Medical assisting is a popular health care profession. Like any other medical professionals, they too are facing many challenges in their career. Thus, knowing the different laws and bio ethical guidelines concerning their profession can help them a lot to becoming proficient and qualified health care staffs.
Friday, 10 June 2011
Implementing SOA in Healthcare Systems
Service Oriented Architecture (SOA) is the latest concept buzzing in software and IT circles. SOA is the next evolutionary step in systems development. Properly implemented, it builds upon existing architecture while it better addresses efficient reuse of business functionality inside and outside the organization. At its core, SOA is about providing true interoperability that reflects real-world use cases.
Most organizations do not realize the dream of enterprise-wide systems, but instead rely upon a portfolio of independent systems. Often these systems have duplicate data and functionality. The goal of SOA is to select and encapsulate certain pieces of functionality as services that can be made available across the organization. With this being the goal, the organization can shift their focus from individual, often file-based interfaces, to creating service-oriented applications. These new applications not only create a truly interoperable environment, but they also more accurately reflect the actual business functions in a healthcare environment.
Most industries, including healthcare, are faced with the dilemma of providing operational systems, supporting the revenue management and any administrative features. For healthcare, the operational could be capturing the insurance payment for a claim as defined by the remittance advice. The revenue piece could be the posting of that payment to the proper account and recognizing the affect on the aging balance. The administration piece could be the security that makes sure the person entering the transaction has the proper authority to do so. It is not unusual, nor is it bad, for this to be done in three different systems. SOA allows the different systems to know what has happened and to interact when changes are made.
SOA is different from legacy systems integration in that it requires system design and management principles that support reuse and sharing of system resources across the organization. It does this without requiring re-engineering the existing systems. With SOA, existing processes are combined with new capabilities to build a library of services. These services then become the solution. The goal is to create shared services that reflect actual business processes. SOA strengthens interoperability while reducing the need to synchronize data between isolated systems. Properly implemented, the organization has readily available services regardless of the originating system, department, location or desktop.
Let's examine a relatively simple transaction and how the SOA approach applies. A clinic has a new patient coming in for a visit. A list of items to be done includes:
* Examining if the patient exist
* Verifying patient eligibility
* Adding the patient to the Master Patient Index
* Examining the Doctors schedule
* Creating the appointment
* Accessing public records
* Creating an EHR visit
We have potentially accessed three to seven different systems depending on the functionality of the base applications. Many healthcare environments either do not perform all the functionality or do it with a series of point-to-point file-based interfaces. Still others do it by entering the data into multiple systems. Manually entering data into multiple systems is essentially human-interoperability because it is up to a person to coordinate and control the interfaces.
As the number of systems increases, standard interface formats, such as Health Level 7 (HL7), and central data interface engines are adopted by larger healthcare organizations. Internet-based communication allows organizations to exchange data with external organizations, such as payors.
Although data is passed among systems, the file exchange approach falls short of supporting true data interoperability. File exchanges can work, but they have multiple inherent problems:
* Multiple points of failure - creating the file, configuring where the file should go, security to write the file, confirmed delivery of the file, file reader services, configuration of picking up the file and reading the file are just a sample of the issues that have to be solved. Not that these are not solvable problems, they all are. With each point of functionality comes an increased probability that something can break.
* Increased cost - Using all of the multiple points of failure mentioned above, each step requires additional development, testing and maintenance. All of these combined equals increased cost and elongated time lines.
* Finger pointing - Any time a file is create and security is needed to create the file, we have a blending of development teams with infrastructure teams. Management never wins when both of these technical groups are pointing fingers saying it is the others fault.
With SOA, IT processing is organized and represented as a collection of services. Each service is made available to the entire organization through a standard protocol. All departments that maintain or use the same data use the same service. This makes any redundancies transparent to users. Applications supporting a specific workflow will reference the same service. Each service communicates with the systems to which it is related. Users no longer need to switch between systems to complete a workflow. Data is naturally synchronized between systems. Services aligned in this manner enable true interoperability among the healthcare organization's processes and people.
As SOA is further adopted by the healthcare industry, collections of services, as well as specific services, will be available for use by a healthcare organization's internal and external resources. This is possible because the origin of the service is transparent. Imagine adding a patient in one application and having that patient synchronized in all other systems without specific point-to-point interfaces and files being generated.
Integrating data and interoperability are key requirements in evolving healthcare technology, and healthcare is behind the curve in adoption and investing in these technologies. Healthcare adopting these technologies and getting the right information in the right place at the right time can result in the following benefits:
* Greater claim accuracy
* Reduced medical errors
* More accurate diagnosis
* Increased access for patients
* Reduced payment cycles
SOA takes on greater significance with the emergence of Healthcare Information Networks (HINs). A HIN is collaboration among the government, hospitals, specialty labs and pharmacies and payors to provide a network of data exchange that builds shared information, data repositories, applications and interfaces. The collective applications efficiently and accurately exchange key information across a spectrum of healthcare. Existing HINs are currently accomplishing the following:
* Exchange of patients' electronic medical record between providers to get key information like medical history, allergies, persistent problems, medications and active treatments
* Referral exchanges
* Electronic patient eligibility for a visit or procedure
* Electronic claim filing and payment
* Electronic ordering and monitoring of prescriptions
* A consolidated repository of key healthcare information for disease control
* A consolidated repository of data to support government-funded programs and benefits of those programs
* A portal for the patient, providers and payors accessing patient data
There is little debate regarding the benefits of implementing HINs. There is debate about the cost and the ROI of HIN investment. Part of the ROI equation is the cost of supporting the legacy applications and their participation in the network. If every time a new hospital, clinic, pharmacy, or government program was introduced a new point-to-point interface had to be introduced, it would not be feasible to build a HIN that has sustainable momentum. The cost of having to build a sequence of point-to-point interfaces for every system involved in the network would be unsustainable to all the practices and the software providers who support them.
When using SOA for HIN integration, the cost of integration can be reduced significantly and a sustainable community value is created. To accomplish this goal, SOA services facing the HIN must accomplish the following:
* Simplify and reduce the interface points to create data interoperability in the network
* Address the architecture, infrastructure, software, and related business functions as a cohesive unit
* Have services deployed internally and externally to support the needs of the organization and the HIN
* Support legacy systems
* Support current and evolving data standards
* Be tested for scalability so larger external organization can use it
SOA is the direction IT is moving. SOA gets our focus off of a single application and what it needs to do and onto how this application fits into a bigger world. Whether that world is the organization or beyond, SOA enables the applications key components to become exposed to all who need them. Healthcare, which as an industry has can achieve great benefits from this kind of interoperability, is behind others in achieving it. Healthcare IT managers, and the software companies that support them, need to evaluate how they are incorporating SOA in their design plans.
Most organizations do not realize the dream of enterprise-wide systems, but instead rely upon a portfolio of independent systems. Often these systems have duplicate data and functionality. The goal of SOA is to select and encapsulate certain pieces of functionality as services that can be made available across the organization. With this being the goal, the organization can shift their focus from individual, often file-based interfaces, to creating service-oriented applications. These new applications not only create a truly interoperable environment, but they also more accurately reflect the actual business functions in a healthcare environment.
Most industries, including healthcare, are faced with the dilemma of providing operational systems, supporting the revenue management and any administrative features. For healthcare, the operational could be capturing the insurance payment for a claim as defined by the remittance advice. The revenue piece could be the posting of that payment to the proper account and recognizing the affect on the aging balance. The administration piece could be the security that makes sure the person entering the transaction has the proper authority to do so. It is not unusual, nor is it bad, for this to be done in three different systems. SOA allows the different systems to know what has happened and to interact when changes are made.
SOA is different from legacy systems integration in that it requires system design and management principles that support reuse and sharing of system resources across the organization. It does this without requiring re-engineering the existing systems. With SOA, existing processes are combined with new capabilities to build a library of services. These services then become the solution. The goal is to create shared services that reflect actual business processes. SOA strengthens interoperability while reducing the need to synchronize data between isolated systems. Properly implemented, the organization has readily available services regardless of the originating system, department, location or desktop.
Let's examine a relatively simple transaction and how the SOA approach applies. A clinic has a new patient coming in for a visit. A list of items to be done includes:
* Examining if the patient exist
* Verifying patient eligibility
* Adding the patient to the Master Patient Index
* Examining the Doctors schedule
* Creating the appointment
* Accessing public records
* Creating an EHR visit
We have potentially accessed three to seven different systems depending on the functionality of the base applications. Many healthcare environments either do not perform all the functionality or do it with a series of point-to-point file-based interfaces. Still others do it by entering the data into multiple systems. Manually entering data into multiple systems is essentially human-interoperability because it is up to a person to coordinate and control the interfaces.
As the number of systems increases, standard interface formats, such as Health Level 7 (HL7), and central data interface engines are adopted by larger healthcare organizations. Internet-based communication allows organizations to exchange data with external organizations, such as payors.
Although data is passed among systems, the file exchange approach falls short of supporting true data interoperability. File exchanges can work, but they have multiple inherent problems:
* Multiple points of failure - creating the file, configuring where the file should go, security to write the file, confirmed delivery of the file, file reader services, configuration of picking up the file and reading the file are just a sample of the issues that have to be solved. Not that these are not solvable problems, they all are. With each point of functionality comes an increased probability that something can break.
* Increased cost - Using all of the multiple points of failure mentioned above, each step requires additional development, testing and maintenance. All of these combined equals increased cost and elongated time lines.
* Finger pointing - Any time a file is create and security is needed to create the file, we have a blending of development teams with infrastructure teams. Management never wins when both of these technical groups are pointing fingers saying it is the others fault.
With SOA, IT processing is organized and represented as a collection of services. Each service is made available to the entire organization through a standard protocol. All departments that maintain or use the same data use the same service. This makes any redundancies transparent to users. Applications supporting a specific workflow will reference the same service. Each service communicates with the systems to which it is related. Users no longer need to switch between systems to complete a workflow. Data is naturally synchronized between systems. Services aligned in this manner enable true interoperability among the healthcare organization's processes and people.
As SOA is further adopted by the healthcare industry, collections of services, as well as specific services, will be available for use by a healthcare organization's internal and external resources. This is possible because the origin of the service is transparent. Imagine adding a patient in one application and having that patient synchronized in all other systems without specific point-to-point interfaces and files being generated.
Integrating data and interoperability are key requirements in evolving healthcare technology, and healthcare is behind the curve in adoption and investing in these technologies. Healthcare adopting these technologies and getting the right information in the right place at the right time can result in the following benefits:
* Greater claim accuracy
* Reduced medical errors
* More accurate diagnosis
* Increased access for patients
* Reduced payment cycles
SOA takes on greater significance with the emergence of Healthcare Information Networks (HINs). A HIN is collaboration among the government, hospitals, specialty labs and pharmacies and payors to provide a network of data exchange that builds shared information, data repositories, applications and interfaces. The collective applications efficiently and accurately exchange key information across a spectrum of healthcare. Existing HINs are currently accomplishing the following:
* Exchange of patients' electronic medical record between providers to get key information like medical history, allergies, persistent problems, medications and active treatments
* Referral exchanges
* Electronic patient eligibility for a visit or procedure
* Electronic claim filing and payment
* Electronic ordering and monitoring of prescriptions
* A consolidated repository of key healthcare information for disease control
* A consolidated repository of data to support government-funded programs and benefits of those programs
* A portal for the patient, providers and payors accessing patient data
There is little debate regarding the benefits of implementing HINs. There is debate about the cost and the ROI of HIN investment. Part of the ROI equation is the cost of supporting the legacy applications and their participation in the network. If every time a new hospital, clinic, pharmacy, or government program was introduced a new point-to-point interface had to be introduced, it would not be feasible to build a HIN that has sustainable momentum. The cost of having to build a sequence of point-to-point interfaces for every system involved in the network would be unsustainable to all the practices and the software providers who support them.
When using SOA for HIN integration, the cost of integration can be reduced significantly and a sustainable community value is created. To accomplish this goal, SOA services facing the HIN must accomplish the following:
* Simplify and reduce the interface points to create data interoperability in the network
* Address the architecture, infrastructure, software, and related business functions as a cohesive unit
* Have services deployed internally and externally to support the needs of the organization and the HIN
* Support legacy systems
* Support current and evolving data standards
* Be tested for scalability so larger external organization can use it
SOA is the direction IT is moving. SOA gets our focus off of a single application and what it needs to do and onto how this application fits into a bigger world. Whether that world is the organization or beyond, SOA enables the applications key components to become exposed to all who need them. Healthcare, which as an industry has can achieve great benefits from this kind of interoperability, is behind others in achieving it. Healthcare IT managers, and the software companies that support them, need to evaluate how they are incorporating SOA in their design plans.
America's Healthcare System Ranks The Lowest Among Industrialized Nations
The U.S. doesn't get its money's worth when it comes to healthcare, according to recent statistics. The Commonwealth Fund released a report earlier this month on America's ranking in the world healthcare system -- and it wasn't good.
According to the report, residents of the United States receive the poorest quality of care, yet pay the most for it, among six of the top industrialized nations, including Germany, Great Britain, Australia, New Zealand, and Canada. The findings were based on measures including quality, access, efficiency, equity, and outcomes of healthcare. Germany took the overall first place ranking, followed by Great Britain, Australia, New Zealand, and Canada.
While the other five nations on the list provide universal healthcare, the U.S., with its unorganized mixture of employer-funded care, private insurance, and government programs, leaves nearly 48 million throughout the country with no insurance whatsoever. Ominously, the Fund also linked lack of insurance with poorer quality of care in another report released this month.
Texas ranks at the very bottom of the nation in numbers of people left uninsured, at just over 25%. With high incidences of poverty, unemployment, and chronic diseases, such as diabetes, the state stands to gain more than most by measures to update the healthcare and/or to make insurance available to more of the population. Most of those lacking insurance do not receive pertinent preventative care, resulting in increased long-term costs to health, as well as to the state and federal governments.
Particularly in the larger cities of Dallas, Houston, and Austin -- where many from rural areas of the state come seeking care, overburdening the system further -- change would be welcomed.
Activists and members of Congress are calling for an overhaul of the overburdened and outdated system, with suggestions ranging from instituting America's own universal healthcare, to subsidizing private insurance companies in order to make healthcare coverage available to all, regardless of income.
Obviously, it's an issue that needs to be closely analyzed, as it is "pretty undisputable that we spend twice what other countries spend on average," as reported by The Commonwealth Fund. While, in comparison to other industrialized nations, the U.S. has the fewest patients seeing a regular doctor (16%), is the least wired (working with the fewest electronic records, and receiving the fewest electronic updates on disease treatment options), and has one of the highest infant mortality rates, we are actually spending twice as much per capita on healthcare as Germany, at $6,102. Canada spends $3,165 per capita, Australia $2,876, Britain $2,546, and New Zealand $2,083.
The U.S. also has one of the longest emergency room waiting times, takes an average of four months to deliver elective surgery, and is considered one of the less "convenient" nations when it comes to general healthcare. Sixty-one percent of Americans surveyed found it "somewhat" or "very difficult" to receive care on nights or weekends.
What is most shocking perhaps, is the relatively high infant mortality rate, at 5 in every 1,000. The U.S. is tied with Poland, Hungary, Malta, and Slovakia for this statistic, and, among the 32 industrialized nations surveyed, ranked only above Latvia, at 6 in every 1,000 births. Japan, the Czech Republic, Finland, Iceland, and Norway beat the U.S. by a landslide, at approximately one-third the death rate. Every year, 16,000 newborn deaths occur in this country, mostly linked with low birth weights and premature delivery. This suggests a surprising lack of prenatal care and, indeed, measures of mothers' well-being ranks extremely low in comparison to other industrialized nations.
African-Americans suffer almost twice the national average of infant mortality, at 9 in every 1,000 -- which is closer to developing nations' statistics than to industrialized ones. Black babies born in the U.S. are also twice as likely to be premature and have a low birth rate than their white counterparts.
Throw in scandals -- like drug companies enticing doctors with "free" gifts and dinners to sell their medications, or multi-billion dollar pharmaceutical company investments in medical schools -- and it looks like a gloomy picture, indeed. Michael Moore's summer release of Sicko, though sure to be controversial, undeniably raises a subject on the national consciousness.
While it is painfully obvious that something must be done -- and quickly -- the next step is not so clear. States such as Hawaii and Massachusetts have taken their own initiatives with state-provided health insurance, resulting in nearly 90% of their residents having insurance, and therefore better access to care. California has debated its own measures, as well as many Midwestern states.
It's not a straight-forward debate, by any means. While nations providing universal healthcare rank higher in overall standings, the U.S. is still considered a leader when it comes to breakthrough technologies and treatment options. A balance must be struck between revolutionary research and making sure more people actually have access to its results. Reports on new HIV drugs, for instance, hint that turning HIV and AIDS into a chronic, versus fatal, condition is just around the corner...but those medications are expensive, and not everyone in the U.S. has access to them.
Residents of the U.S., however, have done little to push the initiative. The surprising lack of attention on the issue in political debates reflects the fact that voters do not choose their candidate primarily based on his or her plans for future healthcare reform. And, time and again, it has been proven that the masses' outspoken push for measures is what gets things done on Capitol Hill. In the end, it's really time for us -- the people -- to decide how to dig ourselves out of this one.
According to the report, residents of the United States receive the poorest quality of care, yet pay the most for it, among six of the top industrialized nations, including Germany, Great Britain, Australia, New Zealand, and Canada. The findings were based on measures including quality, access, efficiency, equity, and outcomes of healthcare. Germany took the overall first place ranking, followed by Great Britain, Australia, New Zealand, and Canada.
While the other five nations on the list provide universal healthcare, the U.S., with its unorganized mixture of employer-funded care, private insurance, and government programs, leaves nearly 48 million throughout the country with no insurance whatsoever. Ominously, the Fund also linked lack of insurance with poorer quality of care in another report released this month.
Texas ranks at the very bottom of the nation in numbers of people left uninsured, at just over 25%. With high incidences of poverty, unemployment, and chronic diseases, such as diabetes, the state stands to gain more than most by measures to update the healthcare and/or to make insurance available to more of the population. Most of those lacking insurance do not receive pertinent preventative care, resulting in increased long-term costs to health, as well as to the state and federal governments.
Particularly in the larger cities of Dallas, Houston, and Austin -- where many from rural areas of the state come seeking care, overburdening the system further -- change would be welcomed.
Activists and members of Congress are calling for an overhaul of the overburdened and outdated system, with suggestions ranging from instituting America's own universal healthcare, to subsidizing private insurance companies in order to make healthcare coverage available to all, regardless of income.
Obviously, it's an issue that needs to be closely analyzed, as it is "pretty undisputable that we spend twice what other countries spend on average," as reported by The Commonwealth Fund. While, in comparison to other industrialized nations, the U.S. has the fewest patients seeing a regular doctor (16%), is the least wired (working with the fewest electronic records, and receiving the fewest electronic updates on disease treatment options), and has one of the highest infant mortality rates, we are actually spending twice as much per capita on healthcare as Germany, at $6,102. Canada spends $3,165 per capita, Australia $2,876, Britain $2,546, and New Zealand $2,083.
The U.S. also has one of the longest emergency room waiting times, takes an average of four months to deliver elective surgery, and is considered one of the less "convenient" nations when it comes to general healthcare. Sixty-one percent of Americans surveyed found it "somewhat" or "very difficult" to receive care on nights or weekends.
What is most shocking perhaps, is the relatively high infant mortality rate, at 5 in every 1,000. The U.S. is tied with Poland, Hungary, Malta, and Slovakia for this statistic, and, among the 32 industrialized nations surveyed, ranked only above Latvia, at 6 in every 1,000 births. Japan, the Czech Republic, Finland, Iceland, and Norway beat the U.S. by a landslide, at approximately one-third the death rate. Every year, 16,000 newborn deaths occur in this country, mostly linked with low birth weights and premature delivery. This suggests a surprising lack of prenatal care and, indeed, measures of mothers' well-being ranks extremely low in comparison to other industrialized nations.
African-Americans suffer almost twice the national average of infant mortality, at 9 in every 1,000 -- which is closer to developing nations' statistics than to industrialized ones. Black babies born in the U.S. are also twice as likely to be premature and have a low birth rate than their white counterparts.
Throw in scandals -- like drug companies enticing doctors with "free" gifts and dinners to sell their medications, or multi-billion dollar pharmaceutical company investments in medical schools -- and it looks like a gloomy picture, indeed. Michael Moore's summer release of Sicko, though sure to be controversial, undeniably raises a subject on the national consciousness.
While it is painfully obvious that something must be done -- and quickly -- the next step is not so clear. States such as Hawaii and Massachusetts have taken their own initiatives with state-provided health insurance, resulting in nearly 90% of their residents having insurance, and therefore better access to care. California has debated its own measures, as well as many Midwestern states.
It's not a straight-forward debate, by any means. While nations providing universal healthcare rank higher in overall standings, the U.S. is still considered a leader when it comes to breakthrough technologies and treatment options. A balance must be struck between revolutionary research and making sure more people actually have access to its results. Reports on new HIV drugs, for instance, hint that turning HIV and AIDS into a chronic, versus fatal, condition is just around the corner...but those medications are expensive, and not everyone in the U.S. has access to them.
Residents of the U.S., however, have done little to push the initiative. The surprising lack of attention on the issue in political debates reflects the fact that voters do not choose their candidate primarily based on his or her plans for future healthcare reform. And, time and again, it has been proven that the masses' outspoken push for measures is what gets things done on Capitol Hill. In the end, it's really time for us -- the people -- to decide how to dig ourselves out of this one.
Subscribe to:
Posts (Atom)