On our second day we took a trip to Oakland to the Public Health Institute’s Center for Technology and Aging for a presentation from Dr. David Lindeman and his team. The organization was established about 18 months ago and is supported by organizations helping the elderly. The impact is already being felt today from chronic disease, past lifestyle choices, genetics and environmental factors. The system is challenged with shortages in healthcare workers, changing demographics, longevity of the population, and people’s increasing desire to live independently as they age. The group is focused on understanding how technology can improve patient care and engagement, assist healthcare workers, and lower costs across the healthcare system.
One challenge we’ve heard before in Dr. Chatterjee’s class is the lack of coordination between multiple care provides. At the same time, resistance to technology that disrupts the healthcare workflow is strong, even though these advances to minimize cost and impact related to poorly coordinated care. There are some incentives and disincentives being introduced as part of the push towards e-health records. However, the question that came up for discussion was whether these were enough. How does a small practice manage the hardware, software, network admin and training costs when even larger firms like Kaiser and the VA struggle to implement Health Information Technology (HIT)?
A rather interesting point that came up was that of patient intellectual property. Would physician A be inclined to begin marketing towards patients and “stealing” business away from other physician B who was the original contributor of that health information? While this is a possible challenge, there still is no consensus on an industry standard system or suite of systems. When I asked if there was comparative analysis going on, Dr. Lindeman felt while that was something to look into, the industry wasn’t at a maturity level yet to move towards standardizing on any one platform. Groups like the VA have lead the way in digitization and have demonstrated dramatic cost savings over home health care or nursing homes. How do we know that system X or process Y will have the same benefits or return on investment?
One point that Dr. Chatterjee raised was that of understanding the business model of healthcare. Reimbursements are so closely intertwined that they present both opportunity to incentivize but also strong disincentives if migration to HIT doesn’t have a billing code. And how will “meaningful use” and perceived usefulness be measured against that business model over time.
This was a great discussion and I think mostly because it was so relevant to real life. Healthcare reform and aging is something we live everyday and it was great to hear about the fascinating advancements, as well as wicked problems, facing the healthcare industry today and the projects Dr. Lindeman and his team are working on. After breakfast and an insightful lecture, it was off to the Friday farmer’s market for a quick lunch before heading to the neonatal simulation lab back at Stanford. More great architecture to be found in Oakland…too bad we only had a few minutes.
