Guest smg Posted March 9, 2003 Report Share Posted March 9, 2003 I think this is an appropriate place to discuss this issue. Within the health policy circles (my academic background), the electronic health record/ smartcard is often cited as a key to both the continuity of care issues and the family health networks. I really don't know all that much about the technology itself or how far off it may be, but it seems like it could really help things. In a health policy class I took last semester we talked a lot about the possibilities for this type of technology (like any good policy wonks would). In my opinion, it would really increase the flexibility within primary care. For example, it could really broaden the network of physicians who could provide on-call services to a patient pool. You would no longer be limited to those within your practice or those with whom you had special arrangements to access records. It was my understanding that the longer term visions of the Family Health Networks in Ontario included this type of technology, thereby reducing some of the concerns related to 24/7 on-call, although I could be off on this. I'd be very interested to hear about anyone else's experience or understanding of this type of technology. I think if done properly (i.e. privacy issues, cost, etc.) it could really go along way in helping with the reformation of primary health. Also, just to add to the mix, what do people tend to think about proposals to reduce patient demand? This includes ideas like medical savings accounts, user fees and statements of use. Is the abuse really as bad as neo-cons and others make it out to be? I've always thought that our reformation energies would be better placed in other areas, like primary health reform and technologies. Link to comment Share on other sites More sharing options...
Guest MayFlower1 Posted March 9, 2003 Report Share Posted March 9, 2003 smg, It's interesting...in the not too distant past, I was a strong proponent of the two-tiered system, user fees, etc. After having had significant first-hand experience in the medical field (i.e., my wife is a practicing physician and we've recently opened up a family medicine practice with another doc and his wife) studied the Romanow report and the CHA, I have swung the other way. Shifting the burden of paying for essential medical services to the patient would be a grave mistake in my opinion...there are other ways the system can find money to do what needs to be done...there's a lot of waste/duplication in the system (I'll get to this in a bit). One of the central tenants of the CHA is that access to essential medical services in Canada is a RIGHT of citizenship and should not be determined by how much money one has...where one lives...etc. I strongly believe in this. I have a friend who was hit by a drunk driver in the U.S. when he was living in Colorado...he has had several major back and neck surgeries...costing several hundred thousands of dollars. He is very fortunate...he's got a ton of money...but what if this was a student...or a retired person on a limited income? Do they also not have the right to be "fixed" so they can have a reasonable quality of life? I think so. I personally believe, from what I have read and experienced in the medical field...that there's a ton of duplication and waste...and it's not only docs who are duplicating/wasting...it's also the patients...healthcare is a national issue and it will require all Canadians to participate in ensuring we will continue to have it in years to come. EMR is only one case in point...however...it is an example of how system waste/duplication could be reduced. Think about it...a patient going to a walk-in clinic will have to give some sort of history and a description of their problem...at a minimum. How many times has this history been given in the past? How many different walk-in clinics has the person been to? How many times have different docs billed for the same thing? How many files are maintained for this one individual? How much is charged back to the government for "storage" on income tax? Have you been to the ER lately? How many people do you have to give a history of your problem to? The last time I went...I believe I had to give my history three times...one to the triage nurse...one to the admitting person...one to the doctor. Now this doesn't seem like much...but if you added up the time across millions of patients each year...that's significant! Patients also place much burden on the system...going to multiple clinics (and part of this may be due to lack of ability to get a family doc, for sure)...going to multiple docs for the same problem...going to emergency at the drop of a hat...for many non-emergent problems...because they can't/won't take time off work during the day to go see a family doc. And then there's telehealth...while, in principle, it's a good idea...from what I've heard...and from the call I've placed for fun...this system is a huge waste...you can't diagnose or triage properly over the phone...many patients just get sent to emerge anyway...and did you know that each call to telehealth cost about $37 bucks to the system? And do you know what family docs are paid for the same type of "visit" ... about 28 bucks...hmmmm.... Have you ever heard that each doc, in many hospitals, purchases their own preferred supplies (e.g., their preferred type of sutures, etc.)? Can you imagine how much this costs the hospital rather than centralizing all purchases for commonly used materials/equipment/medicines? Sorry...I'm being totally disorganized here...but I think that rather than making Canadians pay more for healthcare at this point, what we need to do is make the current system more efficient, eliminate duplication, eliminate waste, refocus taxpayers money into what really matters...ensuring all Canadians have equal access to top notch essential medical services. Great discussion by the way...I look forward to other perspectives... Peter Link to comment Share on other sites More sharing options...
Guest shutterbug Posted March 9, 2003 Report Share Posted March 9, 2003 Great post Peter. I guess medicine has become so complex that inefficiencies were bound to develop over time...just like any other industry though. The devlivery of healthcare has become so decentralised that it would be very difficult and politcal to try to change anything major (think FHN). I totally agree with you that two tier health care is no way to go. Sure, it provides fantastic, state of the art care if you are rich and powerful but would suck if you weren't. Forcing someone to choose between treatment and (perhaps) their home is not good. We only have to look at the US to see the effects of this type of system. For example, 380 000 jobs were lost in the US last month. Most people aren't just losing jobs they're also losing the employer sponsered health insurance (if they had it to begin with). What about Medicare/Medicaid? Sorry Mr. Applicant you haven't been unemployed long enough or you make xx cents over the mimimun allowed or....in other words, those systems let a lot of people down. I don't think that many people who have been in Canada their intire lives can fully conprehend or appreciate that. But with 85% of the US population with isurance and reasonable health care it is difficult to suggest change (politically). I would suspect that things will get worst when the babyboomer generation starts retiring en masse....the Medicaid bill be simply skyrocket. Link to comment Share on other sites More sharing options...
Guest PerfectMoment Posted March 12, 2003 Report Share Posted March 12, 2003 increase the billing structure so that FPs get more money and thus don't need to work as much which would then make it seem more like a lifestyle type of specialty? maybe doctor's should take courses on running practices efficiently? let more foreign docs in? let more med students in? it'd be great to hear some of your answers... btw Peter(or anyone for that matter), can doctor's hire people to help them with running medical practices efficiently? ie: someone to go through the office and suggest what to do with forms, hiring of people, etc. sorry for being all over the place with this post... Link to comment Share on other sites More sharing options...
Guest MayFlower1 Posted March 12, 2003 Report Share Posted March 12, 2003 perfectmoment, Great questions... With respect to practice management...in your last year of residency, Dr. Tom Faloon has a seminar on practice management which he gives through MD Managemen across Canada. It's a wonderful presentation...don't miss it if you get a chance to attend it. If any of the moderators have attended the seminar I'm sure they will vouch for how useful and excellent it is. I have been working with Dr. Faloon and my wife (who is also a practicing physician) using my Human Factors background and their medical knowledge to create efficient medical forms which we have copyrighted. We call the suite of forms "Office-In-A-Box"...the suite consists of 77 different important signs, forms etc., including: Introductory Letter to Services & Specialists Standard Patient Letters Practice Policy & Information Brochure Speed-Fill™ Medical Forms Speed-Fill™ Integrated Consultation & Requisition Forms Patient Information Sheets (e.g., smoking cessation, tubal ligation) Office Signs (e.g., standard fees for non-insured services) Fax Cover Sheets, letterhead & envelopes Multi-Doctor Practice Appointment Cards Immunization Stamps Doctor Signature Stamps Practice Address Stamps On-line form ordering The forms have been optimized to maximize efficiency, minimize writing and can be used electronically, or printed and written on like a regular form. The forms are also all customizable to the specifics of each doctor/practice. MD Management also offers a service to help you plan your office...I believe this service is offered free to all physicians...but don't quote me on the free part. I am currently working on extending the Office-In-A-Box concept to include a design manual which will provide guidelines and human design specifications to aid new and/or existing docs design an efficient medical office...including overall office design (e.g., where to put nursing, waiting room reception, etc.), room setup, telecommunications & IT infrastructure setup. Anyway...the larger concept is still in development...the forms are currently available. If you know anyone who is interested please feel free to pass on the following email address: peterhill16@hotmail.com Peter Link to comment Share on other sites More sharing options...
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