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>View discussions about this entry Country: United States
Organization: SUNY at Stony Brook
Focus of activity - Service/process
Year the initiative began (yyyy) - 2007
Positioning in the Mosaic of solutions
Define the innovation - What is the main focus (product, services, etc) of your innovation? Who are the primary beneficiaries? How does it make health and/or health care more affordable, accessible, and simpler to achieve/use? How does it differ from what currently exists in the market? My innovation has not been implemented anywhere. It is an innovation that needs to occur and is technologically feasible.
Microsoft foundation could blanket the US with computers outfitted as telemedicine machines; it could round up the "My Neighborhood Health Care" providers and people would enroll. Health Insurers would pay a flat fee schedule for any where "IN THE WORLD" where people accessed the services of their providers and the health care premium would be world wide, thus opening up a huge new market for the Insurers, making health insurance ubiquitous and affordable because the numbers participating would drive down the unit costs. Context for Disruption: - Describe how your innovation is transforming traditional health or related systems in the short and long term. The innovation necessary to transform a public perception of scarcity that enables a high price and justifies a high price for medical care is to make the public aware of the possibility to make health care as prevalent and easy as restaurants. To do this, health care needs to be segmented into invasive and non-invasive procedures. All but invasive procedures can be managed by the patient.
"My Neighborhood Health Care" is a web page set up in each 10 mile square region for each person enrolling in the new website. Providers link to each person's website and offer "telemedicine" through the persons computer. Dell, HP, Microsoft, etc. Apple, invent a computer that is a laptop telemedicine machine in addition to being a computer. A side car to the computer reads: Blood Pressure, Blood Sugar, heart, lungs, etc. using telemedicine technology that is readily available. The existing health care providers transfer to the individuals "blog" or web page all their invasive test results that are current. X Rays, MRIs, blood chemistry. They post the diagnosis and treatment. The patient now has a website where, whenever they use the telemedicine feature to monitor anything, it is posted to their "blog." Then, any refills they use, all medications, etc. are posted by the pharmacy and can be renewed electronically. The individual then has the option to do the following: 1. Link to physicians that announce their availability for diagnosis and treatment. The patient enters all health insurance information etc. When telemedical monitoring is done by the patient, the doctor they have enrolled with responds with the diagnosis and treatment. If it is necessary to go to a Doctor in person because of a test result, the appointment is scheduled online at the nearest Hospital/doctor office etc. 2. Link to ambulance service Delivery Model - How does your innovation reach its target populations? What mechanism(s) (e.g., communications, distribution channels, etc.) do you have in place? What is your current market penetration? How do you measure this? Through Google, Microsoft, computer sales. The first innovation is to adapt computers into telemedicine machines so that health testing remotely becomes common and "everywhere." The patient stays in "my neighborhood" with the knowledge that their health is monitored, diagnosed and treated from home or even while traveling. That prescriptions are filled and records maintained wherever they go that they can be on the internet. All physicians everywhere can conduct diagnosis and prescribe treatment, thus opening up the "world" to uniform healthcare and getting rid of the artifical shortage of health care.
Key Operational Partnerships - What key partnerships have you established to make your disruptive innovation model possible? Who are your partners (business, social, government, other) and what are their roles? How central are these partnerships for your initiative. I would like to establish partnerships with computer and telemedicine companies to integrate these monitoring devices into computers to make health care "physicals" as common as the computer each child/adult/geriatric signs on to to read an email. Their "web page" becomes their health care record.
The companies that set these up now could organize the physician network, the way Napster, for example, has organized record or video providers. We already do this for most things because of the accessibility and reach of the internet, but we are not seeing health care as the same as purchasing a song on Napster because we have not thought innovatively. Financial Model - Describe the financial model for your innovation. What percentage, if any, of the total operating costs does earned income (from products, services, or other fees) represent? Providers of computers and operating systems integrate telemedicine features into their equipment. They organize health care providers to offer services on "the net." Procedures for transmitting health information are already secure. Electronic Medical Records are already available through multiple eHealth providers. The entire world of physicians is enlisted to diagnose digitized photos, telemedicine results, etc. and people organize themselves into their own neighborhoods over the net to be tested and diagnosed for health care.
Artificial shortages dissolve. the costs are spread out over the entire human population; the services are standardized and the system becomes as efficient as the entertainment delivery system. Video teleconferencing is now built in to some computers; Skype and other services allow computer telephone connectivity. There should be no "artifical" shortage of health care to americans or any other citizen of any other country if this new process would be implemented.
Effectiveness - What has been the measurable impact of your project to date? How many people have benefited from your program in total? What policies, communities, or institutions have been influenced to make fundamental changes because of your work? Electronic medical records and telehealth is already shown to be an effective and efficient way to monitor chronic illness. it is also the method of choice for remote, rural populations where wireless technology could be implemented, jumping over the problems connected to fixed telephone lines etc.
Remote diagnosis is also well understood and practiced. What the implementation of this new way of looking at computers and the internet would do is reorganize the world-wide health care delivery system and lower costs while it became readily available to everyone rather quickly. computer and telehealth engineers need to create the "box" and it would be sold and paid for by the health insurance industry that could now sell to a worldwide market based on the physicians who signed up.
Scaling up Strategy - What is your priority for the next 3 years and please describe why. Implement this through Microsoft/Dell partnership with telemedicine diagnostic equipment makers. Try it across multiple countries; use language translation software; create the insurance stream of funds for service based on a standard format for each telehealth increment of service; sell the insurance along with the internet membership the way aol or napster do; give it a test run.
Origin of the Initiative - Tell the personal story that will help people connect to your work. How did the initiative start? Was there a particular individual or event driving the idea? Tell the reader the story behind the innovation. My experience in Health Care and being a health care consumer have led me to conceptualize this new process. It would make my healthcare far easier and more affordable. Diagnosis would be simplified. The internet could email me when it was time for a check up that required a physical visit.
Otherwise, my health could be monitored remotely; my health insurance premium would be based on a world wide market and would fall drastically in price. I would participate in a standard health care process. Researchers would benefit from a huge new data base of diagnostic results and treatments. The internet and telemedicine technology, with people's familiarity with the Internet now makes this new process feasible. Contact Information:
Janet Youngblood
Planning Analyst Health Care SUNY at Stony Brook (University) jyoungblood@notes.cc.sunysb.edu SUNY at Stony Brook,HSC Level 4, Room 255, Stony Brook, NY 11794-8430 United States Tel: 6314449067 Website: http:/www.sunysb.edu Discussions about this entry |
My Neighborhood Healthcare
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The VA healthcare system has VISN's. Some of the VISN's have contracted with dshi systems (www.dshisystems.com) to do telephone care. dshi systems has contracted with a Florida university to encourage online self-review:
Journal of American College Health
Issue: Volume 54, Number 5 / March-April 2006
Pages: 289 - 294
Web-Based Triage in a College Health Setting
Mary Lou Sole A1, Patricia L. Stuart A2, Michael Deichen A2
A1 University of Central Florida School of Nursing, Orlando
A2 University of Central Florida Student Health Services, Orlando
Abstract:
The authors describe the initiation and use of a Web-based triage system in a college health setting. During the first 4 months of implementation, the system recorded 1,290 encounters. More women accessed the system (70%); the average age was 21.8 years. The Web-based triage system advised the majority of students to seek care within 24 hours; however, it recommended self-care management in 22.7% of encounters. Sore throat was the most frequent chief complaint (14.2%). A subset of 59 students received treatment at student health services after requesting an appointment via e-mail. The authors used kappa statistics to compare congruence between chief complaint and 24/7 WebMed classification (? = .94), between chief complaint and student health center diagnosis (? = .91), and between 24/7 WebMed classification and student health center diagnosis (? = .89). Initial evaluation showed high use and good accuracy of Web-based triage. This service provides education and advice to students about their health care concerns.
Those kappa scores are pretty high!
I do not know if data from VA VISN's has been published but that could be another source of verification.
Can this go international - Spechen Sie mit Folk auf Deutschland:
Als Beispiel soll die amerikanische DSHI Software näher erläutert werden, die eigens
The DSHI software has been converted to German and is apparently being used there.
However, an important point is there has to be an intermediary, a nurse or other trained professional, who can assist the patient in the telemedicine diagnostic process. And, this is for getting at diagnostic pointers, not necessarily THE DIAGNOSIS. There has to be a lot of self care stuff built in up front as has been done by the DSHI people (the originator of which is an Emergency Room academic who first published a cunsumer oriented CD-ROM - "Dr. Schueler's....") I have used the three CD-ROM series as a teaching tool with Duke medical students about 10 years ago and have followed the evolution of the DSHI telemedicine effort with interest as a full time VA doc for many years, recently retired. I have no financial interest in DSHI or any telemedicine software, or in any software for that matter.
I do think it is possible to unite the DSHI software with VA's VisTa (as DSHI system has already done with another vendor's help). VA's VisTA has been open-sourced in Vista-Office with private vendor support.
So, this project is feasible in a pilot with the following components:
1) properly trained telemedicine interviewers
2) properly educated consumers with some background education about their health, risk factors and symptoms that are "red flags" for futher consultation....etc
3) a system of telemedicine arranged in regions as mentioned in this proposal as has been done in VA VISN's.
4) a way to connect with small practice settings (as compared to college campuses or VA facilities) so that the telephone interview data do get reviewed by MD's or others who can pursue matters further
5) a way to systematically collect the patients history of present illness in a way that addresses the qualitative aspects of diagnosis that is based more on chronological reasoning than the answers to specific questions (about like a pertinent review of systems for specific well definable "complaints")
6) a way to annotate a person's "Problem List" on the web record from the data collected by the system so that, in turn, could be seen in subsequent encounters.
7) other connections necessary to make this as comprehensive as the proposer would like it to be - such as to DXPlain, a differential diagnosis program available to health care professionals on www.merckmedicus.com
Janet W. Youngblood, MA, MBA, Ed.D.
http://citeseer.ist.psu.edu/context/115641/0
Hi:
Prior comments had wondered if computer diagnostics was sufficiently advanced. The above link leads to multiple discussions of evidence based computer diagnostics. This area needs further development which would occur if it was used widely for computer based, telehealth insurance and diagnosis of illnesses.
Again, this systems approach removes the problem of health care professional shortages.
Best regards,
Janet Youngblood
Janet W. Youngblood, MA, MBA, Ed.D.
Hi:
Thank you for your comment.
In fact, diagnostic procedures by computer based on criteria that is gathered through telehealth machines is very sophisticated. I do not have the citation, but Scientific American published a detailed explanation of how computer assessment based on diagnostic criteria gathered systematically, was more accurate than physician diagnosis.
Telehealth machines gather blood pressure, sugar glucose, blood measures, blood pressure, body temperature and, depending on the sophistication of the machines that would be attached to a computer, gather multiple diagnostic criteria. the information is sent via the internet to diagnostic centers. Individuals who have one x-ray machine available can also have x-rays sent via digital technology to physicians anywhere for interpretation.
The point, I think, is that this is a disruptive way of looking at diagnosis and treatment. It uses the internet to connect isolated individuals with chronic conditions or emergency conditions who do not have access to health care professionals and gives them a diagnosis.
Diagnosis has always been viewed as an art, but research has demonstrated that computer analysis of results gathered systematicall, input to a diagnostic software program and analysed can equal or succeed accuracy of diagnosis done by trained physicians diagnosing in person.
For whatever reason this fact is not widely disseminated.
Again, situations need to be diagnosed. If the diagnosis is that the individual can be treated with medicine, the order is placed and the medicine is delivered to the individual using whatever mechanisms are available at that location. If the diagnosis indicates the individual needs to be seen by a physician for invasive treatment of some kind, for example clean a wound for infection; remove an obstruction; hydrate the person with an IV, etc. then the individual knows that they need to seek out whatever possible health care personnel is local.
One can see that the number of physician/nurse practitioner visits would be dramatically reduced. Individuals with conditions that require regular medication and occasional monitoring could be well cared for remotely. Individuals with emergency conditions needing immediate treatment would know that they have to seek out and find actual health care settings in which they could find invasive treatments.
Diabetes, congestive heart failure, heart disease, pulmonary disease, etc. are chronic conditions that can be successfully monitored and treated remotely. the diagnosis of these conditions can be made remotely in most cases.
The idea is to sort out a huge population of people into those needing to actually see a person for care and those needing monitoring and medication.
Nurses can do 95% of the monitoring and prescribing. Physicians could do the 5% of emergency or invasive treatment.
As mentioned, the internet opens up an international health insurance option for those able to enroll in this system. Poor countries can be "insured" for this through wealthy donations that actually go directly to the purpose of the funds because they go to the insuring "system." Telehealth centers are placed periodically throughout poor countries or individuals are issued the telehealth system when they purchase the computer or are given their system locally through NGO's etc.
It does not have to be healthcare provided through the government. for example, the south Bronx in the US could be outfitted in this way. The telehealth centers would have insured patients through the international telehealth "My Neighborhood Health Care" system. People providing the care would get paid after being hired for this aspect of medical work by the providers. The system would provide regional physicians who might, for that matter, make house calls since the number of people needing personal care would drop dramatically.
There are abundant health care providers who are underutilized world wide; the cost of physicians able to provide invasive procedures as well as diagnosis is exhorbitant. Health care in countries such as the US is not affordable for most people and is not delivered efficiently.
As for electronic medical records, the state of Georgia and Indiana are leaders in this field and have implemented very successful ehealth programs. The ehealth initiative is dealing with issues of standardization etc. However, if a large company, such as Microsoft or Apple were to issue the integrated system as they have done with "music" downloads, they could provide the ehealth medical record standards and systems; health insurance etc. and the approach could be worldwide.
I think if those able to put together world wide internet protocols would partner with the telecommunications, telehealth and computer companies under the umbrella of a division of one of these large companies, the system would be feasible and would work well. as experience with it was gained, problems would be ironed out. shortages would be met.
Right now healthcare is simply not a system.
I appreciate your feedback and hope I have addressed some of your questions. I will try to locate the "diagnostic" article I mention earlier and send it to you. the ehealth organization in DC, Janet Marchiboda President are implementing ehealth medical records and personal medical record systems nationally moving to the personal medical record model.
Telehealth is far advanced and the equipment is now produced by multiple companies.
we need the larger computer organization to package the system and insure the individuals world-wide.
J
In theory this idea might eventually work, but there may be too many technological black boxes needed to make it work. The diagnostic technology is not there, and it assumes a level of almost magical efficacy of electronic medical records that is currently not supported by the evidence in the scientific literature. Is there a component to the project that may help overcome this limitation?
Thank you,
Changemakers Team