From The Examining Room to The Chat Room – Is Information Technology the Prescription for Better Healthcare?
The January Wagner-Commonwealth Health Dialogue titled “From Examining Room to Chat Room: Is Information Technology the Prescription for Better Health Care?" examined the growing use of information technology in health care across a spectrum from hospital-based clinical and administrative information systems to the provider-patient relationship, and the consumer use of the internet for health information.
The dialogue brought together some of the top experts in these areas:
Ann C. Sullivan, Senior Vice President and Chief Information Officer of Maimonides Medical Center in Brooklyn, which was named one of the most Influential IT Organizations in the United States by Advance Executives; Thomas Delbanco, M.D., Chief of the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center; Mary Jo Deering, Deputy Director for Management and e-Health in the U.S. Department of Health and Human Services’ Office of Disease Prevention and Health Promotion; and Dr. George Anderson, MD who has had a 30-year career in health care information technology and who has served as President and Chief Executive Officer of Oceania, Inc., which developed software solutions for physicians and other healthcare providers.
Sullivan said Maimonides’ IT system, Eclipsys, is used by all parties in the hospital and has brought extraordinary efficiencies. They have seen a 68% decrease in medication processing time; 60% decrease in medication discrepancies; 20% overall decrease in duplication of ancillary orders; and 48% decrease in laboratory tests. These savings contributed to a 12.4% decrease in length of average stay and 8.7% decrease in re-admissions, and generated nearly $20 million in increased admissions. They also led to much better information at the point of care, better regulatory compliance and increased patient satisfaction.
While acknowledging that real progress has been made, Dr. Anderson challenged the notion that health care was in the middle of a “technological revolution.” “Off the shelf” solutions to health care IT needs are usually not available, medical software development is expensive and medical applications using products created for other purposes often do not work. “Yes, we are experiencing real change” he said. “But the transformation is slow and far from complete.”
Dr. Delbanco framed his analysis of IT usefulness in terms of how it helps in the doctor-patient relationship. He said IT has given doctors and patients the ability to easily “convene around a shared patient record.” This, combined with a streamlining of information flow to clinicians, administrators and clerks, helps keep the patient fully informed. He regrets that IT has brought about a loss of privacy of the medical record, but said that at this point, ‘there’s no going back.”
According to Dr. Deering, a Pew Internet and American Life Project survey found that 70% of those who search for health information on the internet said that information influenced their decision about treatment; 50% said it led them to ask a doctor new questions or get a second opinion; and 28% said it affected their decision about whether or not to visit a doctor.
The National Committee on Vital and Health Statistics has been pushing for the development of a National Health Information Infrastructure (NHII) in order to capitalize more fully on dramatic transformations in information and communication technologies to improve health on a national and global scale. Dr. Deering said the NHII should be a set of technologies, standards, applications, systems, values, and laws that support all facets of individual health, health care, and public health, and that connects distributed health information in the framework of a secure network with strict confidentiality protections. But, she said, to implement the NHII, strong federal leadership, increased health-related IT funding and laws that protect privacy and make health data gathering easier are needed.
Funded by a generous grant from The Commonwealth Fund, the Wagner-Commonwealth Dialogue Series creates opportunities to facilitate the timely translation of health services research findings –even work in progress –from the researcher to practitioner, policymaker and the informed public.
Getting Older in the Developing Worlds Megacities: Professor Victor Rodwin Comments
Global warming is focus of report by a number of leading experts including NYU Wagner's Rae Zimmerman
A report released Feb. 17, 2009, by New York City Mayor Michael Bloomberg found that the city's average annual temperatures could increase by 4 to 7.5 degrees, yearly rainfall will increase by 5 to 10 inches, and seas could rise by up to 23 inches, or even 55 inches if the rate of ice melt in Greenland and Antarctica persists in speeding up.
NYU Wagner Professor Rae Zimmerman is a member of the expert panel convened by the city government and financed by a $350,000 grant from the Rockefeller Foundation. Professor Zimmerman is Director of the Institute for Civil Infrastructure Systems (ICIS), housed at the Robert F. Wagner Graduate School of Public Service at New York University.
The panel also predicted more frequent and intense "extreme events," like heat waves, short periods of intense rain, droughts, and coastal flooding.
The report is entitled "Climate Risk Information" and can be seen by clicking on the link below.
Guy Scalzi Publishes Book with Prof. Roger Kropf
Half the world is 'unbanked,' says new Financial Access Initiative paper
The Financial Access Initiative (FAI), a research consortium based at New York University's Robert F. Wagner Graduate School of Public Service, has identified that 2.5 billion adults worldwide do not have a savings or credit account with either a traditional (regulated bank) or alternative financial institution (such as a microfinance institution). Nearly 90% of the financially un-served live in Asia, Africa, the Middle East and Latin America. FAI published the findings in a November, 2009, paper, "Half the World is Unbanked" (click below to access it).
"Until now, the margin of error when considering the world's unbanked was about plus or minus a billion-unacceptable in any other field," said Jonathan Morduch, professor of economics and policy at NYU Wagner, managing director of the Financial Access Initiative, and author of Portfolios of the Poor, a new book examining the surprisingly sophisticated financial lives of the world's poor. "These findings are a real step ahead, and they show how better data can help policymakers truly target and serve poor populations with appropriate financial services."
The analysis also revealed new insights; for example, that India, a country with low per capita income and a large rural population, demonstrates much greater use of financial services than many relatively richer and more urban countries. The global data indicate that countries can improve levels of financial inclusion by creating effective policy and regulatory environments and enabling the actions of individual financial service providers. More than 800 million of those using financial services live on less than $5 per day, so it is possible to provide these services to very low-income communities-but there are still nearly 2 billion to reach.
The Financial Access Initiative (FAI) is a consortium of leading development economists focused on substantially expanding access to quality financial services for low-income individuals, offering the next generation of thinking about microfinance. FAI is housed at the Wagner Graduate School of Public Service at New York University and led by managing director Jonathan Morduch and directors Dean Karlan (Yale University) and Sendhil Mullainathan (Harvard University). FAI focuses on basic research and measurement tools that reveal the most effective means of implementing microfinance initiatives. FAI studies the value of microfinance by identifying the demand for financial services; the impact of financial access on incomes, businesses, and broader aspects of well-being; and mechanisms that can increase impact and scale of microfinance.
Harold Varmus, Nobel Laureate and Former NIH Director, Outlines His Vision for 'Science Peace Corps' As Way to Combat Third World Health Crises
Annual Schwartz Memorial Health Policy Lecture at NYU’s Wagner School Focuses on Scientific and Medical Strategies To Increase Health and Wealth of World’s Poor
The AIDS pandemic is only the most visible and urgent of the many health challenges facing citizens in developing countries; others include malaria, drug-resistant tuberculosis, childhood diseases and inadequate maternal and prenatal healthcare. This burden of disease causes staggeringly high mortality rates among the poor in the Third World, especially in sub-Saharan Africa.
Public health experts increasingly argue that there is an intrinsic linkage between the health condition of a nation’s people and the potential economic growth needed for a nation to develop. They make the case that good health is a necessary predicate to, not just a result of, economic development.
On February 28th, Harold Varmus, MD, president and CEO of Memorial Sloan-Kettering Cancer Center, co-recipient of the 1989 Nobel Prize in medicine, and former Director of the National Institutes of Health, delivered the 2nd Annual Arnold Schwartz Memorial Health Lecture at the Wagner School. Entitled “Globalizing Biomedical Sciences,” Dr. Varmus’ address outlined the significant themes of his vision for a more active approach by developed countries for tackling the public health challenges faced by the developing world.
Despite great strides in medical and scientific research during the 20th Century –such as the discovery of cures for malaria and tuberculosis – there remains, said Dr. Varmus, a great disparity between health outcomes in rich and poor countries. He lays the blame for this in part on a failure to focus research dollars or to apply discovered solutions towards actually addressing public health problems in the developing World.
“We have had a very successful century scientifically, but one that is subject to criticism with respect to health outcomes, the equity with which we apply solutions, our ability to find solutions, and our willingness to invest in some of the diseases that are most rampant in poor parts of the world. What can those of us who are scientists interested in health do to make the next century a better one?” asked Dr. Varmus. In response, he proposes three solutions:
- globalizing the “culture of science” and disseminating worldwide vital scientific research and medical knowledge through free Internet-based access to the leading scientific journals;
- creating a “Science Peace Corps” by which newly minted science graduates and senior scientists from developed countries go to those parts of the world now underserved by science and aid in the building of a local science and medical research capacity;
- adopting the recommendations of the December 2001 report “Macroeconomics and Health: Investing In Health For Economic Development” from the World Health Organization, which calls for, among other things, increased, smarter investments in the public health systems within the developing world as both an end unto itself and as a means to economic prosperity.
The Arnold Schwartz Memorial Health Lecture is named for the late Arnold Schwartz, a founder of Paragon Oil Company and well-known health and education philanthropist. His widow Marie Schwartz, a NYU Life Trustee, made a gift of $100,000 to the Wagner School to endow this lecture series, now in its second year. Last year’s inaugural speaker was Yale Medical School Dean David A. Kessler, MD, the former commissioner of the US Food and Drug Administration.