Obstacles

As noted in the section on the History of Healthcare, it is staggering to attempt to comprehend the changes in healthcare over the past 40-50 years. In 1950 it was typical for the majority of medical illnesses to be managed at home under the direction of the family doctor. The hospital was an institution where surgery was performed or patients went to expire. Diagnostic laboratory, x-rays, etc. were very limited in the 1950's and 1960's. With the rapid growth of healthcare, the industry has developed innumerable growth pains. It is impossible for any one individual to efficiently orchestrate the complex medical care that is available for patients today. The physician in charge is now the captain of a ship. The captain must delegate and guide the officers and crew to efficiently sail the ship.

Best care guidelines represent a general plan for resolving a clinical problem. It is essential for the physician in charge to anticipate and set forth the plan of action. A plan of action then is developed as events unfold for a common problem will be less efficient that a plan that anticipates the events. A major criticism for medicine in general is that medicine reinvents the wheel every time a patient presents. Physicians during their practice of medicine have learned to anticipate and interpret the many facets of an illness. It is necessary for this wisdom to be shared when clinical care guidelines are developed.

When the physician is not on the medical floor, it is similar to the captain of a ship being off the bridge. At that point, the physician must delegate guidance of the patient to the charge nurse who represents the officer on deck. By utilizing the nurse as care manager, it is possible to push forward the clinical care guidelines and consult the primary physician when input is necessary. The nurse, as care manager, guides a team to implement the plan of action.

By utilizing a clinical care guideline, it is possible to reduce the number of unnecessary tests. It is also possible to focus on turn-around time in the delivery of standardized guidelines. Currently for a given test, each individual feels that the test is completed once they have performed their duty. The ward clerk feels that the test is done when the order is entered. The lab technician feels the test is done when they have the result. In reality, the test is not done until the physicians have the results in front of them on the chart.

Redundancy of effort is another major problem. When a patient is transferred from the Emergency Room to the floor, the same questions and data base are obtained. It is important that the data base is expanded and refined rather than recreated as a patient moves through their encounter with the medical process. Each encounter with the medical system should build on the prior encounters and compliment rather than duplicate effort. If reliable data is available in the recent past, this should be utilized rather than repeating the effort and expense. Information systems are available to implement this process. Patient privacy can be protected by security screening such as retinal scanning when individuals access a patient’s medical data base.

Unnecessary and redundant paper work is drawing the nurse away from the patient. The redundant paperwork makes review of hospital charts difficult and increases the likelihood that key information is lost in the morass of unnecessary data. With information systems, it is possible to bring the relevant clinical data to the forefront of the chart and place the legal documentation in the background. The relevant data would be highlighted by push information systems and the remaining data would be available by pull information systems. It is possible for each institution and physician to define which parts of the patient’s chart they want in the forefront or background.

With the explosive development of medical tests, devices and treatment options, it is impossible for any one physician to keep up with the pro’s and con’s of a specific element. Through information technology, it is possible when a test, device, medication, etc. is requested to guide the physician on-line with the pro’s and con’s of their request. The advantage is two-fold. First, alternative and less expensive strategies are advanced. Second, the physician is receiving continuing medical education through each encounter. The subsequent encounters are likely to be faster and better focused.

Team work and continuous quality improvement are felt to be the foundation for the evolution of healthcare. We all have vested interests in the development of healthcare. By aligning our interests, we will do better than dwelling on the differences of opinion that are inevitable.