Wednesday, November 18, 2009

Electronic Medical Records - Technology-Enabled Primary Care Doctors

There’s no question the deck is stacked against primary care. Its rates are too low, its hours too long, and its prestige too lagging. Yet everybody agrees a vibrant and broad primary care base is essential to a smoothly functioning and effective health system.

I’m optimistic about primary care. I believe primary care doctors are capable of pulling themselves up by their technological bootstraps. In Innovation-Driven Health Care (Jones and Bartlett, 2007), I devoted several chapters to primary care clinical innovations - having patients create their own histories electronically before visiting the doctor to save time and enhance coding revenues, being trained to perform more procedures and produce more revenue in the office, dispensing medications in the office to improve compliance, using the Internet creatively to reduce staff costs and overhead, doing their own coding, and using protocols to manage metabolic diseases leading to vascular deaths.

Most of these are “disruptive technologies,” meaning primary care doctors can execute them in their office rather than referring them out or depending on someone else.

Now there’s a new technological kid on the block – digital handheld ultrasound devices. These devices are small, less than ½ a pound; handheld and portable; will soon be available for less than $5000; will be marketed by organizations, large (GE and Phillips) and small (Sonasite); FDA approved; emit no radiation, as CT and MRI scans do; and are aimed squarely at the primary care market.

Not only can these devices keep many procedures “at home,” rather than being referred to imaging centers , pharmacies, or other specialists, but they can be performed simply,safely, and more conveniently and more cheaply for patients and the system as a whole.

Handheld ultrasound devices are useful and versatile and can be used to monitor fetal development, guide needle injections, joint aspirations, and lumbar punctures; identify coronary atherosclerosis, peripheral vascular disease, abdominal aneurysms, and intra-abdominal and thoracic masses.

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