Medical care and technology

September 9, 2009 12:00:00 AM PDT
How technology is changing the way we approach medical care, in particular prostate cancer, heart failure and early disease diagnosis.

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KEY AREAS IN WHICH TECHNOLOGY IS CHANGING THE WAY WE APPROACH MEDICAL CARE:

1. Information technology-enabled service improvements

- Get a secure email for your doctor. You can ask questions by email and get prompt answers.

- Kaiser in Hawaii found that secure email plus Electronic Records led to a 26% reduction in the demand for doctor visits -- Think of the convenience, the old way and the new way.

- Also, ask your health care provider if you can make an appointment online. You could ask the MD to order the tests she thought would be needed. You can also send questions in advance that you were planning to ask at the appointment.

- You can email questions to their children's pediatrician at Kaiser and get answers.

- You can find out your children's immunization records and print them online.

- Ask for prescription refills online; tell them where and they will email it to the pharmacy. Cuts out both errors and hassle.

2. Outcomes management

A little known but extremely important fact about medical care is that in most cases, doctors do not have good systematic information on their patients' outcomes. If you ask your doctor "what are the odds of a particular bad side effect?" wouldn't you like the answer to be based on actual data for that doctor and patients like you? Orthopedic surgeon at Kaiser Permanente and his colleagues have created a patient registry for hip and joint replacements, with detailed information about the patient, the prosthesis and the doctor. Then statisticians track the results and report back to the doctors. If a particular product starts being associated with a poor result, they can detect it quickly and feed back the information to the doctors. They are using it to learn how to improve the care and to choose products better. And now they are at work extending the same approach to other areas such as cardiac devices.

3. Give me more control!

- Patients want to be in charge of their health and there are more and more tools out there to equip them with the power of information.

- Online Tool: In the world of prostate cancer screening, there is much debate over the validity of a PSA score. And frequently they result in unwarranted biopsies (70-80% of the time, in fact) costing $750 million per year. The Dynamic Screening system from Soar BioDynamics, an online screening tool, uses advanced statistical computing informed by the latest peer-reviewed research. As a result, doctors and patients can make a more informed decision about ordering a biopsy. Essentially, men can go through a prostate exam without the exam! And often avoid a biopsy.

4. Save your life, while saving time and money

- Technologies and methods of treatments are advancing to reduce the strain placed on the patient and the wallet.

- The heart defect known as Mitral Regurgitation (MR) - essentially a leaky heart valve- is the most common heart problem in the U.S. and only 50,000 of the 250,000 cases/year are able to be treated with surgery. The other 200,000 remain affected by MR and the chronic volume overload requires the heart to work harder, often leading to heart failure.

- In Menlo Park, Evalve Inc. has developed a device, currently in the clinical trial phase, that allows patients to have their leaky valve repaired without surgery. Using the MitraClip® system, patients suffering from MR are treated percutaneously. The MitraClip device is deployed through a catheter-based system and is used to clip the leaky valve. Study results have demonstrated that patients treated with the MitraClip® therapy achieve improved quality of life and have a short hospital stay (1-2 days).

5. Moving away from one-size-fits-all medicine.

The same disease doesn't affect every person in the same way. People get diseases at different ages, don't all have the same symptoms, may have more or less severe disease, and respond to treatments in very different ways. Our unique genetic make-up plays a significant role in these differences. When we understand how genetic factors influence disease, we can use that information to predict who is at greatest risk, who will benefit from specific prevention and early diagnosis strategies, and how that disease is best treated when it does happen. Genomic medicine has the power to tailor healthcare for an individual in a way that has never before been possible. A local example of this is at El Camino Hospital in Silicon Valley - a community hospital that just opened the Genomic Medicine Institute (GMI). The GMI is the first community hospital to offer comprehensive genomic medicine services, including testing, counseling, and targeted therapies.

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