Question

Choose three Milestones of the history of hospitals and examine what you think it would have been like if they did not exist.

Answer 1

Today's health care system is not only complex, it is significantly different from "what it used to be." The changes are many and represent the major shifts involved in moving from an indemnity plan, based primarily on what the patient wanted, to a managed care system. The American health care system has not only undergone drastic changes within two generations but also continues to evolve. Key factors that shape a culture's approach to health and to its health care delivery system. In addition to cultural beliefs and values, there are important economic and situational factors. Many of the changes that have led to a managed care system are rooted deeply within economic realities. The spiraling cost of health care in the United States is evidenced by both per capita expenditures, and also by measuring health care expenditures in relationship to the Gross Domestic Product (GDP).

As the decades passed, the most commonly implemented systems were those designed to automate transactions, either in a clinical or administrative context. An obvious result of more transaction systems installations was the dramatic increase in readily available digitized data. I like to think of this data as pure exhaust from transaction systems; we certainly didn’t install the systems for the data, but data emerged as a critically useful byproduct. All of a sudden, we found ourselves with enormous amounts of data siloed in multiple, discrete applications. Pioneers, such as Dr. Brent James at Intermountain Healthcare, began to articulate to the industry that improving operational performance would require health systems to merge and analyze this data.

Another focus of hospital information system implementation over the years has been reporting. Reporting systems typically exist as components of transactions systems. Historically, this reporting provided snapshots of information about the hospital to management, the board, or other groups.

As valuable as these reporting systems were, they can’t meet today’s industry analytics requirements. Today’s focus, out of absolute necessity, must be on performance improvement; especially on the clinical side. Essential to this focus is the need for an analytics offering that bridges and merges multiple applications: clinical systems, financial systems, and patient satisfaction systems. Reporting systems embedded in a transaction system clearly can’t do that. Furthermore, analytics requires more than mere reporting; health systems must support the ability to drill down into this comprehensive, merged data to achieve real insight into operational performance. Finally, complex analytics queries against millions of rows of data cannot be performed on transaction system databases without adversely affecting performance; a separate data warehouse is required.

The top healthcare milestones

1. Sequencing the human genome
The Human Genome Project (HGP) was one of the great feats of exploration in history - an inward voyage of discovery rather than an outward exploration of the planet or the cosmos; an international research effort to sequence and map all of the genes - together known as the genome - of members of our species, Homo sapiens. Completed in April 2003, the HGP gave us the ability, for the first time, to read nature's complete genetic blueprint for building a human being.

2. Magnetic resonance imaging
Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body in both health and disease. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves to generate images of the organs in the body. MRI does not involve X-rays or the use of ionizing radiation, which distinguishes it from CT or CAT scans and PET scans. Magnetic resonance imaging is a medical application of nuclear magnetic resonance (NMR). NMR can also be used for imaging in other NMR applications such as NMR spectroscopy.

3. The Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act, often shortened to the Affordable Care Act (ACA) or nicknamed Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. The term "Obamacare" was first used by opponents, then reappropriated by supporters, and eventually used by President Obama himself. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the passage of Medicare and Medicaid in 1965.

4. Smallpox eradicated
Smallpox is an acute contagious disease caused by the variola virus, a member of the orthopoxvirus family. It was one of the world's most devastating diseases known to humanity. The last known natural case was in Somalia in 1977. It was declared eradicated in 1980 following a global immunization campaign led by the World Health Organization. Smallpox is transmitted from person to person via infective droplets during close contact with infected symptomatic people.

5. First AIDS case identified
In June 1981, the CDC reported a cluster of pneumocystis pneumonia in five men in Los Angeles while physicians in L.A. and New York identify an outbreak of a rare skin cancer among these men. A July 3 article in The New York Times carries the headline: "Rare Cancer Seen in 41 Homosexuals."