The U.S. is facing an extreme shortage of primary care physicians and some policymakers want to fill the growing gap by expanding the role of nurse practitioners. However, the two professions are currently occupied in a debate over who is better and more qualified to deliver patient care.

The results of a recent survey were reported in the latest issue of the New England Journal of Medicine.

Leading experts did expect some slight controversy, but they were surprised by how much doctors and nurse practitioners vary in their opinions. Among the nearly 1,000 doctors and nurse practitioners surveyed they were most divided on who provides a higher quality of care to patients: Two-thirds of physicians said if a doctor and nurse practitioner provided the same service, the doctor would do it better. Very few nurse practitioners agreed with that opinion.  82 percent of nurse practitioners felt that nurse practitioners should lead their own practices, while only 17 percent of doctors agreed.

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"We weren't surprised that there were differences in their opinions, but we were surprised by the magnitude of the difference," said lead researcher Karen Donelan, a senior scientist at the Mongan Institute for Health Policy at Massachusetts General Hospital, in Boston.

Dr. David Blumenthal, co-author of an editorial published with the study, agreed.

"It's striking how different their perceptions are, even though they work in the same physical environment," said Blumenthal, president of the Commonwealth Fund, a New York-based foundation that supports research on health policy.

Blumenthal and Donelan agree that the divide between doctors and nurse practitioners will have serious implications on the future on health care in the U.S., and the shortage of primary care practitioners is already at a staggering 33k.

A study revealed that 16 percent of U.S. adults have to wait, on average, at least six days for a doctor’s appointment when they have health problems that need immediate attention. The shortage will become far worse when the health care reform extends coverage to 30 million more Americans.

By some estimates 12 nurse practitioners can be educated for the same cost as one doctor, and there is evidence that nurse practitioners perform just as well as doctors. 

Read This Article In The May Edition Of Healthcare Global's Digital Magazine

Chris Hani Baragwanath Hospital, known affectionately as ‘Bara’ is South Africa’s largest hospital and the third largest hospital in the world. Bara is the only hospital in South Africa's largest township sprawling over 173 acres, 429 buildings and 10km of corridor. The hospital has more than 3,000 beds to serve a population of about four million and employs more than 6000 members of staff.

Located in the Soweto area of Johannesburg, it provides medical care to more than 2000 patients every day from catchment areas as far as Klerksdorp. The hospital is one of 40 Gauteng provincial hospitals and is financed and run by Gauteng Provincial Health Authorities. It is a teaching hospital for the University of the Witwatersrand Medical School, along with the Charlotte Maxeke Johannesburg Academic Hospital, Helen Joseph Hospital and the Rahima Moosa Mother and Child Hospital.

Bara operates on three central guiding principles and strives to achieve success on a daily basis, while overcoming challenges associated with its location, funding and skill shortages within the province. Its guiding principles are >>>

1. To achieve the highest level of patient care based on sound scientific principles and administered with empathy and insight;
2. To train our work corps to be the best equipped and motivated to serve the sick and injured;
3. To maintain and defend truth, integrity and justice for all, at all times, to the benefit of patients, staff and the community.

Overcoming Challenges

Like all healthcare institutions, especially those of such a huge scale, the hospital faces many challenges on a daily basis, however Bara is unique insofar as it operates in South Africa, which has the largest HIV/AIDS population in the world; more than half of the patients admitted are HIV positive. Furthermore, the hospital operates within a city with one of the world’s highest crime rates and feels the fall out from that. Nearby Townships mean that there is a huge volume of patients admitted to the hospital every day with violence related injuries and on top of this, reports have suggested that violence within the hospital itself has also been a concern, with theft and assault of medical staff a continuing problem.   

The hospital also suffers from a lack of resources and many of its staff find themselves working around the clock to provide the level of care required by the high volume of patients. There are not enough beds, the equipment is often out of date and the facility often faces power outages.

Bara is likely one of the most challenged medical institutions in the world and yet it still manages to achieve successful levels of patient care day in day out. This is largely down to the dedication and hard work of its senior management team, the provincial health department and its team of medical professionals. In the past few months, the hospital has also appointed a new CEO, leading to a lot of positive discourse surrounding the facility. The new CEO hopes to continue building on the success of the hospital while tightening up processes, assessing where cost savings can be made to facilitate to purchase of more medical equipment and training to ultimately generate a more positive PR image for the hospital that does such good work. 

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Overcoming Skill Shortages

South Africa has for many years suffered from a lack of skilled employees within the healthcare sector. Lack of funding and poor education often means that there are not enough medical professionals qualified to serve in hospitals and healthcare institutions.

Bara has taken great steps to overcome this hurdle by working closely with the University of the Witwatersrand Medical School, along with the Charlotte Maxeke Johannesburg Academic Hospital, Helen Joseph Hospital and the Rahima Moosa Mother and Child Hospital. Not only has this provided the hospital with a steady stream of qualified medical professionals, it has also enhanced the level of care the hospital gives its patients. Being attached to a research institution has meant that medical breakthroughs reach the hospital much quicker. Its connection with these universities has also raised its profile in the local area, sparking new funding avenues.

Furthermore, the hospital is also dedicated to providing its staff with regular training to bring them up to date with the latest processes and health and safety compliance rules. The new CEO believes that training is exceptionally important for all levels of employees from senior physicians through to cleaners and ward technicians to maintain successful levels of patient care. As such training both internally and externally is top of the agenda.

Despite working in exceptionally challenging circumstances, the staff and senior managers at Bara do the hospital and the local community proud every day. The dedication of staff is unparalleled and it is this level of devotion to facilitating better healthcare in South Africa that will see the hospital improve and develop now and in years to come.  

READ THE APRIL EDITION OF HEALTHCARE GLOBAL HERE

Massachusetts-based health centers receiving grants include >>>

• Community Health Center of Cape Cod (Mashpee, MA): A $50,000 grant will support programs related to diabetes, hypertension and hyperlipidemia management.
• Dimock Community Health Center (Roxbury, MA): A $50,000 grant will support programs related to behavioral health integration for coronary artery disease.

The “Innovations in Community Health” grants, which total more than $1 million, have been awarded to 21 community health centers across the country to support the development of innovative, community-based programs and initiatives that focus on the treatment and management of chronic illnesses, specifically heart disease, diabetes, hypertension and asthma.

"Through our partnership with NACHC, we are providing much-needed funding to support affordable community-based health care models that are producing innovative programming in the area of chronic disease management," said Eileen Howard Boone, President, CVS Caremark Charitable Trust.  "We are honored to recognize programs in Boston and Cape Cod that are using a variety of methods to help people manage their chronic disease and improve health outcomes."

While changes in our health care system will qualify millions of more people for health coverage, it's still a challenge for many to find quality care that could help manage – even prevent – many chronic diseases.

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More than half of Americans suffer from one or more chronic diseases every year and chronic diseases are the leading causes of death and disability in the United States. A survey released today by CVS Caremark could explain why. “The CVS Caremark Chronic Disease Awareness Survey” reveals the public’s misconception and understanding of chronic diseases, with the majority of respondents admitting that they are not doing as much as they could to stay healthy. Twenty-eight percent of respondents think there is little they can do to prevent most chronic diseases, yet modifiable health risk behaviors, including lack of physical activity, poor nutrition, tobacco use and excessive alcohol consumption, contribute most to the exacerbation of chronic diseases. Additional insights include >>>

• Nearly forty percent of people think what they eat has little to do with whether they get a chronic disease.
• Approximately thirty-two percent of people think smoking does not have an effect on chronic diseases beyond lung cancer.

The survey also showed that while a majority of people agree that reducing stress, exercising, improving their diet or regularly visiting a doctor can help prevent chronic diseases, more than half of people admit they are not doing much to prevent them.

• Sixty percent of respondents are aware they should take steps to reduce stress in their daily lives but do not.
• Nearly sixty-five percent of people are aware they should exercise regularly, but they do not.
• More than half of people admit they do not take the steps they should to improve their diet.

For more information, please visit www.cvscaremarkfyi.com/BuildingHealthierCommunities

About the CVS Caremark Charitable Trust

The CVS Caremark Charitable Trust, Inc. is a private foundation created by CVS Caremark Corporation (NYSE: CVS). CVS Caremark is the largest pharmacy health care provider in the nation. The Trust's mission is to provide funding for health care, education and community involvement initiatives in CVS Caremark communities. General information about CVS Caremark is available through the Investor Relations portion of the Company's Web site at www.investor.cvs.com, or through the Web site's press roomwww.cvscaremark.com/newsroom.

About the National Association of Community Health Centers

The National Association of Community Health Centers (NACHC) was founded in 1971. Its mission is to promote the provision of high quality, comprehensive and affordable health care that is coordinated, culturally and linguistically competent, and community directed for all medically underserved populations. For more information on the National Association of Community Health Centers, please visit http://www.nachc.com/.

About the Community Health Center of Cape Cod

The Community Health Center of Cape Code believes that patients play an important role in their own good health and well-being. The Center works with patients to develop preventive health and medical program to fit patients’ needs and services such as primary care, mental health, women’s health, dental care and special programs. For more information, please visithttp://www.chcofcapecod.org/.

About the Dimock Community Health Center

Recognized nationally as a model for the delivery of comprehensive health and human services in an urban community, The Dimock Center provides the residents of Boston with convenient access to quality health care and human services that might not otherwise be available to the communities we serve.  In 2009, our providers and staff saw over 73,000 patient and client visits. For more information, please visit http://dimockcenter.org/news/page/About-The-Dimock-Center.aspx.

A top NHS doctor has urged the government to ‘crack down’ on the cosmetic surgery industry, citing a complete lack of regulation in some fields.

READ THE APRIL EDITION OF HEALTHCARE GLOBAL HERE

Bruce Keogh, the Health Service's Medical Director, called for tougher controls over “highly misleading” advertising and voiced his concern at the example set by television reality shows, in a review published on Wednesday.

He also raised doubts over the competence of non-Britain based “fly in, fly out” surgeons in carrying out facelifts, breast implants and nose straightening procedures.

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The report highlighted “the many TV makeover programmes where participants have procedures financed by providers. Of particular concern are TV reality drama shows in which its young stars glamorise cosmetic procedures,” it added. “It is not always made clear that these celebrities have contracts with particular providers.”

Keogh said that those putting their faith in the hands of private surgeons did not have “the safety net that those using the NHS have.”

Health Minister Dan Poulter backed the recommendations and said the government would respond in the summer. “While there are some responsible clinics which do take proper care of their patients, Sir Bruce Keogh's review makes clear that there is a significant risk of people falling into the hands of cowboy firms or individuals whose only aim is to make a quick profit,” he said. “These people simply don't care about the welfare of the people they are taking money from.”

The review was commissioned after breast implants made by the French company PIP were found to contain substandard industrial-grade silicone.

The NHS in the UK has come up with the idea of sending elderly patients, new mothers and stroke patients to so called ‘Hotel Hospitals’ to recover from illnesses, falls and similar conditions as part of a plan to ease ‘bed-blocking’ in hospital wards.

READ THE APRIL EDITION OF HEALTHCARE GLOBAL HERE

Hotel Hospitals will be run by private hotel chains and will provide users with private en-suite facilities, television, internet connection and room service. Visiting hours for family members would also be a lot more flexible that in hospital wards and relations would be given the opportunity to stay in nearby rooms. It is thought that the system could save the health service tens of millions of pounds. The idea came from Scandinavia, where the set is widely used – many large hotel chains run the service on hospital sites. 

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The aim of the scheme is to support patients who are well enough to leave a hospital environment, but who still require more medical support than they could receive at home. 

According to government estimates, such a patient costs the NHS about £260 a day. The total bill for these delayed discharges has been estimated at £4 million a week and has been increasing at a time when NHS budgets are under intense pressure.

Surprisingly, the cost of accommodating a patient in a hotel, even one staffed by trained carers and fitted with medical equipment, would be significantly lower, according to advocates of the scheme.

In Scandinavia, privately run patient hotels are situated in the grounds of hospitals, where they are staffed by nurses and afford quick access to specialist consultants if patients need urgent treatment.

The proposed system has bought success in the past and could benefit the care of elderly patients, not only because they remain under medical care for longer following trauma, but because the hotel environment is more ‘welcoming’ than a hospital ward.

What do you think about the concept? Join the discussion on our Businessfriend page or tell us your thoughts on Facebook. 

The report, conducted by the Care Quality Commission (CQC) also discovered that thousands of hospital patients were forced to wait when they sought urgent help.

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In total, 17 per cent of patients waited more than five minutes after using the call button because they needed assistance from a nurse or doctor and one percent received no response at all.

The report also highlighted patient concerns that there were not enough nurses in hospitals, with one in 10 saying there was not enough medical staff on duty while they were being treated.

Thousands were denied help with basic tasks, with 17 percent said they did not get enough help to eat their meals, overall 19 percent said they only got enough help on some occasions.

Katherine Murphy, Chief Executive of The Patients' Association, said, “Far too many patients, many of them elderly and vulnerable, are left absolutely terrified in hospital because when they need urgent help, the call goes unanswered, and when they need assistance with the most basic tasks, it is not there.”

She said patients ended up collapsing after attempting to get to the bathroom on their own, while others rapidly deteriorated because assistance came too late.

Murphy said that despite Government rhetoric about putting patients at the heart of decisions, the 24 percent of patients who said doctors had discussed their care in front of them as though they were not there reflected a “very paternalistic” way of delivering care.

She continued, “Patients should be involved in their care, but again and again we see this is not happening.”

A Global Phenomenon

The survey carried out by the CQC highlighted problems localized to the UK, however it is fair to say that many of the concerns of British patients can be felt in other locations around the globe.

This highlights the need for healthcare executives to take a long look at customer service and patient care. It is one thing to provide patients with the medical assistance they require, however it is also extremely important to ensure patients feel informed and supported while receiving treatment.

Customer service should be on the agenda in the healthcare boardroom – allowing standards to slip will damage patient recovery and impact upon patient care.

Research conducted at The Johns Hopkins Hospital put the price on some blood tests for six months and found use of tests declined 9 percent. The hospital saved $400,000 over the six month period.

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The results of the study were published online in JAMA Internal Medicine.

Hospitals don't normally display the price of tests to doctors. “We generally don’t make decisions based on what is cost-effective or what is known to be absolutely necessary for our patients, but knowing the cost of things appears to make us more thoughtful about what we think might be best for their health,” Dr. Leonard S. Feldman, an assistant professor of medicine at the Johns Hopkins University School of Medicine and leader of the study, said in a statement. 

“There’s a lot of waste in medicine because we don’t have a sense of the costs of much of what we do.”

Doctors generally chose the cheaper test when shown the prices. The exception was the most expensive diagnostic tests. Researchers said that was likely because those were specialized tests with no alternative.

Feldman said the study's results don't necessarily mean doctors should always choose the less expensive test. Sometimes it is best to order many tests when doctors are stumped about the diagnosis of a patient. The tests may be cheaper than keeping the patient in the hospital while doctors figure out what is wrong.

Come 2015, patients at the Humber River Hospital will be able to change their room temperature, control the lighting, video chat with their nurses and read their medical records on a bedside monitor.

“The control of their environment and the participation in their care” will be the biggest changes for a patient entering the fully digital, 656-bed hospital, Barb Collins, Humber River's CEO and lead of the redevelopment project told CBC News.

Collins said that the build methods and innovative technology employed during the construction and planning process of the hospital was aimed at cutting down on ‘sneaker time’ - the amount of time nurses and doctors spend walking to different parts of the hospital to deliver care. The hospital is located in northwest Toronto and will replace three existing sites as Humber's main acute care centre.

Utilising Video Link

The majority of patients at the Humber River Hospital will be accommodated in single-bed rooms and will communicate directly with nurses via video link. Nurses will also no longer record blood pressure, temperature and other vital signs on paper and have to transfer them to a patient's chart, instead all results will be automatically communicated from the device to the electronic medical chart.

A More Efficient Supply Chain

The way supplies move throughout the hospital will also be more efficient. Food, medicine, waste, linen and other items will be transported around the hospital through a system of chutes and automated guided vehicles.

Canadian healthcare institutions have been slow to adopt digital working, however the new Humber River Hospital sets the benchmark for hospitals in the future and will change the way patient care is delivered in Canada.  

“The retail industry has a long history of adopting automation, complemented by scientific and mathematical models, to improve supply-chain operations,” says Ed Pohl, Associate Professor in the Department of Industrial Engineering. “Conversely, healthcare has been relatively slow to adopt these methods. Based on survey responses, we believe that considerable efficiency gains might be available to the healthcare supply chain through the adoption of best practices from the retail supply chain.”

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• Cost Management Within Hospital Supply Chain
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Researchers found that the retail supply chain has done a better job in the critical area of collaborative planning, forecasting and replenishment, which involves suppliers and retailers – or healthcare providers – working together to adopt order forecasting and inventory planning to create an integrated supply-chain network.

Also critical, healthcare is struggling to catch up with retail in the area of scanning technology, which is used to track materials by means of barcodes and RFID technology.

Furthermore, according to the report, the healthcare supply chain is lagging behind retail when it comes to professional training and education, specifically the skills associated with materials management, purchasing and warehousing.

Considering retail’s success, researchers conducted the survey to get a better understanding of the gaps between the two supply chains and to learn how the healthcare supply chain might benefit from adopting some or all of the best practices used by retail.

The first step involved identifying best practices. The researchers came up with an initial list of 22, based on an extensive literature review and guidance from a steering committee made up of industry leaders. The steering committee scored and ranked all 22 best practices according to their potential impact on business and their associated cost and ease of implementation.

From this ranking, the top 10 best practices were identified and included in the report. In addition to collaborative planning, forecasting and replenishment, scanning technology, and education and training, best practices included >>>

• Centralized purchasing and supply
• Supply chain services reorganization
• Regular cycle counting and stock rotation
• Performance management
• Actual usage inventory management
• E-commerce
• Data standardization

By using retail supply chain management as a benchmark, healthcare supply chain executives should consider implementing best practice strategies to bring healthcare standards up to par. 

The study was conducted for the Center for Innovation in Healthcare Logistics at the University of Arkansas.

Procurement cost accounts for more than 30 percent of a hospitals’ expenditure, in fact it’s the largest financial outlay second only to staffing, and yet many healthcare institutions relegate its management to the back office. Healthcare Global spoke to hospital procurement expert Richard Macintosh, Managing Director at Inverto about ways hospital executives can manage their procurement function to yield tremendous financial savings.

Richard outlined five key points that will help any hospital lean and improve its procurement function >>>

1. Make the move from transactional to strategic sourcing
2. Employ people with a commercial background
3. Address procurement at an executive level
4. Focus on clinical engagement
5. Don’t compromise on patient care

Commonly, the first thing hospital executives will look at when they are losing money is staffing levels, however that method of leaning your institution is limited and often leads of compromised patient care. What hospital executives should be addressing first and foremost is the procurement function.

Transactional Versus Strategic Sourcing

“Typically we find is this is an area that’s not been particularly well managed. The typical procurement function is very transactional; the department is placing purchase orders, monitoring arrivals, and distributing goods, but they are not actually doing any proactive sourcing, they are not driving out cost savings. We find that many procurement departments are transactional rather than strategic,” says Macintosh.

If you took a snapshot of a typical hospital procurement function you would label it ‘back office’. You would probably find the department in a porter-cabin at the back of the hospital, titled, ‘Supplies’ rather than ‘Procurement’ and furthermore a team of people who are not very senior or indeed commercial would most likely run it.

Clinical Engagement

“We find the key to success when it comes to hospital procurement is clinical engagement,” says Macintosh. “The procurement function doesn’t interact with the front line staff; they don’t interact with the clinicians, the nurses or head of estates - they are in the back office managing transactions. To this end it is essential to have very good commercial people heading up the department, who work closely with clinicians. If you can achieve this, you can make some extremely impressive savings.”

“Take an orthopedics department as an example, it requires a very specialised segment of spend. It is the surgeons and clinicians who have the specialised knowledge about technology and products so in order to make cost savings you have got to work very closely with those people. You have got to understand their exact requirements and then it’s the procurement function’s role to fully understand the market. If you merge both expertise and work very closely with one another you can source the best value suppliers and arrangements for the department,” says Macintosh. 

It is vital for the procurement function to work alongside the clinical arm of the hospital. The only way to make significant cost savings is to work out all the possible commercial options and to teach clinicians to understand the commercial implications of their decisions.

“What we often find is that the clinical staff are making decisions regarding procurement, and they are making those decisions without any cost knowledge or commercial understanding. The procurement function should be doing this for them; it should be the conduit for innovation, they should be working with the supply base, to bring innovative products and solutions to the hospital. Instead the suppliers go straight to the clinicians, and it’s a bit like a kid going into a toy shop – of course they want the best, newest products, however it should be the role of procurement to educate and negotiate on behalf of the clinical staff to ensure they get the products they need, while also managing cost base.”

Procurement strategies should be on the boardroom agenda

Focus On Patient Outcome

Not compromising patient outcome is very simple, procurement should be getting best value for the hospital, and it’s not only about cost. It has to take into consideration all factors including quality and outcome, as well as safety. Before you undertake any work on the category of business spend you must understand the business requirements so again it comes back to clinical engagement, you must spend lots of time with the stakeholder understanding what they need now and in the future. If you understand that you can then procure against it - you will select suppliers against what is required by the hospital and you will search for the best commercial option. It is simply no good to source the lowest cost product, because it may not tick all the boxes for the department. This haphazard approach to procurement could in fact end up costing you more money in the long term.

“Within the hospital industry there are lots of collaborative procurement hubs - regional focused buying organisations – however there is a fairly big questions mark over how effective these are,” says Macintosh. “Collaboration is great and there is a theory that says the more you can bundle together in terms of volume, the more attractive it is to a supplier, and the lower cost you get, however, it is hard enough to get surgeons within one hospital to agree on what they want, let alone surgeons across many hospitals.”

When it comes to cost saving, commitment is key. “What we have found is that many hospitals can get better prices, by being able to commit to the buyers that they have selected. It’s a mix, logic says collaboration and volume should trump anything else but in practice it’s not necessarily true,” says Macintosh.  

Employing The Right People

It may be cliché to say, but employing the right team of people within the procurement function is probably the most important factor when it comes to efficiency and cost saving. “You have got to have good people. Strategic sourcing, proactively driving savings requires good people, it requires commercial people and people who are able to manage the supply market, internal stakeholders and business requirements. They must be able to work peer to peer with the CEO or the Head of Orthopedics or the Chief Nurse,” says Macintosh.

There has not been enough emphasis put on the procurement department as a key function, it has been neglected. The procurement function is seen as a low-level function that reports into finance, so it has no executive visibility. Procurement is generally not on the executive agenda and it should be. As Macintosh concludes, “It’s fundamental, procurement should be on the c-suite agenda, without doubt, and you need good people to do that. The procurement function should have a very high profile within the hospital, it should be one of the backbones of the organisation, its just so important.”  

By following the steps outlined by Macintosh, hospitals can make vast savings from a procurement perspective. On average, Inverto helps organisations save a huge 9.6 percent of the spend that they address, certainly not an insignificant figure.  

The US Food and Drug Administration estimates that there has been over 560 deaths tied to alarm fatigue between January 2005 and June 2010. The Joint Commission claims that there had been at least 80 deaths and 13 injuries related to alarms fatigue, and acknowledges that hospitals report the incidents so  that number may be much higher. The Commission is responsible for administering and monitoring the coveted hospital accreditation and note that ignoring the beeps may set off a chain reaction that could lead to death or injury.

Alarms may beep for a number of reasons according to the Associated Press. They may not be functioning properly or there could be an emergency. There is a serious lack of standardization with the abundance of technology, and there is virtually no way that health care professionals can differentiate among the beeps, which leads to the main source of the problem.

Dr. Ana McKee, the Executive Vice President and Chief Medical Officer of The Joint Commission, said in a statement, “Alarm fatigue and management of alarms are important safety issues that we must confront. The recommendations in this Alert offer hospitals a framework on which to assess their individual circumstances and develop a systematic, coordinated approach to alarms. By making alarm safety a priority, lives can be saved."

The Commission is currently exploring other options to address this problem, including the possible development of a National Patient Safety Goal.

Additional Resources: 

• 'Alarm fatigue' can kill, hospital group says
• Many Hospital Deaths Caused by Staff's "Alarm Fatigue"
• Hospital Alarm Fatigue Puts Patients' Lives at Risk
   

Since Primary Care Physicians can barely keep up with the high demand of patients now, imagine what it will be like next year when upwards of 30 million people will finally have access to health insurance under Obama Care. The demand for quality health care professional will significantly increase just to keep up with the number of new patients.

Dr. Wanda Filer, a Physician in York, Penn., and a board member of the American Academy of Family Physicians says, “We need all hands on deck. We need more family physicians. We need more primary care nurse practitioners; we need more Physicians Assistants need pharmacists. Everyone with a focus on the patient,”

The US is facing a desperate need for Primary Care Physicians. While it is estimated that several thousand Primary Care Physicians are practicing today, by 2050 that range is estimated to increase to over 52,000. Annual spending on primary care is approximately $200 billion. It is no surprise that current Nurse Practitioners, Physician Assistants, Pharmacists and others are stepping up to the plate to fill the gaps in coverage. Should Primary Physicians be worried?

Rand Corporation Health Economist David Auerbach thinks that there is good reason for Primary Care Doctors to be concerned. Nurse Practitioners can treat 85 per cent of what a Primary Care Doctor can treat. For powerful medical organizations like the Family Physicians and the American Medical Association, all is not lost. Groups advocate that providers should work together with the physician running the show.

“Currently there are 12 states with active legislation looking at utilizing nurse practitioners at the top of their education to meet patient care needs,” says Tay Kopanos with the American Association of Nurse Practitioners.

Nurses are advocating overturning laws that require some level of Physician supervision, like for writing prescriptions or diagnosis of an illness.

Doctors are mainly concerned about patient safety and less concerned about other health care professionals essentially stealing their jobs. A Doctors training far exceeds any other medical professional and their main concern would be that a Nurse or Physicians Assistant would miss something important.

“I see it as physicians being true to their oath and being true to their training and education. And I think most physicians feel that way. They are not threatened by this. At the end of the day what they want to do is deliver the best healthcare possible,” says Dr. Adris Hoven, president-elect of the American Medical Association.

Not every doctor feels this way. Dr. John Rowe at the Columbia School of Public Health says that in some cases, Nurse Practitioners are already working without Primary Care Doctors. There is evidence that in up to 17 states some Nurse Practitioners are working independently from doctors and there is no evidence that it is not good for patients.  As a doctor, Rowe understands why doctors are worried if doctors and nurses cannot come together to solve the primary care shortage, it could lead to an agonizing and expensive lesson for everyone involved.

Additional Resource on Obama Care:

Overview of Health Reform

The survey examined the analysis and perceptions of consumers and health care decision makers on the patient experience. The report indicates that as information, technology, and the integration of the network become more common both human and digital aspects will become a vital part to the patient experience.

The global report includes responses from 1,547 consumers and health care decision makers from around the world. The survey looked at the views of consumers and health care decision makers on sharing personal health data, participating in in-person medical consultation versus remote care and using technology to make recommendations on personal health.

The study reveals that 94 per cent of Indians surveyed are okay with storing their health records in the cloud for easier access, and 88 per cent are at ease with interacting with their doctors virtually as an alternative to a meeting them face-to-face. 87 per cent of consumers stressed that they would trust technology to conclude if they needed to see a doctor.

Traditionally, face-to-face interaction has been the ideal health care experience; however the survey conducted by CISCO challenges this. Consumers still depend on the face-to-face health care, but a staggering three-quarter of patients are comfortable with a virtual health care experience. Vishal Gupta, Vice President and General Manager of Global Healthcare Solutions explains,

“Virtual healthcare is no longer a myth and this report is an indication of how technology can potentially play a greater role in enabling access to virtual healthcare. The state of convergence between the physical and digital world has raised the expectations of consumers and at the same time expanded scope for healthcare providers to take their engagement further with more collaboration and information.”

Additional Resources:

• Patients Choose Online Medical Communication

A United States federal judge ruled Friday that the US government has to make the morning-after pill available over the counter for all ages. Sixteen years of age and younger currently require a prescription to gain access to the pill.

The ruling of this politically controversial subject comes after a fight that spans a decade over who should have access to the pill. The judge ordered that, within a month, the Food and Drug Administration must make the morning-after pill accessible to girls of all ages.

This ruling reverses a decision made by Health and Human Services Secretary Kathleen Sebelius in 2011 that barred over-the-counter sales of the controversial pill to girls under the age of 17.

Cecile Richards, President of Planned Parenthood hailed the ruling as "a significant and long-overdue step forward for women's health that will benefit women of all ages."

In 2012, the American College of Obstetricians and Gynecologists suggested in order to lower the high unintended pregnancy rate in the US that oral contraceptives be sold over the counter without a prescription. The morning-after pill can work up to 72 hours after intercourse and should not be confused with abortion pills as it does not work after implantation.

Scientists, including those at the FDA, have pushed for unrestricted access to the morning-after pill for years, along with significant medical groups, like the American Medical Association, the American Congress of Obstetricians, and the American Academy of Pediatrics. They argue that the limitations effectively keep adolescents and young teenagers from being able to use a safe drug in a timely way to prevent pregnancy, which carries greater safety risks than the morning-after pill.

Dr Cora Collette Breuner, Pediatrician and Professor of adolescent medicine said the American Academy of Pediatrics considers the ruling as a triumph of science over politics. "Finally, my children and their children will have access to a product they did not have before," she said.

Additional Information on the Ruling:

• Federal judge rules morning-after pill must be available for women of all ages
• Judge: Make 'morning-after pill' available to all girls without prescription
• Judge OKs 'morning-after pill' for girls of all ages

BYOD

The iPad has also sparked a new BYOD trend in the healthcare arena, giving physicians and healthcare executives the ability to work efficiently on a device of their choice. Famed for its usability the iPad has also encourage many physicians to engage with online tools, making patient communication much more efficient. 

There are some clear advantages with BYOD in the health arena, the main plus points being that employees become more productive and even work longer hours while healthcare institutions – in theory at least – save on costsand training while embracing the latest technology.

Mass App Uptake

The birth of the iPad has also led to a huge increase in the number of mHealth apps. Before, healthcare professionals and executives had limited access to a small number of software solutions, which were accessible from either a desktop or laptop computer only. Today, solutions from EHR to financing, HR to medical information can all be accessed on the move and synced with a number of different devices.

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Healthcare In The Cloud

As the iPad has risen in popularity so has the popularity of cloud-based mHealth apps and software solutions. Many hospitals and healthcare institutions now store important information securely in the cloud, so it is accessible from a number of portable devices both on and off site. This level of accessibility – while it comes with its own set of security concerns - has proven to be hugely beneficial in the healthcare sector.

Mobile Healthcare

As well as sharing information, accessing healthcare records and interacting with patients, the iPad has also facilitated a number of innovative patient / doctor communication systems that have helped save time, money and resources within the sector, namely the iRobot and virtual doctors offices, that allow patients to communicate with doctors face to face whilst being in different locations. This technology has also made dramatic improvements to healthcare facilities in rural locations and developing countries.

If the iPad can achieve this in just three years, we have to ask what other advancements and changes it will facilitate as it develops. 

The new research initiative – Brain Research through Advancing Innovative Nanotechnologies (BRAIN) – has been awarded a relatively small initial budget compared to other big research initiatives, however Obama said that it would kick start a field of endeavor that has been likened to the $3.6 billion human genome project to map the complete DNA sequence of man.

“As humans we can identify galaxies light-years away, study particles smaller than an atom but we still haven't unlocked the mystery of the three pounds of matter that sits between our ears,” President Obama said at a White House news conference.

“If we want to make the best products, we also have to invest in the best ideas. Every dollar we invested to map the human genome returned $140 to our economy - every dollar. Today, our scientists are mapping the human brain to unlock the answers to Alzheimer'. Now is the time to reach a level of research and development not seen since the height of the space race,” President Obama said.

The BRAIN initiative is directed at mapping the neural circuits of the brain using sophisticated technology such as tiny nanosensors and wireless fibre-optic tools, in conjunction with more traditional methods such as magnetic resonance.

The BRAIN initiative will be orchestrated by America's federal research institutes in cooperation with the private sector and is intended to grow into what will become the largest collaborative research effort into brain disorders.

This is not the first project launched in recent months focusing on research of the human brain. Earlier this year, the European Commission announced the Human Brain Project, one of two flagship science programs involving more than 80 research institutions from across Europe with a combined budget of €1.19bn over 10 years.

British politician, Ann Clwyd, has spoken out in favour of banning nursing stations, stating that too much time is spent talking with colleagues and not enough time is spent caring for patients. The Labour MP suggested instead that staff desks should be moved to the middle of wards.

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Clwyd, who herself spoke emotionally about poor care received by her husband in an NHS hospital in parliament, has also spoken to numerous relatives of patients who also received poor standards of care. “A big thing that patients that have contacted me talk about is getting rid of nursing stations,” Clwyd told British newspaper, the Independent.

“People are incensed by nurses' stations. They say they just gather and chat constantly. They are suggesting bringing back the desk on the ward – not off the ward,” she continued.

Clwyd insists that she hears the same complaints again and again and yet they never seem to get through to hospital managers and executives. The British Government last week promised to overhaul the system by improving training standards and putting care back at the heart of the health service, however there are lessons that can be learned from what Clwyd highlighted on a global scale.

What do you think? Do you think nurse stations should be located on the ward? How can hospital executives ensure they hear the concerns being voiced by patients and their relatives? Join the discussion at our Businessfriend page.

The agreement between all involved parties was signed on Tuesday, signaling the beginning of the lab development. The lab aims to develop software, which will improve the quality of patient care.

Under the agreement, Allscripts will train staff on its methodologies for software development quality assurance, sustaining engineering and operational support, while IHiS will provide access to clinical staff and resources for the definition, deployment and testing of software features and solutions.

The laboratory will work on enhancing medication management. Projects may include emergency, critical care and specialist mobility systems at hospitals. The lab is also working on interface software for robots to automate and speed up care processes.

The lab will work closely with doctors and healthcare staff at Singapore General Hospital, KK Women's & Children's Hospital, Changi General Hospital and Khoo Teck Puat Hospital to conduct trials and refine the advanced applications.

The joint team will also explore tele-health, mobile health and healthcare analytics solutions.

The IHiS-Allscripts Technology Laboratory will accelerate IT solutions for SingHealth, Alexandra Health and Eastern Health Alliance regional health systems and the Asian healthcare industry.

IHiS Chief Executive Officer, Dr Chong Yoke Sin, said, “The uniqueness about this collaboration is the fact that we can work directly with the developers of Allscripts in order to develop systems which fit our unique environment. We have also got the understanding that we will go ahead of the curve and build innovations that maybe will have that wow factor for our patients.”

For almost 50 years, emergency rooms have been perceived as a major source of excessive health care costs. In recent years, there has been a school of thought that challenged the idea that a large portion of patients visit the emergency room for routine problems, many payers and policy makers continue to focus on these patients as a major source of wasteful spending, according to an article in the New York Times. 

Take for example the effort made to cut back on Medicaid expenditures – many states took action against these so-called ‘unwarranted visits’ and proposed a policy which reimbursed patients' emergency room medical bills based on the urgency of the discharge diagnosis.

Medical expenses would only be paid for true emergencies, for example a heart attack or ruptured aneurysm. However, payment would be reduced or denied for visits that turned out to be less serious, like heartburn, constipation or an insect bite.

“It sounded like an obvious way to discourage unnecessary and expensive visits to the E.R.,” wrote Pauline W. Chen, MD, for the New York Times.

Yet according to a new study, published in The Journal of the American Medical Association, such a policy relies on a huge, and erroneous, assumption: that patients can predict the urgency of their diagnosis based on initial symptoms alone.

Researchers reviewed the records from almost 35,000 patient visits to emergency departments across the country. In 6 percent of cases, the patient was discharged and could have been treated in a doctor’s office.

The researchers then combed through the initial symptoms or complaints of these non-urgent cases and discovered that in nearly 90 percent of the other, more urgent cases, patients came to the emergency room with the same primary presenting symptoms, complaints like abdominal discomfort, chest pain or fever. In addition, more than 10 percent of these urgent patients ended up requiring hospital admission, surgery or intensive care.

In other words, basing reimbursement on discharge diagnoses is inaccurate and could ultimately discourage individuals to visit the emergency room.

“Patients don’t have their diagnosis taped to their forehead when they come into the emergency department,” Dr Renee Y. Hsia, senior author of the study and an assistant professor of emergency medicine at the University of California, San Francisco, told the New York Times. “They present symptoms or complaints.”

And this sort of measure isn’t exclusive. In the past similar financial measures have been implemented in a bid to deter patients from visiting the E.R. unless their condition is serious. We go back to our previous argument – patients do not always understand the level of their condition, hence why they feel the need to visit an emergency room in the first place.

“It’s easy to see why paying for non-urgent problems might make a policy maker’s blood boil,” Dr Hsia said. “But is it right to make patients shoulder the entire burden and associated risk of figuring out whether their presenting complaint meets the payer’s criteria for reimbursement?”

An Alternative Cost Measurement System

Since July 2012, Washington State has implemented a new policy, which while complicated, doesn’t assume patients know the seriousness of their condition before they reach the E.R. and speak to a healthcare professional. The policy educates patients about how to access care as well as other measures designed to improve care, including state-wide guidelines on prescribing narcotics, shared electronic health and prescription information, and regularly updated reports on how emergency department resources are utilized. The policy has already resulted in significant changes and a projected savings of over $31 million by the end of the fiscal year.

Dr Hsia told the New York Times that she believes that the policy’s success, as well as the degree of work and cooperation required, only confirm what her study showed: that when it comes to caring for patients, the best approaches are neither simple nor assumed.

“A policy that requires more coordination and more tailoring means more work than one that slashes benefits across the board,” Dr Hsia said. “But it’s the right thing to do for patients.”

Read the full article in the New York Times

Mobile healthcare is on the rise, particularly in developing countries – the cost of building and running healthcare institutions can be extremely high, however mobile units are much more cost efficient. Furthermore, mobile healthcare facilities can reach rural locations easily and quickly.

A new solar powered truck, equipped with an impressive array of healthcare equipment has taken to the road in Cape Town, South Africa. The mobile unit, developed by Samsung, is pitched to revolutionize healthcare provision in rural areas of Sub-Saharan Africa. The truck specializes in ear care, but also contains a fully equipped blood and eye clinic, as well as a dental surgery.

The seven foot long truck cost around $250,000 and has been billed as Africa’s first solar powered mobile health centre. The aim is to come into contact with six in 10 people in Sub-Saharan Africa who live in rural locations and who would otherwise lack the time and money to travel long distances to receive health services.

Patients will be screened for conditions such as diabetes, high blood pressure, tooth decay and cataracts. There will also be a strong emphasis on healthcare education, regular testing and preventative measures.

Mobile Healthcare Development

Reports also suggest that Samsung is planning to add a mother-and-child clinic, capable of 4D ultrasound scans and deliveries, within the next 10 weeks. “Healthcare and education are the key challenges in Africa,” says Kea Modimoeng, Samsung representative. “The challenges are huge. In Africa our existing healthcare system is overcrowded. We are trying to ease that burden.”

The truck was one of a number of healthcare innovations launched by Samsung during its ‘Built for Africa’ conference in Cape Town this week.

This is the first of its kind, Modimoeng says, and the ambition is to reach one million people in Africa by 2015. “We are scaling up with Africa in mind. We want to collaborate with governments. The intent is there from various countries.”

Solar Powered Healthcare

Samsung are not hiding the fact that 100 percent solar powered healthcare units are not here yet – solar power alone is still not enough – however they are making considerable headway. “This uses a lot of energy. The solar power charges the lighting, TV and so on. The rest relies on an inbuilt generator using unleaded fuel or a power plug. It's a step in the right direction and, as time unfolds, we are looking at getting equipment that uses less energy,” says Modimoeng.

Mobile healthcare is certainly a growing trend within the industry, not only because of its portability and its potential to reach a large number of patients but because of its cost saving ability. Mobile health units could revolutionize the way healthcare is provided to developing countries.

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