Tag Archives: Medicaid

Public Health in Action – Leveraging Health IT to Improve Outcomes

healthit

In the broadest sense, Health Information Technology (HIT) is applying IT to health care in order to improve patient outcomes, quality of life and reduce health care costs.  The field is growing and fast.  By 2017, the field is predicted to yield over $30 billion.  And it’s not hard to find.  A recent visit to Apple’s app store can be overwhelming – even after filtering the apps down to “health.”

Healthcare providers, from hospital systems to individual healthcare professionals, as well as healthcare payers (consumers, government, insurance companies) have bought-in to the promising field.  Startups keep popping up.  Health is a primary focus in various innovation challenges.

In the bigger picture of improving our healthcare system, I think HIT has the potential if leveraged the right way.  I recently interviewed Dr. Ryan Shaw, professor at Duke School of Nursing on his thoughts about the field and its potential in improving our healthcare system.

Here’s Ryan!

Me: Tell us about your past experiences in work, research and academia and how it ties to your current role.  Also highlight your interests in the field of Health IT and what Health IT could lead to in terms of health outcomes.

Ryan Shaw: My undergraduate studies began in computer science and mathematics. After 2 years I switched into nursing. It’s a strange transition but I wanted to go into a career path where I felt I was making a difference in people’s lives. After becoming a nurse, I went back to school to get a masters in informatics at NYU while working as a nurse in NYC. This allowed to merge healthcare and the IT side.

At the end of my master’s program, Duke University just so happened to offer an Information Technology fellowship as part of a PhD program for nurses. I applied for the competitive program and received the fellowship. I ended up working for Duke’s Health Company “Duke Health Technology Solutions” while studying for a PhD at Duke.

Following that, I eventually landed a job as a Professor at Duke’s Nursing School. I love this job and it allows me to do both science and education. On the teaching side, I teach in our masters informatics program. On the research side I discover how to use novel technologies and their data to help patients’ self-manage chronic illness. This is exciting work and allow me to work with an interdisciplinary team of physicians, pharmacists, psychologists, nurses, and IT gurus.

Discovering knew knowledge that will be applied in healthcare is extremely rewarding. While working as a clinician I was able to impact each of my patients lives, research allows me to have a much broader reach of impacting many more lives and creates knowledge that other people will build upon. Our world is changing, and information technology is becoming an integral part of peoples’ everyday lives and thus their health as well. My team and I capitalize on this social change and leverage technology as a conduit to improve health. It’s really cool.

Me: What inspires you on a daily basis, especially when things get hard?

RS: Academia is tough. There are real no work hours and no day is ever complete. I could work 24/7 every day for a year and still have more to do. A lot of what you propose is rejected and people don’t value it. Grants that you work months on don’t get funded, manuscripts are rejected, and sometimes you sit in the office asking yourself if you really do make a difference. In discovering knowledge, there is often nowhere to go to look for an answer. Scientists create answers, we seek to answer the unknown and discover more. You need a thick skin and perseverance is of the most important traits needed.

I drive inspiration from my family, I work through stress by exercising (I run a lot and use to be big into triathlon), and view this video from Apple to get me going.

The video reminds me that innovators are the ones who change world and those who succeed are the ones who keep trying even when they fail.

Me: What do you think it will take for our society to view health more seriously?  As in, why is health lower in priority to careers and education and relationships?

RS: Honestly, health doesn’t come first for many people – and likely won’t ever. Families, safety and financial security usually come first. And in my opinion, that’s probably OK. We need to eat, pay our bills, and survive. These all impact our health. That’s not to say health isn’t important, it’s critical.

For people to take health more seriously, is really going to have to come from the top. In my opinion, there is too much focus on the individual and treatment of health. It’s really societal and public value. We need a greater investment in communities and public health. We’ve created infrastructure that supports poor habits. I think many people forget that physical infrastructure and urban planning are so important. If we make it easy to drive your car to the drive thru down the street, then that’s what people will do. We need sidewalks, urban planning that encourages walking, and a cultural shift that values these things. This is happening, but for so long we’ve focus on suburbs, building a society that is car centric, and making delicious food easy to get. It’s just so hard to change individual healthy habits when the structure around you suggests the opposite.

Me: What are some things/concepts/ideas/insights you’ve learned from your research that can help improve health outcomes in individuals and on a population-level?

RS: Some of the concepts we’ve learned is that technology needs to be designed with the end user in mind. A lot of technology and how it functions is useful for young people and techies. But those aren’t the people who are most in need. The people in need, and the most expensive people in healthcare, are those with chronic illnesses (obesity, diabetes, hypertension, etc.). These are the people that could benefit the most from novel technologies and their data – and they are of all ages, young and old.

We need technologies that truly fit into their daily lives and we need to create infrastructure in the care delivery system that is able to use newer technologies such as wearable devices. As of now, we don’t have this structure. But its possible. If all of our patients monitored their daily data, software could manage most people and guide them in self-management of health behaviors. If people don’t correct those behaviors, it could be bumped up to a nurse or pharmacist to help them. And then after that, it could be bumped up to a physician. This would allow for true population management and would be cost-effective. It would also allow physicians to have a better understanding of their patients’ day-to-day lives when they actually see them in the clinic. This may enhance medical decision making. Check out the article, Mobile Health Technology for Personalized Primary Care Medicine, that we wrote on this.

Me: What are the current needs in your city as they relate to social determinants of health (i.e. SES, poverty, access to care, transportation, safety, etc.)?  Social determinants of health are any factors that directly or indirectly affect health.  For example, being homeless could cause stress and malnutrition which could drastically affect one’s health.

RS: The Raleigh-Durham is certainly trying to address some of these social determinants of health. For example, transportation wise we are trying to get in light rail that will have stops next to low-income housing. The bus system is being revamped to meet more people’s needs.

In terms of access to care, the affordable care act has and is helping with a lot of this. But North Carolina chose not to expand Medicaid as much as many other states, to access to care is still an issue for many people.

The city of Durham is quite focused on measures to alleviate poverty and help with homelessness. There is more focus on adding in sidewalks so people don’t walk in the street for safety reasons, they’ve been building affordable housing, and are pushing measures that new development including a % of low-income housing.

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Public Health in Action – Web Master and Lecturer Betty Jung

Mentoring

An Interview with Betty C. Jung, Web Master, Director of Public Health Expertise and Network Of Mentors (PHENOM) and Adjunct Lecturer, Southern Connecticut State University

Me: How did you end up doing the work that you’re currently doing? Describe the transition from graduation with a nursing degree to public health to academia to your website.  

Betty: When I graduated from NY’s Columbia University School of Nursing I worked as a staff nurse at New York’s Columbia-Presbyterian Hospital’s men’s urology department, where I was basically the medication nurse all the time, while conducting patient admissions, pre-operative teaching, patient discharge education and providing post-surgical nursing care. I was also in charge when the head nurse wasn’t there, which was 40% of the time. After my son was born, I worked part-time as a charge nurse in Babies Hospital, and then took some years off when my daughter was born. Then I worked as a school nurse, and when I was ready to return to the workforce I decided to return to school first to earn a graduate degree so I can teach health in high school.

While I was attending graduate school at Southern Connecticut State University (SCSU), the Master of Public Health program became available as a result of my letter writing to state legislators.  I switched to that program because I was interested in the scope of practice that Public Health offered. I did an internship at the Connecticut Health Department, and ended up being hired to work in the newly developed occupational surveillance program as the program coordinator for the adult lead surveillance program. From there I went on to work in family health, child welfare services, and chronic disease surveillance of cardiovascular disease and diabetes, all of which made the most of my nursing background.

I was hired by SCSU to be a thesis and special project advisor in their MPH program during a staffing shortage, and filled in teaching graduate Community Health Education, and undergraduate Introduction to Epidemiology. Eventually I began teaching undergraduate Wellness, and have been teaching this for many years. I love it.

I originally developed my Web site (which will be 15 years old on 8/25/14) to gain some practice in Web development because I was given the responsibility to work on web pages for the state health department’s Family Health Division’s intranet. Unfortunately there was no money to formally train me so I taught myself. Eventually I used the Web site to support the various activities I was involved with (e.g., support my teaching activities, provide a temporary site for a couple of organizations, and provide credible health information to the public). 

It is now the home of the Public Health Expertise Network of Mentors (PHENOM), a volunteer-based online public health mentoring program that currently comprise of 65 public health professionals working at all levels of public health (federal, state and local), in a variety of settings, from 18 different states, and 3 countries, etc. PHENOM is starting its 22nd year of mentoring services to the Internet community.  

Me: What inspires you on a daily basis, especially when things get hard?

Betty: That I am working on things, along with others, for the Public’s greater good. Public Health covers about every facet of Life, and there is always something that requires our attention. I use my Web site as a tool to communicate to the general public and professionals about issues that need to be addressed, and provide resources to address those issues. And, it’s always inspiring to know that there are many people working providing services (e.g., health, public health, social services, etc.) to those in need. I also enjoy getting feedback from visitors letting me know what they found helpful on the Web site

Me: What do you think it will take for our society to view health more seriously?  As in, why is health lower in priority to careers and education and relationships?

Betty: Good questions! Right now, Health is viewed in rather negative terms, I think, as in the cost of health insurance.  Anyone who can afford health insurance will tell you that it is costly, and what do they have to show for it? Those who cannot afford health insurance feel they are deprived of a basic right.  

Unfortunately, what we pay for in health insurance costs has little bearing on our health status or our perception of what being healthy really means. One can be fully insured and still be very sick because many of us fail to take care of ourselves in ways that promote health, or seek health care in a timely manner.  Then, there is the issue of a dysfunctional health care system.

Medicaid, the public health insurance program has been around for 45 years. While current studies show it to be somewhat effective, there are still gaps in services because of inadequate provider participation in Medicaid.

Also, we probably should distinguish what we mean when we talk about health care spending (e.g., insurance vs. delivery of services).  And, we really need to take better care of ourselves.

I think if we treat our bodies as if they were luxury cars, we would probably take better care ourselves. We would eat better so our bodies can run better, and while we need to buy car (health) insurance in case something bad happens, the longevity of the car would depend on good daily maintenance.  It is now possible to replace worn down parts, but consistent maintenance is key to keeping the car running.

It’s true that other factors, beyond us, also contribute to our health and well-being. These factors may require policy and environmental interventions to ensure that we can live in optimum conditions that support healthy living. This is where Public Health does its best work. But, when you look at the funding Public Health receives, internationally, it is minuscule as compared to what Health gets (basically health insurance, not necessarily health services).  I think that once Public Health receives appropriate funding to do what it has to do, for everyone, then society will start to view “Health” more seriously.

As for your second question, health careers are booming only because the Great Recession has eliminated many jobs in other economic sectors. Health service jobs are physically and mentally demanding work. Many of these are in the delivery of health services rather than in Public Health, which is too bad.

In the long run, it would be more cost-effective for Society to put more effort (and funding) into educating and enabling people to live healthy lives than to providing expensive services to those who are sick.   

Health actually should be a priority for everyone. Without our health we really can’t do all the things we want to do. But, even among those who work in the delivery of health services, many do not deal with stress too well and as a result become susceptible to cardiovascular disease, obesity and diabetes.  For example, 60% of nurses who work the night shift are obese/overweight! But, would you want to be admitted to a hospital that didn’t have 24/7 nursing services?

As for the last part of your final question, the CDC has recently reported that married men are more likely to have had a healthcare visit and/or to have had clinical preventive services in the past 12 months than cohabiting men.  Why would that be true? Because married women have earned the right to nag (my interpretation).

Me: Why are education and mentorship so important in general?  Where do you predict public health as a field to go in the next few years?

Betty: Life is a lot more complicated than it was just 50 years ago. Thanks to technology, how we live is changing a lot more rapidly than ever. Look at what electricity has done for society? Does anyone remember when we didn’t have a computer sitting in front of us – for everything? When you visit your health care provider, you will most likely be spending time with a computer as well.

Because of these rapid changes, it is more important than ever to have the education to help us navigate the ever-changing work environment. We all need skills that can be transferable and allow us to adapt as quickly as possible as the world changes around us.  This is where mentorship comes in to play.  Many concepts that we learn in school can be easily outdated within 5 years of graduation. So, it becomes vitally important to learn with and from those working in the field.
We all should adopt a mentor/mentee approach to our career development. Others can mentor us, while we mentor others. At any given time we can be in mentor/mentee relationships with a variety of different people. I think all institutions should formally support mentoring activities in the workplace to nurture their employees. It is shortsighted to think that developing employees would be a benefit to another employer, so it’s not worth spending money on professional development.  Workers who can grow professionally in their workplace tend to be happier employees and stay with employers that cultivate the professional growth of their employees, and happy employees don’t go looking for greener pastures.

As for predicting where public health would be in a few years? That is a hard question to answer. Right now, who would have thought the US would have to contend with a possible Ebola outbreak? One thing’s for sure, we will still have some kind of disease outbreak in the future because our environment is changing all the time. We hear about global warming all the time. What will the fallout be from that? We will still need to be prepared for disasters, as almost all natural weather events are beyond our control.

More than in any other field, Public Health has always rolled with the punches. It will continue to do so and will probably survive far better than any field that relies too much on specialization. Once again, think about computer technology. Anyone out there remember DOS? How many versions of Microsoft Office have people used in the past 10 years?

Specialized public health knowledge must be as fluid as the problems that keep cropping up. Public Health practitioners will have to learn to live with the fact that they must be what I call “serial specialists” during the length of their careers.  If we really take program evaluation seriously, and we should, then we have to expect the programs we work on to change, based on evaluation results. That’s the whole purpose of evaluation, to ensure the program is still addressing the issue.  And, if the issue changes, then the program must change. What ever happened to the National Tuberculosis Association? It became the American Lung Association.

In a way, this is really exciting for public health practitioners because they don’t have the luxury to be stagnating on the job.  And, if we view change positively, then professional growth is always a possibility.    

Me: What are the current needs in CT, as they relate to social determinants of health (i.e. SES, poverty, access to care, transportation, safety, etc.).  Social determinants of health are any factors that directly or indirectly affect health.  How does this compare with US as a whole and where are they similar?

Betty:  Ramon, I can only answer this in a general sense since I no longer work for the CT Department of Public Health…
Given that, like most states, the Connecticut state health department must rely on external funding sources to carry out its mission. Funding is never as comprehensive in terms of amounts or funding, so we make the most of whatever funding the department would get.  To address issues associated with the social determinants of health, it is necessary that the state health department collaborate with other state agencies that would address issues associated with low income populations, etc.  After all, state health departments must spend all their resources on primarily protecting the public’s health and ensuring that basic preventive services are available so that disease will not spread. This is just the tip of the iceberg of what state health departments must do.

To address social determinants of health, Connecticut’s Department of Aging has a renters rebate program, the Department of Consumer Protection regulates home food service, the Department Development Services provide autism services, and services for those with special needs, etc.  

As to how Connecticut is faring, one could check the Agency for Healthcare Research and Quality (AHRQ)’s Web site’s National Healthcare Quality Reports

Comparatively speaking. Connecticut is doing better than the country as a whole, across 124 quality measures.  The US has achieved 34 of the benchmarks, vs. Connecticut’s 48. In looking at measures by race and ethnicity, the US is far away from benchmarks for Blacks in 34 measures, 26 benchmarks for Hispanics, 21 benchmarks for Whites, and 14 benchmarks for Asian/Pacific Islanders.

Connecticut, in comparison, was far away from the benchmarks for the White, Black and Hispanic communities in the areas of long-stay nursing home resident health issues, adult home health patients who had hospital admissions and urgent, unplanned medical care. For its Asian Pacific Islander community, short-stay nursing home residents with pressure sores and moderate to severe pain were far away from the benchmarks.

So, there are online statistical sources available to look at quality measures, for all states, that are useful for evaluating how well any geographic entity is doing in addressing social determinants of health by how well they achieve national benchmarks and quality measures.

Me: Thank you Betty for bringing all your experiences, knowledge and wisdom to this blog and sharing your thought-provoking insights to the greater public.  At the end of the day, it’s about helping each other out so that we can all improve our respective lives.

“No one is useless in this world who lightens the burdens of another.” ― Charles Dickens