In this class I learned about healthcare policy and reforms and the implications for public health informatics through a fascinating set of readings and videos selected for the class, through presentations by guest speakers, through reading articles of my choice on selected topics, and through lively discussions in class. The need for healthcare reform was presented through George Halverson%u2019s book, Healthcare Reform Now! I learned that Health care cost per capita in the United States is the highest in the world and that in 2007, total health expenditures in the US reached $2.2 trillion, representing $7,421 per person or 16.2 percent of the nation%u2019s Gross Domestic Product (GDP). This places an extreme burden on individuals%u2019 abilities to pay for care, on businesses%u2019 ability to remain competitive in the global economy, and the on nation%u2019s ability to fund health care programs for government workers, the elderly and the lowest-income at the current rates without bankrupting its coffers. I also learned that this extremely high cost is driven by:
%uF0A7 Lack of universal insurance coverage %u2013 There are 47 million people without health insurance or who are underinsured. These people make inappropriate use of very expensive emergency room care, which the hospitals %u201Ccost-shift%u201D as increases in health care costs and insurance premiums.
%uF0A7 Lack of sufficient information for health care for consumers to make informed cost-quality trade-offs
%uF0A7 Little financial reward is provided for preventing health care crises that avert expensive medical procedures.
%uF0A7 Fee for service reimbursement structure rewards performing many, expensive procedures.
%uF0A7 High cost does not necessarily mean better care (Rand Study; Dartmouth Projec0
I also learned about the Public Health discipline and how Public Health Informatics is used for:
%u2022 Health Surveillance through disease registries, communicable disease reporting, ongoing analysis and reporting to practitioners.
%u2022 Health Protection through restaurant inspections, water treatment and air quality monitoring.
%u2022 Disease and Injury Prevention through immunizations, investigation and outbreak control, population-based screening programs.
%u2022 Population Health Assessment through community health needs assessment, health status report/system report card.
The HICSS Symposium on Cyberinfrastructure for Public Health had Panels present thoughts/issues on cyberinfrastructure from the perspectives of agencies that fund projects, researchers or organizations seeking funds, practitioners, Journal and Publication Opportunities. The Report of the Blue Ribbon Panel provided a very detailed insight into the vision for cyberinfrastructure not only for large scale collaborative research, but also the cyberinfrastructure as itself the object of study.
The lectures provided by Dr Noam Artz on standards and interoperability in pubic health with specific examples of work in Vermont and Utah were very informative.
Nathan Bott%u2019s guest lecture on PHRs (HealthATM) for underserved populations.
Sue Feldman%u2019s lectures on the role of Public Health in large scale disasters was fascinating. There are many agencies at the local, state and federal levels involved in large scale disaster response; the %u2018who does what%u2019 is determined based on whether responding during the first 72 hours after the disaster or thereafter. The lack of volunteer registry and subsequent tracking of their health created issues in the aftermath of 9/11 .
I also learned about global public health issues and the importance of using information and communication technologies to deliver healthcare services to remote population. Desmond Tutu%u2019s impassioned plea for e-Health was memorable for his depth of understanding about the technologies. Sue Feldman%u2019s presentation on the trip to Andrha Pradesh where over 580,000 people had a disability was heart wrenching for the social stigma attached to the self-reporting of disabilities and the high correlation of disability with low income, unemployment, isolation, and lack of social network
Also, it was fascinating to follow the healthcare reform events unfold in Washington, D.C. The passage of the ARRA that included provisions for HIT, the appointment of the National Coordinator for Health Information Technology, etc.