Cheap is not always bad

Why do manufacturers always release models that exceed the needs of the simple man?

In 2005 I was trying to buy a mobile phone with basic features (phone and screen), but was forced to fork out $330 for a AM/FM, 2.0 megapixel, MMS etc. Nokia contraption that was outdated within a year. Mine was luckily one of the 70% that wasn’t built to fail.

This year I was in the market for a car. You can’t buy a car in Australia for less than $15,000. Why? Because they all have extra, often superfluous, features – I could list so many.

In both cases I asked myself why these companies didn’t produce a dirt cheap featureless model. Surely it would be a hit amongst the tight-a#$^ buyers like myself?

Sure enough the cheap mobiles appeared about one year ago in Australia and are a hit – partly because they are $50, and partly because the are thin because they don’t carry all those crappy features.

Now in Europe, Renault, who mistakenly thought the French wouldn’t buy a tin on wheels are finding themselves inundated with requests for a car designed for the Romanian market that sells for around $11000 AUD.

About time they started looking after the low end of the market!! Perhaps our medical specialists could learn a thing or two from them!!

The Future of surgery

Surgery as we know it will one day be dead. It is just a matter of time before technology and training systems make the surgery of today unrecognizable.

So I was interested to read new about the latest minimally invasive endoscopic surgery. This uses natural orifices for it’s entry incisions and therefore leaves no external scarring at all and minimizes down time. Natural orifices refers to going through the mouth, anus or vagina, and proceeding towards your internal target through incisions distal to these respective entry points.

Surgical companies are rushing to develop technology in this area, desperate not to be left behind. Already, some surgeons in France have removed a gall bladder through the posterior vaginal wall. Quite a feat, if you ask anyone that has done the standard lap-chole.

Just another sign that the ‘monopoly’ is ending.

AGPN wants lead eHealth role

The Australian General Practice Network recently released it’s National eHealth Strategy Submission. It claims to be well placed to drive changes in e-health because primary care is already the most computerised health sector and divisions have the local infrastructure to deliver e-health programs.

Indeed the AGPN has pilot projects in a number of eHealth areas but they also have some major hurdles. The vast majority of GP’s are tied to in-house practice management software such as MD. We have already seen examples in NSW where these software companies were uncooperative in government Healthelink project.

To my mind a private company is still best placed to deliver a comprehensive solution that cuts through the red tape existing in every government body and medical interest group. But the only way they can do this is with a product that provides obvious benefits to patient, doctor and health departments. No one seems to have that vision yet, with most companies focusing on only one of these three core aspects.

There were some very positive aspects to the AGPN proposal. I’ll list the AGPN priorities to provide a vision for, and desired outcomes of national actionin e-health over the next 5-10 years, through Infrastructure:

1. Unique Patient Identifier Registry
2. Unique Provider Identifier Directory
3. Nationally consistent approach to security certificate authentication
4. Secure Messaging – interoperable and low cost including open source alternatives
5. Improved and affordable Broadband cover for rural health initiatives
6. Primary care repository of common de-identified data with sector governance
7. Grants program for specialist, allied health professionals, and residential aged care facilities, to improve IM capacity
8. Increased investment in validated and widely distributed Clinical Decision Intelligence (CDI) systems that can be integrated into practice software
9. Assistance to health sector small business enterprises, including general practice, with security, backup and storage capability
10. Funding assistance by Governments for secure mass storage for data bases that support the evolution to a SEHR
11. Targeted financial incentives included through Medical Benefits schedule payments, and grants, for activities that improve e-health infrastructure investments

More on the health budget and Public vs Private

The debate has raged since my last post on the 2008 Budget. No one to my mind is a clear victor. I am still confused about who will lose out most here – the private sector, the public sector, the public (most likely) or the state governments.

Initially the debate focused on the simple economics of transferring costs from one sector to another, how many patients would move across, and how private health insurance would lose out. Now we are getting into detailed debates about the comparative efficiencies of each system, the charges private clinics levy and the supposed tendency to ‘over-analyze’ their patients with procedures.

Much of this seems to be without evidence, particularly the claim that unnecessary procedures are performed in the private sector. Many specialists work in both sectors and are unlikely to have different levels of practice unless the public sector is unable to perform proceedures they deem necessary. In other words, if the public sector is in any way more efficient, it is probably due to it’s inability to do everything necessary for patient management.

Like the two party political system we are in and our combination of public and private schools I believe the sectors complement each other. My only gripe is that the private sectors are not sharing the role of education. I see this as a loss to the doctors there, and a failure of our medical culture in the modern world to continue the traditions that have kept medicine strong as a well regarded vocation.

Mobile phones and eHealth

eHealth growth will be exponential once the basics are in place.

I was reminded of this while reading a list of 101 things to do with a mobile phone in healthcare.

The publisher, Wireless Healthcare, has a number of other great reports worth reading if you can afford it!

I myself have been using a Palm to help me on the wards. The only problem I’ve ever had is with old-school doctors that feel threatened by new technology and ask me to put it away when around them!

Google Health for Medical Students

In my search through Google Health’s features I discovered that google has enlisted A.D.A.M to provide a comprehensive list of every medical condition imaginable.

As an example it mentions
Coccidioidomycosis, acute pulmonary
Coccidioidomycosis, chronic pulmonary
Coccidioidomycosis, disseminated
rather than limit itself to a general explanation.

Hopefully this will be a nice backup to Wikipedia, the most researched site by medical students in my faculty – if only Google will make it’s entries searchable.

Google Health OPEN!

Google Health is finally live.

Unfortunately it doesn’t like Safari, so I’m going to have to install something inferior before I can tell you what it’s like.

While there already exists a plethora of EHR websites, only Google and Microsoft have real potential to link their version with related applications that enhance the user experience and add the kind of value that might draw our aging medical workforce away from the pen and paper.

Microsoft’s Healthvault got a leg up by opening in Oct2007. Already it has a number of independent applications, but they are primarily for patient self-management of lifestyle issues.

More chunky applications that make the doctors life easier will be required if these EHR’s become truly pervasive. I certainly can’t see my GP dropping his in-house system for either of them right now.

MSF shares its Wisdom

The international medical humanitarian organisation Médecins Sans Frontières (MSF) today launched a website on
which it makes available, for free, published research based on its medical work.

MSF is archiving all its peer-reviewed research and commentary articles on the site. At its launch, there are over 350 articles on HIV care, malaria, tuberculosis, leishmaniasis and other diseases, as well as more general topics such as medical care in emergencies, refugee health and health politics.

This is of great personal interest to me as on previous trips to third world countries I have only ever found paltry information by medical workers ‘in the field’ of basic medicine. HIFA, another great resource I’ve discovered, has given me many other links to health workers worldwide looking to share information, for free!

CeBIT and eHealth

An unplanned visit to the CeBIT ehealthexpo yesterday proved rather dissapointing. The NEHTA information booth was nowhere to be found amongst the myriads of technology floggers.

I did have a chat with an eHealth tablet PC provider. Their system is already operational in several aged care facilities and 4 hospitals in WA. The hardware is built from scratch and includes a built in barcode reader, wifi and bluetooth, as well as a camera and slots for sim cards allowing nextG communication. Their name escapes me at present.

It’s a sign that things are moving – but I can’t see any public hospitals going onboard for some time. Most are still trying to get their heads around the idea of EHR’s. Let’s hope it doesn’t take them too long – we’re wasting a lot of resources in the meantime!

Post Budget Health Shake up – what does it all mean?

In the wake of this Labor government’s budget, health analysts were always going to have their work cut out. My overall impression is that no one is quite sure how to summarize the health budget, except by noting that it is redirecting funds back towards the public system. Even then, it is hard to know what impact this will have on our health system.

Undoubtedly, some will drop their private health insurance. The majority of these will be young adults. So the impact on the public system should be negligible, as demonstrated by no increase in surgery waiting lists. Indeed, when the private healthcare rebate was introduced there was apparently no decrease in waiting lists to begin with.

The other ‘big announcement’ was an extra $10b for infrastructure. The shift in funding towards the public sector must be welcomed by anyone that works there. Upgrading of infrastructure is always needed. No one will argue with this. Another question from some is whether this measure signifies a general attack on the concept of private health care.

No country has a perfect system. Australia seems to balance the rigidity of the UK or France with America’s high in-equality, lucrative private system. We are in a good place but cannot guarantee we will stay here or that our system can be further improved by moving one direction or another.

A discussion about the benefits of private vs public within our regulatory framework and economic and sociodemographic constraints is not possible here. One little mentioned point, however, is that the flexibility of a private market seems a necessity for progress in our rapidly changing world. This does not negate the concept that universal health cover is essential.

My greatest disappointment is that the health budget debate in the media has narrowed its interests to Alcopops and the private health insurance rebate. There are far greater issues we must address – particularly those that affect our immediate future, such as the training of doctors and allied health staff. Half the proposals in the budget rely on a sustainable workforce, and that simply doesn’t exist now. Unless some gaps are plugged with great speed, we will witness blowouts with the potential to destabilize the system entirely.