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Technology Is the Way

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Clifford Goldsmith, MD, has made it his mission to improve care delivery through technological advances.

Goldsmith, chief medical officer at Aptima Inc., a "human-centered engineering" company that aims to improve the way humans and technology interact, once served as the U.S. director of healthcare for Microsoft Corp., where he helped create Microsoft's physician digital dashboard and clinical portals. Goldsmith was educated in South Africa, where he practiced medicine and worked for the National Center for Occupational Healthcare, Division of Epidemiology, in Johannesburg.

On lowering costs without lowering quality: There are some things within the U.S. healthcare system that could be done in a more automated, routine way. An example would be immunization. That kind of service could be removed from the typical physician-patient interaction and could be moved to the retail clinic. That doesn't seem huge, but it's those types of things that will lead to significant savings.

On the role of technology in healthcare: With patient-centric care, patients have to give more consideration to what options are available to them and how to improve their overall health. They need that information to be available to them, so we become a knowledge-driven healthcare system. And at the center of that knowledge is information technology. Access to complete personal health records that have all the patient's information is vital. Right now as patients or consumers we really don't have the information we need to make informed decisions.

On reducing medical errors: The vast majority of medical errors can be managed with more standardized mechanisms for checking and validating patients and their conditions. One thing technology can do is reduce even the simplest order entry errors. Very basic forms of technology can make a huge difference, like e-prescribing, barcoding, and other ways of checking that patients are who you think they are or making sure the information you get in the ICU or the OR is correct.

On the shift to a consumer-driven healthcare model: Under our current model, physicians do whatever tests they want, give you a diagnosis, and at the end of that transaction is a prescription. If they want you to have a chest X-ray, then you have a chest X-ray. But if you are paying for that directly, under the consumer-driven model, you'll want to know why you need the X-ray. It's going to change the dynamic completely. The question is: What's the mountain we have to climb to get to this end point? The hurdle from where we are now to a consumer-driven market is huge, and there may even be a period where we have to raise costs and put more money into the system just to create a consumer market.

Kathryn Mackenzie

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