Just a simple vanilla blog site from a physician


One of my convictions is:

  • The total cost of healthcare is proportional to the amount of technology available at the primary point of care.

A corollary is:

  • The closer a task is to the patient the more efficient care will be.

Until recently healthcare stood out as an outlier from other industries in that technological advances have not resulted in increased productivity with decreasing costs.  There are a myriad of reasons for this and one big reason is most high end medical technology is found in the most specialized and expensive venues; imaging centers, surgery suites, intensive cares, procedure rooms and sub specialist offices.

This is totally reasonable as over the last 20 years the reimbursement models (especially in the US) were heavily weighted in favor of high-cost procedures.  The return on technology investment in a surgical suite dwarfed that of any investment in a physician’s office.  Subspecialty and hospital based services are relatively large revenue sources.  Comparatively speaking almost no investment was made in the humble exam rooms where the overwhelming majority of care is being delivered.

This is beginning to change.  Newer value-based reimbursement models are now turning the revenue stream on it’s head.  In a shared savings, value-based reimbursement model the extremely expensive surgical suite and subspecialty care become cost centers rather than revenue sources.  The most profitable interventions migrate from the surgery suite and special procedure’s labs outwards to the clinic and even to the patient’s home.  The hospital becomes a “point of failure.”

Unfortunately we’re not ready for this.  Very few, if any, of our training programs are embracing heavy point-of-care technology investments at the periphery of healthcare system.  Physicians in training are not being shown how to exploit the thousands of very low cost yet high-tech devices to augment patient interactions.  The main reason is most primary care programs in Academic Medical Centers do not have the funds needed to purchase hand-held devices and apps to give to their residents-in-training and medical students. That needs to change if we’re going to be able to finally join other industries in leveraging technology to lower the cost of care for our patients.  To this end we’ve created a fund to invest capital in technology as close to the primary point of care as  possible.

Family Medicine Technology Fund

We have created a special technology fund to give Family Medicine Resident physicians at Truman Medical Center’ Department of Community and Family Medicine the resources necessary to practice medicine in the 21st Century.

  • A significant portion of this fund underwrites the cost of providing state-of-the art computers for each
    Smartphone Otoscope for Doctors and Patients

    Smartphone Otoscope for Doctors and Patients

    of the 14 first year residents and subsidizes the cost of upgrading 2nd and 3rd year resident’s devices.

  • Each year we see advanced portable diagnostic devices hitting the market that enable primary care physicians to make more accurate diagnoses immediately in the exam room while engaging their patients. These tools, like Cellscope’s Oto, a smart phone physicians use to capture pictures or movies of a patient’s ears to share immediately with the patient are going to be a fundamental part of the primary care physician’s toolkit.
    Other similar products include the MobiUS SP1 hand-held ultrasound units from companies like Mobisante,  smart phone driven Mobile ECG devices from AliveCor

    Mobile electrocardiogram for physicians and patients

    Mobile electrocardiogram for physicians and patients

    and even more robust solutions like Triomi’s 12-lead EKG device that is being developed by a new startup company here in Kansas City as part of the Sprint Accelerator’s program.
    Other diagnostic programs such as MIR’s Minispir Spirometer are capable of very quickly producing sophisticated flow-volume studies previously only available in specialist’s departments.
    These new instruments put into the hands of primary care physicians tools that speed up and lower the cost of obtaining diagnoses thereby enhancing the value of primary care medicine.
    Unfortunately they are not cost-free and often beyond the budget of our training program and certainly for our individual residents.  A major portion of this technology fund is used to purchase these for our resident physicans to learn to use while they are in our program and better prepared as they begin their careers.

  • This fund has also been used to provide extra large screens for residents to use as second screens for their laptops or stationary workstations. Expanding the screen real estate helps resident physicians in their day-to-day activities and learning by reducing the time needed to display the right information at the right time.

Special Fund Raising Event

Every year I have a tradition of either running my age in miles or, as I’ve gotten much older, switched to walking and playing my age in holes of golf.  This year I’ll be turning 65 so on June 18 or 19 (dependent on weather) I’ll be walking 65 holes of golf.  This year’s goal is $200 per hole or $13,000. Stay tuned to my Facebook and Twitter feeds to follow me.   Once again Dr. Paul Terranova will be caddying for me.  Please help me reach our goal by going on line and making your donation to the Family Medicine Technology fund.

How to Make A Contribution

  1. Point your browser to Truman Medical Center’s Charitable Foundation donation page https://foundation.trumed.org/donate,TMC Charitable Foundation
  2. Select the amount of your donation
  3. Make sure to select the Family Medicine Technology Fund2015-05-07_09-34-17
  4. Complete the process conveniently and securely

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