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In 1996, the Institute of Medicine (IOM) released its report Telemedicine: A Guide to Assessing Telecommunications for Health Care. In that report, the IOM Committee on Evaluating Clinical Applications of Telemedicine found telemedicine is similar in most respects to other technologies for which better evidence of effectiveness is also being demanded. Telemedicine, however, has some special characteristics-shared with information technologies generally-that warrant particular notice from evaluators and decision makers. Since that time, attention to telehealth has continued to grow in both the public and private sectors. Peer-reviewed journals and professional societies are devoted to telehealth, the federal government provides grant funding to promote the use of telehealth, and the private technology industry continues to develop new applications for telehealth. However, barriers remain to the use of telehealth modalities, including issues related to reimbursement, licensure, workforce, and costs. Also, some areas of telehealth have developed a stronger evidence base than others. The Health Resources and Service Administration (HRSA) sponsored the IOM in holding a workshop in Washington, DC, on August 8-9 2012, to examine how the use of telehealth technology can fit into the U.S. health care system. HRSA asked the IOM to focus on the potential for telehealth to serve geographically isolated individuals and extend the reach of scarce resources while also emphasizing the quality and value in the delivery of health care services. This workshop summary discusses the evolution of telehealth since 1996, including the increasing role of the private sector, policies that have promoted or delayed the use of telehealth, and consumer acceptance of telehealth. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary discusses the current evidence base for telehealth, including available data and gaps in data; discuss how technological developments, including mobile telehealth, electronic intensive care units, remote monitoring, social networking, and wearable devices, in conjunction with the push for electronic health records, is changing the delivery of health care in rural and urban environments. This report also summarizes actions that the U.S. Department of Health and Human Services (HHS) can undertake to further the use of telehealth to improve health care outcomes while controlling costs in the current health care environment.
"The Nation has lost sight of its public health goals and has allowed the system of public health to fall into 'disarray'," from The Future of Public Health. This startling book contains proposals for ensuring that public health service programs are efficient and effective enough to deal not only with the topics of today, but also with those of tomorrow. In addition, the authors make recommendations for core functions in public health assessment, policy development, and service assurances, and identify the level of government--federal, state, and local--at which these functions would best be handled.
Telemedicineâ€"the use of information and telecommunications technologies to provide and support health care when distance separates the participantsâ€"is receiving increasing attention not only in remote areas where health care access is troublesome but also in urban and suburban locations. Yet the benefits and costs of this blend of medicine and digital technologies must be better demonstrated before today's cautious decision-makers invest significant funds in its development. Telemedicine presents a framework for evaluating patient care applications of telemedicine. The book identifies managerial, technical, policy, legal, and human factors that must be taken into account in evaluating a telemedicine program. The committee reviews previous efforts to establish evaluation frameworks and reports on results from several completed studies of image transmission, consulting from remote locations, and other telemedicine programs. The committee also examines basic elements of an evaluation and considers relevant issues of quality, accessibility, and cost of health care. Telemedicine will be of immediate interest to anyone with interest in the clinical application of telemedicine.
Drawing on the work of the Roundtable on Evidence-Based Medicine, the 2007 IOM Annual Meeting assessed some of the rapidly occurring changes in health care related to new diagnostic and treatment tools, emerging genetic insights, the developments in information technology, and healthcare costs, and discussed the need for a stronger focus on evidence to ensure that the promise of scientific discovery and technological innovation is efficiently captured to provide the right care for the right patient at the right time. As new discoveries continue to expand the universe of medical interventions, treatments, and methods of care, the need for a more systematic approach to evidence development and application becomes increasingly critical. Without better information about the effectiveness of different treatment options, the resulting uncertainty can lead to the delivery of services that may be unnecessary, unproven, or even harmful. Improving the evidence-base for medicine holds great potential to increase the quality and efficiency of medical care. The Annual Meeting, held on October 8, 2007, brought together many of the nation's leading authorities on various aspects of the issues - both challenges and opportunities - to present their perspectives and engage in discussion with the IOM membership.
For all too many dedicated physicians, stuck in a cycle of seven-minute patient visits and production line healing, medicine has become a frustrating vocation. Furthermore, the current epidemic of chronic illness demands a new care standard that can break down the existing structural barriers to full resolution. It requires functional medicine. The Evolution of Medicine provides step-by-step instruction for building a successful "community micropractice," one that engages both the patient and practitioner in a therapeutic partnership focused on the body as a whole rather than isolated symptoms. This invaluable handbook will awaken health professionals to exciting new career possibilities. At the same time, it will alleviate the fear of abandoning a conventional medical system that is bad for doctors, patients, and payers, as well as being ineffectual in the treatment of chronic ailments. Welcome to a new world of modern medical care, delivered in a community setting. It's time to embrace the Evolution of Medicine and reignite your love for the art of healing.
This work traces the social origins of the rise of Durham, North Carolina as a regional health center and describes in detail the philosophy, funding, administration, educational theories, research objectives and regional aid programs of the Duke health care institutions up to 1941.
In 1860, the nation's first college-hospital was founded in Brooklyn. Initially called the Long Island College Hospital, Collegiate Division, this innovative institution was the first to bring controversial, cuttingedge methods of teaching to the study of medicine in the United States. Until this time, medical students had been taught exclusively in schools, rarely leaving the lecture hall for first-hand experience. With the belief that medical instruction should be brought to the hospital bedside, the renowned institution that became SUNY Downstate Medical Center was founded, changing the course of medical instruction forever. In 2000, on its 140th anniversary, SUNY Downstate is celebrated for its innovative teaching practices and superior instructors and equipment. Now the largest medical school in New York State, SUNY Downstate prepares about 1,500 students per year for careers in medicine, nursing, and the allied health professions. SUNY Downstate Medical Center is an incredible new volume that includes not only photographs but also announcements, bulletins, degrees, theses, and countless other memories from the last 140 years.
The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.
The number of women practicing medicine in the United States has grown steadily since the late 1960s, with women now roughly at parity with men among entering medical students. Why did so many women enter American medicine? How are women faring, professionally and personally, once they become physicians? Are women transforming the way medicine is practiced? To answer these questions, The Changing Face of Medicine draws on a wide array of sources, including interviews with women physicians and surveys of medical students and practitioners. The analysis is set in the twin contexts of a rapidly evolving medical system and profound shifts in gender roles in American society. Throughout the book, Ann K. Boulis and Jerry A. Jacobs critically examine common assumptions about women in medicine. For example, they find that women's entry into medicine has less to do with the decline in status of the profession and more to do with changes in women's roles in contemporary society. Women physicians' families are becoming more and more like those of other working women. Still, disparities in terms of specialty, practice ownership, academic rank, and leadership roles endure, and barriers to opportunity persist. Along the way, Boulis and Jacobs address a host of issues, among them dual-physician marriages, specialty choice, time spent with patients, altruism versus materialism, and how physicians combine work and family. Women's presence in American medicine will continue to grow beyond the 50 percent mark, but the authors question whether this change by itself will make American medicine more caring and more patient centered. The future direction of the profession will depend on whether women doctors will lead the effort to chart a new course for health care delivery in the United States.
Evolution and Medicine provides an accessible introduction to the new field of evolutionary medicine. Evolutionary concepts help explain why we remain vulnerable to disease, how pathogens and cancer cells evolve, and how the diseases that affected our evolutionary ancestors have shaped our biology. The book interweaves the presentation of evolutionary principles with examples that illustrate how an evolutionary perspective enhances our understanding of disease. It discusses the theory of evolution by natural selection, the genetic basis of evolutionary change, evolutionary life history theory, and host-pathogen coevolution, and uses these concepts to provide new insights into diseases such as cystic fibrosis, cancer, sexually transmitted diseases, and malaria, incorporating the latest research in rapidly developing fields such as epigenetics and the study of the human microbiome. The book concludes with a discussion of the ways in which recent, culturally constructed changes in the human environment are increasing the prevalence of man-made diseases such as diabetes and cardiovascular diseases, and are exacerbating socioeconomic disparities in health. Just as evolutionary biology is concerned with populations and with changes in populations over time, evolutionary medicine is concerned with the health of populations. Evolution and Medicine emphasizes the role of demographic processes in evolution and disease, and stresses the importance of improving population health as a strategy for improving the health of individuals. This accessible text is written primarily for physicians, biomedical scientists, and both premedical and medical students, and will appeal to all readers with a background or interest in medicine.