Our Aging Population, as A Trend in Healthcare

Data from: http://www.census.gov/population/projections/data/national/2008/downloadablefiles.html

The US population is aging. Markets in the health care industry are changing as a result. People are getting older at a faster rate than children are being born. In fact, the present US birthrate is at its lowest level since 1920! According to the graph above, over the next forty years, the ratio of 0-17 year-olds and 18-64 year-olds in our population will be slowly decreasing. During that same period, the population ratio of 65-100 will be increasing, and considerably. Between the years 2006 and 2050, the US will see a 15 point fluctuation in population ratios between its “young” (18-64) and “old” (65-100) populations. Our country has never witnessed a fluctuation of this magnitude in its regularly recorded history.

The fluctuation will be protracted, but palpable. Despite having small population numbers now, older populations will experience significant growth in the future. It will be important for communities at large to consider the effects of this increase. The increase will not happen in a vacuum, out of sight from society. It will be noticeable in everyday life. In relation to health care, our country’s health care system—both private and public—will realize greater demands for geriatric care. Nursing home, rehabilitation and hospice care will see increases in their patient base. The elderly will gain a larger foothold (and, in doing so, gather market power) in the US consumer market as a result of their expanded presence.

Competition in future health care markets will be contingent on appreciating the changing composition of our country’s population. The fact of the matter is this: health care becomes a constant one’s life when someone reaches a certain age. Based on Census data, our future will bring with it more people reaching that “certain age”.  These people will demand more care than they have in the past, and we must reasonably and cost-effectively respond to meet that demand.

Pointing Fingers is Costing U.S.

We’ve all heard it by now. We know that health care costs are increasing. We know that things will soon be “unsustainable” if our present health care practices continue. Interestingly, despite all the stimuli we receive through the mainstream media, it doesn’t appear that the US people care as much as they should.

People haven’t done enough to appreciate the cost issue. Aside from the general if-I-use-more-then-I-pay-more concept, I would guess that most people in the US haven’t looked at the connection between the use of health services and the cost of health services. For those who haven’t, it basically gets down to this: one’s unnecessary use of health care services raises both the individual cost of care, as well as national cost of care. This means that your choice to use an unnecessary amount of health services not only increases your costs, but my costs, too!

Understanding the factual basis that underlies the “cost conundrum” isn’t that simple, though. Researching the cost issue is complex, taking many hours, if not days, of research to appreciate. There are so many moving parts, and to grasp and make sense of these parts requires time and energy that, frankly, many people don’t have. In addition to raising a kid, reading for school and trying to stay ahead of life by working two or three jobs, who among the general population has the time to dive into the boring, fact-intensive literature that outlines why health care costs are such a problem in the States? I joke, but the problem is serious. The US people–the mass of health care consumers who do not subscribe to Health Affairs–cannot reasonably inform themselves about the basics of our health care (e.g., medical terminology, billing, etc.), let alone the costs of health care that have begun to financially cripple our nation. We can’t expect them to be smart consumers, but giving-up on them and telling them what to do isn’t the answer.

We must include them in the discussion. We–those thoroughly educated in health care and its associated topics–cannot continue our insulated discussions, disseminating new and important information amongst ourselves, in our own communities and journals. Doing that isn’t the answer to correcting the education gap. We need to reach out to people in the community at-large. This doesn’t mean writing an Op-Ed in the NYTimes. This doesn’t mean hosting a panel discussion on CNN. Prestigious mediums aren’t always the answer. Health care in big cities is different than health care in small cities, and health care in small cities is different than health care in small towns. All people aren’t the same, and we can expect everyone to learn and appreciate the same way. The patient-centeredness movement is a start, however, we have a long way to go before reaching a semblance of parity.

The Epic Task Ahead for Clinicians

“But a bulldozer will do the same thing in a fraction of the time. IT was like this—speeding up dramatically work that can be done by hand.”

EPIC, the wonderful health informatics software that will revolutionalize health care, will be rolled-out in many of our Country’s top hospitals over the next few years. For those who don’t know, EPIC is an EMR database (electronic medical record) and pretty much EMRs generally, will be given a big task–to make our health system more efficient and bring it up-to-date with 21-century technology. Good luck with that!

In my experience so far, I haven’t seen the large rewards that it promises. I’ve found Epic to be another layer of paperwork. For most clinicians more paperwork is…well, it sure doesn’t make work any easier. New demands have a tendency to avert the practitioner’s focus away from the bedside.

It’s interesting to see how EPIC has affected clinical pharmacy at some hospitals. Clinical pharmacy micro-manages patient care mostly from a central or satellite pharmacy location. They review computerized physician orders. They verify medications on electronic data systems instituted by hospitals years ago, to do the same thing expected of EPIC–provide better, more efficient services.

I believe that new software should improve the manner in which a discipline practices, not change the method of practice altogether. What I mean is, it’s hard to fathom a clinical nurse being sedentary profession while the techs do all the running.

The day-to-day tasks of pharmacists seem to be following this trend. On any given day, clinical pharmacists are tasked with accesses patient information in a computer system, and then responding to gleaned data in an appropriate manor and entering their stamp of approval online. Repeat. Only when defects occur and clinically requires it (e.g., needed presence at a code) do they leave their post. Essentially, they inform most of their patient care decisions to a computer screen, not a patient, and then hope the software behind the computer screen does its job. This medium is sort of like a permeable barrier between the patient and practitioner, and is becoming ever-present on more clinical fronts.

How can we add new electronic systems without disrupting the essence of clinical practice methods? How can we maximize patient content when technology enables us to minimize it? What can we learn from pharmacy’s experience that we can use in nursing and medicine, or anywhere other field or practice for that matter? I strongly believe that professional methods of practice should not be affected. Patients need practitioners with them as much as possible for one reason: to get better. EPIC is a software, not a practice method, and the coders who created the software ultimately don’t know what is best for the patient.

Moral of the story: Keep the patient on the pedestal. Don’t replace her with something trendy. Work with the patient and find ways to use the tools to best fit her needs.