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C799
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Medicine
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Dec 6, 2023
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A. EVOLUTION OF MEDICINE
Medicine has evolved immensely over the centuries, allowing great strides in the world
of healthcare. Galen, a Roman doctor from 129-216 AD, created highly influential writings.
Much of the knowledge of early medicine comes from the writings of Galen (Wasson et al.,
2019). He believed that knowledge of anatomy was essential for a physician. For Galen, the body
was the orderly structure of nature. Echoing the modern theory of optimal health, he
recommended exercise, a balanced diet, good hygiene, and bathing. Galen did not accept the
views of his peers - ideas based on speculation rather than research or experimentation. Galen is
remembered for revolutionizing medical research and challenging the status quo (Wasson et al.,
2019).
Another prime example of advancements in medicine includes the
discovery of penicillin
in 1928. Scottish scientist Alexander Fleming discovered penicillin’s
antibacterial properties
making it the world's first antibiotic (Markel, 2013). Fleming revolutionized medicine with his
discovery and paved the way for others like Dr. Howard Florey and Dr. Ernst Chain to research
and perform experiments to make penicillin useful. Fourteen years after the initial discovery,
Anne Miller became the first civilian patient to be successfully treated with penicillin in March
1942 (Markel, 2013).
A1. ROLES OF HEALTHCARE PROFESSIONALS
Significant historical events have also enabled advances in the medical profession. The
establishment of State Medical boards was an important milestone as it enacted laws regarding
the licensing of doctors. By 1910, nearly every state had an admissions board and an independent
examination (Johnson & Chaudhry, 2012). Once states began requiring proctored exams as a
prerequisite for medical licenses, private schools could no longer openly take advantage of state
laws. Government licensing regulations were seen as a genuine attempt to protect the interests of
the public and independently trained professionals. The 1877 Illinois Legislature created a board
of health chaired by John Rausch, which launched a vigorous campaign to review medical
qualifications, evaluate qualifications, identify counterfeit capabilities, and eliminate unqualified
physicians. In addition, the Illinois Board of Governors instituted a classification system for
medical schools before subsequent national efforts. By 1883
,
Mr. Rauch and the board had
identified 24 institutions whose graduates were ineligible for licensure (Johnson & Chaudhry,
2012). Illinois' initiative soon led to a de facto "mandatory" list of all medical licensing agencies.
This historical milestone, along with diligent verification efforts, improved the standards and
quality in the field of healthcare physicians (Johnson & Chaudhry, 2012).
The nursing field experienced a similar progression in 1884 when the Detroit Harper
Hospital nursing school opened. This movement ushered in the profession of nursing (Bernard
Becker Medical Library, n.d.). On December 7, 1883, just ten years after founding the first
nursing school in the United States, a group of twenty St. Louis educational, medical, legal, and
civil society leaders convened an organizing meeting to establish St. Louis training school for
Nursing. By the end of the 19th century, 24 nursing schools were founded in Missouri (Bernard
Becker Medical Library, n.d.). This movement was widespread throughout the U.S., paving the
way for the nursing profession and forever changing the healthcare system.
A2. TECHNOLOGY IN HEALTHCARE
A significant milestone in medical technology that we use today was invented in 1816 by
Rene Theophile Hyacinthe Laënnec. Laënnec found that heart sounds could be heard more
clearly and loudly using indirect listening rather than direct listening (Roguin, 2006). Over the
next three years, Laënnec experimented with different materials to make tubes and improved his
stethoscope design. Laënnec is considered the father of clinical auscultation and created the
original explanations of bronchiectasis and cirrhosis based on the sounds he heard, as well as
classified lung diseases such as pneumonia, bronchitis, pleurisy, emphysema, pneumothorax,
phthisis, and other lung diseases. With his device, Laënnec perfected the art of physical
examination of the chest and presented numerous clinical terms still utilized in today's
professions (Roguin, 2006).
A pivotal occasion that immediately revolutionized the fields of physics and medicine
was Wilhelm Conrad Roentgen's discovery of X-ray in 1895. The X-ray developed from
Roentgen's lab and into broad use in an astonishing jump. Within a year of Roentgen's
declaration of his findings, applying X-rays' ability to diagnose and treat patients was a milestone
in the medical profession (APS News, 2001). In February 1896, X-rays were used in Dartmouth,
MA, USA, when Edwin Brant Frost produced an image of a patient's Colle’s fracture. Before
long, attempts were made to obtain clear images of organs and blood vessels by inserting metal
rods or injecting radio-opaque substances, but the results varied. Angiography, moving image X-
ray, and military radiology were first performed in early 1896 (APS News, 2001). X-rays were
used for diagnostic benefits, and some experimenters began using them to treat diseases. Since
the early 1800s, electrotherapy has proven popular for temporary relief from real and imagined
pain. In January 1896, just days after Röntgen's work became public, Chicago electrotherapist
Emil Grubbe irradiated a woman with recurrent breast cancer. By the end of the year, several
scientists had discovered the palliative effect of radiation against cancers (APS News, 2001).
B. COMPONENTS OF A HEALTHCARE DELIVERY SYSTEM
The three main components of a healthcare delivery system include organization,
funding, and delivery. Funding is necessary to maintain healthcare facilities. For most
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Americans, employers offer some form of health insurance. Employers provide health care
financing as a benefit. Plans usually extend to the employee's spouse and dependents at
additional costs. Smaller employers may not have the means to offer such benefits to their
employees. Public programs financed by the government are another option for coverage (Shi &
Singh, 2015).
The delivery of healthcare refers to the entities that provide healthcare services. Nurses,
Physicians, Imaging clinics, Specialists, diagnostic labs, hospitals, dentists, and medical
equipment suppliers are examples of these healthcare entities. The form of healthcare can also
vary from face-to-face to telehealth (Shi & Singh, 2015). The healthcare system in the United
States does not provide universal coverage. It is best described as a hybrid system in which
publicly paid government Medicare and Medicaid health coverage coexists with privately
financed market coverage (The Professional Society for Health Economics and Outcomes
Research, n.d.). To provide the best care possible, delivery and organization collaborate using
organizational features, including services, consumers, technology, and employees. These
facilities frequently serve people with insurance and HMO contracts with particular insurance
plans (Shi & Singh, 2015).
B1. PATIENT CARE ACCESS
Access to patient care is affected by the healthcare delivery system. Typically, patients
with state-funded insurance receive a lower quality of care due to underfunding and limited
qualifying facilities. Most people unable to receive private insurance through employers are not
financially stable enough to obtain insurance through the marketplace. Frequently employers
provide coverage with HMO plans. These plans limit the patient to one facility, commonly with
limited access and low-quality care contracted with the insurance provider.
B2. PATIENT CARE COST
The cost predominantly affects patient care. Many people go without care or wait until
conditions become serious before seeking care due to high costs. Patients with insurance through
their employers choose from different coverage plans with correlating expenses to fit their needs.
Ancillary services such as labs, imaging, and auditory or optic testing may or may not be
included with low deductible plans and are frequently more costly. Patients must be diligent and
mindful when choosing coverage and understanding what healthcare needs are being satisfied.
B3. QUALITY OF PATIENT CARE
Sadly, the quality of care depends on location, insurance, and socioeconomic status.
Government-funded healthcare is known for lower-quality care with limited access to
experienced professionals and high-quality equipment. A VBPS is a value-based program
specifically for Medicare Part A patients receiving inpatient care at a participating hospital
(Centers for Medicare & Medicaid Services, 2022b). The VBPS provides incentives to acute care
hospitals based on assessments of the quality of care, mortality and morbidity, efficiency and
cost savings, health-related infections, patient safety, and patient experience. VBP Programs help
improve the quality-of-care patients receive in the hospital. Participating hospitals receive
adjustments on Medicare payments based on a score of achievement and improvement (Centers
for Medicare & Medicaid Services, 2021b).
With that in mind, there are programs for qualifying facilities to receive reimbursement
with the Merit-based Incentive Payment System (MIPS). MIPS scores eligible outpatient
clinicians based on cost, quality, improvement activities, and promoting interoperability.
Facilities will receive a rating of negative, neutral, or positive MIPS payment adjustment
(Centers for Medicare & Medicaid Services, 2021a). The MIPS reimburses for care provided to
Medicare Part B patients (Centers for Medicare & Medicaid Services, 2022a).
C. FEDERAL GOVERNMENT INITIATIVE
On December 13, 2016, the 21st Century Cures Act (Cures Act) was signed into law. The
Cures Act is designed to help increase medical product development, provide these innovations
and advances to patients who need them quicker and more efficiently, and improve the flow and
exchange of electronic health information (U.S. Food & Drug Administration, 2020). The Office
of the National Coordinator for Health Information Technology (ONC) is responsible for
implementing, related to advancing interoperability, prohibiting information blocking, and
enhancing the usability, accessibility, privacy, and security of health IT. All individuals, their
families, and their healthcare providers have appropriate access to electronic health information
to help improve the overall health of the nation's population due to the diligence of the ONC
(Office of the National Coordinator for Health Information Technology, 2023). Implementing
these provisions will advance interoperability while facilitating the access, exchange, and use of
electronic health information. In addition, the regulation finalizes substantial alterations to the
2015 Edition health IT certification criteria and Program to advance interoperability further,
enhance health IT certification, and minimize burden and costs (Department of Health and
Human Services & Office of the National Coordinator for Health Information Technology,
2020).
C1. EMERGING TECHNOLOGY
An example of an emerging technology is Speech Recognition Technology. Producing a
quickly accessible, transparent, final, signed note or report based on computer speech input has
remained a developing technology (Oachs & Watters, 2020). The improvement and application
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of diverse speech recognition innovations in healthcare continue to improve workflow and
errors. The ultimate goal of speech recognition technology is to speak to a computer's central
processing unit and quickly build a vocabulary for applications without needing to collect speech
samples or train the system (Oachs & Watters, 2020).
References
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November 8, 1895: Roentgen's
Discovery of X-Rays
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Bernard Becker Medical Library. (n.d.).
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documents/2020%20Promoting%20Interoperability%20Quick%20Start%20Guide_1.pdf
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Hospital Value-Based
Purchasing (VBP) Program
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