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Practice of Medicine Begins to Evolve

— Most people agree the U-S needs to reduce the cost of health care. The problem is how to do it. Some say the key is changing the way this country practices medicine. That evolution is starting to happen. KPBS Reporter Tom Fudge explains how it's happening in San Diego.

Heart problems have been a hardship to Chula Vista resident Shirley Haley, who says she's had by-passes done on five vessels to her heart. But last year she found a new way to keep track of her heart health. It's an electronic bathroom scale, and its one part of a monitoring system run by Sharp Rees-Stealy medical group. Every morning, Haley says she turns on the electric scale and she presses yes and no buttons as a recorded voice asks her questions.

"'Are you dizzy. Are you light-headed,' whatever," Haley says, as she quotes the machine. "'Have you taken all your meds.' And then it tells you 'Good Job!' And then it tells you… 'STEP ON THE SCALE!'"

"Please step on the scale," says the machine.

"This is when I start yelling at it," says Haley.

Her weight is important, though, because a significant increase in weight overnight means a water-weight gain. And that can be the sign of a weakened heart. All of the information gathered by the scale is transmitted over phone lines to the Sharp clinic. There, it's monitored by a nurse who calls right away if there's something wrong.

The scale is one example of how technology can change the practice of medicine. Dr. Jerry Penso is director of quality programs at Sharp Rees-Stealy. He says 80 percent of the cost of medicine today relates to chronic conditions. Dealing with diabetes and heart patients for instance.

He say the future of health care will require better tools for better, more cost-effective health maintenance.

"You know, think of this as your car with all the electronics," says Penso. "The electronics are keeping track of all sorts of things. I have a new car. It even tells you if the pressure on your tires is a little bit low and maybe you need to got get it fixed."

The American model of medical practice that's developed over time has become obsolete, if the goal is keep patients healthy in a cost effective way. That's the view of doctors like Joe Scherger, a professor of family and preventive medicine at UCSD.

"We know that with this make an appointment, come and get it, visit-based model of care, that the outcomes to a population are poor at best," he says. "Only about 20 percent of people in a population have the desired outcome of controlling their blood pressure. Controlling their diabetes."

He says episodic, visit-dependent healthcare is also very expensive.

"Just six minutes in front or your doctor is going to cost you sevety-five dollars. And the doctors overhead for providing that service is also quite high. Terribly inefficient," says Scherger.

The new model of medical practice, Scherger says, relies less on doctor visits. It relies more on patients being well informed and playing an active role in their health care. One way to do that is to use electronic health records.

Now I'm a member of Kaisar Permanente, and most of their hospitals have electronic records. I can go to their website and enter a user I.D.

(click click) I enter a password. (click click) Here it says health updates. View your test results. So I click on that. And here are the results of my recent blood test.

Advocates of the new model say our future interaction with the health care establishment will not occur through doctor visits. It'll be by phone, by email, and over the internet. Shirley Haley says that's fine as long as she continues to get what she has in her heart monitoring program.

"One of the things I like about this is the human factor. The nurse the calls me. I mean I'm sixty two years old. I need a person to talk to. I'm old school I need to have somebody who explains to me what's going on," says Haley.

Over the Christmas holidays, Haley stepped on her electronic scale. She then got a call from her nurse, who noticed that she had gained two pounds overnight. Haley was going into congestive heart failure. While she says likes the human touch, it was also a phone line connection between her scale at home, and the clinic, that saved her life.

Tom fudge, KPBS News.

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