How would you change Healthcare Delivery?

[BostonTerrierLover, BSN, RN]

We live in a time where getting ANY bill through the Congressional Process is a (pun intended) Act of Congress!!!

I want you to assume YOU could change the current ways things are done in your Country, Region, or Facility. I hope to hear from a range of Nursing Arenas. Also, this is broad spectrum, so think out of our scope, you can change ANYTHING.

Here is my example:

The Urgent Care Centers, After Hours Clinics, and "Doc-In-a-Box's" that are popping up everywhere now, Urban Areas, Suburban Areas, Small Towns, and even Pharmacies! (seen several at major department stores now!)

PROs

Easy Access to Healthcare that is more affordable than ERs

Huge Pressure of Emergency Departments when Utilized, or "Triaged-To"

Higher Insurance Reimbursement

Quicker than ERs in most cases for lower and Moderate level Medical Needs

Greater utilization of APNs

Wonderful for ACUTE problems that are not emergent

CONs

No Consistant Primary Care Provider for the patient on an ongoing basis

Fractured or Partial Care for Chronic Conditions "Bandaid Effect"

Less Follow-Up, and Familiarity with patients

Largely Profit Driven

According to the New England Journal of Medicine they miss complex diagnosis such as various cancers, Rheumatic Conditions (e.g. Lupus) , Nerve Problems, and Mental Illnesses).

My Grandmother is notorious for using these Facilities. She has a Co-Morbid Factor that drives me crazy for her to use these places (yes, MORE than one) for their ease of access, and rarely sees the same one again! This leads her COPD to be treated like Colds, and it's nothing to find her going 2-3 fails before being hospitalized for Pneumonia!

NOW MY SOLUTION: Get Rid of the "Doc-in-a-Box?" . . . . . No Way!!!!!!

Before they came about, sometimes I couldn't get her into a Physician anywhere in a 4 county area!!!! These are God Sent! But, there's the continuity of care issue.

I would Repeal HIPAA:yeah:, and create a new Rider Bill with Privacy for the patient, but a new Information Highway for your Health History- Just like your Credit History. It would only be dispensed AT YOUR PERMISSION!!!!!!!!!!! (Just like your Credit History) I know this needs much more thought, and could mean some really negative things, (I REALIZE THAT PROSPECTIVE EMPLOYERS ALREADY CHECK CREDIT HISTORY!) But, you do sign a form giving them that liberty. So I would have in the bill that it would TOTALLY BE FOR MEDICAL REASONs ONLY, and could only be accessed for the duration of your care, could be contested/corrected/updated. It would have your vaccination history, all medical tx, surgical tx, Allergies, Negative Responses to therapies, fails, What works for chronic conditions, XRays, Laboratories, Endoscopy Results, Scheduled Procedures, Preventive Medicine for "At Risk Populations," and Genetic Predispositons and more! You could Opt out for religious reasons, or Political Disagreements.

Please understand I have NO Political Intentions, and any intention is to advocate for the BEST outcome for the patient. "Above All Do No Harm!"

Disclaimer: For the greatest freedom of my posters on this thread, PLEASE don't criticize what another poster would do, I want to know WHAT YOU WOULD DO! Just want to keep it clean, and not get anyone excited NEGATIVELY. If you want to add or say you would like that IF . . ., that's fine, just please keep it courteous.* Let's play Congress and start a discussion by people who REALLY WALK the halls, areas, and rooms where healthcare is delived.

*I KNOW THIS IS A SUPER SENSITIVE SUBJECT. This could potentially include Abortion, Stem Cell Research, Sterilization/Eugenics, Population Control/Child Bearing Limitations, Obamacare (USA), Socialized Medicine, Addictions/Chemical Abuse, Religous Issues, Privacy, Promoting Dignity, Assisted Suicide, and many more sensitive issues. NO :argue: ALLOWED, LOL!!

:redlight:HOW or WHAT would you change about Healthcare?

[Tarabara]

My very first thought when i read your question was to fix the continuity of care too. I completey agree with what you've said about having a system like with credit history so that patients can have all their medical history together and accessible to who they want. I myself have been to many different primary care docs as i've moved a lot and i dont have any history from when i was younger. Its like starting completely over every time. I also think there should be more continuity among the specialties, for example if a pts cardiologist prescribes a BP med, their primary care doc needs to be told so they dont prescribe another one! Right now it seems each specialty only cares about their area and ignores the rest which is just ridiculous. Lastly, I wish there was better communication between docs and nurses, I want to be involved in rounds every time. (i can dream )

[That Guy, BSN, RN, EMT-B]

The ability to refuse services to people that show up at the ER 4 times in one day and AMA every single time.

[LostCauseCCRN]

I would change the way doctors are soooo revered. What other business would you walk in and wait 4 hours to meet with, get stripped naked and put in a backwards gown, and then they spend 5 minutes with you, and charge you a FORTUNE!

I like the Medical History Account deal, imagine the ease of admission history, and the help with getting a non-communicative patient without any power of attorney or family present.

Go Boston!:redbeathe

[33762FL]

Three words: Single Payer System.

[melmarie23, MSN, RN]

Three words: Single Payer System.

stole the words right out of my mouth.

[txredheadnurse, BSN, RN]

I want to chime in on the wonderful concept of accessing the whole array of health care information but I would amend that to accessibility only being allowed to actual health care providers; not employers or health care insurers.

I want to see nurses of all levels and ancillary nursing services such as CNAs, CMAs and HHA organize into professional groups like physicians do. No longer would we be employees of a facility and our exceedingly invaluable services be lumped into the room charges. For nursing to truly become a profession and be able to spread our wings and revisualize and revitalize just what it is we bring to the table without the trappings of being an employee of a non nursing entity.

[Altra, BSN, RN]

The proposition of a centralized medical history record fascinates me, in the context of another recent AN thread in which a number of posters vehemently defended a patient's right to only selectively provide information to a new provider.

[VICEDRN, BSN, RN]

1. A universal electronic medical record for every.single.patient.

2. A single payer system/universal coverage system with low co-payments.

3. Scaling back EMTALA so we do not have to see every single minor complaint *in case* its an emergency.

4. The developement of a comprehensive institutional mental health system (instead of a prison system) for psych patients.

[BlueDevil,DNP, DNP, RN]

Agree w/ single payer system. also would adopt the Japanese system of providing everyone with a chip or the like to access their lifetime medical records, including all immunizations and prescription fills. Standardized, with every venue having access.

[Anna Flaxis, BSN, RN]

1. A universal electronic medical record for every.single.patient.

2. A single payer system/universal coverage system with low co-payments.

3. Scaling back EMTALA so we do not have to see every single minor complaint *in case* its an emergency.

4. The development of a comprehensive institutional mental health system (instead of a prison system) for psych patients.

Totally agree with this. Also, a grant program for medical and advanced practice nursing education to increase the number of primary care providers.

[Nurse SMS, MSN, RN]

I would include beginning the recognition of and planning for the inevitability of death for all human beings at a young age when good health is still intact, just as we start planning for discharge long before a patient is ready to leave the hospital, so that we start raising generations of people who have a realistic idea of how they honestly want that to play out and the ability to approach the concept in a fashion that is less reactionary and more purposeful and dignified. This would be in hopes of giving a sense of control over how that happens when the time comes, lessening the fearfulness of death and dying and breaking through the taboo nature of admitting when death is at hand. Obviously this goal would be so that we have fewer people whose lives are being pointlessly and torturously extended at massive expense to the emotional and fiscal well-being of pretty much everyone and to help combat both the sense of nobility in doing "everything" simply because "everything" is possible with no thought to whether it is right, compassionate or even sensible. I would find a way over generations to elevate the concept of dignity being ahigher goal than longevity at any cost.

I would mandate education for all healthcare providers on communication in difficult situations so discussing death becomes less intimidating than it obviously is now.