Healthcare

1. Healthcare • By: Kristine Cargill, Tifenie Harris, Kayla Klosterman, Lindsey Post, Rebecca Williams, William Winowiecki

2. Mental Health In Michigan - Past • Prior to opening of mental institutions, people classified as insane were locked in cellars, attics, and jails • Care of mentally ill patients shifted after the opening of mental institutions • Kalamazoo Asylum for the Insane (Kalamazoo Public Library, n.d.) • States first mental institution • Opened August 1859 • Pioneered improved medical treatment of mentally ill patients • By 1959 - Consisted of 3500 patients and was a city on its own including a bakery, library, greenhouse, and other resources • Used such treatments as insulin shock therapy • State Psychopathic Hospital (Hill & Hirchbein, n.d.) • Opened in 1906 with direction from Professor William J Herdman • Facility focus was to diagnosis and research mental illnesses • Rise of mental health intuitions rose in the first half of the 1900’s • 1965 - 41 state-operated psychiatric hospitals and centers for persons with developmental disabilities (Public Sector Consultants Inc., 2010)

3. Mental Health in Michigan - Present • Care of mentally ill patients shifted from institutions to the current community based care after President Kennedy signed Mental Retardation Facilities and the Community Mental Health Centers Construction Act of 1963 (Michigan Psychiatric Society, 2012) • The new community based system was arranged in the Mental Health Code, Public Act 258 of 1974 and the revisions under Public Act 290 of 1995 (Michigan Psychiatric Society, 2012) • People with mental illnesses are managed through a local Community Mental Health Services Programs (CMHSPs) (Michigan Psychiatric Society, 2012) • 46 Community Mental Health Programs & 5 state hospitals in 2010 (Public Sector Consultants Inc., 2010) • Focus of care today in treating the whole patient: mental, physical, family, financial • Patients live in their own community and homes – have access to care for managing mental health medications, individual and group therapy, and acute care in hospitals when needed during a crisis • Patients play an active role in planning their care

4. Mental Health in Michigan - Future • Increased awareness and acceptance of mental illness will create an increase of patients seeking mental health care • More Community Health Programs will be developed to provide easier access to care for patients • Pharmacologic improvements and mental health research will provide patients with more health care options

5. Aortic Stenosis Aortic Stenosis is when the aortic valve is narrowing and its inhibits delivery of blood throughout the body. Some of the signs and symptoms of this disease are fatigue, fainting, heart failure, and chest pain. http://www.medicinenet.com/aortic_stenosis/article.htm

6. Older Procedures for Aortic Stenosis Patient’s In cases of severe aortic stenosis, it was always recommended to replace the aortic valve with a pig valve or mechanical valve. In elderly patients it was always contraindicated to operate due to the risk factors against the benefits. But now……. http://www.medicinenet.com/aortic_stenosis/article.htm

7. Transcatheter Aortic Valve Replacement At Munson Medical Center, Traverse City Michigan, in August of 2012 they performed the first TAVR procedure in this region. What the TAVR procedure entails is entering through the femoral artery using a small incision and catheterizing the valve verses splitting the chest open and performing open heart surgery. What this entails is shorter hospital stays and minimal risks for infection. This procedure is only performed on the clients with severe stenosis whom aren’t qualified for open heart valve replacement. http://www.munsonhealthcare.org/News/MunsonApprovedforNewHeartProcedure http://www.harthosp.org/Portals/1/Images/21/tavr.jpg

8. PAST HEALTHCARE • Dr . Wilhem Roentgen discovered x-rays in 1895. This allowed health care professionals to “examine visual images of the human body without performing intrusive procedures” (Basu, 2012). • Albert Solomon developed mammography in 1913. It had been used for the use of early detection of breast cancer since 1927. • In 1959, ultrasound was developed “to detect tumors and examine the health of unborn babies” (Basu, 2012). • Magnetic resonance imaging (MRI) was developed in 1972, “a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body”. • Computerized axial tomography scanner was developed in 1982, a test that “uses x-rays to make detailed pictures of structures inside of the body”. • http://www.webmd.com/a-to-z-guides/magnetic-resonance-imaging-mri • http://www.webmd.com/hw-popup/ct-or-cat-scan • Picture retrieved from http://www.bing.com/images/search?q=mri&view= • detail&id=E1097F9C9BEB5C50B55C08865C5A29E112B98F5A&first=38

9. PRESENT HEALTHCARE • Health care today is becoming more advanced. Many of the devices that we use today have gone digital. Due to health care going digital, patients are able to receive procedures that are less invasive. • In order to obtain precise data to treat patients, doctors are using modern technology. • Images obtained from CT scans, MRI scans, ultrasounds, and even x-rays can be sent to doctors over the internet so that they are able to see the image without having to step foot in the hospital. (Topol, 2011) • Doctors are able to put orders in the system for their patients from the convenience of their office, or even their home through the new computerized physician order entry (CPOE). (Topol, 2011) • Picture retrieved from http://www.bing.com/images/search?q=mri&view=detail&id=17DFE0030787014A1FAB6E2582BC6DA159FE81B0&first=73

10. FUTURE HEALTHCARE • Even though we are using computer based charting, not everything is charted in the computer. We still have paper charting. “Eventually all paper based patient related data will be converted to electronic medical records, thereby eliminating the need for paper based records” (Hamilton, 2011). • Telemedicine is “a process of connecting physicians and patients through modern day technology, such as the internet” (Hamilton, 2011). Telemedicine is something that will eventually eliminate the need for patients to make office visits with their physician. They will be able to get medical advice from the comfort of their own home. • Robots will be used by the surgeons to assist them in surgeries. Having the robots assistance will cause less invasive surgeries. The incision area will not need to be as large, which also makes the recovery time shortened. http://www.bing.com/images/search?q=da+vinchi+surgery&view=detail&id=A62042FB0CFB706986E11A3B7CDD017005FC5DB3&first=1p://

11. Medicare in 2010 Medicare is an insurance policy for people over the age of 65 and it is continuously changing because people want to get better insurance for the money they are paying. The major problems with Medicare during 2010 was the coverage and the payments. The past problems with Medicare were called “the donut hole” because some seniors hit a point where they weren’t getting insurance to pay for their medications since they had reached a certain limit and some weren’t able to pay for it on their own because there medications were very expensive but there was a way to help with the cost of medications, it was a rebate check for $250 that senior citizens had the chance for when they reached their limit. http://money.usnews.com/money/blogs/the-best-life/2009/11/13/2010-medicare-changes-demand-careful-review http://www.rd.com/health/healthcare/medicarewhats-new-for-2012/

12. Medicare Currently In 2012 the Medicare coverage was able to change to covering drug benefits and health-care unlike in the previous years. Compared to 2011 in 2012 elders are only charged a small amount out-of-pocket co-pay. Some of the different parts of Medicare can be charged a smaller amount for a co-pay compared to years before. The “donut hole” in Medicare is still a problem now but it is Shrinking. At the moment generic medications can be discounted by 14% which is double the discount from 2011 which was 7%. An additional change that has occurred over the years is that if someone had Medicare or Medicaid they don’t have to pay for any co-payment of their medications. http://www.rd.com/health/healthcare/medicarewhats-new-for-2012/

13. The Future of Medicare The “donut hole” that has been a problem for years with Medicare could be non existent in 2020 and someone that has Medicare would only be paying 25% of any prescription medication they needed. Some parts of the future of Medicare are looking bad because there might be a $716 billion cut after 2013 because of the Affordable Care Act. There is also a possibility that the age that people can start using Medicare will raise because there are so many people that are starting to use it. The “baby boomers” are going to start getting older and they will start to need Medicare and it will cause problems for the people that need it after them. Some of the premiums that people have to pay every month could also start to rise and when people don’t have an income other than Social Security it makes it difficult for them to afford their Medicare and medications. http://www.rd.com/health/healthcare/medicarewhats-new-for-2012/ http://articles.orlandosentinel.com/2012-10-19/news/fl-medicare-guide-qa-20121019_1_coverage-gap-doughnut-hole-drug-coverage http://www.aarp.org/health/medicare-insurance/info-05-2012/future-of-medicare-proposals.html

14. Nursing Bed side care relied upon mother, wife or good neighbor to care for or keep an eye on patients at their homes. Children were born and the doctors relied upon their own wife's or a preachers wife to go in and help with the care. Hospitals Logbook by Capt. Alex Harrison indicated someone was hospitalized with a date of Oct 11, 1785 Hospital barrack conditions in Detroit June 24, 1790 Hospitals = one room, 21 single berths and one chimney Earliest hospital in Detroit which is still in existence is St. Mary’s June 9, 1845 Nursing and Hospitals in MichiganPast

15. Nursing New healthcare delivery models Shortage of nurses – helps drive to do more with less Nurse going beyond being the caregiver to being the integrators, care coordinators and efficiency experts News models have in common 1. Moving nurse from caregiver to “care integrators” 2. Team approach 3. Bridging the care to outside the primary care 4. Home being a setting for care 5. Targeting people who access healthcare on a regular basis 6. Focusing more on patients 7. Using technology as an advantage 8. Improving satisfaction, quality and cost Nursing and hospitals in MichiganPresent

16. Nursing and hospitals in MichiganPresent continued • Hospitals • Mandates for hospitals to improve quality and continuity of care • Financial cuts may force community hospitals to merge with larger hospitals • Penalties for 30 day readmissions for certain medical conditions = number one reason for readmission is patients do not understand their discharge instructions

17. Nurses Robots – future of patient care Radiofrequency – ID tags that track every employee Smart beds – track patients breathing and heart rates to their chart Hospitals Will have two goals 1. improve clinical care 2. cut error rates By 2015 The home will be the main place of care. Monitoring equipment at home that will be sent automatically to the Doctor – will keep patients out of ER’s and urgent cares Michigan has 31 hospitals who use robots to rapidly diagnose stroke before the narrow window of treatment closes Nursing and Hospitals in MichiganFuture

18. Pharmacies in the Past In the past pharmacies were commonly called drug stores. In the mid to late 1800’s many doctors began creating medicines. Some of these doctors dropped their practices and focused solely on the development of drugs. They did not need a pharmacy degree although degrees began to be offered in 1895 at the University of Michigan. Pharmacists learned through apprenticeships. Many pharmacies were not located in their own building, one called the Opera House Pharmacy was located in Baird’s Opera House in Lansing, other locations were just as interesting. Most drug stores also had things such as food and soda fountains. Lansing was a major center for pharmacy operations between 1873 and 1920. Over 86 druggists, chemists, and drug manufacturers appeared in the city directory during that time. Almost all pharmacists were males. Pharmacists main role was to fill prescriptions. The University of Michigan started to teach Pharmacy in 1868, Ferris State University (then Ferris State Industrial School) taught its first pharmacy student in 1893, and Wayne State University (then the Detroit College of Medicine) offered its first Pharmaceutical degree in 1891. Old prescription bottles from http://www.glswrk-auction.com/contest06-7.htm

19. Pharmacies Today Walgreens Logo from http://www.wehokey.com/ Today pharmacies can be found in nearly every community. Walgreens, CVS, and Rite-Aid are popular retail pharmacy chains found in Michigan. Pharmacies are also located in hospitals. Pharmacists work with insurance companies for cost effective care for the patients. Pharmacies have started to use electronic prescriptions and online pharmacies are frequently used. A greater focus is on patient care as opposed to strictly filling prescriptions. Only three Colleges of pharmacy exist in the state, they are at Wayne State, Ferris State, and The University of Michigan. Most pharmacists go to school for at least 6 years and receive a PharmD degree.

20. Pharmacies in the Future • Pharmacists may take on an even more patient care centered role with more direct patient interaction. • Although pharmacy activities may become more automated, the role of a pharmacist will adapt to the changes. Pharmacists will have a stronger focus on advising on medications and educating patients to help them become better able to manage their diseases. • Pharmacists will continue to be a valuable and accessible member of the healthcare team. • If the demand for pharmacists continue to rise, more pharmacy school may open in the state beyond the three existing today.

21. * Each link below is hyperlinked to the slide it belongs to. Clicking on the link will bring you to the slide. References • Hill, W. & Hirchbein, L. (n.d.). A century of improving mental health care at Michigan. Retrieved from http://www.psych.med.umich.edu/about/history.asp • Kalamazoo Public Library. (n.d.). Kalamazoo psychiatric hospital. Retrieved from http://www.kpl.gov/local-history/health/kph.aspx • Michigan Psychiatric Society. (2012). Mental health in Michigan. Retrieved from http://www.mpsonline.org/info/Pages/MentalHealthinMichigan.aspx • Public Sector Consultants Inc. (2010). Mental health in Michigan. Retrieved from http://www.rosehillcenter.org/wp-content/uploads/2010/01/Mental-Health-in-Michigan-July-2010.pdf • http://www.medicinenet.com/aortic_stenosis/article.htm • http://www.harthosp.org/Portals/1/Images/21/tavr.jpg • Basu, C. 2012. History of health information technology images. Retrieved from http://www.ehow.com/facts_7563543_history-health-information-technology-imaging.html • CT or CAT scan. Retrieved from http://www.webmd.com/hw-popup/ct-or-cat-scan • Hamilton, B. Future of healthcare-Impact of technology. Articlesbase, 3 July 2011. Web. 3 Nov. 2012. Retrieved from http://www.articlesbase.com/print/4980922 • Information and recourses: Magnetic resonance imaging (MRI). Retrieved from http://www.webmd.com/a-to-z-guides/magnetic-resonance-imaging-mri • Topol, E. The future of healthcare: Information technology. Modern healthcare, 25 July 2011. Web. 4 Nov. 2012. • Picture retrieved from http://www.bing.com/images/search?q=mri&view=detail&id=E1097F9C9BEB5C50B55C08865C5A29E112B98F5A&first=38 • Picture retrieved from http://www.bing.com/images/search?q=mri&view=detail&id=17DFE0030787014A1FAB6E2582BC6DA159FE81B0&first=73 • Picture retrieved from httwww.bing.com/images/search?q=da+vinchi+surgery&view=detail&id=A62042FB0CFB706986E11A3B7CDD017005FC5DB3&first=1p:// • http://money.usnews.com/money/blogs/the-best-life/2009/11/13/2010-medicare-changes-demand-careful-review • http://www.medicare.gov/quality-care-finder/ • http://www.rd.com/health/healthcare/medicarewhats-new-for-2012/ • http://sandiegofreepress.org/ • http://articles.orlandosentinel.com/2012-10-19/news/fl-medicare-guide-qa-20121019_1_coverage-gap-doughnut-hole-drug-coverage

22. References Continued • http://www.aarp.org/health/medicare-insurance/info-05-2012/future-of-medicare-proposals.html • http://thepragmatictheory.wordpress.com/2012/08/23/exactly-how-obamacare-cuts-medicare/ • Andrews, Michelle. “Technology of all kinds is transforming the way medical systems work.” The High-Tech Hospitals of the Future. U.S. News, 15 July 2009. Web. 11 Nov. 2012. • Beattie, Linda. “Models are redefining the role of nursing.” New Healthcare Delivery. N.p.,2009. Web.11 Nov.2012 • McKinney, Maureen. “Many hospitals will struggle to escape or absorb penalty for readmissions.” Preparing for Impact. N.p.,n.d. Web. 11 Nov. 2012. • Smith, Richard R. History of Hospitals and Nursing in Michigan. N.p., n.d Web. 11 Nov. 2012. • http://en.wikipedia.org/wiki/University_of_Michigan_College_of_Pharmacy • http://www.pharmacytimes.com/publications/issue/2010/September2010/NGP_Future_of_Pharmacy-0910 • http://www.netdoctor.co.uk/healthy-living/wellbeing/role-of-pharmacists.htm • http://www.usmedicine.com/articles/as-role-of-pharmacist-evolves-expands-va-challenged-to-fill-positions.html#.UKGEPcWHKSq • http://www.michiganpharmacists.org/public/pharmacy/ • http://www.drugstoremuseum.com/sections/level_info2.php?level=1&level_id=49 • http://www.glswrk-auction.com/contest06-7.htm • http://www.ferris.edu/HTMLS/colleges/pharmacy/about/Historical-Information-.htm • http://cphs.wayne.edu/history.php • http://umhistory.dc.umich.edu/history/Faculty_History/Pharmacy_History/College_of_Pharmacy.html • http://www.wehokey.com/

23. Kristine Cargill- Slides 1-3 • William Winowiecki- Slides 4-6 • Tifenie Harris- Slides 7-9 • Kayla Klosterman- Slides 10-12, reference slide and putting slide show together • Rebecca Williams- Slides 13-16 • Lindsey Post- Slides 17-19