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Senior Citizens need to have comprehensive medical evaluations that are readily available to emergency providers. Electronic Medical Recording is ideal for having much needed information at the proper person's finger tips. The hesitancy of primary care physicians to employ EMR/EHR systems places a heavy burden on emergency departments in the United States. Senior citizens often have special needs that are not readily known by first responders and in a crisis situations, the care provided is based on standard of care and not special needs. Innovative alternatives to the current data taking, storage and retrieval process.

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White paper healthcare

  1. 1. 2 Whitepaper 0NEEDED MEDICAL 1 1 Closing the Gap in DisparityDOCUMENTATION of Healthcare for the Elderly Pairing EHR Web-Based Technology with MEDICARE- APPROVED WELLNESS EXAM Epiphany Enterprise I, LLC Velva Boles, MD Microsoft 11/18/2011
  2. 2. EXECUTIVE SUMMARYVery few senior citizens grasp the concept of a wellness visit to their primary care provider because they areconditioned to go to the “doctor” when they are sick and in the “15-minute visit”, senior citizens are carefulnot to take more time than they are allotted. Barriers to their taking advantage of the free annual MedicareWellness Examination, which does not require a co-pay, include the lack of clarity between the terms“physical exam” and “wellness exam”. Senior citizens have limited avenues to learn of changes in Medicarecoverage and their primary care providers are reluctant to explain Medicare changes because explanationsdisrupt productivity schedules. The current systems in place concord transportation arrangements tohealthcare facilities with appointments given for follow-up visits for diagnosed conditions therefore, there isan inherent problem with getting transportation arranged for wellness visits. Finally many seniors adhere tothe general belief that, “if nothing is broken, don’t fix it”.This whitepaper provides a roadmap to successfully providing preventive healthcare to an ageing populationwho, out of ignorance, disempowerment, or limited access to private physician healthcare do not takeadvantage of a health supportive process enabled by Medicare. It proposes that a specialized service providedby a clinical practice with focused interest in geriatric healthcare and community stability can facilitateimproved healthcare as described in Affordable Care Act (ACA) and generate universal access to medicalrecords utilizing a network based electronic health record (EHR) in line with Health Information Technologyfor Economic and Clinical Health (HITECH) Act recently adopted by President Obama’s Administration. © 2011 Epiphany Enterprise I, LLC. All Rights Reserved 2|P a g e
  3. 3. OBSTACLES TO BEST HEALTH CAREMultiple factors contribute to health disparities observed with senior citizens and ethnic minorities, includingsocioeconomic factors, social environment/ neighborhood, educational and economic opportunities,racial/ethnic discrimination, work conditions, and access to preventive health-care services.Age is a major factor in health disparities because many older Americans exist on fixed incomes which often makepaying for health care expenses difficult. Additionally, they may face impaired mobility or lack of transportationwhich make accessing health care services challenging for them physically. Too often, they may not have theopportunity to access health information via the internet, as less than 15% of Americans over the age of 65 haveaccess to the internet, putting older individuals at a distinct disadvantage in accessing valuable information abouttheir health and how to protect it.The Agency for Healthcare Research and Quality identified numerous barriers to good healthcare, a few of whichare listed below:  Lack of a Primary Care Provider and Usual Source of Care. More than a quarter of African Americans do not have a regular doctor. Compared to whites, minority groups in the United States are less likely to have a doctor that they go to on a regular basis. People who do not have access to a usual source of primary preventive health care are more likely to end up in the emergency department or in the hospital; indeed, African Americans use the emergency department at twice the rate of white Americans. Emergency Departments are not intended for comprehensive health care. It has been shown that care via a primary care substantially improves health outcomes. Sometimes communication problems stem from a lack of cultural understanding on the part of white providers for their minority patients. A patient’s health decisions can be influenced by religious beliefs, mistrust of Western medicine and familial roles, of which a white provider may not be familiar.  Lack of insurance coverage. Without health insurance, patients are more likely to postpone medical care, more likely to go without needed medical care, and more likely to go without prescription medicines. Minority groups in the United States lack insurance coverage at higher rates than whites. Racial and ethnic minorities are more likely to be enrolled in health insurance plans which place limits on covered services and offer a limited number of health care providers.  Structural barriers. Poor transportation, that is, public transportation or unreliable family transport causes an inability to schedule appointments quickly or during convenient business hours, and excessive time spent in the waiting room can be problematic for the elderly on diuretics requiring frequent urination or those with “brittle diabetes” who must eat at tightly scheduled times to avoid extreme drops in blood glucose levels. All of these concerns affect a persons ability and willingness to obtain needed care.  Lack of diversity in the health care workforce. A major reason for disparities in health care is the cultural differences between predominantly white health care providers and minority patients. Only 4% of physicians in the United States are African American, and Hispanics represent just 5%. Poor communication with health care providers results in a host of problems including less access to preventative care and higher rates of re-hospitalization. Miscommunication can lead to incorrect diagnoses, © 2011 Epiphany Enterprise I, LLC. All Rights Reserved 3|P a g e
  4. 4. improper use of medications, and failure to receive follow-up care. Health care providers may unconsciously or consciously treat certain racial and ethnic patients differently than other patients. There are data to support that ethnic minorities are less likely than whites to receive a kidney transplant once on dialysis or to receive pain medication for bone fractures.  Lack of preventive care. According to the 2009 National Healthcare Disparities Report, uninsured Americans are less likely to receive preventive services in health care . POOR HEALTH LITERACY –A MAJOR OBSTACLE“Literacy and Health Outcomes”, an Agency for Health Care Research andQuality report, states that low health literacy is linked to higher rates ofhospitalization and higher use of expensive emergency services. This Two-thirds of Americanevidence-based literature review highlights numerous studies that adults age 60 and over, have inadequate orprovide a detailed analysis of the correlation between low health literacy marginal literacy skillsand poor health.Health literacy is not simply the ability to read; it includes the ability to understand instructions onprescription drug bottles, appointment slips, medical education brochures, doctors directions and consentforms. It also includes the ability to negotiate complex health care systems. Matriculating the health caresystem requires a complex group of reading, listening, analytical, and decision-making skills and the ability toapply these skills to health situations. Health literacy varies by context and setting and is not necessarilyrelated to years of education or general reading ability. A person who functions adequately at home or workmay have marginal or inadequate literacy in a health care environment. With the move towards a more"consumer-centric" health care system - as part of an overall effort to improve the quality of health care andto reduce health care costs - patients are expected to take an even more active role in health care relateddecisions.According to the American Medical Association, poor health literacy is "a stronger predictor of a personshealth than age, income, employment status, education level and race. Groups with the highest prevalence ofchronic disease and the greatest need for health care had the least ability to read and comprehendinformation needed to function as patients". The American Medical Association defines health literacy as “theability to read, understand and use health information to make appropriate health care decisions and followinstructions for treatment.” Many Americans face serious challenges interpreting basic information required tochoose a health plan and understand their health benefits. Patients with low health literacy have great difficultymanaging chronic conditions.There are both direct and indirect consequences of low health literacy. The direct effects include non-compliance and medication errors. The indirect effects are harder to measure, but often include insuranceissues, accessibility to health care and poor health behavior choices.Among patients with Type 2 diabetes low health literacy is associated with poor blood sugar control and higher riskof stroke. Patients with marginal health literacy are also less likely to seek out routine and preventive services. Lowhealth literacy is associated with poorer adherence to drug warning labels leading to increased safety risks. In“Health Literacy: A Prescription To End Confusion”, the Institute of Medicine reports that ninety millionpeople in the United States have difficulty understanding and using health information. As a result, patients © 2011 Epiphany Enterprise I, LLC. All Rights Reserved 4|P a g e
  5. 5. often take medicines on erratic schedules, miss follow-up appointments, and do notunderstand instructions like "take on an empty stomach". Eighty-one percent of patientsage 60 and older, at a public hospital, could not read or understand basic materials such asdirections on a prescription. Approximately half of Medicare/ Medicaid recipients read Use it or lose it - Readingbelow the fifth-grade level. Low literacy skills are multifold, many are abilities are typically threeattributive to a lack of educational opportunity, a decline in literacy that starts to five grade levels belowwhen school training stops and cognitive abilities decline in older adults as a the last year of school completed. People with aproduct of ageing. The relationship between literacy and health is high school diplomacomplex. Literacy impacts health knowledge, health status, and access to typically read at a seventhhealth services. Literacy impacts income level, occupation, education, housing, grade reading level.and access to medical care. The results of the 1992 Adult Literacy Survey (NationalCenter for Education Statistics, US Department of Education) indicate that adults withlow literacy were more likely than those with higher literacy levels to be poor and to havehealth conditions which limit their activities.Inadequate health literacy is nearly twice as high among African Americans (75 percent) and Hispanics (73 percent)as Whites (38 percent). Approximately 81 percent of adults age 65 and over have inadequate health literacy. TheUnited States spends more than any other nation in the world on health care - in 2007, $2.2 trillion was spent.Despite consistent increases in spending, disparities among demographic groups persist. Patients with a poorunderstanding of good health may not know when it is necessary to seek care for certain symptoms. While problemswith health literacy are not limited to minority groups, the problem can be more pronounced in these groups than inwhites due to socioeconomic and educational factors. Low-income Americans and racial and ethnic minoritiesexperience disproportionately higher rates of disease, fewer treatment options, and reduced access to care. Four inten low-income Americans do not have health insurance, and half of the nearly 46 million uninsured people in theUnited States are poor. About one-third of the uninsured have a chronic disease, and they are six times less likely toreceive care for a health problem than the insured.In addition to the effects of low health literacy on the individual patient, there are economic consequences of lowhealth literacy on society. The National Academy on an Aging Society estimated that additional health care costsdue to low health literacy were about $73 billion in 1998 dollars. After adjusting for health status, education level,socioeconomic status, and other demographic factors, people with low functional literacy have less ability to care forchronic conditions and use more health care services. Increased attention must be devoted to the problem of healthliteracy benefits. GROWING OLD COMPOUNDS HEALTH CARE PROBLEMSSENIOR CITIZENS- POOR HEALTH HISTORIANSSenior citizens often forget with whom they have shared – or not shared - information, according toresearchers, at Baycrest Rotman Research Institute, Toronto, Canada who identify this phenomenon as“destination memory failure,” or “destination amnesia.” They report that seniors are extremely reluctant toadmit they are wrong. This kind of memory faux pas can lead to awkward or embarrassing social situationsand even miscommunication at critical times, like in a doctors visit. Ironically, after making these memory © 2011 Epiphany Enterprise I, LLC. All Rights Reserved 5|P a g e
  6. 6. errors older adults remain highly confident in their false beliefs. "Destination amnesia is characterized by falselybelieving youve told someone something, such as believing youve told your daughter about needing a ride to anappointment, when you actually had told a neighbor.LIMITED RESOURCES FOR HEALTH CAREThe financial plight of the oldest citizens in the U.S. is growingvery much worse. One out of every 10 senior citizens is living in WHY ARE OLDER ADULTS MORE PRONEpoverty and the rate of bankruptcy among those ages 65 and TO DESTINATION MEMORY FAILURES?older has more than doubled since 1991. The number of senior A study funded the by Natural Sciences andcitizens (age 65 and older) in the U.S. living in poverty jumped to Engineering Research Council of Canada, Canadian3.6 million in 2007, up from 3.4 million in 2006. The percentage of Institutes of Health Research, U.S. National Institute on Aging and a Baycrest Jack and Rita Catherallall seniors living in poverty increased from 9.4 percent to 9.7 Award showed that the ability to focus and paypercent from 2006 to 2007. Individuals nearing or in retirement are attention declines with age, so older adults use uprealizing how difficult it can be to manage their debts as they age,” most of their attention resources on the telling ofsays Elizabeth Warren, a Harvard Law School professor and national information and dont properly encode the contextexpert on bankruptcy. Most Americans have two major assets: their for later recall.homes and their retirement plans. And borrowing against those assets "Older adults are additionally highly confident,can present new risks when home values and stock markets decline. In compared to younger adults, that they have neversome cases, older Americans trying to help children and told people particular things when they actually had," "This over-confidence presumably causes oldergrandchildren, borrow too much, putting themselves at risk. "Age is adults to repeat information to people."increasingly associated with financial distress and more seniors areseeking protection from creditors through the bankruptcy courts," says A critical finding in the study is that destination memory is more vulnerable to age-related declineTeresa Sullivan of the University of Michigan. Health care costs than source memory (Source memory is the ability toproved to be the top reason for many bankruptcies among senior recall which person told you certain information)citizens according to Sullivan and Deborah Thorne of Ohio University The first experiment required the individual to readin a study published by the AARP Public Policy Institute. The out loud 50 interesting facts to 50 celebrities (whosegrowing cost of health care is much faster than inflation for other faces appear on a computer screen), one at a time,goods and services and is the chief suspect in why more seniors are and then remember which fact they told to whichliving in poverty. Social Security, the most significant or only income famous person. For example, "a dime has 118 ridges around it" and I told this fact to Oprah Winfrey.for many retired Americans is increased annually at a rate less thanthe annual jumps in health care prices. The second experiment required the individual to remember which famous person told them aSPECIAL HEALTH CARE CHALLENGES FOR SENIOR particular fact: “Tom Cruise told me that the averageAFRICAN AMERICANS person takes 12 minutes to fall asleep".Consistently, the Centers for Disease Control and Prevention In the first experiment for destination memoryMorbidity and Mortality Weekly Report (MMWR) describes health accuracy, older adults performance was 21% worsecare disparities experienced by black Americans, most notably than their younger counterparts.stroke, hypertension, diabetes, obesity, and childhood asthma. The In the second experiment for source memoryexperience of racial discrimination may be a key factor in explaining accuracy, older performed 50% in recollecting whichwhy African Americans suffer at higher rates from diabetes and famous face told them a particular fact.cardiovascular disorders according to Vickie Mays, a UCLA professorof Psychology and Health Services and Director of the Center for Research, Education, Training and StrategicCommunication on Minority Health Disparities. “Discrimination causes enormous stress on a person’s mental andphysical health as shown by measurable physiologic responses of elevated blood pressure and heart rate. When aperson experiences discrimination, the body develops a cognitive response in which it recognizes the discrimination © 2011 Epiphany Enterprise I, LLC. All Rights Reserved 6|P a g e
  7. 7. as something that is bad and should be defended against. This response occurs even if the person merely perceivesthat discrimination is a possibility. When the brain perceives discrimination, a series of physiological responses areset into motion to protect itself from these stressful negative experiences. These physiological responses triggerbiochemical reactions which induces adverse health consequences.”With marginally literate African Americans and many senior citizens, responses toperceived discrimination occur so frequently that immunologic responses and The Journal of thecellular repair mechanisms no longer function correctly. According to Professor American MedicalMays, the experience of race-based discrimination is akin to the response a persons Association identifies racebody mounts when it experiences significant life-threatening danger. When the as a significant determinantbody mounts a response to protect itself against a "life-threatening" experience on a in the level of quality ofregular basis, it is strained and overworked. Many of the chemicals that come to its care, with ethnic minorityrescue cause damage in the body resulting in disease and obesity. African groups receiving lessAmericans faced with constant discrimination for many years experience high intensive and lower qualitylevels of stress. When the stress challenge to the cardiovascular system is prolonged care. Ethnic minoritiesand excessive, the immune system is suppressed, blood pressure increases and, over receive less preventativetime, atherosclerosis can develop, resulting in coronary vascular disease. "As we care, are seen less bydeal with skyrocketing rates of obesity and rising rates of diabetes in African specialists, and have fewerAmericans and other racial and ethnic minority groups, we need to think about the expensive and technicalimpact of race-based discrimination and how they respond to that stress," Mays procedures than non-ethnicsaid. "It may not be just a matter of telling a person to eat better or exercise. We minorities.may need to take a look at the persons environment and the race-baseddiscrimination that that person is experiencing." TIME TO PLUG THE HOLESENDING DISPARITY OF HEALTH CAREDefining a problem is not the same as finding a solution. Recognizing problems, however, provide an opportunity toeradicate them. To reduce disparities of health care provided to racial/ ethnic groups and the elderly, health careinstitutions must become more conscious of the staff within their facilities. It is essential that more minority groupsbe represented within the various health care offices and clinics; health care professionals be trained to work withminority groups; health care workers should be supportive and able to adjust health care plans according to thepatient’s cultural beliefs and traditional health practices because cultural competency is vital in obtaining consentand adherence to treatment plans. There must be convenient locations of the healthcare offices for minority seniorcitizens, public reliable transportation availability, evening and Saturday clinic hours, senior citizen accommodatingphysical environment of the clinic, and good rapport between staff and patients to facilitate equable health careaccording to the Agency for Healthcare Research and Quality. In a report on “how to eliminate health disparities”compiled by the Commonwealth Fund, greater minority representation within the health care workforce was a majorrecommendation.A readily accessible comprehensive medical history log performed annually for citizens who do not have continuityof care, who are poor historians, who, due to low income or illiteracy, have poor compliance to medical advice, isthe scope of a network based EHR service. For years, experts have praised electronic health record (EHR) keepingfor its potential to improve patient care, reduce medical error and the contain costs. President Obama’s © 2011 Epiphany Enterprise I, LLC. All Rights Reserved 7|P a g e
  8. 8. administration has made EHR adoption a major health care policy objective. The goal is for physicians to beginusing electronic health record keeping over the next decade and $19.2 billion has been committed through theHealth Information Technology for Economic and Clinical Health (HITECH) Act to make this a reality. To applythese objectives, the HITECH Act facilitated the establishment of 60 regional extension centers (RECs) throughoutthe United States. The Department of Health and Human Services (DHHS) allocated $640 million to the funding ofthese centers, requiring their most intensive assistance to be focused on providers furnishing primary-care services,with a particular emphasis on individual and small group practices and community health centers that predominatelyserve uninsured, underinsured, and medically underserved populations.To improve the health care of senior citizens, the Affordable Care Act (ACA) Schmitz, a retired engineer fromextended preventive coverage to more than 88 million patients covered by health Portland, Maine, was pleased wheninsurance, and Medicare has codified that benefit in the form of an annual he read that, under the new health care law, Medicare had begunwellness visit. This has been available since January 1, 2011, but both clinicians covering annual physicals free ofand eligible senior citizens have shown confusion over the type of examination charge. But after he had one,to be provided. The official handbook, "Medicare & You 2011," explained its Medicare denied his claim.intent by stating that "Medicare covers two types of physical exams — one when "When I asked the doctors officeyoure new to Medicare ("Welcome to Medicare") and one each year after that what had happened, they clued me(Annual Wellness Exam)." Both have value, but neither exam, described by in that I was mistaken about theMedicare, was what patients or physicians usually regarded as a physical difference between [Medicares] wellness exam and a physical," heexamination. says. "I was upset that the way its"The annual wellness visit can be performed without the patient ever having to set up is misleading."undress, and that sums up the problem," says Yul D. Ejnes, M.D., a practicinginternist in Rhode Island and chair of the board of regents of the American College of Physicians. The annualwellness examination requires the clinician to record and evaluate the patient’s medical and family history, currenthealth condition and compile a list of current medical providers and prescription/non-prescription drugs; to checkblood pressure, vision, weight, height and waist measurement to calculate body mass index (BMI); to performcognitive impairment testing; to review risk factors; to review functional ability; to establish a writtenscreening schedule for next 5-10 years; to establish list of risk factors; to discuss voluntary advanced careplanning, and to provide advice and referrals to health education and preventative counseling servicesincluding: Smoking and Tobacco Cessation Counseling; Screening Pelvic/Breast exam; Screening Pap SmearCollection; Medical Nutrition Therapy Services; Screening Mammography; Bone Mass Measurement; Colon CancerScreening. Such a visit would not include evaluating a new complaint or symptom with the expectation of treatingan ailment. WHAT YOU NEED TO KNOW ABOUT FREE MEDICARE CHECKUPS During a wellness visit, the doctor measures the patient’s height, weight, body mass and blood pressure – and perhaps listens to his heart through his clothes. The rest is a discussion of the patient’s medical and family history, any physical or mental impairments, and risk factors for potential diseases such as diabetes and depression. The doctor also establishes a schedule for future care, and may refer the patient for tests and screenings, many of which are now free under Medicare. In other words, the wellness visit provides a snapshot of the patient’s current health, as a baseline for future yearly visits, and is intended as a preventative service, a way of catching potentially serious health issues early. © 2011 Epiphany Enterprise I, LLC. All Rights Reserved 8|P a g e
  9. 9. “The fact that Medicare in now recognizing the importance of wellness visits and supportive services and then iswilling to pay for them is a big step forward. That cannot be overstated”, says Dr. Ejnes. “A lot of times, thecounseling that occurs is more important than the poking and prodding. You’re talking about weight, smoking,exercise, and screening for depression. But it’s not what we would normally consider a physical. Hence theresistance we’re seeing from physicians offering the wellness visit service and perhaps a sense of dissatisfactionwhen the patient leaves and realizes that what they got wasn’t what they thought they’d be getting.” Research hasshown that most doctors don’t talk to their patients about weight loss or diet, but when they do take time to discussit, people often act on it. In one study, patients who were obese and advised by their doctors to lose weight werethree times more likely to try to lose weight than obese people who didn’t receive such advice. G ETTING THE J OB D ONEThis white paper addresses an important problem – disparity of healthcare to American elderly citizens – anddescribes an innovative method to overcome critical barriers that prevent progress towards a more homogeneoushealthcare system in the United States. Having an EHR web-based system in place, which cataloguescomprehensive medical history for segments of the population who utilize large portions of healthcare resources viaemergency room visits, will facilitate better responses to chronic health problems, as well as, minimize socialservices interventions related to morbidity associated with advanced irreversible diseased states. Successfulimplementation of the program described in this treatise will change the concepts, methods, technologies,treatments, services and preventative interventions for the senior citizen community. The insights in this whitepaperprovide a step-by-step guide to achieving success with the proposed process. 8 Tips for improved health literacy and health care for Senior Citizens INTERACT WITH THE COMMUNITY TO IMPROVE HEALTH LITERACY 1. Interact with senior citizens at an organized senior function in a Community Center to establish trust and credibility 2. Work with churches to schedule health literacy classes as part of their health program 3. Give Power Point Presentations and Webinars on Health-related Issues 4. Increase public access, especially for senior citizens, to computers with internet service to utilize nationally- prepared teaching resources SELECT DEDICATED CLINICIAN TO DO ANNUAL WELLNESS VISITS EVALUATIONS 5. Utilize Provider who is sensitive to the cultural needs and medical beliefs of the community 6. Utilize Provider who works with network EHR to facilitate universally easy access to Medical History. 7. Utilize Providers who work outside of traditional clinic settings 8. Utilize Providers genuinely interested in geriatric health disparity causes © 2011 Epiphany Enterprise I, LLC. All Rights Reserved 9|P a g e
  10. 10. TE AC H I NG TH E B E NEF IT S O F P REV E NT IV E C AR E Being able to meet clients at the level at which they present is imperative to be successful in providingquality clinical care. There is a lingering distrust of government programs, among elderly poor AfricanAmericans in the south, from the government’s abuse of private citizens as recorded with the syphilis study -Tuskegee Experiment. Only interactive community-based health providers can confront such fears. Localclinicians are more likely to patiently listen and validate patrons concerns then provide clear statements ofthe facts regarding the programs to be implemented. “Client Readiness Services” are necessary to recruit,retain and serve the low socioeconomic income population and the elderly. Preventative care is paramount to stopping the root causes of disease as well as detecting diseases in their earlystages when treatment is most effective. African Americans continue to have lower life expectancies on average thanwhites in the United States. Even with rates adjusted for age, African Americans are 1.6 times more likely to diefrom one of the 10 leading causes of death in the United States than European Americans. The life expectancy gap isaffected by collectively lower access to quality medical care. With no system of universal health care, access tohealth care in the U.S. generally is mediated by income level and employment status. As a result, AfricanAmericans, who have a disproportionate occurrence of poverty and unemployment as a group, are more oftenuninsured. For a great many African Americans, healthcare delivery is limited, or nonexistent. And when theyreceive healthcare, they are more likely than others in the general population to receive substandard, even injuriousmedical care. Better Outcome with Early and Consistent InterventionLow-income women are 26% less likely than women in the highest income bracket to receive a mammogram, asimple screening that is vital to the early detection of breast cancer, Although, African American women suffer frombreast cancer at a lower rate than white women; they die from the disease more often. Less than one-third of peoplewith low incomes receive proper care for diabetes; they incur kidney disease and foot amputations as late-termconsequences – conditions that are much more likely among African Americans. Diabetes requires consistentmanagement which includes hemoglobin testing, eye and foot examinations, influenza vaccinations, and lipidmanagement to prevent progression of the disease. African Americans are twice as likely to have diabetes as whites,and twice as likely to die from the disease. Obesity affects 37% of men and 51% of women. This and other factorscontribute to hypertension, which affects 40% of all adults. African American men are twice as likely to havediabetes-induced end-stage kidney disease, and twice as likely to die of it than white men of the same age. AfricanAmericans are 1.7 times more likely to have a stroke and 60% more likely to die from it. Two reasons for poorerhealth are lack of routine preventative medical care, such as mammograms and colonoscopies, and the absence of aprimary care physician. Disease Happens with Sex After 50HIV among adults over 50 is not a new phenomenon. Since the early 80s, HIV in persons older than 50, haveaccounted for about 10 percent of all cases. Heterosexual transmission in men over 50 is up 94 percent and the ratehas doubled in women since 1991. And while prevention and education dollars are concentrated toward young adultpopulations, seniors are not getting safer sex education and continue to get HIV infected. Studies have shownphysicians do not routinely assess for HIV risk factors in persons over 50. The incorrect belief that people over 50do not have sexual risk factors for HIV is contributing to the incidence of unprotected sex among seniors and the © 2011 Epiphany Enterprise I, LLC. All Rights Reserved 10 | P a g e
  11. 11. lack of safer sex education directed at people over 50. Lack of HIV In Newark, New Jerseyknowledge combined with the belief that safer sex is only for young women among senior citizens (50wanting to prevent pregnancy leads to at risk behavior among our elders. years and older) rates ofWithout intensive education, post menopausal adults are less likely to infection for HIV/AIDSdiscuss condom use, since the risk of pregnancy is removed. It cannot be make up 16% of all newassumed that senior citizens understand the basic facts about HIV reported cases. For thistransmission. Prevention programs must be developed specifically for this population, the number ofpopulation recognizing the stigma attached to discussing HIV-related cases has doubled in thebehaviors. A broad baseline assessing senior citizens knowledge and last four years; yet therebeliefs about HIV risk reduction must be developed so that appropriate are few programs in theprevention programs can be designed and implemented. United States that target older adults, and littleAfrican Americans are the American ethnic group most affected by HIV research conducted toand AIDS, according to the Centers for Disease Control and Prevention measure their knowledge(CDC). Black men are six times more likely to have HIV than white men and attitudes aboutand black women are nearly 18 times more likely to have HIV than white HIV/AIDS.women. A 2004 "CDC analysis of men who has sex with men in five citiesfound that while only 18 percent of the HIV-infected white men wereunaware of their infections, 67 percent of the infected black men were unaware. We seldom think about HIV andsenior citizens. HIV surveillance shows that 11 percent of all new AIDS cases are in people over the age of 50.Statistics also show that new AIDS cases rose faster in the over 50 population than in people under 40. Expertsreport that more than half of persons over 50 are having sex a couple times each month. Unfortunately, knowledgeof safer sex practices among seniors is much less than that of persons in their late teens and early twenties. Thiscombination of facts explains in part why the HIV population among seniors continues to grow. K EEPING THE F OCUS ON THE P ATIENT N OT THE D ISEASEThe key to successfully closing the gap of the disparity of health care for elderly citizens is personal interaction withthe target population. A relationship must be fostered so that the recipients of the information/care trust theproviders. Many government agencies advocate developing partnerships with community-based organizations,public libraries, senior-citizen facilities, adult day care, assisted-living facilities, nursing homes, and health careassociations to have ready access to the target population of senior citizens, but these programs have marginalsuccess because too little culturally-sensitive elements are imbedded into the design of the plan resulting in thetarget population not trusting those authorized to facilitate health care information programs.The Medicare Modernization Act of 2003 mandated that the Centers for Medicare and Medicaid Services utilize acommercial model for chronic disease management. The agency launched the Medicare Health Support PilotProgram to test the model in 2005. The conscripted companies used nurse-based call centers to assess the needs ofpatients with diabetes and heart failure. Each program used “coaches” to improve patients’ understanding of theirdiseases, their ability to manage self-care, and their ability to communicate with providers. Companies wererequired to meet preset targets for clinical quality and patient satisfaction and to hold health care costs under a presetlimit. The disease-management programs “had little success” in curbing hospital admissions and emergencydepartment visits for conditions amenable to ambulatory care according to investigators reporting in the NewEngland Journal of Medicine (2011:365:1704-12). The average monthly health care costs increased substantially forall patients in the disease management groups. Dr. McCall and Dr. Cromwell of RTI International ( a consulting © 2011 Epiphany Enterprise I, LLC. All Rights Reserved 11 | P a g e
  12. 12. firm) which evaluated the outcome of the Medicare Health Support Pilot Program made the following observationsabout why the “disease-managed” program failed.  Medical care of elderly, chronically ill patients- typically covered by Medicare and Medicaid- are inherently difficult and expensive, unlike the care of the average patient covered by a commercial disease- management program.  Non-physicians involved in the care of elderly, chronically ill patients are usually surprised by the number of health and psychosocial problems that are prevalent among Medicare patients and are less equipped to address issues raised during conversations.  The unpredictable nature and immediacy of chronic disease flare-ups call for real-time information on health status which is inaccessible from disease-managed programs. Partnerships with community-based organizations are necessary to develop outreach programs for senior-citizensthat provide health information. Public library should host health information classes as part of public serviceinitiatives. Literature that is multi-lingual, culturally appropriate and easy to read should be readily available onmass transit systems, at shopping malls, grocery stores and on billboards. Low income and elderly citizens shouldhave ready access to computers, placed in supervised public places, with internet service so that published webinarscan be utilized.The health care reform legislation signed by President Obama in March 2010 leverages health care informationtechnology to improve quality, cost and access for patients. This legislature supports programs to foster the reportingof quality measures through the use of health information technology; directs the use of health informationtechnology (IT) in improving health care outcomes and supports health information technology education andtraining among medical practitioners. TO GET THE FREE WELLNESS VISIT CHECKUP  Find doctor participating in the Medicare Program  Ask the doctor for the free Wellness Visit Evaluation  DON’T just ask for a physical—you will have to pay for it  Get Wellness Visit Every Year – Always FreeDespite widespread use of information technology in other sectors, few physicians have embraced the long-termvalue of electronic medical recording files. Regional Extension Centers (RECs) will support health care providerswith direct individualized and on-site technical assistance in selecting certified EHR product that offers best valuefor the provider’s needs; achieving effective implementation of a certified EHR product; enhancing clinical andadministrative workflows to optimally leverage an EHR system’s potential to improve quality and value of care. Aspart of an integrated solution, with practice management and patient communications services, electronic medicalrecording systems can dramatically boost efficiency of continuity of care for the elderly and underservedpopulations. When done right, focused effort on maximizing Medicare Wellness Examination accessibility andrecording the data via EHR-network based systems will result in an improved health care system providing moreequable care to the elderly and the underserved population. The office of the National Coordinator for HealthInformation Technology has recommended that regional extension centers focus on the most at-risk communities. © 2011 Epiphany Enterprise I, LLC. All Rights Reserved 12 | P a g e
  13. 13. Epiphany Enterprise offers a unique clinical service utilizing Medicare Wellness Visit – Preventative Health Careinitiative and HITECH-supported electronic health record web-based approach to electronic health recordscompilation and storage to deliver greater clinical control and insights to medical practices while closing the gap forthe disparity of healthcare among the elderly and other underserved populations. Ready access to a patient’scomprehensive medical history, doctor’s visits, laboratory reports, hospitalization course information and pharmacyuse ensures continuity of care for all American citizens. Such services promise: Better patient care. Improved access to patient information and clinical data could mean reduced medical errors, better patient safety, and stronger support for clinical decision making. Process integrity. An electronic health recording system can help get things done the right way, at the right time, and the same way each time – all based on best practice work flows. Primary Care Provider and staff satisfaction. Use of electronic health record-keeping can strengthen a practice team by allowing more time for direct patient care and reduced administrative burdens. Greater patient satisfaction. Elderly persons often feel that insufficient time is spent on the “human” aspect of providing medical care. Having ready access to information on social history and family history will make it possible for a “new physician” to interact with greater familiarity with the patient and thereby allowing the patient to relax and feel more trusting.To learn more, visit http://circlepad.com/EpiphanyEnterprise1/Homepage © 2011 Epiphany Enterprise I, LLC. All Rights Reserved 13 | P a g e
  14. 14. ENDNOTES 1. Office of the Actuary, Centers for Medicare and Medicaid Services, National Health Expenditure. Projections for 2008. U.S. Department of Health and Human Services, 2. Report on the Council of Scientific Affairs, Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association, JAMA, Feb 10, 1999 3. Mead, H., Cartwright-Smith, L., Jones, K., Ramos, C., Siegel, B., Woods, K. (2008). “Racial and Ethnic Disparities in U.S. Healthcare: A Chart book.” The Commonwealth Fund. 4. Agency for Healthcare Research and Quality, National Healthcare Disparities Report, 2008 5. Kaiser Family Foundation, Medicaid and the Uninsured, (Washington, DC: Kaiser Family Foundation, 2009). 6. Fiscella, K., Franks, P., Gold, M. R., & Clancy, C. M. (2000). Inequality in quality: Addressing socioeconomic, racial, and ethnic disparities in health care. The Journal of the American Medical Association, 283(19), 2579-2584. 7. Brach, C. & Fraser, I. (2000). Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A Review and Conceptual Model. Medical Care Research and Review, 57, 181-217. Retrieved March 31, 2008 from Google Scholar 8. Lohr, Steve. “Most Doctors Aren’t Using Electronic Health Records.” New York Times, June 19,2008 9. Title IV – Health Information Technology for Economic and Clinical Health Act. Prepared by the Majority Staff of the Committees on Energy and Commerce, Ways and Means, and Science and Technology, January 16, 2009. 10. New England Journal of Medicine (2011:365:1704-12): Medicare Health Support Pilot Program 11. American Medical News, AMA; American Medical Association. Vol 54, Number 22, November 21,2011 12. Internal Medicine News : Vol 44, Number 19, November 15, 2011 13. "Income Stable, Poverty Up, Numbers of Americans With and Without Health Insurance Rise, Census Bureau Reports". U.S. Census Bureau News. August 26, 2006. Archived from the original on September 29, 2006. 14. "Ethics and Human Rights Position Statements: Discrimination and Racism in Health Care". American Nursing Association.. March 6, 1998 15. "Risk Factors and Coronary Heart Disease". American Heart Association. 16. Tronetti, Dr. Pamela (18 January 2011). "Senior consult: Black health statistics are alarming". Melbourne, Florida: Florida Today. pp. 1D. 17. "HIV Prevalence Estimates – United States, 2006". Centers for Disease Control and Prevention. © 2011 Epiphany Enterprise I, LLC. All Rights Reserved 14 | P a g e
  15. 15. Epiphany Enterprise I, LLC 1429 Third Street Alexandria, Louisiana 71301-8250 318-487-9254 At Epiphany Enterprise I, LLC we offer personalized service to elderly clients always sensitive to their limitations and needs. This sensitive allow us to be successful in breaking down barriers encounter by primary care providers, emergency room personnel and other institutions. To learn more about our service visit our website. © 2011 Epiphany Enterprise I, LLC. All Rights Reserved 15 | P a g e