1. Zolot, Joan PA

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Transformations in health care systems.

Figure. Health care ... - Click to enlarge in new window Health care organizations are easing up on dress codes. The Mayo Clinic Health System now allows female employees, including nurses, to forgo hosiery though visible tattoos continue to be discouraged and body piercings other than in ears are "unacceptable." The Indiana University (IU) Health System went further, allowing visible tattoos, unnatural hair color, colorful socks, and shoes with sports logos. Sarah Love, an ED nurse at IU Health West Hospital in Avon, Indiana, shows one of her tattoos. Photo by Kelly Wilkinson / IndyStar.

* Consolidations. In an effort to reduce costs by increasing market share and bargaining power, health care organizations have been consolidating-a trend likely to continue in the coming year. In 2017, health care mergers and acquisitions increased by nearly 13% from the previous year, with Pennsylvania, Georgia, and Texas as the most active states. And, during the first half of 2018, mergers and acquisitions (announced and/or closed) increased by 12.3% compared with the same period in 2017. Such alliances, however, may not deliver the promised bounty; a 2018 paper by the National Bureau of Economic Research found that hospitals acquired in a merger save on average only $176,000 or 1.5% annually.


* Health system innovators. In 2018, Amazon, Berkshire Hathaway, and JPMorgan Chase and Co., formed a partnership with the stated goal of reducing health care costs while improving employee satisfaction with health care services. The initiative, which is still in development, would create a separate company to provide health services to U.S. employees of the founding companies. Surgeon and author Atul Gawande has been named chief executive officer. Amazon has stepped into the health care business in other ways, including teaming up with Arcadia Group to offer devices for hypertension and diabetes management. Amazon also reportedly is planning to operate a primary care clinic for employees at its headquarters in Seattle, following the example of Apple and Tesla, which are also developing on-site clinics.


* Corporations join the fray. Among the most visible corporate alliances in 2018 was the $69 billion merger of CVS Health and Aetna, which the U.S. Justice Department approved in October following an antitrust review. Other corporate deals included GlaxoSmithKline's acquisition of Novartis AG's share in their consumer health joint venture and the merger of drugmakers Celgene Corporation and Juno Therapeutics.


* Electronic health records (EHRs). According to a recent survey by the College of Healthcare Information Management Executives, 95% of clinicians regularly consult EHRs to obtain clinical information. While many health care professionals remain ambivalent about the utility of EHRs, dissatisfaction may be lessening. In a 2018 survey of about 7,400 RNs by Black Book Market Research, 69% of respondents said EHRs were disruptive to productivity, down from 84% in 2016.



The new language of health care: buzzwords to know. It's important for nurses to understand the latest medical terminology, and to help explain new terms to patients, who may need to understand them in order to comprehend their plan of care. Forthwith, a primer on a few of the new medical buzzwords currently in use:


* Artificial intelligence, often referred to as AI, is the capability of a machine to imitate intelligent human behavior. Examples are robots used in surgery, virtual nursing assistants, and voice-to-text transcription capability.


* Digital health care refers to the use of technology to provide potentially motivating fitness and wellness feedback to patients-exercise and diet trackers, for example.


* Genomic medicine is defined by the National Human Genome Research Institute as "an emerging medical discipline that involves using genomic information about an individual as part of their clinical care." Examples include newborn screening for gene mutations that cause disease and DNA sequencing to investigate infectious disease outbreaks.


* Population health, a term developed in 2003, is evolving and continues to engender debate. According to the Centers for Disease Control and Prevention, the term refers to an "interdisciplinary, customizable approach that allows health departments to connect practice to policy for change to happen locally."


* Precision medicine is defined by the Precision Medicine Initiative as an innovative approach to treatment that takes into account "individual differences in people's genes, environments, and lifestyles" rather than a one-size-fits-all approach.