New idea: patient-centered healthcare

American health care, with or without the reform so desperately needed, seems headed in the direction of comprehensive care. For us patients — those of us fortunate enough to have coverage allowing us to be patients — part of this is having one doctor who really knows and follows your general condition. A century ago, before costs went through the roof and access to care went out the window, American health care worked that way.

At the California Wellness Foundation‘s Healthy Aging Conference in Los Angeles earlier this week the talk was all about “medical home“. Unwilling to risk a blatant display of ignorance I spent much of the morning frantically searching the speaker’s handouts for a clue about what a medical home might be. The speaker, it being early on in the event when my bewilderment arose, was keynoter John Rother, Executive Vice President of Policy and Strategy for AARP.

Though it was not in the handouts — the audience consisted largely of health professionals who presumably knew all this — I will clarify the medical home business here. With a little help from Wikipedia: “an approach to providing comprehensive primary care… that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family.”

Rother’s power-point presentation, billed as “Moving Past Talk: the Challenge of Wellness” reviewed the state of U.S. health, health care and endangered health reform before getting to the medical home issue. When he did, he characterized the medical home as “more personalized delivery of services,” adding that the concept envisions that “someone’s in charge.” It enables hospitals and doctors to work more closely together, Rother said, and provides extra payments for primary care doctors.

Kaiser has this. Many of us enjoy this. Could we please find a way for the healthcare homeless of America also to find a medical home?

New killer: high tech in the front seat

How many people will this latest gadget kill?

Some cool dude can decide between the Boeuf Bourguignonne or the Coq au Vin en route to the restaurant – what difference should running over a pedestrian or two make? Or rear-ending a smaller car with a new baby in the back seat? Maybe he’ll smack into another cool dude flipping through music albums and they can take each other off the map. But it seldom works that way; usually the dead include innocent people who were doing nothing stupid at all.

That, clearly, should be where the line is drawn: when our obsession with high tech and cool toys means we will be killing other folks. But high tech cool toys make a lot of money.

To the dismay of safety advocates already worried about driver distraction, automakers and high-tech companies have found a new place to put sophisticated Internet-connected computers: the front seat.

Technology giants like Intel and Google are turning their attention from the desktop to the dashboard, hoping to bring the power of the PC to the car. They see vast opportunity for profit in working with automakers to create the next generation of irresistible devices.

This week at the Consumer Electronics Show, the neon-drenched annual trade show here (New York City), these companies are demonstrating the breadth of their ambitions, like 10-inch screens above the gearshift showing high-definition videos, 3-D maps and Web pages.

The first wave of these “infotainment systems,” as the tech and car industries call them, will hit the market this year. While built-in navigation features were once costly options, the new systems are likely to be standard equipment in a wide range of cars before long. They prevent drivers from watching video and using some other functions while the car is moving, but they can still pull up content as varied as restaurant reviews and the covers of music albums with the tap of a finger.

It really is beside the point to blame Intel and Google. Drunk drivers kill people and nobody blames Old Crow. Or, as the NRA folks like to say, “Guns don’t kill, people do.” People, lacking the common sense to admit that hurtling around in a few tons of steel requires paying attention while you hurtle, are going to kill people with these new toys.

Safety advocates say the companies behind these technologies are tone-deaf to mounting research showing the risks of distracted driving — and to a growing national debate about the use of mobile devices in cars and how to avoid the thousands of wrecks and injuries this distraction causes each year.

“This is irresponsible at best and pernicious at worst,” Nicholas A. Ashford, a professor of technology and policy at the Massachusetts Institute of Technology, said of the new efforts to marry cars and computers. “Unfortunately and sadly, it is a continuation of the pursuit of profit over safety — for both drivers and pedestrians.”

One system on the way this fall from Audi lets drivers pull up information as they drive. Heading to Madison Square Garden for a basketball game? Pop down the touch pad, finger-scribble the word “Knicks” and get a Wikipedia entry on the arena, photos and reviews of nearby restaurants, and animations of the ways to get there.

A notice that pops up when the Audi system is turned on reads: “Please only use the online services when traffic conditions allow you to do so safely.”

Oh, sure. As if someone with the arrogance to believe he or she can drive a car while drinking a latte, negotiating a business deal and reserving tickets to the ballgame is going to notice a little thing like a kid on a wobbly bike just ahead.

The technology and car companies say that safety remains a priority. They note that they are building in or working on technology like voice commands and screens that can simultaneously show a map to the driver and a movie to a front-seat passenger, as in the new Jaguar XJ.

“We are trying to make that driving experience one that is very engaging,” said Jim Buczkowski, the director of global electrical and electronics systems engineering at Ford. “We also want to make sure it is safer and safer. It is part of what our DNA will be going forward.”

Ford’s new MyFord system lets the driver adjust temperature settings or call a friend while the car is in motion, while its built-in Web browser works only when the car is parked. Audi says it will similarly restrict access to complex and potentially distracting functions. But in general, drivers will bear much of the responsibility for limiting their use of these devices.

Drivers are proving every day that they would rather multi-task than pay attention to their driving. Lives are lost every hour to distracted drivers. More lives will be lost to people engaging in Mr. Buczkowski’s driving experience because driving without paying attention is not part of our DNA.

There is a family joke around our house about my husband, who doesn’t eat, drink or talk on cell phones while riding and has certainly never drunk anything or phoned anybody himself while driving, suggesting that “a car is something intended to get you from point A to point B.”

Maybe we should quit laughing.

Driven to Distraction – Despite Risks, Carmakers Integrate the Web With the Dash – Series – NYTimes.com.