Monday, April 1, 2019

Highlights From The Last 250 Years of Healthcare

Hi fellow #Informatics enthusiasts, physician leaders, CMIOs, CNIOs, and other #healthcare junkies,

So I'm working on a blog post about physician leadership and healthcare traditions, but before I can write that blog post, I had to research some about our history in healthcare - When major things happened, how we got here, and how those discoveries years ago helped to shape our modern healthcare landscape today.

Initially, I thought I'd go back 100 years, to see what the major achievements were - and how they impact us in today. And then I found out - there were several achievements way before that, that I needed to include, because they are still shaping modern healthcare. 

The healthcare environment we think of today is largely the result of many decisions, discoveries, and role developments, some serendipitous, that occurred slowly over the last 250 years.

So I thought I'd document some of the major highlights here, for review and discussion, before I plan my next blog post. Feel free to review and enjoy - And if you see items that need to be added, please leave them in the comments section below!

Some Highlights From The First 250+ Years of Healthcare :
1700s
  • 1765 - First US Medical School opens, the College of Philadelphia (now the University of Pennsylvania). Ben Franklin recommends documenting care, and creates first medical record.
1800s - 1850s
  • 1800s -1900s - While German and British healthcare models grow in Europe, most American ‘healthcare’ exists largely as a mix of voluntary, religious, and charitable alms houses, along with some battlefield doctors and nurses tending to the wounded.
  • 1846 - Hungarian doctor Ignaz Semmelweis recommends hand washing to help prevent the spread of disease. 
  • 1846 - Dentist William T. Morton and Surgeon John Collins Warren do first surgical procedure with anesthesia at Mass General Hospital.
  • 1854 - Florence Nightingale documents first Quality Improvement project during Crimean war, reducing mortality rate in Crimean War from 42% to 2% - Registered Nursing soon becomes a profession, with formal hospital-based training programs.
  • 1854 - Cholera outbreak occurs in London, and John Snow investigates and practically invents Public Health
1860s 
  • 1860 – 1960 – Deliberate Quality Improvement efforts take a foothold in other industries (eg. automobile manufacturing, etc.)
  • 1861 – 1865 – American Civil War
  • 1862Louis Pasteur develops pasteurization.
1870s - 1890s 
  • 1879 – French physician Charles Chamberland develops sterilization technology.
  • 1881Louis Pasteur develops anthrax vaccine.
  • 1883 - German Chancellor Otto Von Bismark develops first state-run medical insurance program.
  • 1885Louis Pasteur develops rabies vaccine.
  • 1895 - William Conrad Roentgen accidentally discovers X-rays, wins Nobel in 1901.
1900s - 1920s 
  • 1910 - Flexner Report formalizes and standardizes medical education to 4-years plus residency.
  • 1914 – 1918World War I
  • 1916 - After isolating it from canine liver cells, heparin discovered by surgeon Jay McLean and physiologist William Henry Howell, but not available for clinical trials until 1935.
  • 1918 - Influenza Pandemic kills millions worldwide. Surgeon General Dr. Rupert Blue uses public health tools and documentation to save lives.
  • 1920s – 1980s - A predominantly employer-based fee-for-service health insurance system develops in the US, in a very fragmented, decentralized manner - with private insurers and the government eventually filling some, but not all of the gaps.
  • 1928 - Sir Alexander Fleming accidentally finds an empty circle around some mold on a staphylococcus culture plate, and discovers the "wonder drug" penicillin.
  • 1928 - First MCAT Test.
1930s - 1950s 
  • 1930President Hoover creates Veterans Administration and first VA Hospitals.
  • 1935 - Heparin first available for clinical trials.
  • 19411945World War II
  • 1942 - William Beveridge publishes "Beveridge Report" which advocates for England to build a "National Health System"
  • 1942 - After noting that WWI mustard gas was a potent suppressor of hematopoeisis, nitrogen mustards were further developed during WWII at Yale University and were given by vein (instead of inhaling irritant gas) to several patients with advanced lymphomas who had temporary but notable improvements, in what was the first chemotherapy regimen
  • 1945 - Industrialist Henry Kaiser builds first pre-paid health program for his employees which becomes "Kaiser Permanente"
  • 1945 – 1950Penicillin becomes more widely available. Narcotic analgesia also becomes available.
  • 1950sJonas Salk develops polio vaccine. Nursing training programs begin to move from hospitals to colleges and universities.
  • 1950s - Physicist Gordon Brownell and neurosurgeon William Sweet from Mass General use first PET scanner to detect brain tumors using sodium iodide.
  • 1951Joint Commission establishes itself as “The Joint Commission of Accreditation of Hospitals”, but accreditation has no significant impact until 1965 (see below).
  • 1951 - American College of Obstetricians and Gynecologists (ACOG) formed, formalizing specialty training for obstetric care and Women's Health.
  • 1952 - American Psychiatric Association publishes first Diagnostic and Statistical Manual (DSM) of Mental Disorders, standardizing and formalizing diagnostic criteria for patients with mental health needs.
  • 1953 - Although they did not 'discover DNA', James D. Watson and Francis Crick build upon X-ray crystallography work by Rosalind Franklin and Maurice Wilkins to publish description of double-helix structure of DNA.
  • 1955 - Chemist Leo Sternbach invents benzodiazepines when he accidentally discovers chlordiazepoxide (Librium), first available for clinical use in 1960.
  • 1956 – 1958 - Dr. Peter Safar develops A-B-C technique for CPR, convinces Baltimore Fire Department to have first ambulance staffed with Emergency Medical Technicians, and creates first 24-hour ICU.
1960s - 1980s 
  • 1960 - First oral contraceptive pill, Enovid, is approved by FDA.
  • 1964 - First loop diuretics ethacrynic acid and furosemide approved for use. 
  • 1965Centers for Medicare and Medicaid Services (CMS) established, and establishes Joint Commission accreditation as a Condition of Participation (CoP).
  • 1967 - South African surgeon Christiaan Barnard does first heart transplant.
  • 1968 - First 911 call made in Haleyville, Alabama to the Fire Chief, starts first US 911 service.
  • 1968 - NEJM publishes 'Medical Records that Guide and Teach' by Larry Weed, MD, creating the first SOAP note allowing easier transfer of patients between providers.
  • 1971 - First CT scan used to image a living brain.
  • 1970s - 1980s – Most US patients continue to receive care in Fee-for-Service. 911 service continues to expand.
  • 1973 – Rising healthcare costs spur President Nixon to sign Health Maintenance Organization (HMO) Act, opening way for development of for-profit hospitals and private HMOs.
  • 1975 - First whole-body CT scanner was built.
  • 1977 - American physician Dr. Raymond Damadian does first MRI to diagnose cancer.
  • 1979American Board of Medical Specialties votes to create American College of Emergency Physicians, formalizing the training and role of Emergency Medicine physicians. Many hospitals go from having daytime ‘Accident Rooms’ to formal, 24/7 ‘Emergency Departments’.
  • 1980s - AIDS epidemic discovered to be caused by HIV virus, nationally changing infection control procedures and safety standards for blood supply.
  • 1980s - 1990s – HMOs and Payment Reform start to significantly change the billing landscape and increase demands on physician documentation.
1990s 
  • 1996Health Insurance Portability and Accountability Act (HIPAA) first signed into law (with updates in 2004, 2005, 2009, and 2013). NEJM Publishes first article describing new specialty of Hospitalist Medicine.
  • 1999Institute Of Medicine (IOM) releases report To Err Is Human : Building a Safer Healthcare System.
2000s - 2010s
  • 2000 - 93% of the US Population has access to 911 service, and WHO ranks Britain 18th, Germany 25th, and America 37th best in the world.
  • 2008 – Global financial crisis leads to US American Reinvestment and Recovery Act (ARRA), including HITECH Act with $19.3 Billion for Meaningful Use. EMRs become ubiquitous across healthcare landscape.
  • 2017More female candidates than male candidates enroll in American medical schools.
[ End of List ]

Remember : This list is not comprehensive - Have anything you'd like to add to this list? Leave comments in the comments section below! Remember, this blog is for only for educational/discussion purposes only!

2 comments:

Mark Weisman, MD said...

1854 Cholera outbreak in London. John Snow’s work essentially creates public health. Also, his use of a dot map was an early success for data visualization in healthcare.

Dirk Stanley, MD, MPH said...

Thanks so much!! Will add them to the master list!