Introduction to Healthcare and Public Health in the US: Delivering Healthcare
(Part 2)
Audio Transcript
Slide 1
Welcome to Introduction to Healthcare and Public Health in the US: Delivering
Healthcare (Part 2). This is Lecture (d).
The component, Introduction to Healthcare and Public Health in the US, is a survey
of how healthcare and public health are organized and services are delivered in the US.
Slide 2
The Objectives for Delivering Healthcare (Part 2) are to:



Describe the organization of clinical healthcare delivery in the outpatient setting
and the organization of outpatient healthcare.
Describe the organization of ancillary healthcare delivery in the outpatient setting.
Discuss the role of different healthcare providers, with an emphasis on the
delivery of care in an interdisciplinary setting.
Slide 3
This lecture will discuss laboratory, pathology, radiology, and ancillary healthcare
services provided in the outpatient setting.
Outpatient laboratories are facilities where laboratory tests are done on clinical
specimens in order to get specific information about the health of a patient that may
facilitate the prevention, diagnosis, or treatment of diseases.
The lab may be associated with a hospital or may be freestanding. It is not necessary
that the testing be done in the same location where the specimen is obtained. The
patient’s specimen, such as a blood sample, might be obtained in one location and then
transported to a different location where the actual testing is performed.
Slide 4
Many of the tests performed by labs fall within the realm of pathology [puh-thol-uh-jee].
One subset of pathology is anatomical pathology, which is composed of several types.
Histopathology [his-toh-puh-thol-uh-jee] is the study of whole tissues, whereby the
specimen is collected by biopsy, prepared in various ways, and examined under the
microscope. Cytopathology [sahy-toh-puh-thol-uh-jee] is the study of tissues at the
cellular level, for example, a pap smear. Electron microscopic pathology uses advanced
technology to generate highly magnified images of tissues to help identify and diagnose
diseases.
Another subset of pathology is surgical pathology [puh-thol-uh-jee], which involves the
gross and microscopic examination of surgical specimens as well as biopsies.
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare, Part 2
Lecture d
1
This material (Comp1_Unit3d) was developed by Oregon Health & Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
Yet another field is chemical pathology [puh-thol-uh-jee], or clinical chemistry, which is
the analysis of body fluids. This field includes tests of general chemistry, such as
electrolytes or liver function tests; tests of endocrinology [en-doh-kruh-nol-uh-jee] such
as the hemoglobin [hee-muh-gloh-bin] A1C test, which is a blood test used to diagnose
and manage diabetes; and tests of immunology or tests of toxicology.
Slide 5
Another division of pathology [puh-thol-uh-jee] is hematopathology [hih-mat-toh-puhthol-uh-jee], or the study of blood cell diseases. Blood cells can be examined using
traditional microscopy [mahy-kros-kuh-pee] or more sophisticated techniques.
Immunohistochemistry [im-yuh-noh-his-toh-kem-uh-stree], or IHC [I-H-C], is the process
of localizing antigens [an-ti-juh ns] such as proteins in the cells of a tissue by exploiting
the principle that antibodies bind specifically to antigens [an-ti-juh ns] within the tissue
itself. Flow cytometry [sahy-tom-uh-tree] is a technique for counting and examining
microscopic particles of cells and chromosomes by suspending them in a stream of fluid
and passing them through an electronic detection mechanism. This process allows the
simultaneous analysis of physical and chemical characteristics of thousands of particles
per second and is used in the diagnosis of disorders such as blood cancers. Molecular
diagnostic tests are specialized blood tests that leverage the principles of molecular
medicine to diagnose diseases.
Another entire division of pathology [puh-thol-uh-jee] encompasses blood banking and
transfusion medicine, which involve the acquisition, storage, and dissemination of blood
and blood products.
Another aspect of pathology is the discipline of cytogenetics [sahy-toh-juh-net-iks],
which is a branch of genetics that is concerned with the study of the structure and
function of the cell, especially the chromosomes.
Slide 6
Other branches of pathology [puh-thol-uh-jee] include clinical microbiology, which is the
study of microorganisms. Microorganisms are abundant in nature and include bacteria,
fungi [fuhng-guy], parasites, and viruses. These entities are studied by bacteriology,
mycology [mahy-kol-uh-jee], parasitology [par-uh-sahy-tol-uh-jee], and virology [vahyrol-uh-jee], respectively. The microbiology lab uses various methods to culture, grow,
and identify organisms.
Forensic pathology [puh-thol-uh-jee] is a specialized discipline pertaining to medicallegal issues and is often used to determine the cause of death, especially when the
cause of death is not thought to be natural.
Molecular pathology [muh-lek-yuh-ler puh-thol-uh-jee] deals with the development of
molecular [muh-lek-yuh-ler] and genetic approaches to the diagnosis and classification
of human tumors. This field relies on the design and validation of predictive biomarkers
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare, Part 2
Lecture d
2
This material (Comp1_Unit3d) was developed by Oregon Health & Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
to determine treatment response and disease progression. We now understand that
individuals have different genetic constitutions and that this influences the susceptibility
of individuals to develop cancer. Molecular pathology [muh-lek-yuh-ler puh-thol-uh-jee]
also looks at the environmental and lifestyle factors that have been implicated in
carcinogenesis [kahr-suh-nuh-jen-uh-sis].
Slide 7
Diagnostic laboratories include radiology services. Radiology is a branch of medicine
that uses imaging technology to diagnose or treat diseases. Radiologists are
physicians who specialize in radiology after completing medical school. These
physicians receive five additional years of training, the first year of which may be a
transitional residency or a general internal medicine or general surgery residency.
Outpatient radiology services may be freestanding or housed within a hospital.
Radiology departments in hospitals share some of the equipment, especially expensive
equipment, such as MRI (magnetic resonance imaging) scanners, with inpatient
radiology services.
Slide 8
One method used in diagnostic radiology is the x-ray. The first x-ray was taken by
Wilhelm Röntgen [rent-guhn] in 1895 and was a picture of his wife’s hand, which is
reproduced on this slide. Radiology services are termed diagnostic radiology when the
tests help clinicians diagnose diseases.
Slide 9
Techniques of diagnostic radiology have advanced considerably since Wilhelm Röntgen
[rent-guhn] took his first x-ray picture. Now, clinicians use techniques such as
computerized tomography or CT scans, magnetic resonance imaging or MRI scans,
positron [poz-i-tron] emission tomography or PET [peht] scans, ultrasound,
mammography, bone density tests, and nuclear medicine tests to diagnose diseases in
patients.
Slide 10
Interventional radiology is a subspecialty of radiology in which invasive tests are
performed to help make diagnoses. For example, a patient may undergo an
angiography [an-jee-og-ruh-fee], a procedure in which a needle is inserted into a blood
vessel to inject radiopaque [rey-dee-oh-peyk] dye, which allows the blood vessel to
then be imaged.
Teleradiology allows radiologists to review images remotely. Technology now allows
images to be archived and retrieved at multiple sites. The Picture Archiving and
Communication System, or PACS [pax], allows radiologists at a remote site to obtain
images of patients, interpret them, and render an opinion. There is now a standard for
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare, Part 2
Lecture d
3
This material (Comp1_Unit3d) was developed by Oregon Health & Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
handling, storing, printing, and transmitting information in medical images, called
DICOM [dahy-kom], or the Digital Imaging and Communications in Medicine standard.
Slide 11
This slide now turns to ancillary services. One example of an ancillary service is home
healthcare, also known as domiciliary [dom-uh-sil-ee-er-ee] care or home care. This is
care that is provided at the patient’s home for various reasons, including illness or
difficulty traveling to a primary care center to see a physician. These patients may have
care provided in their own home using methods such as house calls, nurse visits, or
visits by home health aides. Home healthcare is designed to help patients with
activities of daily living such as personal hygiene, dressing and undressing, eating,
transferring from bed to a chair and back, toileting, and moving around as opposed to
being bedridden.
Slide 12
Another example of ancillary services is hospice care. This is a specialized level of care
for terminally ill patients whose life expectancy is six months or less. Hospice care
allows palliative care outside the hospital. The venue may be a hospice institution or
the patient’s home, and care is usually delivered by a multidisciplinary team, including a
physician and medical director, nurses, healthcare aides, a social worker, and a
chaplain. The objective of hospice care is not to provide treatments, but to keep the
patient comfortable and manage pain and other symptoms.
Slide 13
Other ancillary services include physical therapy, which is intended to restore function
after injury or illness. Physical therapy is most commonly prescribed for
musculoskeletal [muhs-kyuh-loh-skel-i-tl] diseases, but it is also used for cardiac or
pulmonary diseases.
Occupational therapy helps patients return to their occupation after disease or injury.
Occupational therapists teach patients how to break down tasks and activities into
achievable competencies. They may also conduct comprehensive home and jobsite
evaluations and make recommendations for adaptation. Environmental adaptation,
such as removing physical obstacles in the home or providing specialized equipment
and training patients in its use, is also an essential part of occupational therapy
services.
Speech therapy helps patients recover from diseases that affect speech, such as
strokes.
Care provided by ancillary staff, physical therapists, occupational therapists, and
speech therapists is usually supervised by a physician, either the primary care physician
or a specialist such as a physical medicine and rehabilitation physician.
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare, Part 2
Lecture d
4
This material (Comp1_Unit3d) was developed by Oregon Health & Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
Slide 14
This completes Lecture (d) of Delivering Healthcare (Part 2). In summary, this lecture
described laboratory, pathology, radiology, and ancillary services.
Slide 15
References slide. No audio.
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare, Part 2
Lecture d
5
This material (Comp1_Unit3d) was developed by Oregon Health & Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.