In his new essay, David M. Cutler prognosticates an intriguing, yet impersonal healthcare future. He says, “the idea that technology will change medicine is as old as the electronic computer itself.” And we agree with his proposal.
However, there’s a lot of information out there, and for the most part, it’s not made available at the right time. Think about it: how many times do we hear about a patient receiving an incorrect dosage or a drug that causes an allergic reaction? And, as more docs “get wired” and adopt EMRs, there will be even more parties contributing to the collective consciousness of medicine. Just look at the numbers. Since the 2009 American Recovery and Reinvestment Act created the HiTech program, billions of dollars have been allocated for doctors and hospitals to purchase EHR software/systems. According to Cutler, “Since the program was enacted, rates of ownership of such systems have tripled among hospitals and quadrupled among physicians.”
Okay, but what happens when all of medicine gets connected?
Cutler says healthcare will be delivered in a more standardized fashion, with less overall cost, but less of a personal touch.
Cutler’s argument compares healthcare to the retail sector, showing what Amazon and Walmart were able to achieve (massive distribution and declining prices) through the use of information technology. His imagining of the future is a bit of a catch-22 for us primary care docs. He does predict that “healthcare will be less frustrating when the power shifts from sellers to buyers, and when patients are more in charge.” That’s an idea we’ve been empowering through our direct care movement. We succeed by creating business offers that make using insurance for primary care illogical. We achieve that by putting the patient first, and making prices transparent. This enables us to offer superior care. However, David’s proposed information-driven health sector also renders primary care obsolete. He says:
“With an electronic backbone in place, one doesn’t need to see a doctor for every issue. There is little the primary care doctor does that can’t—and increasingly isn’t—being done by a nurse practitioner, perhaps at a clinic in a Walmart or CVS. Routine prescriptions for medication refills can be handled online, with an electronic doctor watching.”
That pronounced of a reality, where patients just order their prescriptions like books and get diagnoses from a wiser version of Web MD, is not something we imagine happening just yet. There are still aspects of care that are intuitive and relationship-based. For instance, this doctor predicting a patient stroke minutes before it occurred.
David’s future is definitely not one-to-one with the one we’re envisioning. However, he’s on point because something has to give. The red tape in healthcare is staggering. And someone has to cut it. According to the Institute of Medicine, “inappropriate care, lack of adequate prevention, administrative waste, and prices that are too high account for nearly one-third of medical spending. Just the billing and collection operations in healthcare account for 25 percent of total costs.” The question is whether individuals and entrepreneurs will capitalize on this opportunity, or if doctors will surrender to a Walmart/Amazon-type organizations who manage to make sense of the mess that is electronic health records.