Health care's response: hold my beer.
Mr. Fowler listed four suggestions for how to make gadgets great again, and they're worth repeating:
- Respect our time: we know tech companies can make gadgets addictive, but can they figure out "not how to fill more of our time, but rather help us spend our time better?" Plus, he also offered this rule of thumb: "Before making a product, ask yourself: What would the “Black Mirror” episode about this tech be?" I.e., think about the unintended consequences.
- Security is not our job: It seems everything can get hacked, and all of our personal information is at risk. We try to come up with new passwords and apply security patches, but he points out: "When I buy a car, I don’t have to purchase seatbelts and bumpers on my own—I trust the automaker took care of making it safe." Why isn't that true for other technology?
- Focus on the "Internet of Services," not the "Internet of Things." Sure, tech can connect almost anything, but that isn't the goal. At the end of the day, we don't care about the device, we care about what it can do for us.
- Don't lock us in: We're increasing getting into tech silos. The more data you give one of the silos, the harder it is to switch. You're either an Apple person or a Google person. You either like Alexa or Google Home. Mr. Fowler rightfully complains: "I’ve got four different talking assistants on various devices in my house, but unfortunately my virtual staff doesn’t communicate well with each other."
Let's apply these four suggestions to health care:
- Respect our time: Ever waited to see your doctor? Ever had to wait for a test or procedure, or to fill a prescription? Ever been on hold with your health plan? Most of us would say "yes" to at least one, if not all, of those. The health care industry does not respect our time; it values the time of the people working in it.
- Security is not our job: Has your personal data -- perhaps including your most sensitive health data -- been hacked at your health plan or health care provider? Has any of it been sold to third parties, probably without your explicit knowledge or consent? Whether you like it or not, the answer to these is also probably "yes."
- Focus on the "Internet of Services," not the "Internet of Things." Almost all of us have smartphones, and more of us are getting wearables. Those of us who need pacemakers or new knee joints will soon find them all connected. We're even going to swallow pills that are connected. It's all certainly cool from a technology standpoint, but we're definitely in "Black Mirror" territory here. We're rushing into health IoT before we really know what we can or should do with all the information, or how to protect it.
- Don't lock us in: Health care is consolidating like crazy, whether health systems acquiring more hospitals and doctors, health plans gobbling up other health plans, or new combinations like CVS buying Aetna or United Healthcare buying Davita, all while narrow networks keeping increasing and formularies getting more restrictive. Oh, and if your health care information is in one silo, don't expect it to be shared with another. We want choices in health care, but our choices are getting more restrictive.
I've already covered things about health care I'm dying to redesign, as well as my thoughts on how a truly 21st century health system might work, but, while all of Mr. Fowler's suggestions also apply to health care, I'll offer four aimed specifically at making it great:
- Make it about us: We talk about our health care system being all about the patient, but that's not true. It's about the doctor, the hospital, the health plans and the medical industry -- them, their incomes and their processes. Hopefully those work to the benefit of us, but, as the saying goes, hope is not a strategy. What health care organizations focus as intently on us and our health as Amazon does its customers? The ones which do will be the ones to survive.
- Make it about health, not care: There is an oft-cited statistic that 80% of the things that impact health are SDOH -- social determinants of health -- and only a small portion are due to the care we receive, but our spending is the exact opposite. We need to move focus, and money, away from care and invest in SDOH, away from specialty care and into primary care, and stop trying to do expensive moonshots until/unless we get the basics of our system right.
- Make it about facts, not faith: Too much of health care doesn't really work, for too many people. The placebo effect doesn't just apply to placebos, many doctors don't have or know empirical evidence of effectiveness for many of their treatments, and as a result too much of our treatment is wasted, unnecessary, even harmful. We're supposedly moving into a Big Data fueled, AI-assisted world; we must use those to move to an empirical age of health.
- Make our data ours: Our health care data is not ours. It belongs to the professionals who treat us, to the companies who help us collect it, or to the third parties who buy it. We may have access to some, although not all, of it, but no one -- no one -- has a compete picture of our health. If we're going to be person-centered, health-oriented, and data-driven, it has to start with the explicit understanding that any data about our health belongs to us, and we can choose when and to whom we share which of it.
I'm not sure when the golden age of health care supposedly was (or tech's either, for that matter), but I know this: we finally have the tools and the technology to make this it. The question is, do we have the will?