Tuesday, October 28, 2014

Living in a Jetsons World

The quote of the week has to go to Deloitte's Harry Greenspun, M.D..  Speaking at WEDI's annual conference, FierceHealth IT reports he said:  "We live in a Jetsons world, but when you go to the doctor's office it's like an episode of The Flintstones."

Millennials, you're going to have to look up those references.  

To be fair, we're not quite in a Jetsons world yet -- anyone driving a flying car? -- but, on the other hand, I haven't seen a tablet at a doctor's office that is literally a stone tablet either.  Still, I wouldn't at all be surprised to find doctors' offices that don't yet have computers, much less tablets, and the number of providers who can easily share patient data with other providers is low enough to remind one of the pre-Internet days.  So, all in all, most of us know exactly what Dr. Greenspun was getting at.

Dr. Greenspun noted that the vast amount of health-related data that is, or soon will be, available challenges both providers and patients about how to best make use of it in a way that will positively impact patients' health.  It's a good problem to have -- we've muddled along too long with only intermittent and incomplete data about what is happening with people's health -- but it is a problem nonetheless.

After all, about one-in-five Americans own a wearable device, according to PwC's The Wearable Future with one-in-ten wearing it daily.  Two-thirds of Americans say would use one in exchange for discounts on their health insurance. Forty-four percent of those without wearables claim that better advice from their provider would be an incentive to use one.  Analysts are predicting crazy growth rates for wearables -- 43.4% CAGR over the next 5 years -- and even if they're off it is clear there is going to be a heck of a lot more tracking.

That's potentially a lot of data, but it's as the old expression says: be careful what you wish for...

The other great point Dr. Greenspun made was that people are only patients in health care settings but are healthcare consumers all the time (or they should be, at least).  I believe Dr. Greenspun was pointing out that there is a lot about people's health that happens outside health care settings -- which is certainly true -- but I'm also struck by the implicit duality in his characterization.  Aren't they always consumers?

I've suggested before (Mistaking Success for Failure) that perhaps continuing to use the term "patient" is part of the problem.  It fosters the illness-versus-health, dependent-versus-responsible, passive-versus-proactive attitude that pervades our health care system.  We need a new word, something that recognizes that we're responsible for our own health, although sometimes we need help -- often a lot of it -- from others.

I'm open to suggestions.

What would care look like in a Jetson's world, hopefully one in which we've decided to really put patients/consumers/people first?  Here are a few thoughts:

  • For one thing, I wouldn't expect to get too much of that care in a doctor's office.  As I wrote in I'll Take My Care To Go, we increasingly expect services to be ubiquitous, and health care is tracking in that direction.  Yes, many people -- especially doctors -- firmly believe in a physician needing to see and touch patients, but with even today's optics and with steadily improving virtual reality for touch (e.g., Nimble VR), physical presence becomes much less important.
  • I also wouldn't expect that you'll be seeing as much of doctors, or, in fact, actual humans for your care, at least for E&M.  I wrote about the use of AI in May I Speak to the Doctor's Computer, and in a Jetsons world I fully expect a large percent of things that currently would require a physician could be dealt with via an expert system using AI.  You wouldn't ever have to wait for them to call back.  Of course, the system would need to know when to triage issues off to human experts (usually but not necessarily always physicians). 
  • Care will become much more proactive.  All that monitoring will create massive amounts of data about what is going on with you and your health, analyzed real-time and producing targeted feedback.  I see much of that feedback coming from -- again -- AI, in the form of a virtual health assistant or avatar.  We've already got Alme from NextIT and Molly from Sense-ly.  These avatars are only going to get better -- not only able to deal with more kinds of problems, but also more tailored to your needs and personality (e.g., some people need to be nagged, some rebel against nagging).  They're not going to wait for you to notice or complain about a problem.
  • We're not only going to get virtual replacements for caregivers.  The Jetsons had a housekeeping robot named Rosie; maybe that will happen, but someone is going to make a fortune by developing a personal care robot.  Hospitals, nursing homes, and assisted living centers struggle to staff their aides now, and the impending aging Baby Boomer demographics will demand we solve the staffing shortfall through technology.  Toyota, for example, is already working on what they call "personal assist robots" for this very purpose.  These will allow people to stay home longer/go home sooner and reshape our concept of "care," not to mention many of our institutional settings.
  • Your health record will, indeed, be yours, in a graphic, easy-to-understand, actionable form that is available on-demand 24/7.  Rather than worrying about providers trying to connect their various versions of your record, which they may or may not let you notate or even view, they will annotate your record, downloading whatever they need from it for their business needs. 
  • We're going to know what care costs in advance.  These shell games that are being used to hide and disguise health care costs (e.g., absurd charge structures, out-of-network billing in in-network settings, after-the-fact medical necessity decisions) are evidence of a very dysfunctional market.  We shouldn't be paying blindly for piecework that may or may not produce good results; we should be paying for actual results.  Frankly, I'm not sure anything we're even testing now will resemble the payment and financing mechanisms we'll find in a Jetsons health care system.  
I only hope I don't have to wait until 2062 to see these changes.

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