Healthcare Meet Gall's Law

I can’t believe I’ve gone this long without knowing about Gall’s Law (thanks to @niquola for tweeting it!).  For those of you similarly unaware, John Gall was a pediatrician who, seemingly in his spare time, wrote Systemantics: How Systems Work and Especially How They Fail in 1975.  His “law,” contained therein, is:

Have you ever heard of anything that applied so perfectly to our healthcare system? 

As anyone who has been reading my prior articles may know, I’m a big believer in simple.  I’ve advocated that healthcare’s billing and paperwork should be much simpler, that “less is more” when it comes to design,  that healthcare should first do simple better but, above all,  that healthcare should stop doing stupid things.  I’ve equated the ever-increasing intricacies of our healthcare system to the epicycles that kept getting added to the Ptolemaic theory in a desperate attempt to justify it. 

Few would disagree that the U.S. healthcare system is complex.  Healthcare systems in general have evolved towards more complex, but the U.S. system takes complexity to extremes, with its thousands of payors, its powerful pharma/medical device industry, and its highly concentrated hospital markets (including ownership of physician practices), among other things. 

Simple isn’t always better, of course.  Life is complicated and so is our health, but, come on: how many people can explain why PBMs exist, what their heath insurance plan actually covers, how their health care bill was arrived at, or why we spend so much time in the healthcare system just waiting?  Literally no one understands our healthcare system.

It shouldn’t be that way.  It doesn’t have to be that way.  But it is.

Some pundits argue we don’t even have “a system” but, rather, thousand or even millions of smaller health-related markets that co-exist but don’t really work together.  For anyone who doubts that, try to explain the presence of workers compensation healthcare or why dental is at best a separate form of coverage (last I looked, the mouth was part of the body).  Try to explain why child care is most definitely not part of healthcare but home care is – depending, of course, on whether it is “custodial” or not.   Silos abound.

It could be argued that healthcare started with a simple system that “worked.”  Some are nostalgic for the days when people saw their family doctor, paid their doctor, and that was it.  It doesn’t get much simpler than that.  Of course, those doctors couldn’t really do all that much for their patients and didn’t really get paid all that much, so to say that it “worked” for either party is debatable. 

Many reform advocates propose what they see as a simple solution – Medicare For All!  Having everyone with the same coverage could lessen some administrative burdens, but no one who has been covered by Medicare, nor treated patients with Medicare, would describe Medicare as either a simple system nor one that “works.”  Medicare For All would have to be radically different from the Medicare program we know now, and that would seem to risk Gall’s “inverse proposition.”

We need, to use Dr. Gall’s words, a “working simple system.”

The trouble is, I’m not sure I can imagine what that is.  Group practice HMOs were supposed to be one, but that experiment has not gone the way it was forecast to.  More recently, new entrants like Oscar Health or Iora Health were going to reinvent health insurance, but, as it turns out, not so much. 

Health system integration/consolidation was supposed to make care more effective and efficient, but it turns out that is a false promise.  Companies like TelaDoc and AmWell have been preaching telehealth for a couple decades now, and the world has awoken to its potential, but it keeps tripping over the complexities of the non-digital parts of our healthcare system. 

One of the barriers to developing a working simple system in healthcare is lack of agreement on which of healthcare’s many problems to focus on.  Is it lack of universal coverage, or excessive costs?  Is it our poor health behaviors?  Is it how health prices are so radically different between payors?  Is it how we continue to tolerate our intolerable health inequities?  Is it our lack of data interoperability?  

Credit: OECD

For me, though, the core problem that needs to be addressed is this: we don’t really know what “quality” is – not only whether care has been delivered “correctly” but whether the treatment was even likely to be effective (e.g., look at NNT or any number of studies on unnecessary procedures). 

“Quality” in healthcare is like what Supreme Court Justice Potter Stewart said about pornography: he can’t define it “but I know it when I see it.”  Unfortunately, in healthcare, we don’t even know it when we see it.  Without actual evidence, we all think our doctors are the “best” and our faith in even fringe remedies is enduring (how many supplements do you take?).   

Oh, we have lots of quality measures.  We spend lots of money collecting them, and even make some of them available to the general public.  But we’re kidding ourselves if we think that any of these various measures actually measure quality, or that consumers understand, much less really use, them. 

As consumers/patients, we’re not demanding better measures, and, as healthcare professionals/institutions, we’re more worried about increasing our malpractice exposure than in figuring what we’re doing “right” and who is doing it better.  Shame on all of us.

Job #1 of our healthcare system should be to find a simple working system for measuring quality for something important – a condition, a treatment, a procedure.  Something accurate, easy to measure, and easy to understand.  Get agreement on it, and use that to drive decisions about what to pay how much for that part of healthcare.  Then iterate.

I’m not saying this is going to be easy—it’s not – but I am saying that if we don’t do this, then all the brainpower we’re using on other problems in healthcare is, essentially, wasted.   

Our healthcare system is broken.  It’s way too complex yet way too ineffective at every level.  As Dr. Gall urged us, we have to start over, and starting with a simple working system for measuring quality seems like as good a place as any.

I Am Dr. Groot

 The healthcare world is abuzz with Dr. David Feinberg’s departure from Google Health – another tech giant is shocked to find healthcare was so complicated! – while one of those tech giants (Amazon) not only just surpassed Walmart in consumer spending but also is now planning to build its own department stores.  Both very interesting, but all I can think about is robots. 

Most of the recent publicity about robots has come from Elon Musk’s announcement of the Tesla Bot, or the new video of Boston Dynamic’s Atlas doing more amazing acrobatics, but I was more intrigued by Brooks Barnes’s New York Times article Are You Ready for Sentient Disney Robots? 

Like many industries that serve consumers, healthcare has long been envious of Disney’s success with customer experience.  Disney even offers the Disney Institute to train others in their expertise with it.  Disney claims its advantage is: “Where others let things happen, we're consistently intentional in our actions.”  That means focusing on “the details that other organizations may often undermanage—or ignore.” 

You’d have to admit that healthcare ignores too many of the details, allowing things to happen that shouldn’t.  

1964 audio-animatronics.  Credit: Walt Disney

One of the things that Disney has long included in its parks’ experience were robots.  It has had robots in its parks since the early 1960’s, when it introduced “audio-animatronics” – mechanical figures that could move, talk, or sing in very life-like ways.  Disney has continued to iterate its robots, but, as Mr. Barnes points out, in a world of video games, CGI, VR/AR, and, for heaven’s sake, Atlas robots doing flips, its lineup was growing dated. 

Mr. Barnes quotes Josh D’Amaro, chairman of Disney Parks, Experiences and Products, from an April presentation: “We think a lot about relevancy.  We have an obligation to our fans, to our guests, to continue to evolve, to continue to create experiences that look new and different and pull them in. To make sure the experience is fresh and relevant.” 

Enter Project Kiwi. 

In April, Scott LaValley, the lead engineer on the project, told TechCrunch’s Matthew Panzarino: “Project KIWI started about three years ago to figure out how we can bring our smaller characters to life at their actual scale in authentic ways.”  The prototype is Marvel’s character Groot, featured in comic books and the Guardians of the Galaxy movies (he is famous for only saying “I am Groot,” although apparently different intonations result in an entire language). 

By 2021, they had a functioning prototype:

Mr. Barnes reported that his interactions with the would-be Groot were quite remarkable.  It spoke to him, reacted to his initial non-response, and, eventually, “I wanted to hug him. And take him home.”  Mr. Panzarino was similar impressed: “Multiple times throughout my interaction I completely forgot that it was a robot at all.” 

That’s the goal.  “And all of this technology must disappear, which takes a crazy amount of engineering,” Leslie Evans, Disney’s Senior Imagineer, told Mr. Barnes. “We don’t want anyone thinking, ‘That’s the most sophisticated robot I have ever encountered.’ It has to be: ‘Look! It’s Groot!”

According to CNBC, “Project Kiwi is heading for the “play test” stage, where the Imagineers bring the character into the park to interact with guests and gather feedback. The company has not shared when this will take place or at which park.”  

Groot is only the beginning.  Mr. Barnes said:

He is a prototype for a small-scale, free-roaming robotic actor that can take on the role of any similarly sized Disney character. In other words, Disney does not want a one-off. It wants a technology platform for a new class of animatronics.

CNBC also reported on Disney’s Project Exo, which is similarly creating a “full body exoskeleton system” as a platform to bring to life larger characters (think the Incredible Hulk). 

The Disney world is already speculating on whether the goal is to replace human workers in the parks (walking around in the heat in those Disney character costumes is no picnic), but Mr. Barnes believes it is more about Disney needing to change traditionally passive experiences into more interactive ones.  Ms. Evans told him: “These aren’t just parks. They are inhabited places.”   

If, as Elon Musk believes, “the economy is, at the foundation, labor,” then there may be no sector in which this is more true than in healthcare (especially long term care).  Tech companies may be failing in healthcare because they think adding a tech layer will “fix” things, but our current system isn’t going anywhere until we address labor – its costs, its supply limitations, its productivity output.   The pandemic almost broke our healthcare workers last year, and the recent surge is overwhelming them again. 

Healthcare could use more robots. 

Hanson Robotics' Grace.  Credit: CNN

Yes, there are robots in healthcare.  People often point out to robotic surgery, which has not managed to reduce costs, improve quality, or remove the human component.  There are also delivery robots (often used in hospitals), “patient simulators,” even companions, but, honestly, we need more robots like Hanson Robotics’ Grace, specifically aimed for healthcare.  "I can visit with people and brighten their day with social stimulation ... but can also do talk therapy, take bio readings and help healthcare providers," Grace “told” Reuters. 

It’s not there yet; it would need considerable evolution to play a significant role in our healthcare system, but, with the right investments, it will get there.  And, yes, eventually there will be robot doctors, powered by AI. 

Mr. Panzarino brings up the field of human-robot interaction (HRI), and asserts that, of all the companies, industries, and academic centers working on it, “the most incredibly interesting work in this space is being done in Imagineering R&D.”   Again, as the Disney Institute preaches, focusing “on the details that other organizations may often undermanage – or ignore.”

I wish healthcare was leading HRI. 

Healthcare needs to change its customer experience from passive to interactive.  If Disney recognizes the need to stay “fresh and relevant,” that is all-the-moreso in healthcare.  Healthcare thinks it is in the care business, but it must also recognize it is in the experience business – and that its experience currently is pretty woeful (often literally).  It’s undermanaging and often ignoring the details that make up that experience.  And when does technology in healthcare ever “disappear”? 

Robots alone aren’t going to change all that in healthcare, but the level of attention – to detail, to relevancy, to customer experience -- that Disney brings to its robotics efforts could go a long way. 

Yes, Shit

The Conversation had a provocative article by Stanford professor Richard White about how America has a bad pattern of wasting infrastructure spending.  In light of the surprisingly bipartisan $1 trillion infrastructure bill recently passed by the Senate, this seems like something we should be giving some serious thought to. 

I’ll posit that we’re doing it again, by not adequately addressing the potential that our excreta, to be polite, offers to detect health issues, including but not limited to COVID-19. 

Illustration by Ori Toor for The New York Times

No shit: excrement can be an important tool in public -- and personal -- health. 

COVIDPoops19 Twitter picture

Take wastewater monitoring.  It is not a new concept – for example, to track polio – and has been used during much of the current pandemic.  According to the COVIDPoops19 dashboard, run by UC Merced’s School of Engineering, there are 55 countries with 89 dashboards monitoring the wastewater in 2,428 sites for signs of COVID-19.  The project even has its own Twitter handle (@CovidPoops19). 

According to Kaiser Health News, the University of California San Diego’s program has identified 85% of COVID-19 cases over the last year, using a largely automated monitoring system.  Infected people shed virus particles long before they show symptoms, allowing such programs to act as an early detection system. 

“University campuses especially benefit from wastewater surveillance as a means to avert COVID-19 outbreaks, as they’re full of largely asymptomatic populations, and are potential hot spots for transmission that necessitate frequent diagnostic testing,” said UCSD study first author Smruthi Karthikeyan, PhD.  Any university debating vaccine or mask mandates in order for students to return to campus should seriously be considering this kind of monitoring mechanism.

Similarly, the University of Minnesota has been sampling the wastewater of 65% of the state’s population, and has correctly predicted the rise and fall of each of the three waves in the last year.   North Carolina has also had success. 

Credit: Biobot Analytics

Biobot Analytics, an MIT spin-off, is one of the leaders in this field, now is helping nearly 500 communities, in all 50 states, and recently got an HHS grant to collect and analyze data from 320 waste treatment plants, covering 100 million people.  As its site points out: “Everybody pees and poops, every day.” 

What else can you say that about?

The CDC is piloting the National Wastewater Surveillance System (NWSS) to create a federal database of such data.  “We think this can really provide valuable data, not just for covid, but for a lot of diseases,” Amy Kirby, a microbiologist leading the CDC effort, told KHN.

Wastewater monitoring is an important tool, but it suffers from a few weaknesses.  It is most effective at a macro-level: a city, a neighborhood, perhaps a building (e.g., a dorm).  Heavy rainwater can distort results.   And, as results begin to drill down to the DNA level, privacy starts to become an issue (as controversy about using wastewater data to spot illicit drug use has already shown).

So, where’s the money in the new infrastructure for this kind of monitoring? 

The infrastructure bill does include an eye-popping $55b for water and wastewater infrastructure, but spending is more focused on threats like lead pipes and emerging contaminants.  Building 21^st century public health monitoring systems against threats like COVID-19 doesn’t seem to be a top priority. 

As Professor White points out about our infrastructure history:

Many of these projects did not end well. The problem wasn’t that the country didn’t need infrastructure – it did. And the troubles weren’t the result of technical failures: By and large, Americans successfully built what they intended, and much of what they built still stands.

The real problems arose before anyone lifted a shovel of earth or raised a hammer. These problems stem from how hard it is to think ahead, and they are easy to ignore in the face of excitement about new spending, new construction and increased employment.

We’re not thinking ahead.  Getting rid of lead pipes and cleaning water of contaminants is basic 20^th century infrastructure; we should expect it.  Automated monitoring of public health threats is 21^st century infrastructure. 

Even wastewater monitoring is not thinking far enough ahead.  If comprehensive wastewater monitoring should be a universal 2130 infrastructure, smart toilets should be a 2150 one. 

Smart toilet illustration.  Credit: SciTechDaily

I don’t mean the kind of smart toilets that warm the seat and perhaps add a bidet.  I mean the kind that can track your health.  It doesn’t get much more personal than that.

There is lots of progress in the field.  In April, Stanford researchers reported on a smart toilet “that can detect a range of disease markers in stool and urine, including those of some cancers, such as colorectal or urologic cancers.”  The monitoring add-ons can be mounted on traditional toilet bowls.   

Lead researcher Sanjiv Gambhir pointed out: “The thing about a smart toilet, though, is that unlike wearables, you can’t take it off.  Everyone uses the bathroom — there’s really no avoiding it — and that enhances its value as a disease-detecting device.”

In May, Duke researchers presented smart toilet advances that categorized stool images using A.I., allowing much more accurate and objective reports about things like consistency, frequency, and bleeding.  That kind of information is important for people with I.B.S. or who may have cancer. 

Sonia Grego, PhD, a lead researcher on the study and founding director of the Duke Smart Toilet Lab said: 

We are optimistic about patient willingness to use this technology because it's something that can be installed in their toilet's pipes and doesn't require the patient to do anything other than flush,

An IBD flare-up could be diagnosed using the Smart Toilet and the patient's response to treatment could be monitored with the technology. This could be especially useful for patients who live in long-term care facilities who may not be able to report their conditions and could help improve initial diagnosis of acute conditions.

The Duke Smart Toilet Lab, in case you weren’t aware, “is dedicated to the opportunities that human excreta offer to empower people to manage their own wellness.”  It now has its own spin-off, Coprata.  We're going to see lots more start-ups like it and Biobot.

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Our politicians are proud of including broadband in the infrastructure bill.  That’s so 2010.  We should be thinking much further out, making investments now for the infrastructure our health will depend on.  We don’t like to think of bodily wastes, but we should be building the infrastructures to take advantage of them.  What else aren’t we thinking enough about?

Health Care You Do Not See

Within a mile from my home in one direction, there are two pharmacies and a primary care office.  In another direction, there’s a multi-specialty physician practice, complete with lab and pharmacy.  And in a third direction, an urgent care center.  Widen the circle another mile, and there are more physician offices, a plethora of other health care professionals, another urgent care, a retail clinic, and an imaging center.  Add a couple more miles and hospitals – plural – to start show up.

Hospitals are anything but unobtrusive. 

I’m not sure that’s a good thing.

Admittedly, not everyone has so many options.  If you live in a rural area or a disadvantaged neighborhood, there may not be so many choices.  Chances are, though, even in those places, whenever you find retail activity, some portion of it is probably healthcare-related.

Walmart retail clinic.  Credit: Walmart

Retail clinics helped blur the lines between retail and healthcare, and early moves by retail giants like Walmart or Kroger to incorporate first pharmacy, then primary care, into their stores made getting care easier for millions.  All in all, probably a good thing.

Still, though, you know when you’ve gone from shopping for home goods or groceries to getting your healthcare.  You know because there’s more waiting.  You know because there are more forms to fill out.  You know because you don’t know what will happen to you. 

And you definitely know when you are getting health care services.  You get an injection, you take a pill, you have an image taken, your body is invaded by a tube or a scalpel.  That’s why we go, isn’t it?  We go because we fear something may be wrong and we want someone to do something about it.  Advising us to make lifestyle changes is all well and good, although usually not effective; we want some concrete treatment.

And you know because you don’t (usually) call your doctor by his/her first name, but use the honorific, even when he/she addresses you more familiarly.     

We’ve made places of care very visible, persons who give that care very distinct, and the care itself obvious.  At those prices, it’s not too surprising.  We spend over twice on healthcare as on education (although you don’t see many rich teachers) and four times as much as on the military, so you’d expect to see evidence of all that spending -- and we do.

It may be that what we’ve built is not what we want.

A few years ago Steven Downs took my breath away with his call to “build health into the OS” of our daily lives.  “It would mean” he said, “building a culture where people don’t have to think consciously about being healthy, but rather being healthy is a natural consequence of going about your day.”  He and Thomas Goetz continue this work at Building H.

That work is important, and necessary, but not sufficient.  We’ll always need a healthcare system, we’ll always need some form of care, and we’ll always need some help with those.  The question is, how visible do they have to be?  How obvious does it have to be when we are getting “care” and from whom we are getting it?

For example, not that long ago, to measure your blood pressure, a blood pressure monitor had to be attached to your arm to take a reading.  It might have been taken at your doctor’s office by a nurse, at the pharmacy using a self-service machine, or by a family member at home.  Now, though, your smartwatch can measure it for you. 

Apple Watch health features.  Credit: Apple

Your smartwatch might also track your heartbeat, detect irregular heartbeats, monitor your blood oxygen, gauge your stress levels, or track your sleep.   Many expect blood sugar monitoring for diabetics via smartwatch will come soon.

That’s care built into the OS of our lives.

Yes, it’s a marvel that we can do cardiac caths and heart bypasses to fix hearts, that we can use radiation and chemotherapy to attack cancer, that we have lasers to improve vision.   Yes, it’s the right idea to aim for precision medicine.   Yes, our various healthcare advances are (generally) resulting in less collateral damage to our bodies (although not to our wallets), but they’re not making our health care less obtrusive and less obvious. 

For example, many cite the pandemic as bolstering the use of telehealth visits (although its persistent effect remains to be seen).  It was great: see your doctor (or, at least, a doctor) without having to go to an office, without having to wait with all those sick people!  But, for the most part, you still had to schedule an appointment, you still had to use a specific application, and you still were talking with a doctor.

Imagine, instead, your personal A.I. assistant acts as your healthcare concierge and as your first line of “care,” helping you deal with most common issues and triaging you quickly to either more specialized experts or in-person care.  There’s no bright line between asking for help with groceries and with colds.  You expect quick, expert advice, and you get it.

That’s care built into the OS of our lives. 

Illustration of nanobots in bloodstream
Credit: Human Paragon/cnet

My favorite example of “invisible care,” though, remains the use of nanobots and/or synthetically engineered microorganisms at work inside your body.  They could deliver targeted medication to just the right place in just the right amount, repair damaged tissues, spot and address potential issues long before any symptoms manifest.  They’d work tirelessly, unobtrusively, fixing things “at the source code level.”

Healthcare designers are working to make the healthcare experience more retail-like, with prettier buildings, nicer layouts, better amenities.   Resource and cost pressures are driving more care to “extenders” like nurse practitioners and physician assistants.  Digital health is becoming a thing, with more of the speed and convenience we’ve become accustomed to elsewhere.   Again, all are important, but we may be missing the forest for the trees. 

For those who want to reform our healthcare system, how do we “hide” it into our everyday lives?   How do we make care not just more effective but also more unobtrusive?  How do we build our healthcare, as well as our health, into the “OS” of our daily lives?  Let’s not build ever more elaborate healthcare institutions and practices; let’s design ever more subtle approaches. 

The best healthcare system, it may turn out, is one in which we don’t even realize we’re getting care. 

Let's Meet in the Metaverse

I really wasn’t expecting to write about the Metaverse again so soon, after discussing it in the context of Roblox last March, which itself followed a look at Epic Games CEO Tim Sweeney’s vision for the Metaverse last August.  But darn that Mark Zuckerberg!

Credit: niphon/iStock

Not many noticed when Mr. Zuckerberg told Facebook employees in June that the company would become focused on building a metaverse, but he got some attention when he expanded on his vision for The Verge in late July.  Then last Monday Andrew Bosworth, Facebook’s head of AR/VR, confirmed a product group had been formed to bring it about.  And, finally, in an earnings call last Wednesday, Mr. Zuckerberg and his executive team couldn’t stop gushing about the importance of the metaverse to the company, and the world.

So, yeah, the metaverse is in the news.  And, once again, I worry healthcare is going to be late to the party. 

I won’t go into too much detail about what the metaverse is; for those who want a deep dive, there’s Matthew Ball’s nine part primer, or you could just read Ready Player One.  Mr. Zuckerberg described it to The Verge as follows: “you can think about the metaverse as an embodied internet, where instead of just viewing content — you are in it.”  In the earnings call, he clarified: “The defining quality of the metaverse is presence – which is this feeling that you’re really there with another person or in another place.” 

Depending on your age/preferences, the concept of “an embodied internet” is either chilling or thrilling.  Maybe both.   

It’s potentially a big deal.  Gene Marks, writing in Forbes, says, “business interactions will forever change.”  The Conversation’s Beth Daley goes further, stating “creating a virtual world for users to interact with their friends and family is not just a fancy vision, it is a commercial necessity.”

It’s not VR, it’s not AR, it’s not 3D internet, although all those may be part of it.  It’s not gaming, it’s not entertainment, it’s not social network, although all of those will be part of it too.  Mr. Zuckerberg promises: “It’s going to be accessible across all of our different computing platforms; VR and AR, but also PC, and also mobile devices and game consoles.”  Not to overstate it, but he sees the Metaverse as the “next generation of the internet.”  Mr. Zuckerberg also described it as “the next computing platform.”

Credit: TechCrunch

He is openly telling people that the goal is for Facebook to transition to a metaverse company, “within the next five years or so.”  Analysts on the earnings call pressed Facebook to confirm an estimate of a $5b investment, but only got an admission that, yes, the investment was “billions.”

Significantly, for Facebook, Mr. Zuckerberg believes: “this is going to be not something that one company builds alone, but I think it is going to be a whole ecosystem that needs to develop.”   As Mr. Zuckerberg said in The Verge interview, “Hopefully in the future, asking if a company is building a metaverse will sound as ridiculous as asking a company how their internet is going.”

This will require interoperability; “People are going to want to reach the people they care about no matter what service they're on and be able to move between these.” In other words, “it has to have the sense of interoperability and portability.”   These are not the kind of sentiments words we’re used to hearing from Facebook.

Nobody, not even Mr. Zuckerberg, thinks we’re going to see a metaverse right away – perhaps five years, maybe ten, possibly more -- and no one is really sure where the money will be.  It may become a “huge economy,” with “entirely new types of work” and plenty of virtual goods, as Mr. Zuckerberg predicts, but, admittedly, the concept is still not well defined.  The Next Web warns: “The hype train has arrived.”  

That article, by Thomas Macaulay, goes on to add

There is some merit to the hype. Technological advances in fields like VR and AI are rapidly making virtual worlds more immersive and layered. Their escapist appeal has also grown during pandemic restrictions.

In the short term, however, buzzwords rarely live up to the hype. But once the underlying tech matures, effective strategies develop, and realistic objectives emerge? It has the potential to be truly transformational. Just don’t expect it to happen overnight.

Tech companies, you see, are deathly afraid of missing “the next big thing.”  They’ve been the beneficiaries of previous next big things, and they know both how fragile their perch is and how quickly a newcomer can ride that next wave past them.  Just ask AOL, MySpace, Netscape, Kodak, Nokia, or Wang, to name a few. 

Microsoft famously was late to realize the importance of the Internet, Google was flummoxed by the introduction of the iPhone, Facebook didn’t take mobile seriously enough initially, and Apple is still well behind its peers in cloud computing.  Each survived, even prospered, but none wants to miss the metaverse too.

Credit: The Hospitalist

Not so much in healthcare, though.  The incumbents just keep rolling along.  For all the adoption of EHRs, they still are not living up to the promise of better care and shared data.  For all the ballyhooed gains of telehealth during the pandemic, they’re already starting to dissipate.  For all the investment in digital health, there’s no real sign that it saves money or improves health.   Healthcare takes new technologies and kludges them into submission. 

Let’s face it: healthcare was late to computers (well, at least to PCs).  It was late to the internet.  It was late to mobile.  It still doesn’t understand the importance of social media or gaming.  It isn’t even thinking about the metaverse. 

I don’t know what health care might be in the metaverse.  I doubt anyone does.  But, for example:

• Your digital twin could see your doctor’s avatar (or an A.I. doctor!), for a virtual in-person visit;
• You could connect with others with similar conditions/interest in a much more personal and robust way than Zoom or Facebook allow;
• You could immersively educate yourself about health (and other) topics of interest.

More importantly, new uses will be found as people get used to the technology, just as we found new uses for smartphones and the internet as more people started using them.  This will happen in health care too.

Ignore it at your own risk.