Tech Can't Fix the Problems in Healthcare

Shira Ovide, who writes the On Tech newsletter for The New York Times, had a thoughtful column last week: Tech Can’t Fix the Problem of Cars.  It was, she said, inspired by Peter Norton’s Autonorama: The Illusionary Promise of High Tech Driving.  The premise of both, in case the titles didn’t already give it away, is that throwing more tech into our cars is not going to address the underlying issues that cars pose.

It made me think of healthcare.

Credit: HealthcareITNews

What’s been going on in the automotive world in the past decade has truly been amazing. Our cars have become mobile screens, with big dashboard touchscreen displays, Bluetooth, and streaming. Electric cars have gone from an expensive pipedream to an agreed-upon future, with Tesla valued at over a trillion dollars, despite never having sold a half million cars annually before 2021.

Credit: chombosan/Getty

If we don’t feel like driving, we can use our smartphones to call an Uber or Lyft. Or we can use the various autonomous features already available on many cars, with an expectation that full self-driving vehicles are right around the corner. Soon, it seems, we’ll have non-polluting, self-driving vehicles on call: fewer deaths/injuries, less pollution, not as many vehicles sitting around idly most of the day. Utopia, right?

This is what Ms. Ovide and Dr. Norton are questioning. Ms. Ovide says: “There’s also a risk that devoting our attention to these technological marvels may give us a pass from confronting a deeper question: How can we make our lives less dependent on cars?”

Making it cheaper, safer, and more convenient to hop in a car, their argument goes, might very likely just make us drive more miles (just as adding/expanding highways has proved to induce demand instead of relieving congestion). 

Ms. Ovide describes some of Dr. Norton’s arguments:

But Dr. Norton also said that it would be useful to redirect money and attention to make walking, cycling and using shared transportation more affordable and appealing choices.

Dr. Norton asked us to imagine what would happen if a fraction of the bonkers dollars being spent to develop driverless cars were invested in unflashy products and policy changes.

She concludes: “We know that technology improves our lives. But we also know that belief in the promise of technology sometimes turns us away from confronting the root causes of our problems.”

So it is with healthcare.

Money is flowing into digital health in ways that make the housing market look rational. Every day there are new investment rounds valuing digital health companies you’ve never heard of, and that few of us could distinguish, in the hundreds of millions of dollars. Healthcare, the belief must be, is going to be more digital; we don’t really know exactly how or when, but safer to cover all the bets.

Meanwhile, the big healthcare systems and the big health payors are getting bigger, each gobbling up competitors and new tech-based entrants at ways that Big Tech would recognize. These days, if you’re in healthcare and someone isn’t acquiring or investing in you, you’re doing something wrong.

But, as was pointed out about cars, tech isn’t going to solve the many, many problems that healthcare has. As Nick van Terheyden, MD, tweeted last week:

If you work in healthcare, you know the kind of systemic problems he’s referring to. If you have ever received healthcare, or known anyone who has, you also have probably seen some of them. And if you have the “wrong” insurance status, gender, race/ethnicity, or location, you have undoubtedly experienced them. 

To call our healthcare system a “system” is to overstate the case; it doesn’t work anything like a system. For many people, it doesn’t work at all. It evolved from something smaller, something simpler, and, like evolution generally, it has lots of kludges that are serve no evident or useful purpose. The goal of evolution is, after all, survival into the next generation, not efficiency, elegance, or equity.

Recently, Rasu Shrestha, MD, quoted Atrium Health’s Geoffrey Rose, MD: "A system that needs a navigator, is a system that needs to be redesigned." What we’re doing in healthcare is adding more and more navigators, especially tech-based ones, instead of redesigning the system.

We can add all the tech we want – and healthcare should have much, much better technology – but that doesn’t necessarily mean people without insurance (or with low-paying insurance like Medicaid) will get the same care. We can apply artificial intelligence and Big Data to many healthcare problems, but, unless we are very careful and very purposeful, that doesn’t mean women or people of color will get the same care, with the same outcomes, as white men. We can build lots of beautiful new buildings but that doesn’t mean the care in those buildings is going to be of the same quality as in the places with the best care.

Even if we gave everyone all the healthcare we could, that doesn’t mean our health would be what it should/could be. If there’s one lesson our healthcare system continues to ignore, medicine is not the same as health. The now-familiar SDoH graphic suggests that only around 20% of our health results from the healthcare we receive.

Dr. Norton wants us to invest in “unflashy products and policy changes,” like zoning changes that encourage us to walk more instead of driving. Similar unflashy products and policy changes would get a bigger bang for our buck than most of our healthcare spending. How do we eat better, get more exercise, have cleaner water and air, etc.?

We’ve built our cities – and our suburbs, and our interstates -- around cars (not to mention our parking lots!). Our lifestyles depend on easy access to them. We’re going to see electric cars, autonomous cars, on-demand cars, but unless we rethink our basic attitudes towards driving, we’re not going to achieve the results that we’re hoping for.

The same is true with healthcare. I love technology as much as anyone and am excited about how new technologies can apply to healthcare, but let’s be clear: technology alone is not going to solve the basic problems our healthcare system has.

Ask the people at Building H or Cityblock how they suggest we might go about solving them. Our health is about our lives, not our health care, and so should our healthcare system.