As the last of the large American industries to undergo forcible automation, health care is currently in a state of prolonged agony. The HealthTech NextGen 2011 Conference, held in San Francisco recently, highlighted this by calling attention to at least six disruptive changes that are still ahead in health care.
These range from physician workflow to patient responsibility, to perhaps the overall (again) of the entire system.
1)Conversion of physicians to electronic health records. So far, 83,000 physicians have proven to Federal government that they have implemented electronic health records and are using them to manage patient outcomes. Many of these were already using EHRs, and had only to report in to the government and receive their $44,000 per physician incentive for whatever they bought. If you are a physician and haven’t yet done this, you must be finished implementing your EMR by 2012, or the Medicare incentive will start to decline. This incentive goes away altogether in 2014. For the late adopters, subsidized technical assistance is available. So the gathering of patient information into automated systems is underway, and patients will soon have health care portals.
2)If stage one of meaningful use is to capture information about patients, stages 2 and 3 are about sharing it. Health Information Exchanges are springing up all over the US, designed to ensure continuity of care by allowing your medical records to travel between physicians, hospitals, pharmacies, and labs. The current way of exchanging health information is to export it to the patient, one way or another, and give her the responsibility of carrying it with her. In the future, the patient should be out of this process, except for controlling to whom the record can be sent.
3) The rise of the genomic signature as part of the medical record. Within the next decade, state of the art medical care will include tailoring your therapy to your unique genetic signature. You will have your genes sequenced as a matter of course, because the cost to do this is falling rapidly, and the number of therapies that depend for success on knowing exactly who you are is rising just as rapidly. Over 500 actional geneticSNPs influence treatment in oncology therapy alone today.Over 70,000 SNPS are known to affect disease development, course, or response to therapy Soon it won’t be possible to publish medical research without the genomic signatures of the cohort, and state of the art medical care will rely on a complete chart and comprehensive digital genomic sequence.
4)Perhaps the biggest transformational change to the health care delivery system will be moving the responsibility for health care and outcomes from the provider location to the consumer location through telemedicine, mobile apps, and remote patient monitoring. The patient will no longer go to the doctor’s office; the office will be with the patient at all times via a mobile device. Device integration is happening right now in all the major EMRs.
5) The rise of health avatars, trusted online resources to sort through the conflicting information a consumer needs to manage his own health. Your health avatar will help you do everything from stick to your exercise program to take your blood pressure and report it to a central database. In limited forms, these exist today as products like Fitbit and the Withings Connected weight scales and blood pressure monitors, which send information to central repositories on the internet from devices you can now buy for home use. The Fitbit measures your sleep and exercise, while the Withings weighs you, calculates body fat, and takes your blood pressure.
6) The change in physician compensation from fee-for-service to fee-for-outcomes. Your physician will be paid to keep you well, not for treating you when you are sick. In this ideal future, he will spend more time with you planning out how you plan to stay healthy than fixing you when you don’t stick to the plan, because he will be compensated for your health, not your illness.
One of the nation’s largest health systems, Kaiser Permanente, has pretty much ridden the front wave of these disruptions, and after four years of turmoil emerged with a fully integrated and automated system in which all of its 150,000 patients, 15,000 physicians, 36 hospitals, and 454 medical offices all participate. It boasts 100% of patient charts and 100% of its hospitals and clinics online. The online system processes 20,000 emails a day and has a full hot failover between data centers. To accomplish this, Kaiser Permanente also had to deliver 3,000,000 hours of training. But it has saved over 12,000 lives so far, by channeling the vision of Kaiser’s Founder, Dr. Sidney Garfield, who first published his vision of a completely integrated system in a 1941 edition of Scientific American. An overnight success.
