The only big lever for

by francine Hardaway on October 28, 2003

The only big lever for change in the health care system is digitization. Health care as a system is so broken that every process must be taken apart and looked at in a new way. Fortunately or unfortunately, that’s what happens when industries digitize. Today only 22% of health care is digitized, although all cement manufacturers are digitized and all traffic control processes are digitized. Every industry in the country has already automated. Only doctors still use paper records.

In the next few years, health care will be digitized and information will be the backbone connecting all the processes. Digitization can standardize and automate processes, which cuts costs. Northwestern University automated its labs and dropped its time for lab results from eight hours to 1.5 hours; its costs are also 30% lower. Human handling is less, and malpractice is less. The software does error-checking for mistakes in transmission of judgment. (Pharmacies that automate have ZERO error rates in dosage or prescription.)

The baby boomers will push health care into the 21st century. They demand more of health care, and will push it to be faster, cheaper, smaller, easier, simpler, prettier, more efficient, more secure, with more features, better access, and more service. They know what can be:

Signing authority can be built into email, so the doctor doesn�t need to be there. Calendaring of surgeries dynamically can happen, with automatic synchronization. Retrieval time on charts can drop. Entire records can be displayed on a PDA.

Patients can then “order” their own care (make appointments).

The technology exists now to move information quickly around an office without a person physically carrying a chart into a room. In some hospitals, robots deliver charts. Diagnostics can be connected through high bandwidth, reshaping the physical shape of hospitals: clinics and mobile units can take health care to the patient, instead of making the patient go to the doctor�s office.

Duke University physicians found out that monkeys with neural implants can not only drive a computer with their thoughts, but they can figure out that they can project their thoughts directly into the computer. Blind people can drive with a chip implanted in their brains and a computer to process the information. If monkeys and blind people can process information digitally, I’m sure we can get doctors and hospitals there.

There’s so much awesome medical technology: Imaging is now three dimensional, and can find the presence of tumors and look at them any way you want, from any angle; a surgeon can specify what he wants to see, and make all the surrounding tissue translucent or transparent. He can virtually remove skin, remove tissue, remove part of the skull, then replace the tissue. Now he goes into the body laparoscopically, which is called minimally invasive, but soon surgery will be done within an MRI machine, and the surgeon will track what he�s doing in real time.

There’s already a surgical robot (DaVinci) that is like a 3D Nintendo for surgeons. They can sit across the room from the patient and guide the instruments. No standing for hours, no scrubbing. Soon the doctor can be in New York and the patient in France.

Several area hospitals already have the Cyberknife –a linear accelerator that has a map of your skull and your tumor, moves around your head and shoots electrons at it. No pain, no anaesthesia, no invasiveness.

Robots also already deliver pharmaceuticals to the bedside. The robot doesn’t bring the patient the wrong drug.

Nanotechnology makes possible the virtual colonoscopy:you swallow the camera and it delivers the image of your digestive system.

Entire laboratories exist on a chip: quantum dots can bar code proteins and watch them in action.

Your genome can be read in real time. Tissue samples can be analyzed by computers. Remember the sick bay on Star Trek where they scanned patients with a “tricorder”? The tricorder is coming, and it won�t be a hospital device, it will be a home health device that costs $20-$700.

With all this medical technology in the operating room, why is the hospital still not fully digitized? If the information technology processes in the health system matched the bedside processes, we could aggregate and analyze data and provide a massive database for physician decision support. Care would get better (or at least standardized). Expert systems now can find patterns and can supply missing information for decision support; doctors don�t use them because they self-select to trust their own judgment. But expert systems at the clinical moment could standardize care.

Decision trees can enable a physician�s assistant (or a monkey) to make a diagnosis with 70% probability and find out what tests could give you 100% probability. They can also provide a session record, an accountability track and education about rare cases and how you differentiate them. (Latent in this system is that 90% of what doctors do can be replaced by software.) You can even digitize an entire patient and test out therapies on the virtual patient.

So fight for digitization in health care. Ask for email. Ask for electronic medical records. We need them if we want to have health care we can afford in the future.

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