By Yong Suh, MBA, MSc
It has been a decade since the excesses of the tech bubble began to unwind, and a shadow of doubt was cast over the technophile’s vision of a new world in which people would buy books without thumbing through the pages, order groceries for home delivery, make friends at the click of a mouse, and gain instant access to the latest movies and music without getting off the couch.
Many innovative companies that had first sold us this vision are no longer around but have left in their wake a wave of strong successors that have turned what were once novelties into an essential part of our daily lives. Amazon, Apple, and Netflix are among a large stable of companies that have vindicated the vision of the early technophiles and have reinvented markets once dominated by brands such as Borders, Tower Records, and Blockbuster. Although the extent of its reach has been variable across industries, the explosive growth of information technology (IT) has touched every sector of the economy. Low touch industries with low barriers to entry, such as consumer retail, have been forever changed by IT, while high touch industries with high barriers to entry, such as healthcare, have largely escaped its grasp.
The current regulatory and reimbursement structure, privacy concerns, technical challenges, cost, workflow disruption, and the medical community’s reluctance to embrace technology without convincing evidence of its benefits are just some of the factors that have slowed the adoption of health IT. National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention reported that in 2009, only 6.9% of office-based physicians in the US had fully functional electronic medical record systems.
On the demand side, however, the picture looks very different. OECD’s 2009 survey showed that 63.5% of US households had access to broadband, and Nielsen reported that smartphones accounted for 40% of all mobile phones in the US as of July 2011. NCHS’ 2009 survey also showed that 51% of adults aged 18-64 used the Internet as a reference for health information in the preceding 12 months.
The current gap in IT penetration between the suppliers and the consumers of healthcare services will rapidly close over the next decade, as software innovators and investors increasingly focus their attention on healthcare, which accounts for 17% of the US GDP. The gap will be further narrowed as IT demonstrates its value by improving healthcare quality and lowering costs in the clinic and as patient demand grows for telehealth services.
Innovative companies like ZocDoc, Hello Health, Practice Fusion, PatientsLikeMe, and Voxiva have already begun to sketch out the future of healthcare. This will be a world in which patients will be able to search online to find physicians who can accommodate their schedule, videoconference with physicians who can e-prescribe medications and update medical records accessible on the cloud by other healthcare providers. They will be able to connect with a community of other patients with like medical conditions for moral support and for collective wisdom about the latest treatment options and set up delivery of timely medical information and reminders to their mobile devices to promote healthy behavior.
This concept of healthcare delivery may seem as unconventional as online purchasing of books and groceries may have seemed a decade ago, but regardless of whether these innovators go the way of Webvan and not Amazon, the ideas they are currently testing will reshape the landscape of healthcare. The survivors will drive the healthcare delivery system closer to a patient-centered model, where patients will be armed with specialized information and have more choices over how they access healthcare, choosing the time, the place, the mode of communication, and the healthcare provider.
In this push to redefine the healthcare system, numerous IT enterprises have begun to tackle secondary activities such as health data management, claims processing, and social media; however, developing IT solutions to improve healthcare’s primary activities – diagnosis, treatment, and prevention – presents a more compelling challenge.
Distinguishing sick from non-sick is arguably the most important step in patient care, but according to a 2005 meta-analysis funded by the Agency for Healthcare Research and Quality, misdiagnosis accounts for 10-30% of medical errors. This study cited time and resource constraints of healthcare providers in addition to cognitive errors as sources of potential diagnostic errors but concluded that IT could help address the problem of information overload. The reliability and utility of clinical decision support systems such as Isabel and GIDEON have increased dramatically, and these systems have begun to gain acceptance by many members of the medical community.
IBM’s Watson has the potential to advance clinical informatics further with its DeepQA technology, which was successfully validated in the historical Jeopardy! tournament in February 2011. These systems could help decrease the number of medical errors by generating more robust differential diagnoses and flagging medication errors.
Natural language processing, the technology underlying Watson, will become important in cataloging and digesting voluminous medical knowledge that is doubling every five to seven years. The pace of innovation in medicine is exceeding the frontline healthcare providers’ ability to effectively incorporate the latest findings into practice, particularly in non-academic settings. Medical diagnosis is an iterative process, and new tools like Watson could help clinicians systematically rule in or rule out the most consequential diagnosis sooner, thereby improving outcomes and saving costs. The utility of natural language processing in healthcare could extend beyond diagnostics to support comparative effectiveness research as well.
Healthcare delivery is on the cusp of a radical revolution that will be driven by advances in IT. Democratization of medical knowledge and expert systems such as Watson will accelerate the ongoing shift from inpatient to outpatient care and increase patient autonomy
Yong Suh is a medical student at The Johns Hopkins University School of Medicine. Prior to medical school, Yong worked as a healthcare analyst and completed a research fellowship at the National Institutes of Health.