Thursday, March 10, 2011

Variability 3.0

In yesterday's post, the Disease Management Care Blog pointed out that heath care variability is not only unavoidable but ultimately welcome. While amateur futurists point to "personalized genomic medicine" as the ultimate driver of variation, the DMCB respectively disagrees. It believes the promise of genomic medicine exceeds reality. In contrast, there are other cultural forces outside of medicine that will profoundly alter patients' expectations and change health care delivery in the coming years.

Say hello to Variability 3.0

One of the points of Alvin Toffler's Third Wave is that society tends to organize itself along the lines of assumptions that characterize ages, i.e., the the "industrial age" and the "information age." In past industrial society, schools, city planners and politicians prized uniformity and standardization. That's since been blown away. Apple's business model is not only based on ease-of-use, but uniquely customized music lists and personalized "apps." It's possible to go on line and order tailored clothes manufacturing. Amazon knows what the DMCB likes before it's even aware of it.

The fact is that consumers rapidly are becoming acclimated to "mass personalization."

For further insight of where this is going, check out this interesting article in the Feb 12-18 issue of the Economist on "The printed world." It describes how industrial and consumer manufacturing is moving toward "three dimensional printing" that creates items such as "medical implants, jewelry, boots, lampshades, care parts, batteries and phones." Consumers will eventually be able to apply this to any consumer good by pulling up a design using a computer, customizing the specifications and then "printing" a violin or a car or a kitchen using combinations of plastics, binders, powders and filaments and fibers. Not only will these products be personalized, but the approach uses far less raw materials and, even better, economies of scale don't matter. Uniquely fitted shoes for your feet, car seats contoured to minimize that back ache and a cell phone that fits your hand and ear are coming in a futureworld of computerized mass customization.

In the meantime, the clunky faux-modern approach to health care is antithetically attacking variation with one-size fits all clinical guidelines (hydrochlorothiazide first!), decision support tools (age 50 plus female look back 12 months = mammogram no exceptions), medication formularies (one or two drugs in each therapeutic category, all others denied because they're "not medically necessary") and quality improvement programs that impose the silly expectation that an operating room and primary care clinic should stamp out gall bladders and strep throats like aircraft engines. It's possible to use guidelines, decision support, formularies and QI to stomp out all that variation, but the DMCB predicts that that expertise will peak just as consumer expectations begin to reach a post-industrial tipping point. That point is defined by expecting an alternate approach of uniquely tailored treatments based on the their individual health status, preferences and values.

The future buyers, employers, health insurers, heath providers and government policymakers that figure out how to make this health care Variability 3.0 work will win. Everyone else will be behind the curve.

You read it here first.

Image from a Wikipedia article on 3D printing.


GlassHospital said...

I'm wondering about the tipping point on direct-to-consumer health care. Seems like FDA may start inserting health professionals into genome testing, but it's opened the door to do-it-yourself medicine.

Thanks for pointing out this article.


GlassHospital said...

re: "Tipping point"-i've been wondering about reaching the TP for public acceptance/adoption of DTC genetic testing.
I think it augurs a new era of DTC medicine, irrevocably changing the doctor-patient relationship.

Now the FDA will likely try to slow this process down, given the controversies in DTC genetic testing.

You heard it here first.

Moshe Sharon said...

With the advent of new medical technology called Molecular Diagnostics, we have a new double edged sword for the new world order. While DNA and RNA analysis will prove useful in reducing medical costs and take the guess work out of prescribing drugs, there is the danger of DNA profiles being used in the nefarious new world order conspiracy for domination and control.