Monday, January 16, 2012

If It Can Be Digitized, It's Transport Can Be Commoditized: Implications for Health Care Providers

Navy telemedicine, coming
to a clinic near you
The Disease Management Care Blog is not only a simultaneously superb and humble physician, it's a needy and impatient patient.  In the course of recently seeing one of its doctors, it endured having to arrive early (waiting room), getting past the dreary check-in line (confirming my zip code again?), answering all the the nurse's inane questions (no, I don't have pain), seeing the doc ("Yup! Everything is fine!") and getting out (with an after-visit summary). It was a time consuming hassle that ate up half of a day.

The time is ripe for some disruptive technology.

Enter this highly interesting video by futurist Edie Weiner, who illuminates the underestimated links between "digitization" and "commoditization." While Ms. Weiner's point had more to do with the generalities of mainstream data processing, the DMCB thinks there are parallels in health care that have important downside implications for the industry's knowledge workers.

And the most vulnerable of those knowledge workers are the primary care physicians, because, thanks to digitizing of patient information, a lot of physician office visits will be going away.  That's not only a lot of disruption, that's a lot of income.

The DMCB explains:

Recall that a "commodity" is any market good or service that is supplied without qualitative differentiation. Classic examples include wheat, copper and oil, which are bought and sold on the basis of upstream supply and downstream product demand (such as bread, computers and gasoline).

What does this have to do with health care?  While the physician DMCB is not saying that humans are the same as wheat, copper and oil, that doesn't mean that their symptoms and treatment can't be digitized.

Before you scoff, recall that the management of upper respiratory illness can be distilled down to a fairly simple algorithm. The same is arguably true for other myriad conditions such high blood pressure, diabetes mellitus and even heart attack.  "Inputs" including age, gender, concurrent conditions, disease severity, medications and other factors can be digitized.  This, in turn, can be informatically processed to create evidence-based treatment recommendations from afar.

Until now, the new paradigms associated with health care reform still rely on the assumption that patients with their colds, hypertension, diabetes and chest pains will continue to personally bring their medical problems to the doctor's office.  What's supposedly "new" is that advances like the teaming of a medical home, the decision support of an electronic record or the incentives of value-based insurance designs would make the office visit a more rewarding, efficient, effective and less costly affair. All well and good says the DMCB, but even with a new wrapper, it's still destined to remain a dreary and time-consuming office visit.

Thanks to Edie Weiner, the DMCB suggests that that business model and all those carefully laid policy assumptions could blow up.

Here's why.

Our clinic-based and see-the-doctor approach to care is being eclipsed by an approaching "perfect storm" made up of four key ingredients:

1. Highly organized electronic databases.  Not to be confused with electronic health records, this is the access of updated and easily accessible patient information, plus

2. Networked patient monitoring systems. This is periodic assessments of, for example, blood pressure, glucose levels and EKGs in persons with hypertension, diabetes and heart disease, plus

3. Artificial intelligence-backed decision support. While this may not be ready for prime time in the average doctor's office or via a voice-activated smart phone, the recent broadcast of the game show Jeopardy featuring IBM's Watson showed us just what's possible, plus

4. A tipping point of consumer acceptance of informatics. The DMCB's spawn have applied their mobile devices to every part of their lives, why not their health care?

In a traditional care setting, patients assemble their concerns (the "data") and personally transport them to the doctor (the "processor"), who renders a treatment plan. Thanks to the four-fold perfect storm described above, the digitization of patient information will enable patients like the DMCB to avoid the high opportunity costs of a usual-care office vist.  The DMCB will be able to use the network. In effect, it's the transport of the DMCB's information that will, in a round-about way, be "commoditized."

In some respects,it's already begun. Because patient problems can be be digitized, packaged and transported just like all the world's other data that are described by Edie Weiner, video physician visits, decision support-backed nurses and touch-screen kiosks are now processing the information and rendering treatment recommendations outside the office visit.

What will this mean?  Many diagnoses can be made remotely. Treatment plans can be adjusted without need for a face-to-face visit. Oversight can be provided by non-physicians.

In tomorrow's post, the DMCB will review the implications and what it means for primary care physicians.

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