21st Century Health Care: It's Going to Be A Lot Different, And Most Likely Better And Cheaper (Joe Rothstein's Commentary)

October 19, 2009

By Joe Rothstein
Editor, EINNEWS.COM

One of the problems with the debate over the current state of health care is that it's mostly a debate over the current state of health care. That's the wrong context. When you look ahead a few years----and not that many years-----many of the prescribed changes set the stage for the health system's inevitable new realities.

If you're not there already, it won't be long before you will be monitoring your own weight, blood pressure, pulse and other vitals on at-home devices and sending that data to your doctor via smartphone. Coming back at you, also on your mobile phone, will be reminders to take your pills, notices of any changes in your heart rate or other bodily systems that require an office visit---or more personalized data dealing with whatever chronic condition you might have.

If you live in a rural area where specialists are scarce, you might talk with a dermatologist who inspects your rash by broadband video, in real time, or from your local doctor's office while she gets online advice from an urban medical center specialist talking her through a procedure.

Your medical records will be online, of course, available for any caregiver, anywhere in the world, to diagnose you or monitor you. And you will be able to rate the quality of care you're receiving the way you might now rate a hotel stay on Travelocity. That will give others the benefit of your experience so they can be more informed health care consumers.

A lot's happening in this new world of health care. More than you can imagine. And as the digital health industry develops it will lower costs, allow physicians to spend more time with patients and less with record-keeping, handle the increasing demands of our aging population and help overcome the maldistribution of medical specialists, particularly in rural areas.

The truth of the matter is that none of us really ever wants to check in to a hospital. Sometimes it's unavoidable. No one has yet figured out how to take out your appendix or a tumor while you're lying on your living room sofa. But then there's all that other stuff, much of which can be handled at a distance in the new digital age.

Using a combination of medical coordination and home telehealth devices the VA has experienced a 19% reduction in hospital readmissions and a 25% reduction in hospital days. Instead of you having to trek to the hospital or your health care provider, the health care system is finding more and better ways to come to you.

The Brookings Institution had an informative discussion about all of this the other day. The experts on hand acknowledged that this move into the world of digital health is unnerving to a lot of people concerned about privacy, cybertheft of records, and the loss of human contact with health care providers. Many of us are having a hard time wrapping our minds around this transformation.

But there will be many upsides, not the least of which is cost. Darrell M. West, who directs governance studies for Brookings estimates cited a PriceWaterhouseCoopers study that estimates more than $600 billion is wasted in the U.S. each year on medically-related practices that can be vastly reduced through adaptation of digital reforms.

But many hurdles occupy the space between now and then, in addition to the obvious one of paying the cost of transforming a $2 billion industry.

Physicians and patients are going to have to learn how to migrate into the new medical world. That may not be as difficult as it seems with a generation or so now having grown up with Nintendo and Game Boy as their constant companions. And who now doesn't have a cell phone, or a smart phone, or an ipod? In the near time horizon it's likely we will all be customers at the medical app store, customizing our own devices.

More difficult will be such matters as 1) encouraging public and private health insurers to cover most mhealth communications and wellness programs (they don't, now), (2) rewarding providers for work performed within the new system, not just for personal visits or tests ordered, (3) changing licensing of health providers to permit the practice of medicine across state lines (by telemedicine) (4) achieving compatibility among devices made by various manufacturers, and (5) integrating preventive care into the entire system as a full-fledged, and insurance reimbursable, partner.

When you look closely at the incipient changes to health care that digital technology already has made, and the rapid state of development of new devices and communications systems, it's clear where medicine is heading. Steered correctly, technology is going to cure a lot of our health care, and health cost ills. Digital technology is revolutionizing commerce, finance, transportation and other pillars of every day life. Medicine has been more resistant, but many factors make the shift inevitable.

All of this is important to keep in mind as the congressional health reform debates moves to its final laps. The plans on the table certainly apply to today's system. But they also provide migration paths to what's coming. That's why it's so important that this year, unlike years past, the entire effort must not wind up terminal in Congress' intensive care heap.

(Joe Rothstein can be contacted at joe@einnews.com)