I recently viewed health care through the lenses of a technology entrepreneur by attending the Health Innovation Summit hosted by Rock Health in San Francisco. As a practicing primary care doctor, I was inspired to hear from Andy Grove, former CEO of Intel, listen to Thomas Goetz, executive editor of Wired magazine, and Dr. Tom Lee, founder of One Medical Group as well as ePocrates.

Not surprising, the most fascinating person, was the keynote speaker, Vinod Khosla, co-founder of Sun Microsystems as well as a partner in a couple venture capital firms.

“Health care is like witchcraft and just based on tradition.”

Entrepreneurs need to develop technology that would stop doctors from practicing like “voodoo doctors” and be more like scientists.

Health care must be more data driven and about wellness, not sick care.

Eighty percent of doctors could be replaced by machines.

Khosla assured the audience that being part of the health care system was a burden and disadvantage.  To disrupt health care, entrepreneurs do not need to be part of the system or status quo. He cited the example of CEO Jack Dorsey of Square (a wireless payment system allowing anyone to accept credit cards rather than setup a more costly corporate account with Visa / MasterCard) who reflected in a Wired magazine article that the ability to disrupt the electronic payment system which had stymied others for years was because of the 250 employees at Square, only 5 ever worked in that industry.

Khosla believed that patients would be better off getting diagnosed by a machine than by doctors. Creating such a system was a simple problem to solve. Google’s development of a driverless smart car was “two orders of magnitude more complex” than providing the right diagnosis. A good machine learning system not only would be cheaper, more accurate and objective, but also effectively replace 80 percent of doctors simply by being better than the average doctor. To do so, the level of machine expertise would need to be in the 80th percentile of doctors’ expertise.

Is it possible technology entrepreneurs can disrupt health care? He challenged any doctor in the room to counter his points.

Silence.

Was it because everyone agreed? Were the doctors in the room simply stunned? Was there a doctor in the house? And where did he get that 80 percent statistic?

Was Kholsa serious that technology could make health care better by utilizing large data sets and computational power to clinch better and more precise diagnoses?  Was he simply being provocative to hear other points of view to learn even more? Like many others in the conference, he believes that giving consumers more opportunities, access, and choice to information about themselves and their bodies would empower them to do the right thing. He held up an EKG attachment to the iPhone which was just one of many consumer directed products in the pipeline his company has invested in.

Kholsa is a very smart and successful entrepreneur. Does innovation mean the two guys in a garage who come up with a radical idea or is it possible that innovation is having people with different experiences and point of view looking at the same problem as best selling author Malcolm Gladwell noted in his New Yorker piece Creation Myth -  Xerox PARC, Apple, and the Truth About Innovation? Surely to make health care better, technology entrepreneurs must engage with doctors. All the speakers before and after Kholsa spoke about the incredible value and insight different stakeholders to bring to the table.  The most vocal? The doctor entrepreneurs and those who worked with doctors to bring their ideas to market.

Kholsa’s criticism of the health care system is completely valid. Can we do better in being more reliable, consistent, and creating a system process and design that is comparable to highly reliable organizations and industries? Of course. Can we be more systematic and doing the right things every patient every time on areas where the science is known to level of the molecule? Yes. Care must be incredibly simple to access, extremely convenient and intensely personal.

It isn’t that we don’t have smart people. Compared to a century ago more illness are understood, specific medications and treatment protocols can be designed. But we haven’t solved it all. When we thought we knew it all, we were shown how little we truly knew. Thirty years ago, doctors predicted the demise of infectious diseases as a specialty, another footnote in medical texts as more powerful antibiotics and vaccines were available. Enter AIDS, the swine flu, and many super-bugs which have humbled our profession. Ask accomplished physician and writer Dr. Abraham Verghese about his experiences. Dr. Verghese is rightly worried, as many others are, that even doctors are being too focused on the iPatient and not on the real patient as he writes in his New York Times op-ed Treat the Patient, Not the CT Scan. Is this what we want our health care system to look like?

Health and medical care is an incredible intersection of technology, science, emotions, and human imperfections in both providing care and comfort. As conference speaker Dr. Aenor Sawyer, an orthopedic surgeon from UCSF noted, we need to figure out how to have our different cultures of doctors, gamers, designers, and technologists interact. Fixing health care is more than simply “we know the problem and we know the solution”. She reflected that the level of dedication, perseverance, and a willingness to make impact among the different groups demonstrates more similarities than differences.

I know health care can’t simply be solved by smart people in Silicon Valley alone.  To solve health care we need everyone to collaborate. As Harvard Business School professor Amy Edmondson noted in her book Teaming -

“For over a century, we’ve focused too much on relentless execution and depended too much on fear to get things done. That era is over…human and organizational obstacles to teaming and learning can be overcome…Few of today’s most pressing social problems can be solved within the four walls of any organization, no matter how enlightened or extraordinary… Generating ideas to solve problems is the currency of the future; teaming is the way to develop, implement, and improve those ideas.”

Perhaps Kholsa’s call to action was simply an entrepreneurial mindset, but simply ignoring those who have chosen a field to improve and safe lives and who meet humanity everyday on the front-lines is problematic and dangerous. There are some things that may never be codified or driven into algorthims. Call it a doctor’s experience, intuition, and therapeutic touch and listening. If start-ups can clear the obstacles and restore the timeless doctor-patient relationship and human connection, then perhaps the future of health care is bright after all.

Davis Liu, MD, is a practicing board-certified family physician and author of the book, “Stay Healthy, Live Longer, Spend Wisely – Making Intelligent Choices in America’s Healthcare System.” Follow him at his blog, Saving Money and Surviving the Healthcare Crisis or on Twitter, davisliumd.

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88 Responses for “Vinod Khosla: Technology Will Replace 80 Percent of Docs”

  1. Let me tell you what machinization is going to do to medicine: exactly what it did to “other industries”.
    It will industrialize it into several predefined sizes to fit all (more or less).
    It will not reduce the number of knowledge workers, but it will allow the work to be moved to areas where labor is cheap, plentiful and hidden from the ultimate user.
    It will redefined “quality” to mean “quick ,cheap and lots of it” (think plastic forks).
    It will centralize the physical venues for obtaining and distributing it to the masses (think plastic forks at Walmart).
    It will create several tiers of service, from Per Se to Cheese Factory to McDonalds, or Neiman Marcus, Macy’s and Walmart, or Lexus, Honda and Chevy Neon (used), or …. everything else.
    It will redefine health “care” to be health “services” and all those visionary leaders of ours will make enough money to never have to set foot into one of their “innovative” creations.

    • Mike says:

      To Margalit Gur-Arie:

      Most of what you have told us “is going” happen to medicine has already occurred. And already a lab test can diagnose more than half of patient problems. As we improve our testing this number is going to increase, and treatments are going to also be better matched to specific patients.

      There is always going to be some “care” in health – for the same reason there are few atheists in foxholes. If we trust progress and maintain faith for human compassion then we can drive most of the mercenaries out of healthcare.

      Mr Khosla voiced profound statements; he is successful and talented. But his statements are not new. He had a stage and was able to synthesize the ideas of others to gain appropriate attention to an area of need. Kudos to Mr. Khosla and Dr. Liu!

    • Christine Wren says:

      Mechanization and automation _will_ reduce the number of knowledge workers in the field. It is already happening in other large swaths of the economy.

      One of the most significant, if under-reported, aspects of our long jobless recovery is that automation is doing a great deal to improve productivity, while minimizing the need for more human-filled jobs.

      Tom Edsall wrote in July about this “hollowing out” (http://campaignstops.blogs.nytimes.com/2012/07/08/the-future-of-joblessness/) wherein jobs at all levels of the economy are losing to automation.

      Erik Brynjolfsson and Andrew McAfee of MIT recently wrote Race Against The Machine (http://amzn.com/0984725113/) which makes explicit the claim that the knowledge economy has now developed to a point where knowledge workers are losing to the machines which embed their knowledge.

      Doctors are right to be worried that they will lose as automation overtakes healthcare. But they are no more privileged in this fear than are other credentialed professionals (lawyers, etc.) who are also losing the race.

      • Linda DiFeliciantonio Rocca says:

        Thank you, Christine, for stating the obvious but the under-reported: automation has replaced, a stat cited, up to 28% of all jobs in the US. When are the politicians and the media going to bring this front and center? I

        The medical community can expedite and perfect the prognosis/diagnoses methodology through the use of advanced intelligence diagnostics but the future also involves changing healthcare delivery in general. Why replace organs when we can re-grow them? We already have the technology in place but we lag behind Europe due to our outmoded FDA regulations, slow adoption of big pharma and their constituency and physicians’ archaic paradigms: we do things because it’s always been done this way?. We all know that Innovation starts with the desire for improvement but change needs to be ‘adopted’ first and foremost. It’s time for cross-functional and multi-dimentional solutions to tip the scales…computers and robots included.

    • io says:

      doctors earn too much for a profession which relies so much on memory! mathematics is much harder and yet paid a lot less!

      • Dr. Know-it-all says:

        so you’re saying that people who play with their calculators should earn more money than people who save lives? how idiotic and absurd. BTW, medicine is much harder than math, and that is a FACT. For proof, just look at people like you who does math for living because you didn’t have the scores to get into medical school. HA!

    • Jacqueline Mosqueda says:

      I agree with you 100% but have a few things to add all based on my experience of 30 years as a Registered Nurse and 6 years as a Clinical Informaticist:
      The available technology is phenomenal! But if BMW hires 12 year olds with no experience to build the cars, they aren’t going to function to spec. This is what is happening today in Healthcare Technology. In theory and on project plan, yes, the computer program is safer, smarter, quicker, and more thorough than any human. But the practice of hiring a 20-something keyboard hog (on the cheap) with little life experience and therefore no concept of the magnitude of importance the build holds, coupled with being on a “Team” which in today’s world just means when the thing doesn’t work none of the team members need worry about being held accountable, and add in that the health systems who are buying the technology are relying on the vendor to have a system of checks and balances in place to ensure everything functions correctly—which they do not! Well, maybe they do, in the virtual world, tied up with a fancy ribbon, something to pull out for the regulatory body in on an infrequent percursory visit, but that doesn’t, in all reality, even make it as far as the laptop of the next step builder.
      Physicians today who practice clinically, are in it for the calling, not the money. Any person who goes through that many years of study with little or no financial reward, and is intelligent enough to have chosen any profession ,and who could right this minute be lying on a resort beach as a lifestyle while managing someone’s Hedge Fund instead of impacting real people in their real lives on a daily bases–in other words, dealing with blood and guts–these are the people who deserve the awe and the respect.and who’s voice needs to be heard about how technology plays out when the rubber hits the road. But they are not being heard, even when they voice legitimate concern over the computer programs they are contracted into utilizing. Even when they point out the dangers in the technology, and even when they are forced out of practice because they cannot afford the technology and refuse to succumb to partnering with the wealthy technology giants to stay in it–as a matter of ethics.
      Personally, if you call yourself a physician but you didn’t practice for 30 years before selling out to Daddy Warbucks, I don’t care what you think–and I won’t be buying what you’re selling.

  2. dirkd says:

    idiocy. and they wonder why we look at ‘em sideways when they come into our offices selling cloud-based awesomeness.

  3. J.T. says:

    This absolutely the truth of where we are headed in healthcare from Mr. Khosla . I have thought the exact same thing countless times before myself. The only question is how long it will take to get there.

    There is no guild that is safe to capital intensive technology solutions to artificially high guild induced labor shortages. The legal profession is currently in the early stages of being crushed by the e-discovery and legal content industry (legalzoom.com, pangea3, etc.) . A lawyer can supposedly be as productive as 300 lawyers of yesteryear now. Accounting software is further behind in terms of displacing accountants but that is speeding up (turbotax, experian, etc.). Higher education is going to be forced to change radically in the near future and technology will be part of that transition. Next up healthcare…

    Contrary to what most self-aggrandizing physicians think, most of their work can and will be done primarily by machines. Better, consistent, reliable, cheaper machines… They will begin morphing into the role of highly skilled technicians, but with much less status. Like many others, their future will be as typical salaried employee wearing a big name tag at eye level “Welcome to healthmart, how can I heal you today?” Only a matter of time…

    • Mark Freeman says:

      You can’t really believe that computers will replace healthcare providers in the next 30 years? “Self-aggrandizing physicians” as you speak, will still be providing the best care…it just that only the wealthy will benefit from their services. For everyone else, you suggest that White Castle will do. Sad.

      • House says:

        Dr. Freeman,

        Read Kurzweil’s work on exponential growth of technology. The changes that we are going to see in the next ten years is going to be unimaginable at this time…30 years is way way long time make any projections…

  4. Russ Gerber says:

    This piece is from someone who is open to fresh ideas. Not all of them may be great…or even good. But I’d trade the occasional dud for the opportunity to discover a problem-solving idea that was invisible to some people but obvious to others.

  5. Cynthia says:

    I imagine it’s much more difficult to design a machine that can care for newborn infants and severely handicapped adults than it is to design a machine that can make decisions and solve problems at top levels of business or accurately diagnose illnesses and devise the best available treatment plans. So if anything, the corporate world has got it all backwards in assuming that it’s easy to replace lower-skilled workers with machines, leaving most of the highly skilled work in the hands of humans.

    Look at this way: being a top-notch corporate executive is very much akin to being a grandmaster chess player. Or, being a great medical diagnostician is simply someone who’s really good at algorithmic thinking. Needless to say, these are the kinds of skills that a computer is very good at doing. OTOH, it requires a highly advanced robot with a great deal of touchy-feely skills to care for our neediest and most helpless members of society. In fact, most of our IT companies have designed machines with decision making/problem solving skills that rival that of our most highly-prized corporate execs or our most gifted medical diagnosticians. By contrast, it’s still very challenging for the most advanced robotics labs in the world to design a robot that can do the touchy-feely work that’s required of our most prized and highly valued bedside nurses.

    That’s why I propose that we replace most healthcare executives making seven-to-eight figures and many medical doctors with six-to-seven-figures with robots that’ll work for free (24-7), freeing up the necessary funds to provide all bedside nurses (as well as all hands-on physicians) with a much needed cost-of-living raise! It’s time that we get back to rewarding skills that humans will always be far better at doing, despite all of the advancements we make towards making robots more and more like ourselves.

  6. bmore_bulldog says:

    The cloud is a paradigm of interconnected openness. Over 60% of web-users under 35 report critical infrastructure weakness in critical tasks at least 3 times a week. Disruptive innovation will spur entrepreneurial synergy that will diversify operations systems, creating opportunities for creative asset parameterization.

    I wonder how long I could speak like that at one of these conferences before they noticed I was making fun of them?

    • Dixie Dawg says:

      Another paragraph that includes, pivot, discernable matrix and theonoms and they would throw money at you , especially if you gave them a first round shot at your “A” series. Hay, who wouldn’t want a sunrise theonom that is Think Tank proven to deep shift the lax ellipticals in your burn rate.

      Theonom /s an applied for registered trademark /s of the one and only Dixie Dawg from the tale pines of South GA. Even us Rednecks can to the VC thang.

  7. tcoyote says:

    Big thinkers like Khosla have had an embarrassing track record investing in healthcare over the past twenty years. The Silicon Valley geninuses have squandered hundreds of millions of dollars of venture money in “molecule of the month” biotech companies, brought us “recreational genomics” from 23andme, etc., and $3000 a test single gene tests with debatable connections to future health risk. It’s been fun to watch. Glad not to be one of their limiteds.

    The healthcare landscape sure looks different from 40 thousand feet than it does from the ground. I think Khosla’s thesis is abject bullshit. It’s not just diagnosis physicians do, but manage evolving and complex situations in real time. Knowing the patient and knowing how patients think and act is really important in being a good physician. We’re a hundred years away from knowing enough about human disease to do what he suggests. Sounds great as a TED talk though.

    • Mark Freeman says:

      Excellent analysis tcoyote. Couldn’t have said it better.

    • Dixie Dawg says:

      I live thirty miles from Khosla’s defunct investment known as Range Fuels. Just Google Range Fuels and read all about what “burn rate” means in terms of your tax dollars. This time it was Ethanol from burning pine straw. We are still waiting.

      Another of his investments, Lanzatech bought the defunct 100 million plus company at auction on the Court House steps in Soperton, GA for 5 million. Reality is a real kicker.

      tocyote I could have saved a lot of typing if I simply cut to your bottom line. ” abject bullshit.” You said it all.

    • Peter1 says:

      “We’re a hundred years away from knowing enough about human disease to do what he suggests.”

      Exactly! Computer geeks think that entering enough logarithms will solve all our problems. No need for docs, just use IBM’s “Watson”, no thanks.

    • Bob O. says:

      Excellent commentary – couldn’t have been said better.

      For further proof – look at what I just spotted on twitter – 30 year venture capital returns comparing healthcare investments made by VCs who understand healthcare vs. healthcare investments by IT-only VCs

      https://twitter.com/bijans/status/242278715428585472/photo/1/large

      The data is pretty compelling.

  8. healthquant says:

    Nope – not gonna happen anytime soon.

    Algorithms and statistical models are terrific. They do great things, solve great problems and are just cool.

    But this is orders and orders of magnitude more complex than what’s currently possible. Compare this to speech recognition. It’s pretty good, but not perfect, and has taken years to refine. Building an Artificial Intelligence solution to doctoring is a whole different game.

    Not to mention even with 6 billion people, there would be a talent shortage to make this happen.

  9. Snook says:

    I heard him speak – very disappointing. Not sure he should be in the healthcare arena as he doesnt understand the issues. Offered no real valuable insight into fixing the healthcare crisis. Probably very good at picking companies to make $$$ – but certianly not a healthcare visionary. Tom Goetz did a good job but Khosla was not up to it – note to Rock Health organisers – poor presentation – quality speaker next time please.

    • lauramontini says:

      Actually I’m glad Rock Health included him in the lineup. If you caught his article http://tcrn.ch/RuPglA in Tech Crunch at the beginning of the year, you knew what you were going to get. What he said during his time on stage influenced some of the conversation that came after him (and I think it’s safe to say that most who alluded to him disagreed with him).

      I’m not with Khosla here. But the points he makes shouldn’t be written off.

  10. Observed says:

    There is a syndrome I have noticed in the forty years I have spent working in health care. The syndrome is usually exhibited by people who are smart and accomplished in some other domain (like engineering or finance or economics). They look at the health care system and say “Thank God I’m HERE!. All this time these dumb/greedy physicians have been missing the obvious simple things that could be done to bring health care nirvana. My [insert solution here] will revolutionize health care for nothing in less than a year.”

    Boy howdy, here comes an other victim of the syndrome. It will pass, assuming that he has the patience to actually roll up his sleeves and try working in health care.

    And creating an iPhone app to monitor exercise and diet doesn’t count.

    • Christine Wren says:

      There is a corresponding syndrome that afflicts people in professions that demand a great deal of intellectual effort to be credentialed. We come to feel our effort somehow insulates us from great economic vicissitudes. Sadly, it doesn’t.

      The deep waves of technologically-driven economic change are now beginning to seriously rock the ship of healthcare. Earlier waves had capsized the ships of the manufacturing professions, though we paid little heed.

      Now most of us are beginning to feel dread, and some–having moved past that–are beginning to express anger towards the technologists who have no respect for our profession and its history as they work to sink our ship.

    • Well stated. When i was a young and naive physician many years ago I was often awed by well spoken professionals from other domains who had the answer to healthcare. Like you I was consistently disappointed by their results, and continued to roll up my sleeves and delivering care the way I knew. I did learn things from them along the way, and they did change many aspects of the way care was delivered. However their refusal to admit they were wrong was disheartening.
      I firmly believe that technology will help improve healthcare, but I have matured enough to know there is no single magic bullet that will solve all the issues we face. We need to develop the wisdom to recognise what helps, the strength to remove the barriers to its adoption, and the humility to accept that many things will fail and we have to be able to move on.

  11. @bootstrapped says:

    Vinod Khosla – He’s an idiot, he’s a genius. He must be an innovator!

    No matter the justification, health care can’t avoid modernization and that will come in the form of innovative technology. It’s already happening and like all other technological advancements, it will continue to accelerate of its own energy.

    But machines and algorithms can’t treat every patient, every condition, every disease so that means we’ll always need doctors.

    The promise of the “health care system” working with the innovators isn’t the elimination of doctors. It’s that through new technology we’ll eventually need fewer doctors who will be much better armed to care for fewer sick people.

  12. Outsider says:

    Many of the so-called visionary leaders from IT behave just like dogs. They go somewhere and pee. That becomes their territory. You know what you get when you are on the ground.

  13. Daniel Jost MD says:

    “Health care must be more data driven and about wellness, not sick care.”

    Some people get sick. i.e. Rheumatoid arthritis, lupus, genetic diseases, big egos.

    These venture capitalist gamblers have no idea what we do.

    As for machines. Will they look at the patient in the eye and hold hands? Will they have the compassion to gently inform him/her of a life changing illness? Will they be there to guide them.

    Kholsa would you like to spend time with a desktop in a white blouse when your time comes to leave us?

    Think man. Stop counting pennies.

  14. Dr. Mike says:

    Pharma and DME manufacturers survive in large part due to the army of physicians out in front of them ready to absorb the onslaught of the tort system. Can you imagine the fallout for a company who forgot to say, “As always, consult your physician before using our product.” Machines may indeed continue to creep into their places within the health care system, but true inovation, which includes much more than machines, is going to be very slow in coming for as long we labor under both the current coding/billing monstrosity and the current tort system.

  15. D'CM says:

    There is nothing new about Khosla’s ideas, there was software in the 90′s that claimed it could diagnose and suggest treatment. Technology will not be the answer to efficient healthcare until the political will arises to allow it to. Can you really imagine what healthcare would look like if hardly a test, treatment, or admission was done unless it was medically necessary with proven benefit?

  16. Dr Jones says:

    Khosta is an idiot.

    Mr Khosta, a 3 year old comes into the clinic and the quote from the mother is “my son is having trouble breathing.” How is your machine going to figure out what is wrong, and what his treatment is going to be?

    • Adam, software guy says:

      Um, pretty much the same way you would. You would use–I hope–a combination of your senses (sight, touch, sound, smell; I suspect not taste) and your brain’s logic to navigate the results of your sensory input.
      Sight, sound, and smell analogues are pretty far along, technology-wise. Touch: give robotics a few more decades. Brain: the collective wisdom of past and future medical research, computerized.

      • Actually you would first check the child is safe, and then ask a series of questions from which you would determine your differential diagnosis. You then examine rye child and use that information to make some decisions about the diagnosis, and possibly order some tests. It is a complex process with much parallel processing by the doctor’a brain, an understanding of probability theory as it relates to the patient, and an underlying safety first protocol.
        Simultaneously you are managing an anxious parent, determining whether there are other issues in play including child abuse, and at the same time making sure it is all well documented for legal reasons and in case other providers need to be involved. I have missed a whole bunch of other things that need to be done including billing.
        As you can us “witch doctors” actually do quite a bit, much of it not seen but all very important. Some of it can be replaced by technology, some enhanced by technology and some not quite yet.

      • Mark Freeman says:

        You must be kidding.

  17. MD as HELL says:

    Data input. Which data and where to enter it? What is the imprtant stuff and what is wishful thinking from the patient? A physiciaan gets much more information about someone just by looking and listening than can ever be entered into a machine.

    You may get the answer you want, but it will not be the truth. But it will be the answer the insurer accepts because it will have come from a machine made by people with no financial interest in the answer..

    With the physician as an interested party, the outcome should be better for the patient, who most of the time needs to be told they are fine. The computer will schedule tests and treatments, instead of telling you you are fine.

  18. DeterminedMD says:

    Another example of a business model ramming its 4 edged peg through the round boundaries of the medicine hole. Arrogance is so freakin’ clueless most often. Just keep listn’ to them lies, ya all!

  19. SJ Motew, MD says:

    I agree that compared to our current concept of patient evaluation, diagnosis, hands-on care and treatment, the precepts imagined by Khosla seem preposterous. However, this simply highlights the fixed-model view that we as physicians harbor, stifling innovation from within.

    For me, it is not hard to conceive that population disease analysis, technical procedural planning, outcomes assessment, cost-benefit-quality optimization cannot be done better (and will be done better) by technical advances.

    I don’t imaging that the patient reporting “my tummy hurts” can (or should) be best addressed without a compassionate, educated and analytic provider, but we are fooling ourselves to imagine this has to occur only by a physician under the model we currently enjoy.

    Despite the comments here, I wouldn’t bet against technologic innovation.

    • Adam, software guy says:

      Finally, a comment from an MD that demonstrates some sense. Your first paragraph says it all.
      No one is saying all docs can or should be replaced by machines, just that a significant portion of the discrete tasks performed by humans in the course of health care can be replaced or at least greatly improved by technology. Anyone, and I suspect this includes Khosla, would still want a physician (preferably physician-scientist) to manage the course of our care and hold our hands as we wait for sophisticated 21st century diagnostic machines to deliver results live on screen in the exam room, display a recommended course of care, and formulate, synthesize, and deliver custom medication. Iterate.
      No one is saying this will happen tomorrow. But who here would prefer health care from a medieval healer over “Bones” from Star Trek? Anyone?

    • You raise the real issue, the need for new thinking about how we deliver healthcare. Developing new models of care is the basis for the reform we need. Collaboration between clinicians, scientists and technologists will do that. You don’t get collaboration by starting the discussion with hyperbole and insults.

    • Mark Freeman says:

      But, please. Can’t you see that the steamroller of progress is going to throw out the essential human observation and judgment that computers won’t do for decades. The idea that MDs are simply obstructionists is wrong. Physicians SEE what will be lost if we try to treat patients with the miracles of IT way before its time. It is an urgent need to alert our society to the damage of wholesale “revolutionizing” the field.

      Technologic innovation is great, but it cannot be a free-for-all. Large institutions can and must individually take the lead in implementing solutions over a large base. Otherwise, experimentation with 300 software platforms will lead to chaos, expense, and harm. It’s not the technology that’s the problem…it’s the blind implementation and arrogance or the promoters which threatens our nation’s health.

  20. Janie Williams, RN says:

    From the Woodie Allen movie, the red haired kid mutters, “what an a$$hole”

  21. Destruction says:

    Technology will replace 90% of Investors before it will replace doctors…

  22. steve says:

    When do I get my Tricorder?

    Steve

  23. MD as HELL says:

    the Iphone 6000

  24. Ravi Sinha says:

    Despite the forceful pov put across must confess that the elimination of the human element is something that I just cannot fathom.The day humans become process robots this shall happen but afraid Mr.Khosla this shall not be so….maybe yes in the world where you live now but a ceftain NO in the world where you originated!

  25. Vinod Khosia is suffering from the affliction described in the following expression:

    “When you are a hammer, everything looks like a nail.”
    Clearly his passion, his education and his wealth are driven by technology—so to him, technology is the center of the universe. While I believe automation/technology have an important role to play In healthcare…they are simply enablers since technology cannot be designed or programmed to have judgment or intuition or compassion. That’s what makes humans human.

    • SJ Motew, MD says:

      Do you really think that judgement and intuition are as prevalent in medicine these days? I see more waste and error holding on to unproven dogma and habit masquerading as ‘intuition’ in medical care than ever before. Judgement is driven by defensive medicine, payer status and procedures etc.

      It is exactly the holding-on to the traditional practice of medicine that stifles the progress available from Khosla. Time to totally rethink the delivery of health care in my opinion.

      Compassion, I agree, an isolated human quality that rounds-out the purpose of caring for patients…but once again whats makes us think that one needs to be a physician to deliver the compassion part?

      Envision an analytic process driven by technology and data used to diagnose and standardise the treatment of disease based on input from a nurse or trained “diagnostic medical assistant”, treatment planned tailored to known resources, risks and benefit, explanation and compassion delivered by a ‘pastoral care’ specialist. Makes a sound value proposition to me….

    • Well put Archelle! It is disappointing to see our technology colleagues take such a narrow minded view, and in the same breath accuse the medical fraternity of narrow mindedness. We have an opportunity to make a difference, but the us versus them rhetoric is hampering this.

  26. I agree.
    Technology is an enabler but adoption of technology in ecah sector business will accelerate in next 5 year with much higher pace than in past

  27. KB says:

    Today, most doctors diagnose patients based on what the patient or people accompanying the patient say the symptoms are. Doctor’s spend hardly 5 minutes to understand what they hear and write a prescription or ask for lab tests. This is a dangerous process. There is a high probability of communication/language errors. Many times patients or person accompanying the patient may have a wrong perception/observation of the symptoms and may also describe it in a wrong way or may use wrong words. This error can be reduced, if doctors can use technology to quickly (within a couple of minutes or less) validate the symptoms. At the same time it also helps the patients and their family to better understand the symptoms and get more reliable treatment at a reasonable cost. Hopefully technology assisted process will provide more accurate treatments, reduce the expensive and time consuming lab tests and legal costs and hence overall health care cost.

  28. Nice piece David. It’s an interesting question. Could computers interpret human signs, symptoms, and test results more accurately than physicians? And, if they could, could they prescribe individualized treatments and persuade patients to follow their advice? There are so many nuanced ways that diseases present and so many personality factors involved in treating patients successfully–seems like it would be difficult to replace the human interaction.

  29. JCL says:

    Can machines make more accurate diagnoses? Absolutely. Will that bend the HC cost curve? Absolutely not. The massive (and often ignored) difference between being a diagnostician and a clinician will only be more apparent as we penetrate further into the 21st century — chronic disease management commands the flexibility, insight, and ability to adapt that only a (human) physician can provide. The best physicians will be those who leverage HIT, no doubt, but the MD role will be as paramount as ever.

    In much the same way that machines will never replace entrepreneurs, they will never replace the true role of doctors.

  30. Telemedicine says:

    That is certainly a different and radical idea. Technology has already simplified and standardized many of the processes. And, there will probably be more improvements to come. However, there are two things that technology will never be able to do: first, reach out and touch a patient’s Heart and provide them emotional support, and secondly, a computer/software model is only as good as it’s programmer(s) and its logic/deduction model is limited to its software capabilities, whereas a doctor’s mind has the capability to think, to confer with colleagues and to come up with new solutions, procedures and inventions.

  31. dr1337 says:

    What Vinod says about not being part of the system and the status quo is absolutely true. More often than not, most clinicians in the field offer more resistance rather than support of new innovations.

    Medicine is inherently a highly cynical and pessimistic field. I’ve been to many journal club meetings where the whole point of the meeting is to see who can be the biggest troll in the room and shoot down ideas as best possible.

    Too often, the longer that someone has been in the profession, the more cynical and tunneled vision that person becomes as they become ignorant of all the new developments that occur outside their field of expertise.

    I bet, outside the Health Innovation Summit, most clinicians would look at you crazy if you proposed a simple concept as a Machine Learning from data, mostly out of ignorance and arrogance.

    • I don’t understand how highly trained professionals who have spent decades at school to learn the art and science of medicine to relieve their fellow human beings from the pain and discomfort of disease can be called inherently cynical and pessimistic. I too have sat through many journal clubs, and maybe even been one of those that has questioned intensely those presenting. The search for truth in the multitude of publications is not a negative. Scientific vigilance is not cynicism, it is a reasonable and responsible method for building a learning healthcare system.

      • dr1337 says:

        I apologise for not giving enough context when talking about cynicism and pessimism. You are absolutely right. Calling doctors cynical and pessimistic in light of that they do would be wrong.

        What I had meant to say was that many doctors are usually highly cynical and pessimistic when it comes to ideas that involve new technology. Often I’ve heard the saying “We’ve tried x years ago and it didn’t work. So why bother with y?” when new ideas and methodologies are pitched. It’s not necessarily their fault. I suppose it’s not possible for a doctors to keep up to date even with their own scientific literature let alone learn about what happens in fields outside their own.

        • Thank you for your clarification, and I apologize if I suggested any offense. You are right that we can be cynical about new ideas, partly from poor experiences in the past and partly from being swamped as you so rightly note in keeping up with our core knowledge requirements. That is not an excuse and medicine needs to learn how to better try new technologies. Together we have a much better chance of chance of finding a solution

  32. MG says:

    ‘Invest in wellness, not sickness’

    Yeah too bad there isn’t nearly as much money in that and the public health workforce which often returns by far the most impressive societal perspective ROI in terms of outcomes has really been hit hard since ’09:

    “The recession has battered public health; across the country, local and state health departments have shed 52,200 jobs since 2009 . . . . . Forty-one percent of local health departments expect to make even more cuts this year, according to the National Association of County and City Health Officials.”

    http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/07/06/the-incredible-shrinking-public-health-workforce/?print=1

    As for the insistence that Big Data with increased measurement and analysis will be the Holy Grail to solving healthcare inflation cost curve you only have to look at how that has played out in education since the passage of No Child Left Behind:

    “Overall, the last 10 years have revealed that while Big Data can make our questions more sophisticated, it doesn’t necessarily lead to Big Answers. The push to improve scores has left behind traditional assessments that, research indicates, work better to gauge performance: classroom work and homework, teachers’ grades and quizzes, the opinions of students and parents about a school. In his recent book The Social Animal, conservative columnist and veteran education commentator David Brooks identifies this bias—to emphasize and reward what we can measure, and ignore the rest—as a key reason why technocratic promises in social policy have largely failed to materialize. Research, Brooks notes, shows that the key to success is more often found in realms that resist quantification—relationships, emotions, and social norms.

    Even the godfather of standardized testing, the cognitive psychologist Robert Glaser, warned in 1987 about the dangers of placing too much emphasis on test scores. He called them “fallible and partial indicators of academic achievement” and warned that standardized tests would find it “extremely difficult to assess” the key skills people should gain from a good education: “resilience and courage in the face of stress, a sense of craft in our work, a commitment to justice and caring in our social relationships, a dedication to advancing the public good.”

    http://www.motherjones.com/media/2012/08/mission-high-false-low-performing-school?page=2

    What is occurring in educational policy is eerily similar to healthcare policy in the U.S. the past 10-15 years.

    • Sandra_Raup says:

      I think there are opportunities to use Big Data in ways yet not imagined. Right now we don’t have the data aggregated in a way that Big Data approaches will work – claims data is not accurate enough or even the right data, and clinical and related data is locked up in multiple siloes for each person. With genomic information available on a patient level and personalized medicine on the horizon, Big Data methodologies will be necessary to fully realize the potential, I believe.

  33. Johnathan Blaze says:

    Knowing the way healthcare is now, chances are the industry will be able to suppress technologies that threaten to make them obsolete, even at the expense of patient health and advancement

    Remember, medicine in this country is about one thing and one thing only — MONEY. Doctors have a huge entitlement complex and think they deserve gobs of money for short, routine visits & procedures. They also have strong lobbying groups in Washington to keep their salaries artificially inflated.

    The medical industrial complex, composed primarily of doctors, hospitals, and pharm companies, is a corrupt, immortal behemoth that financially rapes the people, and the government.

    • Betty says:

      I just had to comment on this. I am not a member of the medical community, but I take exception to what has been said about money being the only consideration in healthcare.

      Have you read a statement from Medicare, Medicaid, Medi-Cal, or insurance company lately? The actual amount paid to a healthcare provider (doctor, hospital, etc.) is so small that I wonder how they exist at all. It shows me that Government and insurance companies have total control over what is paid and it isn’t what I thought it would be!

  34. Most healthcare is selfcare. And with the internet and all the great medical info that is freely available there (as well as the junk), technology has already replaced a huge amount of the need to see a physician for most things. Besides, most human medical ailments are self-limiting if some physician does not get in the way and make them worse.

    • southern doc says:

      “most human medical ailments are self-limiting if some physician does not get in the way and make them worse.”

      But most ailments that a physician treats are not self-limited.

      Walk into any oncology office and tell everyone in the waiting room that their ailments are “self-limited.”

      You really don’t know what you’re talking about.

  35. Hughes says:

    The debate should not be so focused on whether a machine will replace a doctor, or should replace a doctor, or could replace a doctor… but on whether a machine can make a doctor better. Take an IBM Watson-like supercomputer loaded with the complex algorithms and health information necessary for most diseases and conditions, pair it with a doctor who knows how to spot and interpret the subtle facial expressions and body language that only a human practitioner with years of experience is able to do, and you will much more quickly get to the right diagnosis and treatment plan than either entity could do on its own. The technology is already here and would significantly lessen healthcare cost and human suffering.

  36. Vinod Khosla has triggered a very interesting discussion. Unfortunately he has taken some very large leaps of faith about how healthcare is delivered. First tests alone do not diagnose disease, they are a tool used by clinicians to support their clinical acumen. You need to first suspect a disease and order the relevant tests. As a general rule we don’t just do a random set of tests hoping to find an answer. So Khosla’s assumption that a machine can diagnose better than his so called “witch doctors” is both unproven and essentially wrong.
    But it gets worse. Comments that doctors act on tradition and not science may have been correct in the middle ages, but all of my peers are very well versed in science. We call it evidence because it is science based on facts, not just assumptions based on watching too many Star Trek episodes.
    Then there is the oft quoted statement that we need to focus on wellness not sickness. Unfortunately even healthy people get sick, whether it is as a result of a traumatic accident, or diseases like cancer, or auto immune disease, or infection. Sure we can use preventative strategies to keep people healthier, but ultimately they succumb to the vagaries of sickness. At that stage you really want a doctor trained in sickness to help you get better?
    There is no doubt that technology will assist in making healthcare more efficient and effective. When it helps doctors are eager adopters. However slandering an entire profession you have no understanding of is not the best way of promoting it.

  37. Nitin says:

    Vinod Khosla is ahead of his time. We have succeeded on applying algorithm for Diabetes Complications Management.
    I endorse this claim the concept that 80% of Doctor’s intervention can be replaced by technology, in addition to a well analysed data will give far better outcome that traditional approach.
    Vinod’s point of view must be considered on case to case basis and not ridiculed just because some Doctor’s are trying to defend their narrow views and feel threatened or offended.

    • Seriously Nitin, it sounds like you think doctors are against effective healthcare transformation. This is not a battle between doctors and technologists, it is an opportunity for effective collaboration. However it has to be based on facts, not just hope. Medicine is a complex science, and there is great danger in oversimplifying it. Technology is also very complex, and I admit medicine has much to learn about it and from it. Some technologists, like some doctors as you have so rightly stated have narrow views and are easily offended. They are not the ones that will help transform healthcare.

      • Nitin says:

        I am so glad that there are Doctors who are open minded and willing to get some of their burden. Example could be of Symptoms Analysis and providing non-pharmacology therapies which enlightens the treating Physicians and the Patients ends up getting holistic support from a single source.
        Over a period of time the gap will narrow down and technology (Devices + algorithm program) supported information will become a powerful tool. Busy Doctors who are supposed to go through numerous issues and time being their constraints, occasionally tends to compromises the optimum care their Patients deserved.

  38. jeff says:

    The key in my eyes is not eliminating docs, but eliminating insurance co’s and the govt. Here in the US the trillions wasted every year to keep DC and the insurance co’s in the money is kiiling healthcare and our pocketbooks.

    As for the future of tech in healthcare… only a fool would totally dismiss it. As for projections… nobody knows for sure.

  39. Fascinating discussion, and so glad to see Dr. George Lundberg weigh in here with his eminently common sense response.

    As a dull-witted heart attack survivor, I’ve often thought that if only the E.R. doc who sent me home with a GERD misdiagnosis had just Googled my textbook MI symptoms that morning (chest pain, nausea, sweating and pain radiating down my left arm), I’m pretty sure that he and Dr. Google would have come upon the correct diagnosis – instead of pronouncing confidently: “You’re in the right demographic for acid reflux!”

    Anybody who has read Dr. Jerome Groopman’s excellent book ‘How Doctors Think’ has experienced a crash course in the many personal decision-making biases that come into play when physicians try to navigate the medical mysteries of health care. Over-diagnosis, under-diagnosis, unnecessary procedures, marketing-based medicine, Big Pharma conflicts of interests – let’s face it, Khosla’a controversial stick-poking is a reality that’s been a long time coming.

  40. Sandra_Raup says:

    Just coming back to this as I heard Vinod Khosia speak today. I think Carolyn brings up a point that many in healthcare (physicians and others as well) ignore – diagnosing isn’t perfect, and when healthcare professionals are criticized, they often don’t learn from it but instead get defensive. I don’t know the answers to this, but surely we must agree that many consumers are not happy with the current system, whether for cost or outcomes reasons, and we need to be open to making things better. If that takes technology, great. If it takes a different payment system, great. But let’s not pretend it’s all perfect.

    • Nitin says:

      Sandra has highlighted vital point. This is particularly the case in case of Diabetes.
      We have developed algorithm based program for Diabetes Complications Management. It is Patient-centric and goes through the process of Diagnosis – Prognosis – Guidance (Medical Nutrition Therapy / Therapeutic Lifestyle Modification / Exercise / Medication check-list) which would empower the Physician as a reference point for his Medical prescription.
      The system works through thousands of permutations and combination, which humanly is impossible to contemplate. The program incorporates CDSS features.
      This is one of the ideal example of how Technology complements Physician skill by ensuring that all the established protocols are adhered without compromise.
      The process can also be described as Examination – Evaluation – Education.
      We look forward to any views pertaining to our Dia-Bese concept.
      nitin53@hotmail.com

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