BYOD

the scanadu
After decades of bravely keeping them at bay, health care is beginning to be overwhelmed by “fast, cheap, and out of control” new technologies, from BYOD (“bring your own device”) tablets in the operating room, to apps and dongles that turn your smart phone into a Star Trek Tricorder, to 3-D printed skulls. (No, not a souvenir of the Grateful Dead, a Harley decoration or a pastry for the Mexican Dia de Los Muertos, but an actual skullcap to repair someone’s head. Take measurements from a scan, set to work in a cad-cam program, press Cmd-P and boom! There you have it: new ear-to-ear skull top, ready for implant.)

Each new category, we are told, will Revolutionize Health Care, making it orders of magnitude better and far less expensive. Yet the experience of the last three decades is that each new technology only adds complexity and expense.

So what will it be? Will some of these new technologies actually transform health care? Which ones? How can we know?

There is an answer, but it does not lie in the technologies. It lies in the economics. It lies in the reason we have so much waste in health care. We have so much waste because we get paid for it.

Yes, it’s that simple. In an insurance-supported fee-for-service system, we don’t get paid to solve problems. We get paid to do stuff that might solve a problem. The more stuff we do, and the more complex the stuff we do, the more impressive the machines we use, the more we get paid.

A Tale of a Wasteful Technology

A few presidencies back, I was at a medical conference at a resort on a hilltop near San Diego. I was invited into a trailer to see a demo of a marvellous new technology — computer-aided mammography. I had never even taken a close look at a mammogram, so I was immediately impressed with how difficult it is to pick possible tumours out of the cloudy images. The computer could show you the possibilities, easy as pie, drawing little circles around each suspicious nodule.

But, I asked, will people trust a computer to do such an important job?

Oh, the computer is just helping, I was told. All the scans will be seen by a human radiologist. The computer just makes sure the radiologist does not miss any possibilities.

I thought, Hmmm, if you have a radiologist looking at every scan anyway, why bother with the computer program? Are skilled radiologists in the habit of missing a lot of possible tumors? From the sound of it, I thought what we would get is a lot of false positives, unnecessary call-backs and biopsies, and a lot of unnecessarily worried women. After all, if the computer says something might be a tumor, now the radiologist is put in the position of proving that it isn’t.

I didn’t see any reason that this technology would catch on. I didn’t see it because the reason was not in the technology, it was in the economics.

Years later, as we are trending toward standardizing on this technology across the industry, the results of various studies have shown exactly what I suspected they would: lots of false positives, call-backs and biopsies, and not one tumor that would not have been found without the computer. Not one. At an added cost trending toward half a billion dollars per year.

Continue reading “Will Tech Revolutionize Health Care This Time?”

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There were some impressive enterprise deployments discussed at the AppNation conference in San Francisco on Thursday.

I’ll lead off with Genentech, the Bay Area biotech firm that is now a subsidiary of Roche. Their 7,000 iPad rollout was news to me, and ranks them sixth on my list of largest iPad deployments in the world.

(View the entire list of more than 530 enterprises that have publicly-confirmed iPad deployments here).

According to mobile application team manager, Paul Lanzi, Genentech has standardized on Apple for mobile, with 17,000 iOS device users worldwide (so by inference, 10,000 iPhones, though it surprises me less and less when I hear about companies deploying iPod Touches, too). All of the Apple devices are corporate-owned, as the company doesn’t do Bring Your Own Device (BYOD). Genentech does have 15,000 BlackBerry users, but they are only allowed to do e-mail, no apps. It doesn’t support Android due to the fragmentation-related hassle. “It’s a really tricky one,” Lanzi said.

While many firms talk about how their device deployments are driven by the ROI they hope to get from using apps, Genentech is actually following through. The company has deployed 60-some apps to employees. Indeed, Genentech rolled out its first mobile Web page even before the iPhone was released, said Lanzi. “We’ve already retired some apps,” he said. Continue reading “Why This Well-Known Biotech Firm Deploys 17,000 iPads and iPhones”

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