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Vinod Khosla: Technology Will Replace 80 Percent of Docs

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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CVHDr KKTcheap electrician chula vistaBettyJacqueline Mosqueda Recent comment authors
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CVH
Guest

Some procedures may be replaced by machines, but doctors will not. In my opinion of course.

Dr KKT
Guest

Nice article has ideas, but the body is 1,000,000 times more complex than putting a man on the moon. How much did it cost per trip? My point is a new network came to town and wants to pay $22 dollars a visit. We have saved many lives last year that if the patient had not changed to us the patients would be dead today. This was done by listening to the patient performing tests that were not previously ordered because they were cost cost continence. These patients lives were saved as a result of the Dr spending more time… Read more »

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Sandra_Raup
Guest

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.… Read more »

Nitin
Guest

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… Read more »

Carolyn Thomas
Guest

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… Read more »

jeff
Guest
jeff

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.

Nitin
Guest

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.

Dr George Margelis
Guest

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
Guest

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.

Dr George Margelis
Guest

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… Read more »

Hughes
Guest
Hughes

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… Read more »

George Lundberg
Guest

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
Guest
southern doc

“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.

Johnathan Blaze
Guest
Johnathan Blaze

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… Read more »

Betty
Guest

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!

MG
Guest
MG

‘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… Read more »

Sandra_Raup
Guest

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.

MG
Guest
MG

Possibly but genomic information and personalized medicine ‘have been on the horizon’ for 15 years now and they aren’t going to do anything to bend the cost curve.

Sandra_Raup
Guest

You may be right, MG. There was a recent review article in Health Data Management written by Elizabeth Gardner entitled “Changing the DNA of Clinical Care”, however, that gave some food for thought about what will be available in the foreseeable future. Whether it has an impact on costs is obviously debatable – as it is with any new technological advance. The link to the article: http://www.healthdatamanagement.com/issues/20_9/genomics-ehr-electronic-health-records-gene-therapy-44907-1.html?pg=2