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Ceci Connolly: Will Technology Replace Doctors?

Ceci ConnollyIt’s a provocative question, but it’s also the wrong one.

The question ought to be: When will healthcare fully embrace technology and all it has to offer?

It’s widely known that the $2.8 trillion US health system has significant waste and errors – between 25% and 30% of our health dollars go to services that do not improve health. Technology has the ability to put a big dent in that through standardization, real-time insights, convenient gadgets and complex data analysis the human brain simply cannot perform.

Consider some of the early innovators. There’s the heart monitor in the phone. The wristbands that count steps. And then there’s Oto, the cellphone attachment that snaps an image of the inner ear sparing frazzled parents one more trip to the doctor’s office for yet another infection.

Rather than compete with these, physicians ought to welcome handy new time savers that free up valuable clinical hours for more difficult, higher-paying cases. Letting a machine handle the simple stuff enables doctors and nurses to tackle what they were trained for – the truly challenging cases.

Or consider the tricked-out pill bottles that let us know if a patient is taking her medicine. It may sound trivial, but non-compliance costs about $300 million a year, meaning trackers translate into not only a healthier grandma but savings all around.

Moving onto more sophisticated technology, computers enable caregivers to instantaneously sift through reams of data, pinpoint current problems and, most remarkably, predict future issues. Predictive analytics can drastically reduce hospital readmissions, target therapies to individual genes and start us down the path of population health, reaching those most at risk with early interventions.

It’s time healthcare followed the lead of retail, banking and travel and used technology to foster a more customer-centered business model. Consumers are not only ready for – they’re demanding – more information, choice and control over their health. In a recent survey by PwC’s Health Research Institute, 82% of respondents said they are open to trying non-traditional care options such as a do-it-yourself strep test. They tell us they value the doctor-patient relationship but welcome cheaper, more convenient alternatives, including remote monitoring which pairs technology with clinicians[1].

None of the snazzy gadgets or even the high-end data analytics can cure an illness or create a healthy community. But in a high-deductible healthcare world, purchasers will shop around for the best value. Technology provides tools to improve outcomes and reduce costs. That’s value.

 

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35 replies »

  1. We are living through as superstitious an era as the Dark Ages. There is an unquestionable myth that holding to an single-minded and obedient worship of Technology (whatever that word means) will lead us to the Digital Rapture. The Data does not have to mean anything, or point to anything – one does not question the ineffable meaning of the Words of a God. The Silicon Lord points out which of his weak and fallible Biologicals to throw into the sacrificial fire, the thinking goes. The High Priests of the Silicon God will lead us to end-stage bliss. The Statistics will call forth wisdom. It’s a Jonestown-worthy case of pitiful mass delusion.

  2. Jeff, you missed a fundamental point of EMR use of feedback. It’s NOT to let the DOCTOR know what’s going on – that would be putting the patient first, for goodness sake.
    The drilldown gizmos are there to give reams of digital pasta to the quality overseers who are responsible for punishing the bad doctors. How else can we keep costs down?

  3. I guess the question people are asking all over the world is is it right to have views during the Global War on Terror?

  4. Will technology replace doctors – yes.

    And then there’s Oto, the cellphone attachment that snaps an image of the inner ear sparing frazzled parents one more trip to the doctor’s office for yet another infection.

    What does this do? Why not just make amoxicillin over the counter and let it be up to the consumer?

  5. I so agree! The interesting thing is how many consumers — especially those with mental illness — tell us they would be more comfortable interacting digitally.

  6. Great article. We have certainly seen a reluctance on the part of therapists to use technology even though it would help increase their earnings!! –
    It will take a while to get them comfortable.

  7. Allan,

    Yes, confusing structure on this forum sometimes. I think we’re on the same page, though.

  8. Perry, you placed your initial response as if you were responding to me instead of Ceci. I guess that is why I couldn’t get what you were trying to say. The lines of demarkation create a bit of confusion at times. I wish that the reply box automatically added the name of the one being replied to.

  9. Allan,

    Sorry for the delay in reply. I was essentially responding to Ms. Connolly’s statement that physician’s pay structure will change. Rhetorically asking “how” my short answer is probably for the worst for docs and patients. The current theory is that doctors do more than necessary now to get paid more, so let’s pay them for doing less. I think the result will be less pay for more work and that work will involve more treating charts than treating patients.
    Just my opinion.

  10. Perry, now I know what the “it” is. Can you follow through with a complete question? I have a guess, but I prefer to make sure that we each know what the other is talking about.

  11. “It”, meaning pay structure. I fear the pay structure if changed will involve doing things that are not necessarily productive to the patient or physician.

  12. Perry, I am not sure of the “it” that you are referring to so I will withhold an answer.

  13. How will it change? It will get more complicated and doing more for less, not necessarily patient care.

  14. ““How about paying us like a lawyer,”

    How many lawyers double bill? I think a lot.

  15. we have heard that for 10 years now, “the pay structure is going to change” so as physicians we have changed our work flow to do the meaningless use requirements along with a bunch of other crap that people like the ncqa, bridges to excellence and other cms pilot programs want and all that did was decrease our productivity and job statisfaction and probably quality as well and has never gotten us any meaningfull returns. So either change the system or quit yacking about it.

  16. This article was written by an administrator who has zero experience treating patients, yet is a so-called “expert” on healthcare. Please notice the oxymoron in that.

    Administrators are anxious to control doctors to “hold down costs” while at the same time paying themselves hundreds of thousands if not millions of dollars while supposedly “creating value” that doesnt exist.

    That’s not to say that technology is bad or that there’s no use to it — but it will cause costs to go up, not down. This is what administrators dont understand about health technology:

    1. More data available = more clinic visits. When your automated blood pressure reading shows an isolated value of 147/98 but all the other BP measurements read between 115-120/80 then you’re going to ask the doctor about it.

    2. When you take a picture of your child’s ear drum, who is going to look at that image? Is IBM’s Dr Watson going to call out an antibiotic or tell you that you dont need antibiotics? Doubtful. Millions of kids have red ear drums without having infections — now instead of just playing at home they will brought into the doctors office. Again, costs go up.

    3. Healthcare technology is big on data but short on knowledge. The knowledge and experience to know how to do with these issues will be found lacking by patients, who will come to the doctor to bring up the millions of data points that are generated at home. Again, lots of data at home but no KNOWLEDGE to know what to do with all that data. Most of the time, the answer is nothing, but overall healthcare costs will go up.

    I’m not scared of technology because I offer a service that no computer can offer. I would gladly challenge IBM/Dr Watson to a competition — lets both open up a pediatrics clinic, one staffed by Dr Watson alone and one staffed by me alone. IBM/Dr Watson will get some initial curious visitors to see how it works but over the long run I will win the hearts and minds of patients. Dr Watson is excellent at describing the latest research on how to best treat RSV — he is big on data. But Dr Watson cant put that data into context and cant provide knowledge.

  17. Exactly how?

    The problem is in the specifics and so far I only see generalities.

    Historically the most successful method of payment relies upon the marketplace that you wish to just push aside without dealing with any of the unintended consequences. I wonder if you did the same with Medicare HMO’s when they were promoted as the cure to Medicare’s problems.

  18. “The problem there is fee-for-service medicine ”

    This is ridiculous on many levels. No matter what type of system a code of some type is almost always needed. How will the ACO or its sister the HMO monitor what was done? How would single payer be able to pay without a bill?

    The complexity of the coding is due to government intervention and it seems you are willing to double down on this foolishness.

    The only place where a code might not be needed is in true fee for service where the doctor answers only to the patient.

  19. “How about paying us like a lawyer, when we are reviewing data, reading the lastest treatment plan from NEJM and putting the plan together at 10 oclock at night when are kids are wanting us to watch a movie with them.”
    ___

    I’ve been arguing that for years.

    Blog.KHIT.org

  20. Maybe technology can replace administrators. Then we will really see some value created

  21. saying that the emr puts all the data at you fingertips is like taking an encylopedia and tearing out every page and then tossing it up in the air and then say there is your data, it all there and then spending an hour trying to find the correct information. Oh and by the way you will never get paid for all of that because is the uncompensated work that we do every day. How about paying us like a lawyer, when we are reviewing data, reading the lastest treatment plan from NEJM and putting the plan together at 10 oclock at night when are kids are wanting us to watch a movie with them.

  22. last post should have said practicing physician of 20 years and not 2 years. I also take issue with the issue of waste. while I would agree that there is 20-30% of so called waste, we have to look at the reason for that. With no tort reform you are never going to to change that. Throw on top of that the concern with patient satisfaction and that makes it even worse. \

    I have no problem with patient wanting more control over their healthcare. But that will come with some strings attached. I believe in a single payor system, and that payor is the patient. when they say now “just go ahead and do a tsh on those labs” then that is fine and my response should be “well that is another $75” right now we have traditional plans that want every test they have read about because they know they are not paying for it and then the high deductible plans and people dont want anything done. you just cant win.

  23. I agree with several others. It appears in this blog the author does not understand how physicians function and the parameters under which physicians are paid. The rules that created the present mess were created by people that likewise didn’t understand the dynamics.

    Freeing up a physician from simple problems only means that the more difficult problems will require a higher degree of reimbursement. The second question is who will monitor the simple problems and who will put all the simple things together into a unified process of treating the patient?

  24. Rather than compete with these, physicians ought to welcome handy new time savers that free up valuable clinical hours for more difficult, higher-paying cases.”
    Statements like this indicate to me, a practicing physician of 2 years, that the author does not understand how 90% of physicians in country are paid. We dont make money based on disease severity. We get paid basically by e&m codes in which there are only 5 codes and we all live by level 3 and 4’s. Based on proper coding guideline a routine strept throat and ear infection will be coded and thus paid the same amount as a diabetic with renal failure and heart failure. It all has to do with bullet points and questions asked. So why would a doctor want to give up sinus infections, strept throat, knee pain for a day full of chronic illnesses. Not to mention the hand tele devices out there will not pay enough, never have and never will, plus they will ultimately increase liability as well. Now if i am on salary or direct care then that is different. But you should learn the payment structure before commenting on what is good for the doctor.

  25. “. . .computers enable caregivers to instantaneously sift through reams of data, pinpoint current problems and, most remarkably, predict future issues.”

    Spoken like a spectator who’s never actually used the technology. In most EMR’s, including the market leaders, the data you actually need to “pinpoint” anything is buried six-ten clicks deep in completely unusable Windows 95 style user interfaces. If you’re lucky, you can “pinpoint” problems that happened four hours or two days ago. It’s almost impossible to find the real problems amid the bins full of templated excelsior. If you don’t believe me, ask your doctor to show you your electronic health record sometime. It’s virtually useless. . .

    The people who’ve taken this technology furthest, like Kaiser and Geisinger, had to spend a small fortune on custom built electronic data repositories which abstract data from the patient records and organize it into useable population based files, and on custom built analytic routines and protocols to actually guide the care. . .

    handy new timesavers???

  26. The question nobody seems to care about –

    Will technology replace nurses?

    The answer: it already is.

  27. No Pay = No Work. If the device or technology takes any time away from seeing patients for whom I do get paid, then you can forget about it. Now if I were in a direct pay practice, I would say: “Tell me more – I’m listening.”

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