Feb 13, 2018
The recent approach of Silicon Valley to health care problems, as defined by a direct consumer-based approach, use of applications, cloud-based, with analytics and internet of things (IoT) with artificial intelligence is fascinating. The paradigm is typical of information technology and may have some value. However, there are glaring flaws that are inherent in the approach.
Firstly, the desire to create interoperable applications does not necessarily result in deep expertise in the subjects. For example, the modules we have seen for care management are superficial, impractical, and unrelated to the real-life issues that a case manager or utilization manager faces daily. Or they are expensive, bulky and slow to implement, outdated in technology and divorced again from rapid changes in the industry, e.g., in claims adjudication. Without this profound operability of applications, merely connecting software systems does not solve the problems. It may exacerbate them by making us complacent and may prevent us from taking care of complex medical issues and additionally, may slow us down or impair the ability of health care personnel from doing their work effectively. Bringing the two worlds together, health care and IT is a Herculean task. It took us more than three years to just begin to acclimatize our subject matter experts (SMEs) and software developers with each other’s areas of expertise and to begin to understand the diverse paradigms that each has to contend with.
Secondly, health care transformation cannot be led by information technology (IT). At best, technology is only a tool meant to facilitate close engagement between the provider and the patient. It is meant to augment and enhance. Thus, any change in health care IT has to be led by subject matter experts, not theoreticians. When I hear that Apple or Amazon has hired the Dean of another Ivy League institution, I am amused since the academic centers do not deal with what is happening in the trenches of health care where most of our population is seen. One MUST take into account what happens where the rubber meets the road. Otherwise, the solutions will most likely impede the real work, that of taking care of patients in real-time.
Thirdly, we have still not figured out end-use. The applications are at best minor tools for improved efficiency in terms of speed or data availability. The provider still spends more time with completing electronic medical records than he would have done if he were hand-writing notes. Medical Directors or Physician Advisors still need to wade through multiple screens and programs to get the desired information for their work. Digitization has not made my ability to do notes any faster. It has slowed me down significantly. Creating modules that are simple and intuitive needs a Steve Jobs-like approach with clear design thinking. Simple stuff, like patient portals or re-filling prescriptions, can be improved but the complexity of people’s health can only be reduced by so much and close engagement can and must not be substituted. Our providers and patients are not IT wizards and do not need to be. How to create extremely simple yet sophisticated tools for them that help them improve outcomes is the real challenge.
Fourthly, we seem to have forgotten about an integrated health care approach where not just allopathic medicine but other paradigms of health care may be just as important., e.g., naturopathy, homeopathy, Ayurveda, Unani, Siddha, etc. Ayurveda or yoga may not be run with algorithms or laptops. That is unless we develop IoT to measure yin and yang, or the three humors or find cyber-equipment that will awaken the chakras.
Finally, throwing more IT on health care like a sauce on spaghetti won’t stick as a real solution. Artificial Intelligence (AI) or analytics has to be guided by real and intricate human intelligence that does not get swamped by data. There is no AI without human intelligence, at least not so far. Similarly, telemedicine is relevant only for few specialties like psychiatry or limited circumstances, such as for emergency rooms or specialty consultations. It cannot be a substitute for face-to-face interaction, for the touchy-feely stuff that we in health care are familiar with and which most IT abhors or does not know of.
Thus, the solution may not be one but many, each with several variations or possibilities. It is critical to realize that technology has not yet replaced humans, for we are taking care of humans and their bodies, after all. Creating deep and impactful modules that interface might help but the architecture has to be extremely flexible and modular. Training the humans who handle all these tools might be a good start but real medicine is still rooted in direct interactions. Creating simple end use solutions and speedier work-flows for patients and providers and administrators and managers would require tremendous practical expertise which we have not yet seen deployed.
Thus, the true interface is not between the different modules but between humans and IT. That is from whence our possibilities might spring. Until that interface is made on an intense, sustained, comprehensive and profound level, IT will not only NOT solve our problems, but may only worsen them.
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