So, I know what you're thinking about my impending analogy. The conventional wisdom is that “healthcare is totally different and infinitely more complex than any computer.” I don't totally disagree with this statement. It is true that medicine is far more complicated than even today's computers. One big difference is that computers are people-made (someone knows and understands every single part that goes into any computer). In medicine, on the other hand, we are constantly trying to figure out how Mother Nature put us together. But we do know a lot, and we have developed many new ways of dealing with health problems. However, if we look at where we are and where we could be, there are a lot of potential improvements that we are missing out on, and that we are unlikely to achieve whether Congress passes health reform or not. We can learn a lot from the Ciscos and Microsofts.
As one who has made his career as a professor in medical school since 1984, I've had a long time to develop some perspectives on this.
Computer innovation and improvements have not been accompanied by the skyrocketing costs that healthcare has experienced. Why? Possibly, it is because there has been adequate competition among computer companies with a focused strategy on providing more for less cost. Moreover, as information becomes available to the masses, we move beyond the obsolete and embrace the new. There are several lessons that we can take from the computer business, beyond the electronic medical record and electronic ordering processes, which seem to be the current rage.
For example, when I go to get my computer serviced for basic tweaks and upkeep, I recognize that I don't need Einstein to do this job. The tech guy in his early 20s does a fine, and probably better, job than Einstein would, and he is part of a team with graded responsibilities and referral resources in case an individual gets in over his or her head. The manager with more training and a higher salary is on call to intervene when needed, but the first plan of attack is to rely on the person with adequate training to help most people with the most common problems.
In medicine, by contrast, we insist that only super highly trained, highly paid specialists can fill our dental cavities or diagnose simple problems. From a diagnostics point of view, why are we not taking advantage of artificial intelligence technology to assist primary-care clinic operations in dealing with nonstandard cases (as opposed to complaining how the access to specialists is so limited, especially for patients with limited or no insurance)?
It seems we already have the technology that can help. When I was in medical school in the 1970s, I read about computer diagnostic programs (e.g. Internist 1-3) that could out-diagnose staff physicians at Massachusetts General Hospital's clinicopathologic conferences (even if they were not quite as good as the invited specialist). Where are these programs today? Given how the young generations—and increasingly the rest of us—use electronic media such as text messaging and Internet searches, I'm sure we could do a better job as a health profession in leveraging these tools for public education and self-management.
What the public needs, and demands in other aspects of life, is credible, authoritative sources on health, beyond consumer-fed Wikipedia and personal blogs. The information is out there—we use it to train health professionals in the first place—can't we follow the computer support industry model for diagnostics just a little bit and disseminate it responsibly?
Yes, I can hear the howls about “liability” and substandard care, and a technological revolution in healthcare would have to be carefully thought out to minimize harm. But I'm not aware that having more specialists has decreased the number of malpractice cases we have in this country. We simply can do better than we are doing today: As it stands, I suspect many patients forgo visiting a clinic and use random Internet sources to help heal themselves instead because they have no health insurance, or because they cannot afford top care.
The CMS just came out with a report predicting that our healthcare spending will increase by 6.1% every year over the next 10 years. Whether we pass healthcare reform or not, the costs of this system are going up. As healthcare providers, we have an obligation to step in and do our part. We need to approach our profession that same way as the computer industry does—with an eye toward competitive strategy and embracing advances that can help us do our jobs “better, faster and cheaper.” If we don't, we will be having this same conversation in 10 years, and it will cost us a heck of a lot more than $2,000 to replace our old system.
David Gordon, a physician, is associate dean for diversity and career development at the University of Michigan Medical School, Ann Arbor.
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