By Robert Graboyes.
RealClearHealth – Jul 11, 2016.
My Twitter pal and founding partner of Forthright Health Management, Tom Valenti, wrote in TechCrunch that “there will never be an Uber for healthcare” because “[h]ealthcare is not a transaction business; it is a relationship business.”
I’ll respectfully disagree: Healthcare “Ubers” are already proliferating and will ultimately reshape 21st-century medicine. The more aspects of healthcare we can shift from relationship to transaction, the better life will be for patients and doctors alike.
Tom says “Uber for X, Y or Z” means “making something easy and convenient.” But Uber is also about safety, reliability, and civility. Uber gives your daughter a photo, name, and license plate for the stranger who picks her up in the wee hours; shares a detailed record of her route; and likewise protects the driver. Variable pricing gets her a ride quickly when lightning is crackling above. The GPS keeps a novice driver from getting lost in unfamiliar quarters. For riders and drivers alike, individual ratings discourage rudeness, recklessness, and the abuses that come with monopoly.
Uber’s true essence is this: It accumulates a vast amount of information on the micro-details of cities; overlays that information with real-time data on prospective drivers, riders, and road conditions; reduces staggeringly complex decision trees to algorithms; and instantly presents drivers with a manageable number of highly intuitive options. It thus obliterates the learning curves and fixed costs that such information previously demanded. In effect, Uber establishes, digitizes, and stores relationships to make transactions possible.
As Tom notes, a strong relationship with a specific doctor can be quite valuable. But it would actually be a better world if that were less the case—and that is how the healthcare Ubers are already saving and improving lives.
If your healthcare depends on a long-term relationship with a specific physician, then by definition, your care suffers when you move, when you become ill while traveling, or when your doctor is away or asleep. It means the quality of your care depends heavily on the hard-to-judge abilities and scope-of-practice of your specific doctor. It can harm us when we delay care in order to see the specific physician with whom we have this relationship. Relationship dependency effectively limits choices to doctors in your local vicinity, discouraging remote consults with expert practitioners most familiar with whatever ails you.
When illness strikes while I’m in California, I would strongly prefer a world where the random doctor I see there, armed with Uber-like tools, can provide the same care my own doctor provides me in Virginia—or something close to it.
To shift some (not all) of healthcare from relationship to transaction, we’ll have to imitate what Uber did: Accumulate vast databases of population health care information. Develop better and more comprehensive telemetry for real-time tracking. Apply artificial intelligence to discern patterns no intuitive physician can see and to narrow down treatment options. And package this information for instant comprehension by patients and providers (including non-physicians).
We are only at the dawn of this revolution. With a smartphone or tablet, you can access Doctor on Demand(24/7/365 access to board-certified physicians), Recovery Record (eating disorder analysis and management connecting 350,000 patients and 10,000 therapists), AliveCor (30-second EKG to flag atrial fibrillation), and Heal (a very Uber-like app to summon a doctor to wherever you are). From your own living room, Opternativecan inexpensively measure and fit you for eyeglasses via laptop. e-NABLE matches people worldwide who need prosthetic hands with those who wish to build them on 3D printers.
For this revolution to flourish, the Ubers of healthcare must be bottom-up endeavors, forged through competition, with success or failure resting on the value they provide to patients and providers. In contrast, top-down efforts, such as today’s government-mandated electronic health records (EHRs), present an enormous impediment to innovation. Today’s EHRs are designed to serve insurers, third-party payers, and governments—not patients or providers. They are needlessly souring providers on the promise of technology.
Almost certainly, some aspects of healthcare will be impervious to Uber-like innovation. In these areas, the intuitive physician will remain indispensable. I recently sat down with a roomful of health innovation notables—physicians, entrepreneurs, financiers, and scholars. Someone asked how much of modern medicine we can, in time, reduce to algorithms. Guesses hovered about 80 percent, with one participant suggesting 97.5 percent. Some futurists envision a near future when computers like IBM’s Watson can out-diagnose any physician, as doctors’ capacity to absorb and analyze data is severely limited by time and cranial capacity.
As we convert more and more of medicine to transactions—and we will—patients will find it easier to tend to their health, and doctors will find themselves freer to focus on those areas where relationships are truly irreplaceable.
Read the article in RealClearHealth