There’s a gold rush going on in HealthCare IT, a period of intense growth, described by one Chilmark analyst as a “Tsunami” of new companies attempting to find their niche in the race to “fix healthcare”.

Not all of these companies, nor their founders, have experience in HealthCare, and as such, some truly wacky ideas that could never fly in practice have been proposed, and even funded by respected venture capitalists. For those of us with significant time in the business of healthcare, it’s easy to ridicule these ideas as the naive wanderings of the unwashed masses, bullish business plans that must be tested through the complex meandering paths of modern healthcare.

Yet, you never know; some of these ideas may actually have merit, and the questioning of the sacred cows of healthcare is, of itself, a valuable exercise. For example, I recently had a conversation about continuity of care with a “new healthcare” founder.

“Look”, he said, “continuity of care exists to funnel cash into doctor’s pockets. Think about urgent care clinics. You go, you get treatment and you leave. Does your doctor ever read the discharge summary? I doubt it. It’s a business. Get ’em in, send ’em home”

It’s probably true that many doctor’s have little interest in discharge summaries from an urgent care clinic — unless their patients have relevant chronic disease, and are under active care. At best, they will glance at the faxed paperwork, and in many cases they won’t see it until your next appointment.

This makes sense for relatively healthy patients, and it’s hard to fault overworked, and stressed, physicians for putting their time towards those in greatest need. Many of the new technology companies seek to scratch this itch, focusing on the less complex end of the spectrum. The Chilmark analyst, adroitly described this phenomena.

Low-acuity care is the low-hanging fruit. Much of the consumer-facing technology on display addressed the inefficiencies of receiving care for minor aches and pains, from the care itself to the administrative burden it places on patient as well as providers. While this is poised to further exacerbate what the American Medical Association sees as the degradation of the provider-patient relationship, it’s also poised to provide convenient care options for patients who don’t have a relationship with a provider at all.

On the other end of the spectrum, Medicare has created a new code CCM (Chronic Care Management), where physicians are incented to “create” and “share” a comprehensive plan for healthcare issues, as well as providing 24/7 access to care management services. These patients must;

have at least two concomitant chronic conditions, expected to last at least 12 months or until the death of the patient, that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.

As we know, the largest cost to the healthcare system comes from these CCM patients, the sickest of the sick, and guiding their healthcare with individualized physician attention is of obvious benefit.

What then of the patients that lie in the middle? This is shifting ground, my friends, an area where the sacred cow of continuity of care is very much under review, with significant opportunity for disruption. It’s certain that new practices will emerge as we race headlong towards an overwhelmingly obvious outcome, the denouement of a system that continues to hemorrhage money at an ever increasing rate.

In time, and with true interoperability, we may actually see the computer supplanting the physician in the middle to low section of the spectrum, in effect becoming the actor providing continuity of care.  Sure, we’d all like to see a physician, but realistically, in twenty years few of us may be able to afford to do so.  The economics of the situation almost guarantees that our primary care givers will be machines, at least until we reach a degree of sickness that surpasses their skill.

There was an interesting post on FierceHealthIT this week about the idea that most people go to their doctors for the sole purpose of prescription refill.  This is true, albeit for relatively healthy people, a fact the article didn’t really bring to the fore.   Surely this would be prime territory for a machine – a well established treatment plan that involves certain types of medicines could certainly be managed by an algorithm?

In my view it’s an absolute certainty that this will come to pass.  As with all other “revolutions”, the machine learning revolution will, of economic necessity, push physicians to more skilled tasks, and eliminate the commonplace jobs such as medication refills.  It is, however, unlikely that we’ll see much impact on the less skilled part of the profession, such as less skilled, but critically important nursing tasks.

Obviously, current brittle attempts at machine intelligence aren’t there yet, and there is a truly massive amount of ambiguity in healthcare that must be accounted for.  Yet, as progress marches along relentlessly, there is hope for the physician, who’s new role may draw more on their skills as a scientist, working with the sickest of the population to find creative, non-trivial, approaches to their disease.

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