In the not-so-distant future, healthcare organizations as we know them today will change.
Providers will send prescriptions directly to the patient, follow up by text or asynchronous video, and check vitals such as blood pressure wirelessly through Bluetooth and mobile. They will treat acute conditions—and even more—in the patient’s home, both through direct care and via-real-time video. They will deliver sterile injectables to home caregivers by drone or courier, and monitor their delivery through a plethora of innovative technologies.
Not possible? Think again. It’s already happening—shift and disruption are already here. And the abilities that we have, and will have, are becoming more advanced, more realistic day-by-day. Next-generation wearable consumer devices, remote-monitoring systems, direct-to-consumer lab and genetic tests, smart bandages, digestible and embedded sensors—and even advanced biometric sensors such as smart mouth guards—combined with accessible, secure video, chat, texting, and email to deliver a hyper-connected healthcare tableau that aids in the treatment of now, while predicting the unknown before it happens.
And the heart of this modern day doctors ‘black bag’ is in the home. With more than 35 million people discharged from inpatient care each year, the home has become the fastest growing healthcare setting in the U.S. In the past, a heart attack meant hospitalization for weeks, or months. These days, bypass surgery requires only a few days inpatient time. Patients with heart conditions avoid hospital time thanks to precision testing and measuring, often in the home. Interventions ranging from aspirin to catheterization or PCI require different approaches. Or remember the appendectomies, tonsillectomies, hernia repairs, and even some mastectomies once meant days or weeks in a hospital bed? Today, they take place in a matter of hours in an outpatient surgery center. We have less need than ever for high-cost, high-overhead hospital settings, especially in our hyper-connected, virtually enabled Internet of Things universe.
This shift is something we can expect to see more of across the healthcare industry—patients (think mHealth and telemedicine) and third-party ‘retailers’ (think Walgreens) are already there. But institutions and providers have been reluctant to get on board. What’s holding them back is the same old resistance to change that has always been ready to derail progress—a new era of fearmongering. Vaccines, laparoscopic surgeries, joint replacements, not to mention heart transplants at one time seemed out of reach, reckless, uncertain, or doomed to fail—and yet they revolutionized medicine, they revolutionized our livelihood. Analysis on a scale never before possible today means we can tailor treatments to a patient’s own genetics, customize prevention for risk factors, and develop medications based on specific patient profiles. In essence, healthcare’s greatest challenge in the next century of patient care is getting out of its own way.
The age of the empowered-consumer is here—and it’s already happening in retail, service, and entertainment. In healthcare, it’s portable, virtual medicine—it’s healthcare delivered anytime, anywhere and supported by an evolved continuity of care model. And while this may be new territory, actually very little is new about it—except when it comes to the industry’s reluctance to adopt it, systemize it, and use it for better outcomes, more value, and less cost. It requires providers and institutions to dive headfirst into a decentralized world that’s more like Amazon or Uber than traditional, patriarchal, hospital- and office-visit based healthcare—it requires us to democratize medicine (just ask Eric Topol). Medical technology is now as close as your consumer wearable, radiating out from hard walls of providers offices and into homes—whether that be virtually or in-person, in home—and its what we do with it next that will count.
Resistance is slowing down the shift, along with fierce protection of what were once proprietary functions like prescribing and dispensing drugs, diagnosing and ordering procedures, and choosing providers. The Internet opened new options, and virtual doctors can treat and follow any number of ailments from anywhere, anytime—although this doesn’t negate the necessity of continuity of care. Tech-savvy patients-as-consumers know how to search online for success (and failure) rates for procedures, surgeons, and institutions. Wondering about inpatient infection rates? You can find it online. Add to that the virtual sea of information about symptoms available from more (and less) reputable websites, starting with the Institutes of Health, Merck online, Mayo Clinic and more. Yes, patients must sort through the disreputable information found at “quack.com” but more of them know how—and are willing to do so—to equip themselves with information to make their own health decisions.
Consider the patient in the typical hospital or medical office—you see a passive, voiceless person in the waiting room, powerless to speed up the process, flipping through a magazine or, as is probably the case, equipped with a novel to pass the time. Now compare it with an Amazon customer: searching for the exact item needed, clicking on the picture, adding it to a cart, paying with a stored credit card, and done, with the item set to arrive within days, or even hours in larger markets.
What’s wrong with this picture? We cannot expect our patients to continue waiting on us, as voiceless, passive recipients of care. What’s more, we cannot expect them to passively accept the morass of charges found on the typical bill or insurance statements. Patients-as-consumers will comparison shop for value—and cost. And if hospitals and providers don’t cough up that information, patients will take their healthcare business elsewhere. Again, Amazon may not do everything right, but they get customer service—they understand the ‘age of the consumer.’ Indeed, they have no dedicated department per se; rather, all orders, complaints, and questions go through an online presence. Not having a dedicated customer service call center has not kept Amazon from becoming one of the most customer-friendly companies in the U.S. Can that be said about your average hospital or medical office? I didn’t think so.
Within, and without, the office
As we’ve seen, healthcare is shifting away from the single doctor-patient appointment, to integrated treatment packages that incorporate risk, recurrence, demographics, family support, community, and social aspects such as church, friends, and programs. Moreover, the traditional in-person appointment has become only one tool among many for providing healthcare. Providers and organizations must become conversant in video medicine, whether in real time or asynchronous. Patients are participants who chat, text, and email—and who can expect a response, without the filter of an office assistant, multiple paper messages and missed returned calls. In other words, the new medicine is on demand. It’s what patients-as-consumers want, and as long as providers retain traditional medical barriers by restricting appointment times, withholding information, excluding people and their families from health and medical decisions, they will take their business elsewhere.
This person-centered healthcare rests on more, and better, engagement, with tailored recommendations based on personal visits, and supported by population health evidence. It means changing provider behaviors, and creating systems to stratify at-risk patients. The healthy 50-year-old marathon runner needs a different approach than the 50-year-old with chronic hypertension, diabetes, obesity, and heart failure, but both need prevention and attention to family and social support networks. The marathon runner is susceptible to unexpected heart conditions, even fatal ones. Likewise, the patient with multiple, chronic health conditions like diabetes, metabolic syndrome, or CHF, benefits from prevention and wellness care. Social support networks and personal circumstances affect every patient’s outcomes, regardless of their starting point.
Whether it’s via mobile or in person, healthcare must do a better job of engaging the patient. At the same time, mobile technology must redefine “engagement.” And we need to be there—yesterday. We have the technology—we just haven’t applied it.