Automation drove weavers from their looms in the industrial revolution. The Internet’s and tools facilitated the movement of manufacturing process for most software from the high priced markets in the US to India. So too the digitalization of health records combined with the insight that data yields and embed into work flow engines of care delivery will radically change the healthcare ecosystem.
Since I joined Forrester research, in the fall of 2013, my perceptions of what drives change has changed. I thought that the socio-political forces were driving software to change healthcare. Now I think software is driving changes to the socio-economic fabric. While we pundits are busy noticing:
- EMRs being implemented.
- Master patient indexes are rolling out.
- Capabilities shifting to mobile.
- Insurance companies rolling out tools to better track and communicating with consumers.
- Startups forging new methods and business models to engage patients.
- Large consumer companies making moves to gain access to our healthcare data by offering us free tracking tools.
- Telehealth encounters becoming increasingly important to the administration of care.
- Big data and cognitive computing changing our understanding of epidemiology and personalized care decisions.
The real story might be elsewhere.
Software is quickly changing the fundamentals of care delivery. As the knowledge of care delivery increasingly embeds itself into software, the price of creating this software will rise, and the need to monetize these significant investments will transform what was heretofore not commercial into a commercial profit center.
Previously, medical workflow and standards of care rolled out slowly, via peer reviewed research and best practices that slowly made their way through the system. Now large healthcare providers are embedding these innovations into software and selling that software to other less capable institutions.
- Recommendation engines tell nurse practitioners and physician assistants how to diagnose and treat simple maladies. A new class of primary care givers is born, and instead of seeing a doctor, soon millions of basically well patients will receive their primary care at the local retail outlet, and one doctor can supervise the work of many assistants who do the physical work of examining patients and consulting with the decision support software to order treatments.
- Remote encounters and monitoring taking place in hospitals, clinics, at home, and in our offices powered by software are becoming a core part of the care delivery system. Clinicians to use video and other remote interactive tools to examine, chart, and prescribe for patients. Software alerts caregivers to anomalies and schedules their next appointments with micro precision. While these approaches save lives, it's at the cost of traditional models of human care diminishing.
- Epidemiology via innovative software is moving to a real-time surveillance environment, and rapidly changing the way we perceive of our ability to manage the planet’s global responses to outbreaks of infectious disease.
- Great centers of excellence like Memorial Sloan Kettering Hospital (MSK) are joining with technology giants like IBM: Innovation and institutional knowledge of oncology embedded in software is rolling out internationally, and patients can receive virtual consultations with the MSK oncology team.
The meaning of this is that brands, not heroic individuals, will compose the face of medicine’s future. Does this mean that we are seeing the demise of local practice and custom? It does not have to, but in order to ensure that the global standards of care are improved, the need for rigorous evidence-based methodology is more urgent than ever.