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The Top Ten Advances in the Reorganization of Health Care

Posted Aug 06 2013 10:40pm
Let the breakthroughs begin!
Ask a typical physician to describe some of the most important advances in the history of modern medicine, and her list will likely include vaccines, anesthesia, antisepsis, antibiotics, imaging, obstetrical safety, contraception, early intervention trauma care, the fight against tobacco, heart-lung bypass, transplantation, and endoscopic surgery.  The public health-minded may also include clean water, food safety, motor vehicle safety and public water fluoridation.

Many of these successes caught the imagination of patients and doctors alike, which partially accounts for our collective societal hunger for more “big bang” medical advances. It's therefore no wonder that there was early credit for the "blank shots" of genomics, the electronic record and evidence-based medicine.
  
The Disease Management Care Blog doesn’t doubt that some breakthroughs (novel anti-cancer chemotherapies, the extension of human life-spans or a cure for spousal-induced DMCB deafness) are waiting just around the corner. These surprises are probably lurking outside the academic-media spotlight involving underfunded and contrarian scientists.  They will come from unexpected directions.

Yet, that doesn’t mean that there haven’t been momentous changes in health care. There have been and, what's more, they've escaped the attention of the medical-industrial complex.  That's because they have more to do with how health care delivery, thanks to the twin forces of the internet and consumerism, is being radically reorganized. 

Think of it as the Decade of Healthcare Redesign.  Ten elements of this Redesign include
1. Downjobbing: many tasks that were restricted to highly trained specialists are increasingly being performed by non-physicians, patients and technology.

2. Social Media: patients can not only access the internet for information, they can use the internet to pool input and solicit personalized advice from like-minded individuals

3. Democratized Artificial Intelligence: In addition to social media, we’re on the verge of being able to remotely access AI to generate a reasonably accurate list of diagnoses, suggested tests and recommended do-it-yourself treatments that include the option of doing nothing.

4. The Decline of the Credential: while the academic-industrial complex will continue to churn out superbly trained physicians, massive on-line education will enable persons to gain a surprising level of lay-expertise.

5. Predictive Data Mining with Risk Stratification: we can’t afford to treat every person the same way. Analytics are already enabling individuals to understand which of their individual risk factors have the best ratio of actionability and pay-off.

6. Big Data and Concurrent Research: Going from analog/unique to digital/tabulated means that we can pool data and find correlations that lead to medical insight as fast as the fastest server and processor can crank the numbers.

7. Team-Based Care: Its impact at the bedside, in the operating room and in the primary care clinic is greater than the sum of its parts.

8. Remote Robotic Surgery: think of the World’s Best Surgeon being able to use ultra-fast satellite communication technology to wield surgical instruments from the other side of the country. Just so long as there’s in-person back-up near-by, wouldn’t you want that?

9. Medical Tourism: As the rest of the globe imports the best that western medicine has to offer minus the United States’ overhead costs, the cost of overseas air travel is no longer be an impediment to patients or insurers.

10 Big Government: For better or worse, Washington DC has its nose under the health care tent. In the unlikely event that Obamacare gets repealed, top-down diktats will forever be a part of the landscape.  Get used to it.
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