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by Kent Bottles
Hospital leaders are busy trying to cope with the changes brought on by the Patient Protection and Affordable Care Act and the realization that the federal budget deficit translates into less money for all healthcare providers in the future. The seemingly inevitable transition from fee-for-service to global payments creates anxiety about how quickly the financial incentives will shift.
While the above-described issues are certainly enough to monopolize any busy hospital executive's time, there are other large-scale changes on the horizon that may impact hospital operations just as much. Leaders who ignore these trends will do so at their organization's peril.
The important trends include: personalized medicine that concentrates on the individual not the population; the "quantified self" movement with constant remote physiologic monitoring; the smartphone health applications explosion, and the artificial intelligence, healthcare robot movement.
Personalized medicine: Advances in genomics and digital technology are making it possible to shift the focus of evidence-based medicine from the population to the individual patient. Today drug treatment and disease screening follow a one-size-fits-all approach that leads to overtreatment and unnecessary expense. Genetic testing allows us to individualize the treatment for the patients.
For example, about 20 percent of diabetic patients treated with metformin do not respond to the drug, a condition that can be identified by genotyping that is not routinely done today. Likewise, cancer screening by mammography after age 40 in women and colonoscopy after age 50 in men and women does not take into account the different genetic predispositions for breast cancer and colon cancer in individual patients. Two new books should be on every hospital executive's reading list because they explore the implications for hospitals of personalized medicine: Eric Topol's "The Creative Destruction of Medicine" and David Agus' "The End of Illness."
The "quantified self" movement: The development of sensors that can be worn on or implanted in the body has allowed patients to constantly monitor their physiologic parameters. Heart rate, blood pressure, sleep patterns, blood glucose, oxygen content of the blood, temperature, amount of exercise, and moods are just some of the parameters that can be monitored and shared with a wellness coach or physician. Traditionally we have treated high blood pressure, for example, with infrequent monitoring during visits to the doctor's office. The technology capabilities have spawned a quantified self movement that explores how constant monitoring can change treatment of chronic conditions. Two good places to learn more about this development are here and here.
The smartphone application explosion: Americans have adopted smartphones more rapidly than any other technology in modern times. There are now more than 15,000 healthcare applications available for iPhones and Android phones. Patients and providers have barely scratched the surface on how to use these new applications, but many pundits are predicting that healthcare delivery will continue to migrate away from the hospital and the doctor's office to wherever the patients and their smartphones travel. Find recent reviews on the impact of smartphones on healthcare can here, here and here.
AI/healthcare robot movement: IBM's Watson is moving on from conquering "Jeopardy" to aiding health care providers by scanning the entire medical literature to help make diagnoses more accurate. A computer named Dr. Fill is even entered in the American Crossword Puzzle Tournament and expected to do well. Recent articles have speculated on what kind of physicians will soon be replaced by computer programs and robots, and artificial intelligence experts predict that medical diagnoses kiosks will soon be triaging patients in the third world.
As if hospital leadership did not already have enough on its plate trying to decrease per-capita cost and increase quality in response to federal healthcare reform, they also need to understand and plan for the effects of personalized medicine, the quantified self movement, the explosion of healthcare applications for smartphones, and the increasing use of artificial intelligence and robots in medical diagnoses.
Dr. Kent Bottles is a Senior Fellow at the Thomas Jefferson University School of Population Health and Chief Medical Officer at Verilogue/CareCoach.com. He is frequently called upon to give keynotes and write articles about healthcare reform, the future of medicine and disruptive technologies.
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