Replacing Doctors with Phones 1/24/13

I can’t even remember how I found the article that triggered this post. It might have just come up in one of the news apps I’m using these days (currently a mix of Prismatic, News.me, Zite, Flipboard, and Summly) or one of my stored Google news searches. Either way, I landed on this mHIMSS article about mobile health and doctors, with answers from Patty Mechael of the mHealth Alliance.

There’s not much revolutionary in the article or interview, but I was blown away that people — inside or outside the industry — might think that doctors aren’t adopting mobile health tools and technologies because they fear those mobile tools might replace them. Almost all of the doctors I talk to — and I acknowledge my sample is skewed towards the younger and more tech-savvy side of the spectrum — are really interested in technology in general as long as that technology is not an EMR.

I’ve had multiple doctors, from training to community practice to academics, approach me about opportunities they might be able to pursue in health technology, and many times mobile health technology. Those opportunities might be to leave clinical practice or to incorporate mobile tools into clinical practice.

khosla

All this is to say that the notion that doctors aren’t adopting mobile technology in healthcare for fear of job security is an absurd notion. As much as Vinod Khosla has been saying that machines can replace 80 percent of doctors, I don’t think many doctors have heard his statements. I don’t think many would be very fearful if they had.

The real reasons — and these aren’t revolutionary either — that doctors aren’t embracing and adopting mobile technologies is that mHealth is not reimbursable, doesn’t fit into their workflows, and doesn’t pass the evidence test just yet. That and the fact that most of them haven’t a clue what mHealth even means.

Khosla does have some valid points, as does the mHIMSS article. Mobile technology will disrupt various aspects of our healthcare delivery system, especially when it comes to remote monitoring, routine follow-up, triage, health disparities, closing the feedback loop for patients, connecting patients to providers anytime and anywhere, and lots of "urgent" care.

Connected health apps, services, and devices have the potential to generate a never-ending supply of big data that machines will be able to analyze and turn into useful information, both for clinicians as well as patients. That will give us more insight into individuals and populations than we’ve ever had. If you can link that information to genetic data, then truly amazing things can happen.

In the process of collecting that data, we will be eliminating some doctors? I think so. We’ll be replacing doctors with individuals who have less-expensive letters after their names, something we’re already doing. Either way it’s an aggregate savings, assuming overall health doesn’t tank and we don’t end up with lots more comorbid and acutely krumped cases. If that happens, we’ll need those doctors back that we eliminated.

Will 80 percent of doctors, or anywhere close to it, not be needed because of machines? No.

There are a couple of reasons why that won’t happen, at least in the US. These reasons have nothing to do with doctors, reimbursement, workflows, or evidence. I talked about big data analytics and how endless amounts of data can be turned into useful information. That information, regardless of the reduction in the feedback loop, may be useful, but it’s without value if the patient / consumer doesn’t care to act on it, and maybe more importantly, isn’t held accountable for not acting on it.

Everybody agrees somebody needs to be accountable for the health of people (ACOs, right?) but it’s not going to be the individuals. I’m not trying to be harsh or judge, as I understand and I’m incredibly sympathetic to the fact that the the playing field is far from level when it comes to access to healthy environments and healthy living. Being healthy is harder for some than others, both at the individual and demographic level, and it’s not purely a matter of willpower. That’s really not the point.

The point is that you can collect all the data you want and provide the best, most well designed, and most timely advice to patients possible. If they don’t listen, change, and act on it, they’ll be back at urgent care, the ambulatory office, or the ED. Unless you start staffing all those places with non-MDs, you’re going to have a hard time eliminating 80 percent of them.

The other reason you can’t eliminate such as a large number of MDs with mobile technology is that many healthcare interactions involve more than the acute or chief complaint. Patients want the time with doctors for reassurance, basic support, or as an active listening ear (even if only for 10 minutes). Again, you could put new frontline workers up that are non-MDs, but that’s not really using machines to replace doctors — that’s just finding cheaper workers.

These are issues I think about a lot. Investments and innovations in mobile health will surely change our health for the better and will probably make the delivery and provision of care considerably cheaper. That will reduce the need for physicians in the process. To think that physician job security is to blame for the lack of mHealth innovation at scale is just crazy, though.

TGphoto

Travis Good is an MD/MBA involved with health IT startups. More about me.

  • Rajesh

    “Almost all of the doctors I talk to — and I acknowledge my sample is
    skewed towards the younger and more tech-savvy side of the spectrum —
    are really interested in technology in general as long as that
    technology is not an EMR”

    Priceless!

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