The Challenge Of Building A 'Moore's Law' For Healthcare
I've often marveled at how healthcare has managed to resist the productivity gains that computers and IT, have enabled in so many other industries. By making healthcare more efficient the outcome should be lower, not higher costs. Here's an interesting perspective on this subject.
As Intel's resident MD, Mark Blatt (above) doesn't wear a stethoscope around his neck and he doesn't treat employees. Instead of medical devices, his tools are tablets, smartphones, wireless networks and relational databases.
The doctor-turned-technology evangelist is seeking ways to double the number of patients that a doctor sees while cutting the cost of treating them by half or more.
To reach that goal, Intel's worldwide medical director draws on the same principles that Intel has applied to semiconductor manufacturing -- pursuing what he calls it a "Moore's Law for healthcare" to slash costs.
Before he came to Intel in 2000, Blatt saw patients for 15 years as a general practitioner. Now he's working with patient data -- digitizing it, sharing it and making it more accessible. Recently, Blatt discussed how he sees technology being used in healthcare settings and what it will mean for patients and healthcare providers now and into the future.
You've talked about a "Moore's Law for Healthcare." What is it exactly?
Back in the mid-1990s [when Blatt was a practicing physician] one Saturday morning when I was on call I cared for about 80 percent of patients on the phone and I realized that I'd "seen" more people in those 4 hours than I usually see in a [normal] week. I had taken approximately 30 to 60 seconds for each visit. The price point was cheap; in fact, it was free. For the patients it was extremely convenient and timely medicine.
What I wondered was how to replicate that Saturday morning experience to deliver inexpensive healthcare. How can we deliver inexpensive healthcare conveniently for the masses? When I say inexpensive, I mean pennies on the dollar.
How can we do what Intel does in manufacturing, but for healthcare: double the number of patients [a doctor treats] and cut the cost of treating them by 50 percent at a minimum? That's what I like to call a "Moore's Law for healthcare."
If I have $100 for care of a single person I now want to cut the cost in half and double volume so I can see two people for $50. That points in the direction of an order of magnitude reduction in care costs as opposed to a 5-10 percent savings, which is not going to cut it.
How can technology support that level of cost reduction?
I like to talk about four major functions that technology needs to bring to healthcare. The first one is you have to digitize data. You have to gather data. Everything that exists right now in paper-based format, from lab tests to notes to advice to patients to appointment schedules.
Everything that exists has to be digitized. We're starting to see that happening. I would say the number of clinicians using electronic records in the United States in the last 3 to 5 years has tripled.
Next, we need to look at how we share data. How do we break down silos and take that data that you've accumulated about people at your practice, at your hospital, in your group and share more broadly to where care is actually needed?
Then we need to share [data] on mobile devices. That had been slow in coming until the evolution of smartphones and consumer tablets led to the consumerization of IT. I'd say that in the last 2 years every hospital in the United States has tried a consumer media tablet, specifically the iPad, and I would venture a guess that three-quarters or more of doctors have smartphones.
The final step after gather, share and mobilize is to empower patients and that is an emerging trend with social media.
How has technology changed the patient experience?
I think it's made the patient safer. That's the fundamental thing patients don't quite grasp. Healthcare as we've been practicing it over the last 20 years seems like a really dangerous art. People are really committed to safety, but the processes, the steps we have to go through, have become so complicated that to get it wrong, to make a mistake, is almost commonplace.
The landmark article in this came out [in 2000] by the Institute of Medicine called "To Err is Human." Everyone responded to this with the understanding that somewhere between 48,000 to 98,000 people a year died in US hospitals due to process errors. Some follow-on studies thought they underestimated. It is not out of maliciousness, it's not out of carelessness -- it's that the processes are extremely complicated.
What is the greatest challenge for the healthcare industry when it comes to new technology?
Uniform adoption and dissemination of technology. [Former Intel CEO] Andy Grove once wrote an article for JAMA, the Journal of the American Medical Association, one of the most prestigious journals in the world, about the diffusion time for innovation. He pointed out that the diffusion time for an idea people think is right is 18 years, so that by the time the idea disseminates it's either old news or we're onto the next one.
And that's probably the biggest fundamental issue for healthcare. Practices that have value and benefit don't disseminate easily and quickly across this cottage industry -- that there are too many individuals, nodes, sites and practitioners and we don't get this more uniform approach.
What's an example of technology changing a familiar healthcare process?
IT has introduced systems that can do things over and over again without making mistakes. Introducing end-to-end e-prescribing or the doctor writes an order electronically -- the order is checked electronically for drug, dose, against the other drugs in the database, against allergies ... the pharmacist uses an electronic robot picker to assemble a task so there is very little chance of getting the wrong medicine.
They are using proven technology from other industries like barcoding or RFID tagging to make sure the medicine is administered correctly. It can virtually eliminate prescription errors which by various estimates kill about 17,000 people out of those 50,000 to 100,000 a year at hospitals.
What's the next big change you see in healthcare?
In the short term, it's mobile. Going mobile is no longer an option; it's an imperative in healthcare. The advent of mobility in our personal lives has convinced us that there is tremendous value not only for clinicians of all types -- doctors, nurses, physical therapists, ambulance drivers, pharmacists -- but citizens as well.
Programs that monitor your heart rate, your footsteps, your body mass index, make recommendations that are relevant to you about diet when you walk to a restaurant based on your morning's blood sugar level.
We'll see machine-to-machine connected devices where monitoring systems automatically dump [information] into database systems. Take home diabetes tests. I prick my finger and the results are entered. These things will happen seamlessly.
And maybe the tests become increasingly noninvasive. I stand in front of a mirror and it measures the sub-capillary pulse in my face and it takes my heartbeat.
I'll make a guess that between 5 and 10 years from now about 10 percent of all data that goes into electronic record is typed and 90 percent goes in by some other mechanism like gesture, speech, touch, automation.
What is going to get people to change versus sticking with the status quo?
Healthcare is a very personal service. We are used to consuming it in a certain manner. So how do I get consumers to want to crave the digital experience over the face-to-face experience?
Evidence shows that in many ways the digital experience is safer, more convenient and less costly. Citizens are going to realize that accessing care online digitally is not just more convenient and less expensive, but is actually safer. As the tools become more robust that's going to become a more dynamic experience and [physicians] are going to be able to get into complexities they couldn't before.
I think getting citizens to want to change their expectation about how they consume healthcare is something we haven't even begun to do yet.