Limits of technology, limits of intervention - Limits and Power of Health Care Computerization

A Chat with Doctor Gordon Moore

Two months ago, I attended an Health and Human Services’ innovation forum in Washington, D.C. There I chatted with Gordon Moore, MD. Dr. Moore is a family doctor on the Institute of Healthcare Improvement’s faculty in Boston. He specializes in lean and ideal care systems.

In Rochester, New York, he conducted (he has since moved to Seattle) a 24/7 computer-driven solo practice, now called a “micro-practice.” He did so in a small room with no staff and with nothing to aid him but an Internet broadband connection and best practice algorithms. He described his practice as, “A Norman Rockwell practice with a 21st century information technology backbone.”
Dr. Moore told me many overlooked his approach’s true power. That power resided in the promise of constant access and more time spent with patients.. Yes, the computer sped communication and eased open scheduling, but Moore insisted it paled in importance compared to his renewed bond with patients. The human part of the equation, he felt, received far too little attention.

An E-Mail from Doctor Paul Grundy

Yesterday morning I received an email from Paul Grundy, MD, Director of Healthcare Transformation at IBM, and champion of the medical home. With the help of the computer, he feels the computer in a medical home aligns the interests of primary care doctors and patients and creates the basis for a trusting personal relationship.

Among other things, Dr. Grundy wrote,

Dick, the view you have is one that really looks at the world the way it is-- It is no longer that way -- if you just spent a day in a primary care docs office in Denmark or as I did this week in Chuck Kilo's practice in Portland you would see it would be clear.

I talk a lot about the technology, but it is not the technology, it is the doctor and their relationship to his patient that is aligned to use the technology. Honest, we will never go back to the primary care doc of the Norman Rockwell painting.

Something is happening that holds even greater potential. In a word, our planet is becoming smarter. Healthcare is not only getting more integrated it is getting Smarter. This isn’t just
a metaphor. I mean infusing intelligence into the way the world literally works—the systems and processes that enable physical goods to be developed, manufactured, bought and sold, services to be delivered… everything from people and money to oil, water and electrons to move… and billions of people to work and live.

What’s making this possible?

First, our world is becoming instrumented.
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Second, our world is becoming interconnected.

Third, healthcare is becoming intelligent.

What this means is that the digital and physical infrastructures of the world are converging. Computational power is being put into things we wouldn’t recognize as computers. Indeed, almost anything—any person, any object, any process or any service, any organization, large or small—can become digitally aware and networked. With so much technology and networking abundantly available at such low cost, what wouldn’t you enhance? What service wouldn’t you provide a patient? What wouldn’t you connect? What information wouldn’t you mine for insight?
Grundy is a brilliant man, he has a noble vision of what medical practice ought to be, and he directs Healthcare Transformation at IBM, perhaps the world’s greatest technology company.

Personal Doubts

I doubt smart machines will ever play in the same emotional intelligence ballpark as human intuition and interaction. Smart machines may “align” the relationship. But all too tempting to overstate their importance. The current massive recession may have occurred because we trusted bundled algorithms more than our gut. And this week a hacker penetrated my firewall and cost me $395 by stealing my identity, so I suffer from personal paranoia. I may not be objective.

New York Times Report

And in the January 17 New York Times, Robert Pear reports,

President-elect Barack Obama’s plan to link up doctors and hospitals with new information technology, as part of an ambitious job-creation program, is imperiled by a bitter, seemingly intractable dispute over how to protect the privacy of electronic medical records.

In a speech outlining his economic recovery plan, Mr. Obama said, “We will make the immediate investments necessary to ensure that within five years all of America’s medical records are computerized.” Digital medical records could prevent medical errors, save lives and create hundreds of thousands of jobs, Mr. Obama has said.

So he says, but we shall see if the pudding puddles or muddles.

Danger of Commercial Exploitation

Health IT without privacy may build a gold mine of information used “ to increase profits, promote expensive drugs, cherry-pick patients who are cheaper to insure, and market directly to consumers,” says Dr. Deborah C. Peel, coordinator of the Coalition for Patient Privacy, which includes the American Civil Liberties Union among its members.

Final Thoughts

Violating patient privacy and exploiting patients and doctors alike are two downsides of electronic medical records. The upsides are transparency and rationality. I fear computer dependency may cause us to overlook health care’s personal sides. We may start to think computers are so smart they can replace or overrule human judgment. That would be a mistake.