Sunday, February 20, 2011

Health 10.0 in 2020: I Told You So in 1973

The computer is no better than its program.

Elting Elmore Morison, 1909-1995, Men, Machines, and Modern Times, 1996

It is 2020. Computer evaluation of patients before they visit their doctors has come a long way.

Medical records containing demographic data, personal histories, medication use, allergies, laboratory results, radiologic images, electrocardiograms, rhythm strips, and even the chief complaint and symptoms of the patient ‘s present illness, as spoken and digitized by the patient, are available prior to the visit.

These records, synthesized, homogenized, summarized, algorithmized, and otherwise massaged by massive computer banks, give doctors everything they want to know before seeing and examining the patient.

• differential diagnosis,

• most likely cause of the visit,

• optimal treatment options,

• a review of recent medical literature in the last 24 hours on the subject,

• best current medical practices,

• greatest value for the dollar in the immediate region and at distant national centers,

• most cost-effective and results-effective specialists,

• Appropriate tests and procedures to be done before the patient leaves the office.

This barrage of information is available to consumers and physicians alike before and immediately after the visit. Furthermore, with advances in speech recognition, patients and doctors will be able to talk to the computer in each others presence, ask questions, and settle any lingering doubts.

Once in the physician’s office, doctors and patients can sort out the meaning of it all, arrive at rational decisions, and negotiate solutions. In the parlance of government, these solutions will be deemed “meaningful,” for they will be based on “meaningful use” of electronic medical records, a carry-over from 2015, when these records became mandatory.

Once decisions have been negotiated, tests performed, results will be available before the visit is over They are available because of advances in on-the-spot-testing and quickly performed noninvasive procedures. Patients are now able to leave the office with medical record, treatment plan, and referral information, if needed, in hand.

Health 10.0, as it is now known, will resolve past difficulties – misdiagnoses, delays in diagnoses, and misunderstandings and confusions leading to malpractice suits.

But surely, you say, you are jesting. No, but this is a bit tongue-in-cheek. There will always be uncertainties and lack of scientific evidence covering medicine’s vast panorama. No computer, even IBM’s “Watson,” can ever achieve complete information utopia , i.e, define and delineate and resolve all the variables of humanity. Computer processing will never offer a completely rational solution to the human condition in an efficient, cost-effective manner.

Besides, doctors and their humanist allies will object that medicine is an Art as well as a Science.

You are right. Forty seven years ago, in 1973, I gave an address at Hartford Hospital as part of a symposium to honor T. Steward Hamilton, MD, who had been administrator of that hospital for 20 years.

I foresaw, among other things, “Besides performing his usual duties, the pathologist will become something of an intelligence expert. He will help collect, evaluate, analyze, integrates, anticipate, and interpret information. His prime role will be to unify random test results into practical fingertip information that will clinicians can effectively use to make decisions.”

My title was “The Screening Laboratory of 1980” (published in Perspective of Biology and Medicine, winter 1974). I said it was then possible, using the Internet , to generate a list of realistic diagnostic possibilities in plain English, for I had done so in our own laboratory in Minneapolis.

The Hartford medical establishment received my talk with a notable lack of enthusiasm, even with a touch of scorn. They were correct. The computer was not ready for prime time. I was a prophet before my time. It was a small step forward, before the giant leap forward in health information technology. It was a first byte out of the Apple.

But now it is 2020, the time has now arrived, and all is well on the digital front.

Richard L. Reece, MD, blogs at Medinnovation and has a website under construction. He is the author of three recent books, Obama, Doctors, and Health Reform (Iuniverse, 2009), Innovation Driven Health Care (Jones and Bartlett, 2007), and an E-book, Pros and Cons of Accountable Care Organizations (Practice Support Resources, 2011). He works, on occasion, with The Physicians Foundation, a 501C3 organization representing physicians in state medical societies. Opinions expressed in his blogs are his alone. He can be reached at and 1-860-395-1501.


Doug Mitchell, MD said...

I agree with your prescient comments in years past that pathologist were, to paraphrase, "the keepers of diagnostic data." They remain so.

It's logical, then, that they will be increasingly looked to as chief sources of guidance to clinicians in navigating the turbulent waters not just of the effective interfacing of EHRs and LISs -- but of how to make sense of laboratory data in ways best benefiting patients, and in meeting the stringent regulatory guidelines of the HITECH Act

Doug Mitchell, MD, InfoTechMD Founder

Richard L. Reece, MD said...

Doug: Thank you so much for your comments. From your comments, I can see you are much more qualified to discuss this than I am. I am flattered you took the time to comment. I recommend readers visit your site to see the present status of HIT