Monday, June 11, 2007

Clinical Innovations - Internet Health Markets – Too Disruptive an Innovation?

Are Virtual Visits and Virtual Markets Too Wild a Dream?

This blog emerges out of two visions,

• One is that of Barry Diller, the Hollywood mogul who has become a television/Internet billionaire (he was the nation’s most highly paid CEO last year, taking home $470 million). His vision was that people would buy goods and exchange information “interactively” through remote, animated, and intensely human encounters on the television and Internet screens.

• The second is that of David Brailer, MD, the former national health information coordinator for the Bush Administration, who resigned last year, and who has now founded, with $700 million in support from Calpers, Health Evolution Partners. This venture firm’s mission is to cut costs, mostly through remote technologies that keep people out of institutions. One of Brailer’s visions is to fund Internet Health Markets, which, among other things, might set up competitive markets to read chest X-rays.

Are these two visions, one from a commercial media mogul and the other from a doctor and economist, too radical – too wild a dream – for cutting costs? Would they call for to wrenching a change in current patient-doctor relationships?


Certainly the visions, fully deployed, would radically change the nature of our health system, which is based on hands-on personal encounters between patients and doctors in private settings in medical offices, clinics, and hospital rooms. Keep in mind, however, that changes wrought by this visions, would be evolutionary not revolutionary.

And so far, legal and regulatory barriers, based on privacy, licensure, reimbursement, turf, and relationship considerations have impeded these visions. Telemedicine, after all, has been around for 20 years, and despite its established cost-cutting powers, has yet to take the medical world by storm.

It’s not that the technologies are not there. Already, American radiologists are outsourcing imaging interpretation to radiologists in India, Australia, and other countries. The same is true of interpretation of complex cardiac rhythm strips. Barriers to outsourcing routine X-rays are likely to fall too.

And remote exams of patients using audio-visual technologies are common in the telemedicine world – and in institutions like Mayo are often used to elicit a second opinion within that institution. Furthermore, audiovisual examinations by doctors and nurses of home-bound patients is established in the chronic disease management industry and has been shown to dramatically cut hospital admissions and emergency room visits.

Which leads to another vision. Why not virtual interactive patient visits – using audio-visual interactivity coupled with measurements of vital signs, blood constituents, blood gases, body mass indices, and information from the patients’ personal health record?

The obstacles remain formidable – radical restructuring of the patient-doctor relationship, medical legal issues, and who shall pay and how. These obstacles are not insurmountable if costs continue to rise, if wireless technologies combining imaging, text, and sound continue to evolve, if medical licensure authorities change their policies, if medical legal threats abate, and if the payment system for physicians is altered to make it reasonable for them to participate.

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