I delivered a lecture yesterday in which I listed what I thought were the ten most important trends in healthcare, particularly in ambulatory care. Needless to say, a number of them were directly or indirectly related to information technology (IT). The major trends I listed included telemedicine as a major means for ambulatory care delivery, bedless and "command center" hospitals, cloud-based personal health records for consumers, consumer-oriented genomic testing, and wearable health monitoring devices. One of the audience members approached me afterward and said that my comments had reinforced his belief that the future of healthcare changes was inextricably bound to information technology. It occurred to me that I believe that this is true but I had never heard the idea expressed exactly in this way.
As I mulled over this idea, it occurred to me that IT could potentially be a challenge for the healthcare industry in the future. It has not been particularly adroit in deploying new information technology. How else can one explain why hospitals EHRs, often costing hundreds of million of dollars, are disliked so intensely by one major group of healthcare professionals that they are designed to serve, physicians (see, for example: 9 Reasons Physicians Hate EMR - The 2013 RAND Study; 25 quotes that show just how fed up physicians are with EHRs)? Here is a list of some possible reasons why the healthcare industry might be slow to adopt new information technology:
- The industry is highly regulated so it's difficult for innovative IT solutions to succeed.
- Defensive medicine and the fear of lawsuits militate against many innovations including IT.
- Healthcare professionals are, appropriately, deeply conservative about adopting new technology because patient lives are at stake.
- The industry is partitioned off from others and adheres to its own rules that sometimes serve as impediments to innovations that are common in other industries.
- Healthcare cannot compete on the basis of salaries for the most sought after IT professionals and turns instead to less talented personnel within its own ranks.
I think that part of the solution to this problem, if you agree that it exists, is the empowerment of healthcare consumers who demand IT services similar to what they encounter outside of healthcare. Unfortunately, the trend is being countered by healthcare insurance companies that are trying to reduce consumers choice and competition by various means such as by the adoption of "narrow networks" (see: Network squeeze: Controversies continue over narrow health plans). I suspect that ultimately the boundaries around healthcare are going to become more porous. After all, healthcare expenditures are huge and continue to attract new companies. It has taken a very long time but the basic tier of health services is slowly becoming more competitive with walk-in drug store clinics and urgent care facilities (see: Rapid Growth of Urgent Care Clinics; Cost Competition for Hospital ERs). There now are more than 1,000 MinuteClinics inside CVS/pharmacy stores in 33 states and the District of Columbia (see: MinuteClinic history).