I have been trying to come up with a list of significant ways to reduce the cost of healthcare. I have addressed one of them, telemedicine, in a recent note (see: Ten Megatrends in Healthcare with Special Emphasis on Ambulatory Care). A second would be wellness programs, given that a large percentage of our healthcare costs are caused by lifestyle choices that can potentially be changed (see: Wellness Plans Use Carrots and Sticks; Disease Management Plans Lower Costs; Hospitals Diversify with Wellness Centers; New Facility for Population Health). Drug prices have gone through the roof and can be reduced by political and governmental pressure and new legislation (see: Pharma Money Flows into California Opposing Proposition 61). Broader use of clinical analytics and population health can be employed to diagnose diseases faster, thus increasing the efficiency of care and reduce costs (see: Cerner Emphasizes Population Health but Pay Attention to the Details). Finally, algorithmic medicine can be used in a number of ways to increase the efficiency of care processes.
The term algorithmic medicine is cropping up more frequently to refer to the use of rules (i.e, algorithms) to increase the efficiency and effectiveness of care processes. These include the use of algorithms in various ways ranging from the the very simple example of blocking unnecessary lab tests to more complex ones such as rapid computer diagnosis of diseases. Below is the abstract from a paper published in 1984 by Greeo and van Gelder on algorithms in medicine (see: Algorithms in medicine). Many of the key points still seem valid to me.
The ever rising costs of health care in Western countries necessitate some form of cost control. Restrictions can be and will be imposed externally by, for instance, the government. These measures will probably lead to a decrease in quality of health care and the profession should therefore seek ways to prevent outside interference by developing an internal means of cost control. On short terms a form of internal control with preservation of the quality of care would be the introduction and widespread use of algorithms, restricting the use of useless and unnecessary tests and therapies. For long term results education must take on new tasks leading to a better understanding of costs an benefits of medical activities. The development of algorithms is hindered by the lack of common consensus of optimal care, the lack of relevant data and the inefficient way data are managed. When introduced the algorithm, especially when compulsory, will engender much resistance and unhappily, ways must be found to overcome them by sanctions. The profession must realise that if they do not do anything it will be done for them.
Regarding one aspect of algorithmic medicine, it should be relatively easy to triage ambulatory patient visits to the most appropriate provider such as a nurse, nurse practitioner, or physician. The introduction of algorithm-driven questionnaires prior to a visit would make the process more efficient. Most large health systems and practices have already automated the generation of prescription refills via patient portals. One intriguing question in this context is whether patients will tolerate completing electronic forms prior to a visit. My sense is that they will do so if and when the forms are well designed and the patients understand that the completion of the form will make their visit more efficient. What patients will not tolerate is the frequent request to provide information that they have previously supplied.