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July 3, 2014

The Health Care Contradiction: Medicine's Old and New Ways Clash


Medicine is an industry of contradictions. On the one hand, it embraces technological innovation: new medicines, new types of surgery (e.g., robotic surgery) and amazing new medical devices (e.g., prosthetics).

And yet medicine itself is practiced pretty much the same way it has been for thousands of years. Patients contact a physician, go personally to the office for a visit, pay (at least in the U.S.) based on a set fee schedule, and then (maybe) follow the doctor’s orders.

Health IT, for better or worse, is disrupting that paradigm, and it won’t be easy for some to adapt.

For one thing, patients increasingly want to see their physicians online. Doctors may require an in-person visit initially, at least in some instances. But people do lots of their tasks online now, and they don’t see why doctor visits shouldn’t be one.

And medicine has been embracing virtual visits—unless the patient lives in a different state. State licensing laws have posed a barrier to cross-state virtual visits. State medical boards have begun to address the issue, as they should. Technology is shaking up state licensing practices. Those boundary limitations make no sense to patients and they are going to have to change.

Technology is also taking the doctor’s (or is it the nurse’s?) place—at least in part. New mobile health, or M-health, technology allows individuals to be monitored constantly. Mobile devices, such as cell phones and notebooks, have led the way, but innovators are devising wearable technology that can do that monitoring constantly.

Again, the medical community has been embracing these innovations, but they raise questions, especially who should pay for them and how?

Health insurance has been based on the physician-visit model, but the technology disrupts that approach. Some innovative physicians have come up with their own solution, such as an upfront annual fee that allows doctors to see fewer patients but pay closer attention to the ones they do see, including emails and monitoring.

Some health insurers are looking for ways to accommodate these changes, but progress has been slow.

Where will the health IT explosion be the most disruptive? Probably the Affordable Care Act. It’s based on a 20th century health insurance model, even as insurance is struggling to adapt to 21st century technology.

As President Obama conceded after the disastrous health insurance website rollout, government doesn’t do technology very well. To the extent that health care innovation needs congressional or bureaucratic approval, that will become a drag on real reform.


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