By Eric Gombrich
A few weeks ago I attended a presentation at an engineering school where the researchers showed the work they’re doing in robotics that will progress from specific, purpose-built robotic machines to self-configuring, dynamically capable robots. In other words, today a robot is built to perform a specific task; tomorrow they will be generalists able to do multiple tasks, and they will be able to dynamically make the change themselves.
For example, today a robot is designed and built with the sole purpose of installing the seats in a car on the assembly line. But with the work these researchers are doing, in the future imagine we run-out of the bolts for the seats. Rather than stop the assembly line, these same robots can dynamically change their function and instead begin welding hinges on the door frames. Furthermore, the platform knows what’s happening throughout the assembly line (lack of bolts), and automatically begins changing robotic functions to optimize output.
I left with two thoughts: a sense of being impressed by the ingenuity and progress we’ve made in technology; and a sense of concern for the future of employment; we won’t even need the newly educated machine operators current economies are trying to train to replace the loss of blue-collar jobs. The robots will do it all themselves.
The other night on the CBS show ’60 Minutes’ they highlighted work the US military is doing with autonomous drones. Yet again, here is an example of robots being programed with a mission or goal, and left alone to get there. Again, negating the need for drone pilots to control them.
I’ve continued to contemplate this, and combined it with the advancements I’ve seen in healthcare regarding in vitro diagnostics, surgical robotics, telemedicine and apps in healthcare this has all started to become even more personal. Taken in aggregate, the future of healthcare appears to be based in a pattern that may go something like this:
- I as a patient can take a dab of blood from a finger-prick, a drop or 2 of urine, or a swab from my mouth (DNA, saliva, etc.) and via various potential media ‘connect’ it to my smartphone. A matter of minutes, hours, or a day or 2 later I’m provided the results of a panel of diagnostic tests, effectively telling me what ails me;
- Leveraging the power of Dr. Google and big data, I’m also provided myriad options to address or treat my condition. These may include such things as instantly speaking to a family doctor, nurse practitioner, or specialist via my smart phone; ‘just click here to be connected to…;’
- After my almost instant telemedicine consultation, the course of action may be a prescription. In this new world I’ve seen a glimpse of, again the options are mind-blowing; less than an hour after my conversation with the doctor, a drone rings my door-bell to alert me it’s arrived with my medication. It authenticates me, and delivers my medication to me. Or here’s an even more mind-blowing thought…using technology not entirely dissimilar to digital printing, at the conclusion of the my encounter with the healthcare provider, this device in my home – costing not much more than a conventional printer – actually ‘assembles’ my medication from an inventory of base chemicals that once mixed, results in the prescription I need. If people without a high school education have figured out how to make methamphetamine from easily available and generally innocuous materials, how difficult can it be for engineers to build a robot to do it that sits in my home?
- If the outcome of my telemedicine consultation requires surgery, as we all know, this is now being done robotically. So again, from my smartphone I can choose the ‘surgery center’ based on proximity / location, availability, and price. Tomorrow I’m in the OR with a robotic team attending to me.
While the technology undermining this is fascinating and what’s motivated me for more than 30 years I’ve been in the industry, it’s not the focus of this blog. The question I have is this: what’s the role of the healthcare provider and their healthcare system in all of this?
Let’s consider the impact of my rudimentary scenario:
- Because the diagnostics are done in my home via my smartphone largely via technology, at a minimum there is a significant reduction in the labor required. No more couriers driving to doctors’ offices to pick-up samples and bring them to a central lab. Heck, no more central lab as specimens never leave my home. Ergo far fewer lab technicians and pathologists.
- Because I don’t go to the doctor’s office either, we don’t need as many offices (real estate), receptionists, cleaning staff, or even nurses. We also don’t need those offices to buy medical equipment.
- This paradigm also reduces the need for emergency rooms, except in cases of trauma. This will further reduce the number of doctors, nurses, and allied staff we may need. And again, the number of beds, lights, stethoscopes, and so on needing to be purchased.
- And with this rise of the robots leading a new era of surgery the surgery center will invariably be so automated, again, we don’t need as many trained technicians, nurses, etc. or capital equipment, diagnostic devices, etc.
But wait, while I left that engineering lab about a month ago with this same initial thought of the impact on employment, the context of my blog and the question that is top of mind for me is not simply about the impact on employment and the medical supply chain (although those are thinks I think the industry and academics need to be considering). No, the context of my question is this: in this new world order, what’s happened to the ‘trusted relationship’ between patient and doctor?
In this new paradigm, I may not even know where the analysis of my blood, urine, or DNA is happening, or by whom? Do I know – or care – if it’s a machine or human doing the analysis? From my lay perspective, it’s my smartphone that’s doing it; it’s the Wizard of Oz behind the curtain. This is not that dissimilar to today when I have no idea where my doctor sends my sample. I’m trusting that my doctor has vetted that lab. But it’s unlikely I have a relationship with them. And because there is no doctor in the scenario I laid-out – or at best, they have a role later in the process – what does this mean for large diagnostic companies like LabCorp or Quest?
In this new paradigm, when I get instantly connected to an MD or NP to discuss the results, again, what relationship do I have with them? Is it that I trust the individual, or that I trust their credentials? Perhaps when I indicate I want to speak to someone live, I simply indicate my preferences; I want an English-first-language speaking male, I want someone trained at a tier 1 medical school in North America or Europe (although Thomas L. Friedman in ‘The World is Flat’ suggests this may be irrelevant), and I want someone that has a documented expertise in the condition or diagnosis I now have, etc. But again, I don’t really have a relationship with that individual.
Finally, in this new paradigm, when the treatment phase ensues, again it may be a physician / surgeon based on my chosen criteria (per the above example) that is driving or monitoring the robot. They may be 10,000 miles away, and after this episode of care, I’ll never interact with them again. Or if its medication based therapy, because I don’t need to go to my local pharmacist and instead receive my medications via technology (drone, printer, etc.), there is no relationship there either.
When doctors and healthcare systems alike speak about the trusted relationship between patient and provider, I’m left wondering how that survives in this new world order. More specifically, if that’s how doctors and health systems expect to preserve themselves and fend-off competition based on these trusted relationships, doesn’t something need to change?
Personally, I think the answer is yes. But I also see the opportunity.
The scenario I’ve used here is truly based in an illness requiring treatment; aka ‘sick care.’ But if doctors and healthcare systems begin focusing on ‘health’ and ‘wellness’ this is where the relationship may be preserved. When I as a ‘patient’ am seeking advice and guidance on how to achieve my long-term plans for my life in terms of length, quality, specific activities, etc., I suspect I will seek to do this with someone that ‘knows me.’ And to achieve that – to allow someone to truly know me rather than someone who understands only my ailment – requires trust. And trust is developed over time and with consistency.
It’s my belief that for physician practices and healthcare systems to thrive in the future, they have no choice but to stop thinking in terms of treating ailments, and begin thinking of themselves as health & wellness counselors and guides. In so doing, they position themselves to deliver a service that is based in trust, something they can establish and protect for the long-term. But failure to make this shift from ‘sickness care’ to health & wellness will see the demise of their relationships as more convenient and cost-effective solutions emerge.
Isn’t this the foundational essence of Primary Care; an MD that serves as the ‘quarterback’ for a patient’s health & wellness? Isn’t it also the essence of patient-centered care? As such, does this portend that those specialists or healthcare systems focused on acute and specialty care may find themselves on the outside looking in?
Continue the mental exercise considering how companies and innovators who have focused their marketing and sales efforts on the existing ‘sick-care’ markets must also shift. It used to be, for example, that pharmaceutical companies focused their efforts on getting MDs to write prescriptions for their brand.
They do a lot of work to prove thru peer-reviewed clinical research, for example, that their cardiac drug was the best, and then set-out to convince all cardiologists of that. But that initiative would then be tied to market data for patient populations; if we wanted to increase utilization of ‘Crapostatin’ in Boca Raton, Florida (for example) we needed to get the cardiologists in that area with the largest patient volumes to prescribe our brand. But in the new world order, we may not know what cardiologists are interacting with the Boca Raton community of patients. So how do pharma companies drive adoption of their brands?
I’ve got some ideas. But the point is this; the new world order of healthcare will change everything. There is no aspect of the industry that doesn’t need to consider fundamental changes to how they manage their efforts.
I’m not a physician, nurse, or allied health professional…I’m just a patient. But in this new world order where I have more direct control over when, what, how, and where I receive care, it strikes me that not only does my insurer and health system need to change, but so too do the vendors selling and supporting them.
What do you think?