The previous section of this article introduced this year’s highly successful conference, along with some reports from its lead sponsor, Partners HealthCare in Massachusetts. This section looks at some controversies.
A shiny techno-optimist view was offered by two leaders of the computer industry. Venture capitalist Vinod Khosla, co-founder of Sun Microsystems, is famous for suggesting that 80% of what doctors now do could be replaced by technology. Joichi Ito, Directory of MIT’s Media Lab, reinforced this claim by pointing out how much productivity scientists gained by replacing manual number-crunching with digital calculators. “The less subjective decision-making we have,” Khosla said, “the better health care quality will be.”
With diagnosis and prescribing thus handed over to smart machines (some descendant of IBM’s Watson, in my imagination), doctors can focus on building relationships with patients. It’s easy to parody the role of empathy in health care, but realistically, empathy is the one thing that we’ve found to make a difference in chronic care. One hospital in New Orleans achieved a 45% reduction in readmissions through interventions that reduce social isolation and other barriers such as transportation problems.
Furthermore, technology will not act alone: it will allow the delivery of care to move down the cost stack from specialists to general practitioners and from doctors to nurse practitioners.
However, a couple decades of research stand between us and the empathic, tech-supported future. Khosla expects a 20-year evolution, starting with systems that just recommend questions to rule out rare conditions, and devices to monitor patients. More specific interventions will come with the growth of data. Another speaker pointed out that recommendation systems are currently good enough to recommend movies we might like, but not to recommend what medication we should take.
A lot of data crunching in the health care space goes to predictions that have dubious validity and may even be obnoxious, such as guessing what your health patterns will be on the basis of your credit rating or the kind of car you drive. Thomas Goetz, former editor of WIRED Magazine and now an investor in medical research, stressed the importance of treating patients as partners if we want them to participate in big data research efforts. The subjects of experiments will demand full transparency about what we’re looking for.
The obverse of the coin was persuasively delivered by Ezekiel Emanuel from the University of Pennsylvania, the self-declared token techno-skeptic at the conference. He laid out a few narrow areas where we can expect technology to improve outcomes (or at least reduce costs) over the forseeable future: medication adherence (although he also wise-cracked that most people would do better on half their current medications) and preventing a useless trip to the hospital during the final weeks of life. Everything else we try to do relies on a long chain of technological and workflow changes that will be hard to put into place.
But mainly conference speakers firmly believe that technology is already making a difference, and are building businesses around them. Technologist Rosalind Picard found a possible indicator of epilectic seizures that had been missed by clinical research. Muse makes a headband that trains you to relax by showing your brain waves. And the social aspect of health is being avidly addressed, whether through simple phone calls to isolated elderly people (The Silver Line in Britain) or helping people with mental health problems communicate online anonymously (Big White Wall).
The anonymous communities of Big White Wall, of course, update practices that go back to the earliest days when ordinary people got onto the Internet in the 1980s. And the practice seems to work: CEO Jen Hyatt says that 73% of members share an issue there for the first time in their lives, and 95% of members report feeling better.
The final section of this article will generalize what I discovered at the conference.