Channeling Churchill to deal with innovation, impatience and chaos in healthcare

This post was originally published on this site

By Nick van Terheyden MD

This guest post is part of the Festschrift of the Blogosphere celebrating HealthBlawg’s Tenth Blogiversary. Festschrift posts are appearing throughout the month of June 2016.

To say that healthcare is changing is to understate the situation dramatically. The combination of new technology and a demand by payers and consumers for more value for their money has created an environment rich in both innovation and impatience. You may think you are moving swiftly, but no matter how quickly your organization is adapting, both payers and consumers are tapping their collective feet and wondering why it’s taking you so long to get with the program.

Consumers now expect digital access to everything 24x7x365. The online world has taught us that this is not only possible, but even routine – everywhere but healthcare. So their impatience with our slowness is understandable. They can search at 3 a.m. for answers to health questions that we as healthcare providers haven’t given them. Given that many of the answers they find on the internet may be dangerously wrong, it’s time we did a better job answering their questions, even at 3 a.m.

Payers, too, are impatient for change. They want value-based contracting and want to reward results, not volume of procedures done.

Technology is behind much of this, because appropriate use of technology can speed up the process of everything we do. Beyond speed of connection, though, technology will change, at a very basic level, the way we deliver healthcare.

In speaking of a fundamental change in healthcare, I’m thinking particularly of analytics and the progress toward what I call “augmented intelligence.” While artificial intelligence has a long road to travel to match the thinking abilities of the human brain, technology can now augment our capabilities. Technology can take over the tedious task of searching for data and looking for patterns, giving us an invaluable assistant. No human is capable of reviewing clinical data and images from thousands, even millions, of patients to find the knowledge hidden in those terabytes. But a computer with the right software can do it quickly and efficiently, giving caregivers access to new knowledge.

Finding the zebras among the horses

Computers can also profoundly improve decision support systems, broadening the thinking of physicians. If you ever read the New York Times column, Think Like a Physician, you will understand just how useful this could be. In that column, the author presents a diagnostic challenge that has stumped many physicians before being resolved. Often, it takes months and many different physicians before an accurate diagnosis is made.

In training, we learn that when you hear hoof beats, think horses, not zebras. In other words, think of the common things first. But now and again, those hoof beats turn out to be zebras, and we often miss the subtle differences that tell us that zebras are lurking over the horizon, not horses. We keep looking for horses while the zebras roam freely around our feet. Conversely, we may think we see a zebra when it’s just a pony with odd coloring. This happens in part because we are searching in the dark, and it’s hard to tell a horse from a zebra with the lights off. An augmented intelligence system could help sort through a patient’s complex set of symptoms and clinical findings to offer up a broader range of ranked possibilities and recommendations for testing that could pinpoint the diagnosis. It could flip the light switch and make it easier for us to see whether it’s a herd of zebras or a herd of horses making all that noise.

A new kind of medical progress: R2D2 (or possibly C3PO) will see you now

Vinod Khosla, co-founder of Sun Microsystems, has said, “In the next 10 years, data science and software will do more for medicine than all of the biological sciences together.” He has also noted, “By 2025, 80 percent of the functions doctors do will be done much better and much more cheaply by machines and machine learned algorithms.”

But, even if he is right, that doesn’t mean that doctors won’t be needed. On the contrary, it will allow physicians to bypass the really boring part of their jobs and do that 20 percent of functions that require a thinking, feeling human being to accomplish. It will also extend our resources dramatically, which is important, because the US Department to Health and Human Services predicts that by 2020 we will need 20,400 more physicians, just in the U.S., than will be available.

And it’s not just the supply of doctors that will see a shortfall. Globally, the World Health Organization says that 15% of the need for doctors and nurses isn’t being met. Moreover, in Africa, that shortfall is dramatically worse. The continent has about 24% of the world’s disease burden but has only 2% of the global health resources. The unequal distribution of medical expertise is a serious problem that technology can help solve, with telehealth solutions and cheap, portable diagnostic testing solutions.

And it’s not just the role of physicians that will change

Profound as the changes are that will be coming to medical professionals, healthcare executives are facing an even more profound change in the way they will perform their work. The move from fee-for-service and opaque claims and billings systems toward value-based care and transparent pricing is happening rapidly, and it will require a complete overhaul of the thinking and strategizing of most healthcare executive teams.

Everything you thought you knew about how to make your organization financially successful will change. Profit centers like radiology and diagnostic imaging will become cost centers; the more high-end expensive care you give, which once supported all the more mundane services you provide, the lower your profits will be. Instead of filling beds, your job will be to keep them empty.

It’s a big challenge, but the same kind of augmented intelligence systems that will help physicians keep patients healthy can help you keep your organization healthy. Analytics can help you identify and stratify risk, so that you can contract with payers at rates that won’t kill your bottom line. And it can help you identify gaps in care that could lead to the need for expensive treatments and procedures.

Technology can also help you keep patients healthy. Telehealth and remote monitoring are making significant improvements in chronic disease outcomes.

To face the challenge, be like Churchill

The cultural change required by all this progress will likely create anxiety and chaos within your organization. But it doesn’t have to do so. If the CEO and executive teams stay calm and focused, the people they lead will be less anxious and more able to think creatively.

Remember London in 1940? Bombs were falling nightly from Nazi warplanes, and the city was literally on fire. Hitler believed that by bombing population centers, he could sow panic among the people and make invasion possible. But the people of London didn’t panic. Their leader, Winston Churchill, personified the advice to “Keep calm and carry on.” That firm hand at the wheel of the nation gave the people of London and of the entire country a model to follow. Rather than chaos, the Nazi attacks created incredible resourcefulness that resulted in remarkable innovation that helped win the war.

So when the task of facing the upheaval in healthcare seems too much, channel the spirit of Churchill and keep calm and carry on.

You also might want to get your physician to prescribe for you what Otto C. Pickhardt, MD, prescribed for Churchill in 1932, when he was recovering from being hit by a car on Fifth Avenue in New York: “alcoholic spirits especially at meal times. The quantity is naturally indefinite but the minimum requirements would be 250 cubic centimeters.” For my non-scientific American readers, that’s about 8.4 ounces or about 10 shots!

I’d moderate that dose a bit, but I’d go with Churchill’s choice of medicine, whiskey. Sometimes chaos and challenge require you to sit back, take a deep breath and get some perspective. I find that a good single malt Scottish whiskey gives me a broader view of the world and my place in it. And I find that my thinking can become quite innovative after a couple of ounces.

Nick van Terheyden MD (Dr. Nick) is Chief Medical Officer for Dell’s Healthcare & Life Sciences Services business where he is responsible for providing strategic insight to help Dell advance its support of healthcare organizations, medical professionals and patients through information-enabled healthcare.

You should follow me on Twitter: @healthblawg

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