Atlantic Health Forum: Care, Gone Digital
The Atlantic's seventh annual Health Forum brought together a variety of industry experts to examine critical new developments in health care today. The panel discussion "Care, Gone Digital" focused on technology as it applies to health care. Thanks, in part, to innovations in health care technology, such as electronic health records and increased data tracking by individuals through the quantified self movement, health care delivery is shifting in new and significant ways — with both positive and negative implications for patients and physicians.
"In our increasingly connected world, we are digitizing and centralizing medical records," said Margaret Low Smith, president of AtlanticLIVE. "We are changing the way we make doctor appointments, and companies like ZocDoc and Surescripts are trying to change how doctors and patients engage with one another. The question is: How is it going?"
Shannon Brownlee is a leader and innovator in the field of overtreatment and is the author of the book Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer. She serves on the boards of Families USA and the Robert Graham Center of the American Academy of Family Physicians. She is an editor of the "Less is More" section of JAMA Internal Medicine and an instructor at Dartmouth Institute for Health Policy and Clinical Practice.
Oliver Kharraz, MD, is president and founder of ZocDoc, an online service to help patients find doctors, access verified reviews and set appointments. Dr. Kharraz has a background in global management and using information technology to make health care organizations more efficient. Originally from Germany, Dr. Kharraz received his Doctorate of Neuroscience from Ludwig Maximilian University in Munich and has a master's in philosophy from the Jesuit College of Philosophy in Munich.
David Yakimischak, who prefers to go by "Yak," is senior vice president and chief quality officer of Surescripts, the nation's premier electronic prescribing network. Yakimischak is the former chief technology officer for JSTOR and WebMD Medscape. In addition, he serves on the editorial advisory board of InfoWorld magazine. Hailing from Canada, Yakimischak has an undergraduate degree in computer science from the University of Toronto.
The panel, moderated by Steve Clemons, Washington editor-at-large for The Atlantic, focused on what technology is doing for health — both negative and positive. The discussion began by exploring the effect technology has on primary care. Brownlee emphasized the importance of the human dimension in medicine, stating, "People who are sick need more than technology. People who are sick need to be healed. Healing is partly spiritual. It has a lot to do with that human connection, and if we destroy that, we destroy one of the deeply, fundamentally important pieces of what medicine is about."
In discussing the limitations of technology in the application of medicine, Yakimischak prefaced his contribution with cautions that technology can't magically fix systematic problems within health care. Technology can streamline mundane routines such as writing and delivering prescriptions, entering information into records and searching patient histories for potential adverse interactions. Although these innovations make medical care more efficient and help prevent mistakes, they are not a silver bullet, according to Yakimischak. "We can't just lay technology over a system that isn't fixed yet and expect it to work," he explained.
The panelists agreed that access to primary care is a major ongoing problem. While alternatives to the doctor’s office, including clinics such as CVS MinuteClinic, increase access by offering extended hours and care to patients with minor medical problems, they can lead to deleterious economic consequences for primary care physicians. Brownlee explained that providers like MinuteClinic "skim off the healthiest patients — the ones that are fast and easy for primary care providers — and [leave] physicians with chronic disease patients." Having a population of "generally healthy" patients is necessary to keep a physician's practice financially viable.
In discussing what technology can do to improve health care, Dr. Kharraz stressed the importance of changing "the single most important factor in the health care system: patient behavior." Data represents an opportunity to decipher what motivates people, as distinct individuals, to change their behavior. There is great potential for data and technology to work together to help "nudge people to do the right thing."
- Technology has a great potential to enable better health care, but it must augment, not replace, human interaction.
- Technology is best used to facilitate what panelist Yakimischak called larger "fixes" to the "broken" health care system.
- Technology should be designed to enhance participation by patients, health care providers and the larger community.
With all the buzz, excitement and investment surrounding health technology, this panel discussion offered a welcome chance to stop, take a breath and look critically at the limitations of health technology without disparaging its capability to transform aspects of health care. While this panel pointed out several key problems with the current application of technology to health care, the future is bright for the partnership between health care and technology to join forces and strengthen the health care system.