Providing Healthcare in America—Where, How and by Whom?

For HealthBlog readers who were unable to attend in Chicago, I thought I’d provide a recap of the presentation I gave in the Microsoft Theater. The title of my presentation was aligned to our mission statement, “improving health around the world through software innovation”.

The new administration and our challenging economy will force significant changes in American healthcare. Clearly, our present system with its spiraling costs and uneven quality isn’t sustainable. Unchecked, our healthcare expenditures will top 20 percent of GDP within the next few years. We already spend twice as much per capita on healthcare as most other developed nations creating a sink hole for American businesses that compete globally.

The american recovery will pump hundreds of billions of dollars into the economy. About $20 billion will go towards health IT. While there is no question that America needs to go digital in healthcare and lags behind many nations in our use of IT in health, the real savings will come from how IT helps transform where and how we deliver care, and perhaps also by whom.

First of all, contemporary IT solutions will help move more care out of hospitals and clinics and into other settings including the home. Even though I am a primary care physician, I’ve been a proponent of the retail clinic movement in America. Delivering care that is both convenient and at a price point people can afford is a much needed solution. Retail clinics, especially when they are managed or affiliated with community providers, are a terrific alternative for people needing quick, competent care for minor health issues. I am also a big fan of home health and I hope the new administration will resist and temptation to cut reimbursements for home health services. IT solutions will enable increased connectivity between home health nurses, community physicians, clinics and hospitals making it possible to monitor patients in their homes and provide needed information and support between in home visits. Finally, I see a promising future for high-tech, healthcare kiosks located in the workplace, pharmacies, airports, hotels, and other settings where people gather. The airlines have trained just about everyone how to use a kiosk, and I expect a lot of health information and medical services will be delivered by kiosks in the future.

Information technology is also creating new possibilities for how we deliver care. The Internet and a wide range of commodity-based communication and collaboration tools are opening new avenues for healthcare delivery. If the government and other payers will create the appropriate incentives and start paying clinicians for cognitive services provided by messaging, telephone, e-mail, web video visits, etc., we can significantly reduce the number of people who pack our clinics and emergency rooms seeking advice or reassurance for minor health issues. This is already happening in the state of Hawaii where one of the largest eHealth pilots, sponsored by is now up and running utilizing services from and microsoft healthy vault. How we deliver care will also change as the filed of genomics expands and our need for care becomes more predictive and preventive. Here again, trials are already underway at the Scripps Research Institute where on-line access to genetic testing through and personal health data acquisition and storage on Microsoft HealthVault are testing the waters for this new era in healthcare.

Finally, information technology also provides some interesting possibilities related to who delivers care in America. Although this is likely to be one of my most controversial thoughts, it is clear to me that our present system for delivering care doesn’t scale. I would urge medical educators, licensing boards, and policy makers to think deeply on how we can streamline our training programs to pump more caregivers into the workforce. A system that is dependent on people needing 8 to 12 years of post graduate education not only doesn’t scale, but excludes far too many people from having the opportunity to participate. I believe contemporary information technology, powerful software, artificial intelligence and a globally connected society will enable new categories of healthcare workers. These workers will be able to diagnose and treat patients and even do procedures having had less, but much more focused training, than workers today because they will be aided by intelligent software, sensors, and devices.

Software innovation only sets the stage for all of this to happen. We must remain focused on the outcomes we hope to achieve. However, I firmly believe that information technology will enable new opportunities to transform healthcare including where and how services are delivered, and perhaps even by whom.

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