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By 2020 there will be 83 million millennials in our country becoming the largest generational group. As they take ever more powerful positions in our society their demands on the healthcare system will focus on virtual services. They grew up using the Internet, with its culture of immediate access, virtual relationships and convenience. Millennials expect their healthcare services to provide the same types of services as they regularly use on the Internet – Internet healthcare. For them the baseline is using technology as the platform for accessing, using and paying for services.
Harris Survey for Salesforce – 2015
The millennial generation want to use as their framework for health services all the Internet services they enjoy now: patient reviews, online appointments (including specialists), using mobile phones for services, use apps to manage their wellness, use wearables for monitoring health, 3D printing of devices ie hearing aids, teleservices like video chat with a doctor, and pills that monitor internal organs that are swallowed.
The present system is organized around a primary care physician (PCP) who is the gatekeeper and co-manager of the patient’s health program. All patient records are with the PCP and the healthcare provider, records are not accessible from anywhere in the ‘cloud’. The core guiding principle being that all medical services need to be integrated, not disconnected for increased efficiency, effectiveness and safety.
Artificial Intelligence adds another innovation level to delivery of health services. The AI industry is looking to serve the needs of millennials in healthcare by offering ‘neural network’ based medicine of expert databases and access to the ‘right treatments’ at the click of a button or the swipe of a phone app.
The implications for changing the present PCP, doctor oriented system toward an on-demand patient based system are revolutionary. One challenge will be how to maintain continuity of care when the patient is using virtual services from multiple providers, while ensuring effective care and safety. The human body is one complex entity made up of multiple systems, all integrated tightly to work together. If one system is off balance or damaged other systems maybe impacted, which is why the PCP based system was established. Doctors, not patients are trained to see the interactions of various human body systems, and to know when and how to bring in a specialist to treat a condition. Yet, how will placing tests, treatments and services at the touch of an app by a patient change the doctor – patient relationship? Will quality of care be maintained? Will high quality care only go to the technology savvy patient who knows how access all the health services to obtain a complete health solution? Are we going to be comfortable with AI – a physician advisor robot prescribing medications, treatments, surgery? In this virtual world of services who is responsible for maintaining continuity in care?
The virtual world of medicine does offer ways for reducing the cost of healthcare dramatically to thousands of patients. The U.S. spends 41 % more as a percentage of GDP than OECD countries while life expectancy is 4 years less. Yet how will the present system of layered providers, drug – pharmacy managers and hospitals respond to Internet based healthcare? Will they just use this myriad of disconnected services to charge even more because it will be difficult for the patient to manage costs the same way a health care provider does today. Do we want to place the patient in the center of healthcare delivery of services? The economic dislocation of every health care service provider will be profound and huge. How will we make sure that all our citizens are included and not just those with Internet access? So, what will our health sector plan be?
A few salient points need to be kept in mind in developing a sound policy. The patient does not have the expertise of a physician who has attended years of training, internship and practice before treating patients. Replacing the physicians role in the delivery of healthcare needs to be done carefully and in some cases certain conditions are off limits. Ensuring the safety of medicines, treatments and invasive procedures needs to be paramount in any system change. Patients need to be given options, for example the patient may not want a robo physician advisor and wants a human doctor of his or her choice.
The other major point is our political processes are way behind what technology innovators are creating today, dramatically impacting what our healthcare choices will be tomorrow. Our political processes need to be brought up to date, and forward looking if we are to have any chance at making intelligent decisions about our healthcare delivery system. We need to take this opportunity of a shift to Internet based health care to ensure that everyone receives good quality health care, at a reasonable price and will not go bankrupt in the process.