Digital technology essential and subversive

Physician Executive, March-April, 2004 by Joe Flower

Raise your hand if you like health care just the way it is.

The vast majority of people involved in health care would like to see it change in fundamental ways. Many even would like to see it change radically.

The new digital technologies are, by their very nature, profoundly subversive. You can't just take a health care process and run it through a digitizer. You have to take it apart, down to its genes and RNA, and put it back together differently.

Along the way you will automatically ask yourself deep questions about the nature and purpose of the process: What's necessary and what's not? Who needs what--and what new thing we might be able to do that we had never before been able to contemplate.

These new technologies are the biggest levers that we have if we hope to re-make health care for the 21st century. Everything depends on just how we do use them--the details, the nitty-gritty of design, concept and flow.

As an industry, we are dreadfully slow. The bathtub manufacturing industry is 100 percent digitized. So is the cement distributing industry.

Major cities like New York control all traffic devices from centralized computers assisted by digital video, while the average hospital or doctor's office still uses paper records that would have seemed familiar to a doctor of Charles Dickens' time.

If we are to lever our quality upwards, we must make deep, rapid and wise investments in new technologies. The Institute of Medicine's 2001 report put this flatly: "... information technology must play a central role in the redesign of the health care system if a substantial improvement in quality is to be achieved over the coming decade."

We must make the same investments to lever our costs downwards. Digitization, standardization and automation shorten processes, eliminate steps and reduce human handling--and error checking built into the software greatly reduces medical errors. All of these lead to reduced costs.

There is little doubt that digitization, standardization and automation will make health care cheaper.

* They will also make it faster--images that used to take hours or days to retrieve are instantly available; surgical procedures that would take a surgeon three hours might take a robot 20 minutes.

* They will make health care smaller, shrinking many of its technologies to better fit the doctor's office, or even the home.

* They will make health care easier, moving many processes into the hands of less-skilled professionals, and even into the home.

* They will make health care simpler, eliminating many processes and steps altogether.

Digitization, standardization, and automation will make health care more efficient, a better value. They will make health care more secure. We worry endlessly about the security of digital records, when there is no reason that they cannot be made far more secure than paper records.

They will make health care safer. Since it digitized a decade ago, Brigham and Women's in Boston has seen its malpractice exposure drop by half. Since it digitized and automated one of its principal hospital pharmacies 18 months ago, Christus Health in Texas has seen its pharmaceutical mistakes drop to zero.

Digitization, standardization, and automation will make health care better designed, not only functionally but aesthetically--they will make health care prettier. They will allow better service and better access--making it possible to bring the benefits of health care to more people.

They have already begun to reshape health care physically. For example, Christus pulled back a $42 million in-patient rebuild at a principal hospital in Louisiana, specifically in response to new digital technologies.

In place of a traditional revamping of inpatient services, Christus shifted the funds to building four clinics at key areas around the city, with diagnostic services linked by broadband digital cable to the central hospital. It will supplement these clinics with roving vans that will bring similar services to workplaces, parishes, shopping centers and schools, linked to the hospital through microwave transmission.

Even mundane practices in the health care environment become something entirely different in a digitized and automated world. Robotic surgery has become health care's glamour poster. But the real future place of robotics in the hospital is in the kitchen, in the halls delivering messages and meals with robots, and in the pharmacy dispensing drugs.

Every facet of hospital life that can be automated, from security (software to identify anomalies in security camera images) to housekeeping (robot floor scrubbers and sanitizers) will be automated.

The use of digital information has already led to near-Biblical advances in clinical technologies. As we gain abilities that allow computers to address nerves, the range of possibilities staggers the imagination.

At a private Massachusetts company and at Duke University in North Carolina, researchers have connected brain implants in rhesus monkeys to computers that read the patterns of neurons that fire as the monkeys use joysticks to play simple video games.