Transforming the Delivery of Health Care
Kassirer, Jerome P., Consumers' Research Magazine
Despite the perils of predicting the future of our health care system, many people have weighed in on how they expect the delivery of care to evolve. Such predictions are usually based on the conspicuous trend toward industrial-size delivery networks involving large populations enrolled in managed-care plans, vertically integrated medical center conglomerates, and a few giant insurance companies.
In my view, several subtle trends will have a profound influence on the delivery of health care: the rapid growth of computer-based electronic communication, the fact that a new generation is increasingly comfortable with the electronic transfer of information, and the shift toward giving patients more responsibility for their health care decisions. These trends are likely to induce cultural changes in the delivery of care even more revolutionary than any restructuring that is going on today. On-line, computer-assisted communication between patients and medical data bases-and between patients and physicians - promises to replace a substantial amount of the care now delivered in person.
Trends suggesting that medical care will be delivered on-line are easily detected. Many people either own or have ready access to personal computers and use them now in their studies or business activities. Many already have access to the Internet-the immense collection of independent but cooperating computer networks that connects two to three million host computers.
The growth of the Internet has been extraordinary. The number of networks increased gradually from 2,000 in 1989-1990 to more than 20,000 in mid-1994. Currently, a new network is connected every 10 to 20 minutes. Estimates of the number of users on the Internet today are unreliable, though figures of 7 million to 30 million are often cited.
Until recently, it has been extremely difficult to search for information in the vast reaches of the Internet, but new software tools are making the computer files, bulletin boards, and newsletters more accessible and easier to find. These tools include free "client-server" programs such as Gopher and World Wide Web. Gopher permits users to move quickly from one part of the Internet to another through a menu system and to find and transfer files. World Wide Web, a multimedia hypertext system, provides linkages to related subjects.
Both programs are accessible through a variety of interfaces (such as MacWeb, Mosaic, Netscape, and Turbogopher) that permit the user to search for information by clicking on displayed topics with a mouse. In addition, many new search tools from companies such as America Online, Compuserve, and Prodigy are menu-driven, simple to use with minimal training, and relatively inexpensive.
New multimedia technology, such as "smart boxes" and "smart television sets," which combines the functions of the computer, telephone, fax, compact disc, and video promises to simplify electronic communication even more. In addition, the extension of fiberoptic and coaxial-cable communication all over the country - even in remote regions - will make telecommunication of all kinds, including "telemedicine," accessible to nearly everyone.
A critical factor in the medical use of the new technology is the trend toward patients' taking more responsibility for their own medical care. There is a growing emphasis on incorporating patients' preferences into medical decision-making. Already, patients are using interactive video discs to help them make medical decisions and home monitoring devices to measure their blood pressure and blood glucose, and to test themselves for pregnancy.
An anecdote might help illustrate this future on-line delivery system. The author of a popular book on computer-based communication tells the story of finding a blood-filled tick on the skin of his two-year-old daughter at 11 o'clock at night. While his wife called the pediatrician, he logged onto an electronic conferencing system based in San Francisco that involves people around the world. …