Tech is helping drive some exciting changes in healthcare, though so far they don’t galvanize the public’s attention like driverless cars or virtual reality headsets. But as the industry increasingly embraces digital tools and strategies, every American patient may start to notice a holy grail that seems to be on the horizon: a patient-centric model that will streamline the system and upend the way medical professionals operate.
One company aggressively driving toward that vision is Boston-based athenahealth, which may avoid capitalization but often gets highlighted anyway for its CEO Jonathan Bush’s connection to the recent president and the erstwhile presidential candidate, who are his first cousins.
The heat is on to transform American medicine, both for financial reasons and because the country wants it. It’s just no longer acceptable that the U.S. pays more than any other country for healthcare while its citizens are by some measures considerably less healthy than those of many other countries. A recent Ernst & Young report, Helping Patients and Providers Make the Connections, reports “Life sciences companies are under increasing pressure to do more with less—and are correct to examine digital technologies as a way to transform the entire enterprise. This includes how they improve operations, develop more effective communications, streamline research and development, and lower costs.”
Consultants at Deloitte did their own report, entitled The convergence of health care trends: Innovation strategies for emerging opportunities. It notes that “Traditional players such as health plans and employers, as well as engaged consumers, are demanding more—quality, evidence, and transparency—for fewer dollars. Historical payment models are being upended.”
Big data, cloud computing, analytics, Internet of Things tools that let consumers “quantify” their own health, and other technologies are all part of this changing landscape, but their significance varies depending on where one stands in the industry. “If you’re a patient,” says Todd Skrinar, a partner in the Life Sciences Advisory Practice at Ernst & Young, “it’s a means of greater control of your health, and with that more control over costs. You want more control because your wallet is involved. Being able to digitize your health information allows you to have more meaningful conversations with providers. You’re trying to use data to decide where to funnel money and generate a positive outcome.”
“For most other players in the ecosystem—providers, companies that create and develop medicines—power is decreasing,” says Skrinar. “Today, a lot of the most common healthcare touchpoints are digital. Providers are struggling to be good at that—it isn’t in their DNA.”
In the opinion of athenahealth co-founder and chief executive Jonathan Bush, attaining positive outcomes is getting easier because the healthcare industry is entering the third phase of a revolution that’s taken decades to play out. It “lumbered” through the first phase, he says, when the genome was sequenced and the first electronic health records were created.
Athenahealth has for some time been part of the second, cloud-based wave of change for healthcare institutions. “We tell customers, we’ll take all your information and put it on a common network, on a common platform. You don’t buy the servers, you don’t buy the software, you don’t set it up. And frankly, you don’t do a lot of the work you used to, because you weren’t doing it well in the first place. We’ll handle the insurance stuff, and government reporting of meaningful use. Basically the white noise. And we’ll let you handle the doctoring stuff.”
This phase has been scaling up for more than 15 years, and it’s still only about 10% of the way there, says Bush. The third phase will be about reducing inefficiency, shrinking the physical plant, and freeing doctors of many of the constraints they face in the current healthcare system—all while improving patient outcomes.
Take radiology. Says Bush: “Let’s say you’re a mammography expert. When you’re on duty in the hospital, you’re also looking at brains, or broken bones from the ER. Even if you’re smart, you read all the journals, that’s a ridiculous way to stay on top of your field. You should be sitting somewhere in your favorite place, maybe Aspen, looking at breasts all day long. Maybe even just right breasts. And when you’re not available, somebody else who does that should be ready to step in.” (This parenthetical remark will serve to note our amusement at Bush’s example.)
And seriously, Bush’s scenario, more or less, is already becoming reality.
A case in point, he says, is Candescent Health, which offers an image-management system for radiologists accessed through a cloud-based network. The company, which serves as a sort of air-traffic controller for radiologists, monitors the quality and turnaround time of the reading of images using a consistent nationwide methodology. If a client is too busy or needs an expert opinion of an image, Candescent can route the request to the appropriate source in its network. It takes a cut, just like Uber, for doing so. A radiologist who isn’t busy eliminates a white space in his calendar and one who needs help can rely on a solid result.
For Bush, this is part of a crucial trend in healthcare: the movement from geography-based to problem- and diagnosis-based care. “We’re going to be able to keep learning and getting better. We’ll start to cure things, because there will be continued space for doctors to subspecialize and thrive doing the work they want to do.”
Before we get there, posits Bush, we will need to see a dramatic change in the physical infrastructure of American healthcare. “There are currently about 4,700 hospitals in the U.S.,” he says. “We need in the neighborhood or 2,000, maybe 3,000. Hospitals can be consolidated. There is zero ability to have every different specialty in any given hospital. But with digital health, that’s no longer an issue. Instead, we’ll commoditize much of it. If we do it right, we should be able to treat patients more globally.”
Taking the idea to its limit, the doctor of tomorrow could essentially be a digital health company, untethered to a specific locale. A practitioner who needs a bed, a room, a scope, or even an orderly to clean up will get them from third party companies such as Cohealo, which helps hospitals manage their supplies by moving them where they’re needed most. The sharing economy is coming to healthcare.
This shift is being spurred by consumers, many of whom are paying far more attention to healthcare issues in the age of the Affordable Care Act, because more of their own money is on the line. “Doctors are rarely the driving force behind major shifts in technology in the provider market,” says Quinn Solomon, a principal at Deloitte Consulting. “They’ve long enjoyed a doctor-centric system in which the experience of the patient is often sacrificed. Consumers accustomed to the fluent experience that technology brings to other areas of their lives are starting to expect the same from medicine.” But Bush thinks doctors are starting to embrace new technologies—and pushing the hospitals they work with to get with the program.
“Doctors today face two important issues,” says Ernst & Young’s Skrinar. “They’re working in a more constrained cost environment, doing more with less. And they’re being forced to change the way they deliver services because of that. Digital technology will enable more mobility of the healthcare practitioner, and health records will be more readily available.”
Among the beneficiaries will be people in remote areas, especially the elderly, for whom care will increasingly be delivered from afar, says Skrinar. Digital health will also lead to the creation of strategically placed healthcare clinics, serving as medical hubs.
The key to making this all work is interoperability, the ability of health information technology (HIT) systems to share patient information with each other, even if they’re dealing with multiple institutions that normally wouldn’t do so. Interoperability is part of what athenahealth is trying to facilitate. “For the last eight years we’ve been trying to get hospitals to connect to our clients, our medical groups,” says Bush, “so that the doctor can survey and see and track patients wherever they go.” But many healthcare systems don’t want to share information because it makes it easier for patients to seek care outside their walls, creating a potential loss of revenue. They’re not anxious to break down the silos.
The federal government, via the rules of Obamacare and other means, is pushing for interoperability, though with a somewhat hands-off approach, says Deloitte’s Solomon. “They don’t want to regulate everything, but they do have tools at their disposal to make people do things. If providers get the message from the government that they need to focus on this, they will, even without a law being passed.”
However, he adds, “We’re very far away from a time when consumers own their healthcare records.”
For Bush, the patient outcome is greatly improved when information is shared—when it is liquid—allowing the individual to be at the center of the process and decide where they want to be treated. What Bush calls the “shopping doctor” would have the ability to access patient information at the point of care, and follow patients wherever they go. In such a future it won’t matter who employs a physician or where care is delivered. Doctors would be free to become their own companies and access the information and tools they need through HIT systems. It would be a new business model for doctors.
“When doctors start to understand this, they’ll get demanding,” opines Bush. “And as they get demanding, hospitals and specialists will “product manage”—embrace new technology—in order to keep and gain the business.”
Doctors will ask more of hospitals, and patients will expect more from doctors—to the benefit of all. “Many medical practitioners are demanding that hospitals connect to athenahealth so that their patients can be tracked and monitored,” says Bush. “Some hospitals resist this, but doctors are telling them they won’t send patients to systems that don’t connect. It becomes a kind of diplomatic engagement in which we’re the ambassador, bringing different parties together. And I think that’s sensational.”