New Technology in Healthcare – Allowing Doctors to be More Human, Maybe…

Once again, attending a recent conference, I’ve been struck by the exciting developments in healthcare related to electronic health records (EHRs), digitalization of clinical information, and the management of big data after learning how computers can now interpret x-rays and other imaging studies to provide a sophisticated analysis of their meaning in an individual patient. The basic concept is that each medical imaging test, say a CT scan, contains many more data elements than any human being, no matter how experienced, can interpret on his or her own. The computer is able to take much more of the actual information available into account as it prepares its interpretation.

But this more complete view of any one particular scan is just the tip of the iceberg. Below the surface, the digitalization of medicine is powering a much bigger transformation. As computer analysis at the individual level begins to happen with thousands of patients and scans, innovators are linking and analyzing the data to produce truly amazing results. Combining the individual scan results, the clinical follow up, and other patients’ data from EHRs with increasingly available “big data” analytic techniques, allows further refinement of the computer’s diagnostic readings. The results of any one scan can now be interpreted in the context of the patient’s other medical data and that of numerous other patients who have had scans for comparable indications.

This should allow much better use of the findings. The example that was presented was an application of this approach to interpreting CT scans for lung cancer screening in smokers. It was pretty clear to me that this will be a true breakthrough in care, and should result in fewer interventions for patients with likely benign findings and earlier intervention for those with probable malignancy. And that was just one example, albeit an exciting and “futuristic” one, of the advanced clinical decision support tools that are being enabled by the digitalization of healthcare.

It’s exciting, but also perhaps a little scary for doctors. What will radiologists be doing if images can be read, and be read with more depth and meaning, by a machine? What will primary care physicians be doing when the EHR can recommend the best workup and treatment for a particular patient with hypertension, not based on that doctor’s knowledge and experience but rather on the results from our nation-wide experience? Most physicians welcome more and better information in order to help their patients, but many also feel a sense of loss as less intellectualism is required for the practice of medicine. In the future “cookbook medicine” may often, in fact, be better medicine. It can be a sad fact for doctors.

When this topic came up in our discussion, one of the participants, a distinguished university professor said something that stopped me in my tracks – “Clinical decision support will allow the doctor to be more human.” Wow! Full stop! Let me think that over a bit, were my initial reactions. Hmm…Good point. Haven’t we have expected our doctors to be like computers, to be data and technology experts, to be technologists? Science, sub-specialization, and the information explosion have led to remarkable medical advances, but haven’t we also felt that medicine has at the same time become more impersonal? Aren’t we wishing for the old fashioned human connection in healthcare today? Marcus Welby, MD anyone?

I think the professor is right. These new technologies will let the doctor off the hook for knowing everything. The physician need no longer be the “human computer.” The machine can be the computer and the doctor can be the human – the human who can care more for and about the patient; the human who can be more wise than knowledgeable; the human who can minister to other humans’ spiritual and emotional needs in time of illness. To me, this is the most exciting part.

But nothing is guaranteed. His point was that clinical decision support will allow, or enable, the doctor be more human, not that it will automatically make doctors in general more human.   Remember when computers, advances in technology, and increasing productivity were expected to lead to a shorter workday and more leisure for all? Never happened. Not because it couldn’t, but we, as a society, didn’t make it happen. Capitalism, the free market and our collective overdrive expressed in materialism, consumerism, and status seeking keep us working harder and harder despite our plenty.

Will we let that happen in healthcare too? If computers take work from physicians, will we just use fewer doctors and work those we have harder? It’s not necessarily up to the doctor anymore. Healthcare is now big business and more consolidation is coming soon. Will the healthcare industry use this technology like other industries, to drive labor costs down and profit up? Or can we think through this issue in advance, before the big data waves fully hits healthcare, and design caring back into the system? We have the money; we have the time; we have the people. How do we figure out how to put people above profit and put more care back into healthcare?

I don’t have any exact answers, but I am sure that this idea of decision support technology allowing/enabling the doctor to be more human is a good one. I’m going to give it some further thought and advance it at my organization, in my own little segment of the healthcare industry. If enough of us do the same, who knows what could happen? If you’ve got suggestions, I’d like to hear them.