The Future of Healthare: 2020 and beyond

 

By Thomas Davis, DNAP, MAE, CRNA

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Crafty clairvoyants claiming 2020 vision, can’t wait for the New Year to arrive so they can capture the spotlight and publish their predictions.   However, history reveals that although forecasts from the know-it-all pundits may have sounded logical, many predictions completely missed the mark.  For example:

 

  • In 1876 Western Union Telegraph stated that the telephone had too many flaws and zero inherent value, LOL.
  • In 1954 radio host, Eddie Bond, advised Elvis to keep his day job, predicting the soon-to-be-heartthrob would never make it as a singer. And eight years later, Decca Records opted not to offer the Beatles a recording contract, publicly predicting that guitar music was on the way out and Beatle music would never sell.
  • 50 years ago, when Neil Armstrong took the first steps on the moon, prognosticators said that within 50 years we would have a colony on the moon and that shuttles would take vacationers back and forth. I enthusiastically bought into that concept but have yet to receive my boarding pass.
  • Again in 1954The National Cancer Institute stated that even if excessive smoking played a role in lung cancer, it was only a minor role.
  • In 1988, Dr. Thomas Neff proposed that the newest medical technology – pulse oximetry – would be considered as a basic vital sign along with blood pressure, pulse and respirations. The experts of the day predicted that within 5 years pulse oximetry would eliminate hypoxic brain injury yet, today hypoxic brain injury continues to be a cause of anesthesia related death.

 

Predicting the future is not a foolish pastime; visionary leaders keep a step ahead of the competition by looking over the horizon.  That said, the future is seen through the lens of today which distorts the view of the world that is yet to exist.   Prognosticators use current trends to create a logical foundation which guides the predictions of the world’s wizards, whom I am about to join.

 

In the spirit of full disclosure, I do not possess psychic abilities, nor have I won awards for my spot-on insight into the future.  Rather, I have spent the past several years working full time providing anesthesia, reading professional literature, publishing, speaking and observing trends in healthcare delivery.   Based on emerging technology and current trends, here is what I see when I read the Crystal Ball.

 

Artificial intelligence    Simply put, artificial intelligence (AI) is the use of computer systems to perform tasks normally performed by humans such as visual perception, speech recognition and decision-making.  Computers are being trained to read X-rays better than a radiologist and to read tissue slides better than a pathologist.  The Johns Hopkins has developed and deployed the TREWS system that utilizes AI to detect early signs of sepsis in ICU patients, and other organizations are developing complex AI programs that allow the computer to take a deep dive into medical records and identify trends that predict future healthcare needs for individual patients.   Writing for builtin.com, author Sam Daley gives 32 examples of current uses of AI in healthcare.   Tom’s Crystal Ball reveals an expansion of AI to include computerized a pre-op record review for each patient followed by a prescription for the ideal anesthetic to include choice of anesthetic technique and ventilator settings.

 

Robots    Machines that can replicate certain human functions are referred to as robots.  Factory assembly lines currently use robotic arms to accomplish tasks previously done by human appendage.  The push for automation is extending beyond the factory and managers are actively identifying human functions that can be replaced by machines.   Currently, a robot called TUG is being introduced into the hospital environment.  The TUG device uses programmed maps and complex lasers to navigate its way through the hospital, delivering food and supplies where needed.  Tom’s CB believes that within 5 years, self-directed delivery carts will be commonplace in hospitals.   Indeed, large organizations with multiple buildings covering a medical campus will employ driverless vehicles to transport patients from the parking area to their designated appointment.

 

Pharmacogenetics   The use of the patient’s individual genetic profile to predict their response to drug therapy is termed pharmacogenetics.   For example, anesthesia lore includes the belief that those with red hair require higher doses of anesthesia.  Pharmacogenetics has confirmed that notion and identified the actual genetic cause for the increased anesthetic requirement in red heads.  TCB shows an expansion of pharmacogenetics that includes obtaining cells via a cheek swab on all pre-op patients.  The cells will then be given to AI to determine the patient’s genetic profile and the appropriate prescription for anesthesia will be generated; based on the person’s DNA profile, specific drugs, doses and re-dose intervals will be recommended.

 

Disease targeted anesthesia care   The protocol for early recovery following bowel surgery and the trend for opioid sparing anesthesia technique has shattered the historic one size fits all approach to anesthesia care.  Tom’s Crystal Ball reveals an expansion of anesthesia techniques designed to address patients with specific risks.  For example, anesthesia techniques to reduce recurrence of cancer and protocols to reduce the risk of post-operative cognitive dysfunction are two areas currently being developed.  Over the next few years, additional medical conditions will be targeted for the development of disease specific anesthesia protocols and AI will be used to connect the dots and ensure that every patient receives the best possible combination of drugs.

 

There you have it.  My predictions may prove to be spot-on, or they may result in a disappointing mis-read of the tea leaves.  Robots and AI may join the moon colony in the junk pile of bad predictions, or they may usher in the future generation of healthcare.  But regardless, I think we can all safely predict that Beatle Mania is here to stay.

 

Tom is an experienced leader, author and requested speaker. 

The strategy that will fix healthcare

bundled paymentAs healthcare workers, CRNAs have an interest in the future of healthcare.  In an era where the healthcare industry is tasked with producing better patient outcomes at a lower cost, it is becoming more apparent that the status quo is not working.   In the October 2013 issue of the Harvard Business Review, Authors Michael Porter and Thomas Lee discuss changes that are intended to address the challenges of faced by our current healthcare system.   Below is a brief review of the major points.  Click here to review the original article.

Both healthcare consumers and payers are not happy with our current model for healthcare delivery.  They agree  that it is now time for a new strategy that maximizes value for patients.  The authors foresee the future of healthcare being organized around the patients’ medical condition rather than Physician medical specialties.   The future of healthcare will move away from supply driven healthcare based on what physicians do and move to a consumer driven system based on what patients need.  This change in has been termed the “value agenda”.    With this agenda, the overreaching goal for medical providers as well as all stakeholders must be improving value for the patients.  To do this, the healthcare system must either improve outcomes without increasing cost or it must lower cost without compromising outcomes.

This excellent article continues with a description of areas that need to be addressed in the move from the current state to the future state of healthcare.   The Authors identify 6 essential components:

  • Organize into integrated practice units:  This changes the way healthcare workers are organized to deliver care.   In this model, care teams are organized around the needs of the patient.  Dedicated teams of clinical and non-clinical workers come together to provide everything that is needed to treat a specific medical condition.  In this model, the patient could go to one location and receive medical care, therapy and other support by an integrated team who work together to ensure optimal outcome for the patient.
  • Measure outcomes and cost for every patient: Current quality metrics do not measure quality but rather processes.   In the future state, patient outcome and the cost to achieve it will measure the value received.  Rather than assessing how many treatments were given, providers will be measured by whether or not optimal results were achieved.   In this model, all providers must work together with the common goal of improving outcomes.   Physicians, nurses, therapists, and others must all work as a unified team focused on the patient.
  • Move to bundled payment for care cycles:  Fee for service rewards the volume of care delivered but not the outcome achieved.   Bundled payment encourages teamwork and high value care.   Wallmart recently introduced a program which identified centers of excellence for specific medical conditions.   A single bundled payment is made for all the care necessary and the provider team must work together to deliver an excellent outcome within parameter of the bundled payment.   In this system, teamwork and focus on patient outcome are essential.
  • Integrate care delivery systems:  As the healthcare system moves to bundled payments, care for specific conditions will be concentrated into fewer locations with healthcare teams who specialize in that condition.   Integrating healthcare delivery offers the patient a “one stop shopping” experience at a place known for excellence.  Having highly skilled professionals working as a team with a high volume of patients with a specific condition encourages excellence.  Patients may need to travel farther but will receive the best possible care.
  • Expand the geographic reach:  Once a team of healthcare providers has achieved a level of excellence treating a certain medical condition, the system must leverage their expertise by increasing the volume of patients they treat.  Rather than duplicating efforts at every clinic in the system, referring patients to a high excellence/high volume location will both improve outcome and reduce cost.
  • Build an enabling information technology platform:
    A supporting information technology system is required to support all of the elements described above.   The current model of silos of healthcare delivery has allowed technology to develop within each silo.   Moving to the future state of integrated care, one data platform that can be accessed by all members of the team is essential.

The healthcare system is changing.  Those who cling to the past will become dinosaurs.  Patient safety and satisfaction combined with improved value (improved outcomes) will be the hallmark of the future of healthcare delivery.   How will this play out for CRNAs?   Rather than your value being totally at the head of the OR table, expect to become part of a collaborative team focused on patient outcome.   As centers of excellence emerge, the variety of cases you do may become narrower as your team is called upon to do a higher volume of patients with similar conditions.   Expect to play a larger role in the overall peri-operative experience of the patient to include postoperative care.

In the era of healthcare reform and changing expectations of patients and payers, the only thing that is certain is that changes will be made.

Click here to read the original article