The author of the New York Times op-ed "Our High-Tech Health Care Future," Nov. 9, 2011, is an entrepreneur from MIT and describes the role of a "digital nervous system." The author describes:
... inconspicuous wireless sensors that are worn on a patient's body and placed in their home that would continuously monitor vital signs and track the daily activities that affect health, counting the number of steps someone takes and the quantity and quality of food they eat. Wristbands would measure levels of arousal, attention and anxiety. Bandages would monitor cuts for infection. The bathroom mirror would calculate heart rate, blood pressure and oxygen level.
This notion is ingenious and truly would be a "brave new world" and an incredible change for the delivery and receipt of medical care. This technology would be a great resource for doctors, especially if the technology automatically alerted the health care professional when something was "not right," similar to the way a security monitoring system operates.
In the referenced article, the author writes:
Then you'd get automated advice; software that could analyze and visually enable you to truly understand the impact of your behavior on your health and suggest changes to help prevent illness -- by far the most effective way to cut health care costs. Many situations would still call for professional medical attention, of course, but in most cases you wouldn't need to make a costly trip to the doctor's office." After consulting a diagnostic supercomputer, the avatar would ask you to run a few quick medical tests at home.
This data could be used to improve the quality of patient care and keep everyone, patients and health care providers, current on an individual's health and progress as well as create an enormous depository of data for research into "what makes us sick and what keeps us healthy." A system like this could be used to identify early diagnosis of diseases and conditions which could help reduce long term health care costs.
Adapting to this kind of enhanced technology to improve overall health care and reduce costs has other concerns. Such technology might also be seen or used as an invasion of privacy. Would sensors go off during a heated family disagreement or while watching an exciting football game? Would intimate information be available to insurance companies? Avatars, diagnostic supercomputers and automated services are incredible propositions for a future delivery system of health care. However, do they effectively replace a trained health care provider? Each patient is unique and responds to medications and instructions individually; there is not usually one computerized positive or negative response. Trained health care providers have the ability to evaluate patient responses in more ways than just what is "said" or a "yes or no" response, subtleties that could be lost by a computer or an avatar. Human interaction is often needed as we have all experienced when calling a credit card company or bank with a question that requires a request for "representative." Even if it is just to vent frustration, some things in life require human contact and interaction.
While the referenced article is proposing technology not yet readily available, a "computer chat" with your PA, NP, MD, DO, etc., is available today. It would be easy when you feel sick for a "computer chat" to help diagnose your symptoms, followed by a prescription or a note via email to stay out of school or work for a day or a week.
The benefits of a doctor video chat over an office visit are obvious -- cheaper, faster, more efficient, saves gas and time, is available 24/7/365 and could be designated for medical specialty and language-specific. But what if it is not a computer chat with a live health care professional but instead, as proposed in the article, a computer chat with a computer, a doctor visit with "Dr. Watson"? What might be the result of "Dr. Watson" deciding your diagnosis, initiating treatment, forwarding the prescription via direct computer link to your pharmacy, coding ICD-10 and submitting the bill to insurance? Will "Dr. Watson" perform periodic self-analysis of diagnostic accuracy, initiate treatment decisions and follow overall patient outcome? What if "Dr. Watson" is wrong? How long must patients suffer or do conditions have to deteriorate before human interaction is deemed required and authorized for reimbursement? Do patients receive human interaction if they ask for "representative"?
Will "Dr. Watson" be able to provide for the patient everything but human contact? I cannot help but be reminded of the psychology experiment with the newborn monkey who failed to thrive because of lack of physical contact. Will the patient, craving human interaction and touch, become depressed and fail to thrive, (ICD-10 code R 4582 "worries" or R467 -- "verbosity and circumstantial detail obscuring reason for contact")? Mortality as an outcome, while unfortunate, does provide a cost benefit and if not carefully monitored could be seen as a means to help control the escalating health care costs.
While the power of technology will and should continue to evolve and drive health care forward, technology like avatars, diagnostic supercomputers and automated service must not be considered a replacement for human interaction. Trained health care providers have the ability, unlike technology, to "feel" what the patient may not have the ability or knowledge to say or recognize as significant signs and symptoms that should be noted and questioned. This is the basis of the doctor/patient relationship and is something that we should not take for granted and should fight to preserve.
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