Technology has a definite role in health care, but it needs to be harnessed appropriately.— Chandrakanth Are, MBBS, MBA, FRCS, FACS
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The words “cost control,” “value-based health care,” and similar iterations are floating around freely these days to make us aware of the unsustainable upward trajectory of health-care costs. We are reminded constantly about how health care in America currently costs more than $3.4 trillion annually and accounts for nearly 15% to 20% of our gross domestic product.
Many an economist has posed questions about the paradox in health-care expenditures, as compared to other industries. We can purchase a better computer with more sophisticated specifications for the same or a lower price than a decade ago. Similarly, we can do more with our mobile phones than we could a decade ago, but we pay less for those additional features. Unlike these other industries, why is it that in health care, advancing technology does not lead to a drop in costs? The continually rising prices with newer technology in health care does not make economic sense.
Commodities of Transaction
It may be hard to explain this paradox on a strictly economic scale, but it is not difficult to understand why the paradox may exist. In most industries, the commodity of transaction is an inanimate unit that is created by man or man-made technology. There are costs (direct and indirect) that go into the production of this inanimate unit, which then dictate the final price or value of this unit when it is sold to a customer. Several revisions of the original product may lead to escalated sophistication but also simultaneously drop costs due to similarities in platforms and other built-in efficiencies. Similarly, economies of scale and scope can contribute to a drop in costs.
This is in stark contrast to health care, where the commodity of transaction is the “human life.” The costs of production of a human are hard to measure. If the costs of production are hard to measure, the final price or value of the finished product—a human life—is even more difficult to assess. Some consider it a travesty that we would even consider placing a price tag on a human life, accepting nothing less than a valuation of “priceless.”
Changes at Every Level
Nonetheless, attempts to control costs and improve health-care delivery for the same or lower price have led to changes at every level. At the macroeconomic level, we are witnessing mergers of hospitals and acquisitions of smaller hospitals and practice groups by major health-care systems. Mergers and acquisitions in the hospital industry shattered records in 2014. The volume of mergers and acquisitions increased from 637 in 2013 to 752 in 2014, representing an 18% increase that translated to an increase in the dollar value from $52.7 to $62 billion.
In our day-to-day practice, we have witnessed several changes also that are expected to control costs directly or indirectly through the delivery of better, high-value care with fewer adverse outcomes. Most of these changes are driven by the technology industry, which advertises multiple benefits from newer products. “Handheld health care” is based on the premise of every citizen owning a smartphone through which they can access health care of their choice—anywhere, anytime, and at a reduced price. Patients can be sent home with electronic trackers, which can monitor their blood pressure or blood sugar and conceivably lead to more timely and improved care.
Impact on Physicians
Such technologic changes are also being introduced into the workflow of physicians. The creation of the electronic health record is one example of the major new initiatives that have changed the way we deliver patient care. Telemedicine is also on the rise and can help deliver health care to locations that are inaccessible or have health-care shortages.
Several other changes are underway that will eventually transform the way we practice medicine. For example, one other area of focus has been on how to improve communication between physicians and other health-care workers. This assumes significance for several reasons, such as larger hospitals adding new layers of communication, increasing information originating from newer technology-based treatments, and a greater proportion of facilities adopting shift-work arrangements.
Secure electronic platforms are being sought to improve communication while maintaining the privacy of patients. Multiple application-based platforms are available to improve secure communication between physicians and other health-care providers. We can now just use a short-message service (SMS, or text) to communicate about our patients. All of these technologic advances will certainly help in improving some aspects of health care by incorporating efficiencies and potentially reducing errors.
The Human Touch
While all of these developments may eventually help to drive down costs and deliver better patient care, we should continue to remind ourselves of the differences between health care and other industries that have thrived on technologic advances: Our commodity of transaction is the human life, which most of us think is priceless. And we practice a profession that relies on physical touch. We are among the few professionals who touch our patients (called“customers” by some these days) at almost all of our interactions.
So while texting may transfer the objective information, it does not translate the subjective value of seeing the human suffering in person and touching the patient. Furthermore, a majority of e-mails are misinterpreted. Text messages, which tend to be more brief than e-mails, are more likely to be misinterpreted or taken out of context and not deliver on the accurate points of emphasis. So send a text when it is needed, appropriate, and not critical, but for everything else, go see or talk to the patient or your coworker.
As we continue to move forward with the inevitable technologic transformation of health care, we should ensure that technology, with its numerous benefits, serves as an electronic adjunct to the physical and humanistic delivery of health care. Technology has a definite role in health care, but it needs to be harnessed appropriately. We need to vigorously prevent the technologic aspects of health-care delivery from eroding into the humanistic elements and reducing the physical contact between physician and patient (or verbal communication between physicians) when needed.
Consider the Price Tag
While most of us consider human life to be priceless, several governmental agencies have actually assigned a numeric figure to its value: The Environmental Protection Agency determined the value of human life to be $9.7 million; the U.S. Food and Drug Administration and the Department of Transportation have assigned similar values, at $9.3 million and $9.4 million, respectively.
So the next time you decide to text critical information about a patient, consider the price tag. Few individuals would want to make a business decision worth almost $10 million through a simple text message, so why would we do that with a human life? Put another way, imagine how your patients would feel about critical determinations in their care being based on a few texts from the latest smartphone floating around on a wireless spectrum. ■