National Physicians Alliance

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The Analog Doctor

Posted by William Jordan, MD, MPH September 18, 2011 at 8:11 PM

Is health technology the next PhRMA?  I’m not talking about medical devices, like implantable debrillators, which are marketed to doctors and lobbied for in Washington along the same lines as medications.  Rather, there is a storm of health technology approaching that promises to make itself indispensable.

By way of explanation, I am attending the final hours of this year’s Medicine 2.0 conference at Stanford in California.  For you technophiles, it’s like a mini-TED conference for people in health care.  Lest you think I’m a Luddite, I’m presenting at the conference about a text message-based map of fruit and vegetable street vendors.  The conference is filled with an inspiring, optimistic entrepreneurial spirit reflective of nearby Silicon Valley.

What concerns me is the potential downside of focusing so many resources on technological innovation.  You might be surprised, unless you follow the Pew studies, that cell phone internet use (as opposed to home computer internet) is more common among minorities, so there is potential for using technology to address disparities.  However, other technology, included sophisticated daily monitors, may be reimbursed by private insurance but not available to Medicaid beneficiaries or the uninsured.

Much of the technology, including electronic medical records, is being developed in an unregulated Wild West where software from one company is not compatible with any other.  This means that once you choose a technology, you can be locked in for life.  If you want to change horses, you commit to starting from scratch at substantial cost.  For those of you who have an electronic medical record installed and are not happy with it, imagine how you would feel about scrapping it and starting over.

You can also be locked into maintenance contracts from the vendor, because no one else can repair or update the software.  This is similar to owning a car where only the manufacturer is capable of changing the oil.

Unfortunately, the technology is far out in front of regulation.  Not just in making sure that software programs talk to each other to insure inter-operability and competition.  But also in terms of privacy concerns, where some of these technologies may skirt HIPAA regulations and collect data that can be resold to marketing firms.

There are also equity concerns related to software development.  While it seems promising in terms of growing an important sector of the economy, the software programming can increasingly be outsourced.  So whereas we might have trained a health educator to work with patients on chronic disease management, we may now have a technology startup that hires a programmer outside the country, and automates much of the customized counseling via text message.  This may be more efficient, but may also hasten the hollowing out of the middle class, which contributes to health disparities.

Finally, what happens down the road when there are inevitable consolidations in the industry?  This may solve some issues with inter-operability, but it may also produce companies who lobby for huge tax breaks and carve-outs in health legislation.  It may also result in companies that focus more on marketing the latest minor update on an old technology (me-too technology) rather than investing in research and development of true innovations.

A brave new world awaits us.  For now, it is difficult to tell which emerging technology will be a curse and which a blessing.  Setting aside our love of innovation for its own sake, it is up to us to weigh the implications of new technology and push for the most cost-effective and high-quality services that we can provide to our patients.

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