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Calling Dr. Algorithm

Richard Adler | Oct. 15, 2014
Technology is poised to make big changes in the delivery of healthcare.

In fact, telemedicine is starting to go mainstream. A company called Specialists on Call (SOC) is using high-quality teleconferencing systems to enable smaller hospitals to have on-demand access to specialists such as cardiologists and neurologists. The service is obviously good for patients with an urgent need for specialized care. It also is beneficial for specialists, who can fully utilize their skills by seeing more patients via the service than they could if they were based at a smaller hospital with a limited number of patients.

As telemedicine becomes mainstream, there are still some regulatory and policy barriers that inhibit the advancement of solutions for patients. Two key barriers are interstate licensure for doctors and reimbursement restrictions.

First, in order to provide telemedicine services across state lines, healthcare providers are required to obtain multiple state licenses and adhere to multiple state rules. Patients are restricted from receiving remote medical services from physicians if they are unlicensed in the patient's own state, even if they are licensed in other states. While intended to protect patients, these laws are now limiting the advancement of telemedicine. (In the case of SOC, the company works with participating physicians to get them licensed in multiple states, which adds to the company's costs.)

Second, under today's Medicare regulations, less than 1% of healthcare providers receive reimbursement for telemedicine services. Medicare rules currently limit reimbursement for telemedicine services to rural areas and do not provide adequate incentives for providers to embrace these technologies.

Making healthcare more intelligent. Our knowledge of the mechanisms of health and disease is growing very rapidly thanks to expanding research efforts globally. Insights from fields like genomics and proteomics (understanding the mechanisms of disease at the molecular level) are opening exciting new vistas for the development of highly personalized medical treatments.

But this growth in scientific knowledge is creating a problem for care providers. The total amount of information that can be used to inform medical decisions is doubling every five years, while the capacity of human beings to process this information is not increasing. What this means is that all relevant information is not taken into account in clinical settings by most practitioners most of the time. The result is that the quality of care that is actually being provided is highly variable and often less than ideal: According to Bob Brook, distinguished chair for healthcare services at the RAND Corporation, half of what patients really need in the way of treatment they don't receive, and 20% of the care they do get they don't actually need.

Can digital technology make healthcare smarter? The evidence to date is encouraging. A number of interesting experiments are under way, but perhaps the best-known "face" (if that's the right word) of intelligent medical technology is IBM's cognitive computing system, Watson. After winning at Jeopardy! in 2011, Watson has been put to work on more serious challenges, including healthcare.


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