What does the future hold for healthcare? To find out, we spoke with E-futurist Douglas Goldstein. Set aside your visions of crystal balls and tarot cards; he's not that kind of futurist.
What is E-futurism?
Simply put, E-futurism is the application of electronic and emerging technologies today and tomorrow, and the impact and implications of these on our healthcare system and personal wellness.
How do you approach the healthcare world as an E-futurist?
I always try to be on the practical side of change. I try to focus on the next one to fi ve years. I see what is in the pipeline or very close in terms of research and development, and then translate the changes in technology in a way that helps people solve their problems. For example, imagine I want to cut down a tree. In planning to do this, I have to decide what tool I will use:
If I wasn’t aware that chainsaws existed, then I would not naturally choose the best solution or method for chopping down that tree. If people are not aware of technology coming down the pipe, then they may end up using a less effi cient tool, they won’t innovate properly, and they will use outdated technologies to solve their problems. By painting a picture of the future one to fi ve years out, I believe you get useful information about how to solve the problems you’re facing today.
What is your take on the future of electronic medical records?
Ultimately, it will be part of patients’ lives to manage their own health records, meaning it will be our responsibility to pull information out of the medical records currently kept by multiple healthcare or support partners. We will all be managing our health records similar to how we manage our bank accounts and fi nancial records.
What steps still need to be taken before we have these patientcentric health records?
There are many barriers, but the biggest one is that it’s just not the status quo. We’re used to managing our bank accounts, but we’re not used to managing our health records, because it hasn’t been a part of the way we live, and the information just hasn’t been accessible to us. Based on the health-seeking behavior of people on the Internet, it is easy to envision people demanding electronic access to their own medical records currently being held by doctors and hospitals. The biggest concerns right now are privacy and security, but if online banking can be made secure, so can electronic health and medical records.
What would be the ideal way for patients to store their own medical records?
Th at will come down to personal preference. Where is the ideal place to store your music? On your computer? On CDs? Your MP3 player? There won’t be just one ideal place. The issue is that users must have their medical information at the point of need. You may carry a version on your mobile Internet device—whether that is your iPhone, your smartphone, or whatever new product electronics manufacturers want you to buy next—and you may keep a copy of it on your computer. For example, Bank of America has copies of my fi nancial information, but whenever I want parts of it, I can download it and keep a copy of it on my computer.
The accessibility of relevant medical information appears to be of great importance to you.
Absolutely. Unfortunately, the healthcare industry is a knowledge industry that doesn’t understand the value of knowledge management. The amount of medical knowledge doubles about every two years, yet 50% of the patients being diagnosed at the point of care, according to studies, are not getting access to the most current medical information. The doctors and the health system are not delivering the most current medical knowledge because of the fragmentation of their health IT systems. It’s just an immature state of the art in which people are still developing the needed applications and delivery systems.
What do you think the ideal healthcare system looks like?
In terms of the ultimate goal, I think it’s about predictive modeling; people want things before they need it. What people ultimately desire is pre-emptive healthcare—to know if they are predisposed to prostate cancer or breast cancer based on genetic genotype. The aim of healthcare is to be able to predict who is going to end up with what kind of disease, because it’s called healthcare, not disease care. Right now, healthcare delivers mostly disease care, but there is a significant wellness movement growing throughout the country to move to a more proactive model. We just haven’t figured out a good payment model or incentive approach to create the ideal system in which access to healthcare is a right, every person has an electronic health record, and technology exists to support an early disease warning system.
How many years away is pre-emptive healthcare?
One of my favorite science fiction writers, William Gibson, who in 1984 coined the term cyberspace, said “The future has already arrived, it’s just not evenly distributed.” You can find pockets of predictive modeling being used by health plans, healthcare providers, and pharmaceutical companies. They may be small, but those small pockets grow. The future is here somewhere, just not widespread or widely diff used.
What does it take for these ideas to become more widespread?
Innovation. I think many people feel intimidated by innovation; they think, “Oh you know, I’m not Thomas Edison, I can’t invent the next light bulb.” The reality is that Thomas Edison did not invent the light bulb; he bought the patent for it. Thomas Edison made it practical and commercial. We need what Th omas Edison did with the light bulb. It has to happen in everyday life. I call it “distinctive innovation.” Quite simply, it’s solving problems in a thoughtful way. You have to take a quality improvement methodology, like Six-Sigma, add a little ingenuity and the appropriate technology, and apply those to solving the problems that we face—like the epidemic of medical errors or our primary research challenges on a disease. Unfortunately, people don’t think of themselves as innovators. Life is about change. Change happens through innovation. I think physicians are the best and the brightest. Sometimes you just need to demonstrate to a large number of them the evidence base that supports the technology or approach as a solution in order to have a more rapid adoption.
What advice would you offer physicians who are looking to successfully integrate technology into their daily practice?
Technology is not the solution on its own, but technology—appropriate technology—has to be a part of the solution, and that technology has to be selected based on specific criteria and objectives that physicians are trying to achieve, not just what advertisers tell them is top of the line. The first things to look at are the people and the processes. Then find the most appropriate technology to renovate your processes, otherwise you will not improve efficiency. Just implementing electronic health records is not the solution. You have to change the processes of how people work, because the existing processes are based on using outmoded technology. The fact is that Nike was wrong; they said “Just Do It”, but you can’t just do it, you have to “Do It Better.”