The recent (drawn) match between world chess champion Garry Kasparov and a computer again had chess fans complaining that computers were ruining the game -- and ruining human chess players:
- “We don’t work at chess anymore. We just look at the stupid computer, we follow the latest games and find small improvements. We have lost depth.” (Evgeni Bareev)
- “People don’t experiment as much anymore. That’s a loss.” (Maurice Ashley)
- “What’s happening with chess is it’s gradually losing its place as the par excellence intellectual activity. Chess is winding down.” (Hans Berliner)
How long before physicians start conceding checkmate in their game with machines that diagnose and treat? Some nurses already are. What happens when computers and robots are better than physicians and nurses at providing care?
With almost two-thirds of rocketing medical costs going toward treating chronic illnesses, disease management programs have sprung up nationwide to try to contain them. Most are run by employers and insurers; but one, run by physicians, pays its physician members an annual bonus of roughly ten percent of their compensation if they can document that they have kept patients out of the emergency room, kept the patients’ cholesterol under control, and made sure they’re taking their medications, among other measurable criteria. A study published in the Journal of the American Medical Association found that the average physician group with 20 or more doctors used just five out of 16 “care management processes,” such as case management and patient education, to treat chronic disease patients. Smaller practices often lack the human, technical, and financial resources to do the job.
From a patient’s perspective, the doctor ought to be the point person in managing care, since it is: the doctor who sees and examines the patient regularly. But doctors aren’t usually paid to monitor and manage patients’ care, only to diagnose and treat when something goes wrong. Offering financial incentives to doctors shifts the focus toward better patient care management. In one of the largest experiments, six California health plans covering eight million patients in health maintenance organizations started a “pay for performance” effort in January in which they agreed to pay physician practices extra for meeting certain performance measures.
This suggests one way doctors can make a role for themselves in the trend to self-care. It may be temporary, but it could be better than doing nothing.
Baby boomers and loosening managed care restrictions are contributing to growing demand for hospital care, but hospitals are already short of staff. Boomers want “the latest facilities, the best technology, the ultimate customer service and exceptional quality.” Consultant Anthony Cirillo suggests that hospitals should “Circulate articles that speak to future trends in all areas of hospital healthcare. They should: “Step back. Take the time to look around. See what’s coming. React now. By doing so, you not only position your institution for success but yourself as well. When you address issues that are hardly being talked about, when you raise issues that may not be directly under your purview, you make a statement. It says that you are a future thinker who is not afraid to bring innovative -- maybe even risky -- ideas to the table. That is how leaders are formed. That is how careers leap forward.” We agree.
Statistics culled from New York Health Department data and compiled by the nonprofit Center for Medical Consumers in New York City on its website represent “the most detailed view New Yorkers have ever been given” of the work done by individual hospitals and doctors. For hundreds of thousands of cases covering 44 common procedures (mostly surgeries, but also including coronary artery angioplasty and colonoscopies) the study lists every doctor who performed the procedure in 2001, every hospital where it was performed, and how often it was done. The Center says the data shows that “there are doctors and hospitals out there doing some surgeries so rarely that it could put people seriously at risk.” Others caution that even where correlations between volume and quality of care exist, it is a statistic and may not always be true of an individual physician or facility.
Surgical simulation technology could help surgeons hone their skills, if they have access to it and can take the time to practice. But the patient would still need assurance that simulated surgeries are at least as probative as the real thing.
An AI-based software automatically answers customer questions on an organization’s website, reducing the number of calls and emails to customer helpdesks and improving response time. The system gets its answers from a knowledge base of previously asked questions. Questions that cannot be answered from the knowledge base are forwarded to support staff, whose responses are added to the knowledgebase to be used to answer future queries. The more questions asked and answered, the better the system becomes at handling queries. With such major customers as TDK Systems, Fujifilm, and Sony Computer Entertainment Europe, one assumes the system works, and one wonders whether it might not be applied to answering consumer health questions.
The Internet remains an emerging technology. Harvard University has appointed an expert to teach faculty and students how to create and manage “blogs” (short for Web logs). Blogs are interactive online newsletters that are easy and inexpensive to publish yet offer much of the sophisticated functionality (searches, news clips, forums, etc.) of larger commercial newsletter sites. Their use has exploded in the past year among ordinary people, and blogs are likely to become a key collaborative and communication tool among all members of comprehensive care teams.
As they gain in ever more sophisticated functionality, blogs could become a bias-free, ethically unambiguous alternative to proprietary systems such as the MyDocOnline Connect Web-based personal health care communication tool offered by a subsidiary of drug-maker Aventis and currently being piloted by a 600-patient physician-owned medical clinic in Seattle. MyDocOnline Connect enables physicians to email with patients, refill prescriptions, request appointments, answer billing inquiries and respond to general health questions online. Patients can access a medical library, medical news, and patient education features to learn more about their medical conditions.
Last month’s issue reported an article bemoaning the destruction of the community health hospital system. Below is an example of how that industry can change if it has a mind to.
The newly opened Indiana Heart Hospital has a computerized patient record (CPR) system that transmits medical images to the patient’s electronic chart within minutes of a procedure, where they can be analyzed or shown to anxious family members on any one of the 88-bed hospital’s 650 computer workstations. It is designed not only to improve the quality of medical care but also the quality of customer service, with meals served on-demand from a menu, valet parking, and other services the aging boomer patient population expects.
The CPR system updates patient files almost immediately and allows access from physicians outside the hospital, and eliminates time-consuming and error-prone dictation and transcription, as well as paper and film file storage. Patient care decisions are double-checked by computer for accuracy and appropriateness. The hospital had less trouble than expected in hiring staff, despite the shortage in nurses and some specialists. Fears of “of pushback and fear” from veteran nurses and other employees did not materialize; instead, and applicants seemed drawn by the technology.
Vanderbilt University Medical Center’s emergency department recently introduced a computer system that gives doctors and nurses instant access to every patient’s medical record. Touching the system’s centrally-located 60-inch color plasma screen produces the diagnosis for every patient treated in the emergency department that day. Any ominous trends in symptoms or complaints become visible. The system provides access to the electronic medical record for all patients the department might treat on any given day, including laboratory, radiology and other systems’ reports. The system could be used to quickly detect a disease outbreak or a weapon of mass destruction incident, where speed of detection is of the essence.
A new digital-image technology allows doctors or technicians to view X-ray, MRI, and CT scans from any PC on a hospital network at a very high resolution in just seconds. Current digital X-ray technology takes lots of expensive computing power, so its adoption rate is slow. The new method is fast and inexpensive because it only shows the user a relatively small amount (of what are otherwise huge images) needed at any particular time. It works rather like streaming technology, in which a sound or video clip starts playing before it has been completely downloaded.
It enables a surgeon to zoom in on the details of a brain tumor without wasting computing and bandwidth resources on parts of the scan the surgeon doesn’t need. It enables a standard PC to replace $80,000 workstations, and that means the images can be accessed anywhere at the hospital -- a valuable attribute since multiple caregivers participate in the treatment of one patient but all need access to the patient’s images.
Adding to the strain on pharmacies from staff shortages, accrediting bodies such as the JCAHO are requiring that pharmacists be available to review orders 24-hours a day. As a result, hospitals are under increasing pressure to improve the quality of pharmaceutical care. With support from the Texas State Pharmacy Board, a new service called Rx e-source connects hospital staff over the Internet to a hospital-qualified pharmacist who can review patient charts and verify and dispense prescribed medications even when the hospital pharmacy is closed. It allows hospitals of any size to provide 24-hour pharmaceutical services. The company estimates that 77 percent of U.S. hospitals have a gap in their pharmacy coverage at some time during the night or on weekends. By allowing patients to pick up their prescriptions more easily than they have in the past, the service brings what is commonplace customer service in other industries into healthcare.