Healthcare 2020: Technology in the New Millennium.

Patients will become partners in their healthcare using doctors as consultants rather than managers.

When you pump your own gas at the filling station are you working for the gas station or yourself? When you take a pregnancy test at home are you a savvy self-helper or part of the HMO's

-- Kevin Kelly, "New Rules for the New Economy"

The most pervasive change in the new millennium will be the way technology empowers patients to take control of their healthcare. Internet-informed patients will become partners in the promotion of their health, using physicians and other providers as consultants rather than managers. Information technology will allow patients to access the health system on a "7x24" basis, at their convenience.

Language is often the precursor to change. The word coined for this kind of patient involvement has been called prosumption. In his 1996 book, "Digital Economy," Don Tapscott describes the increasing role of the consumer in functions formerly performed by the producer. For example, "prosumers" might receive custom newspapers over the Internet, with only the stories and subjects that are of interest to them. When the consumer defines, then receives this type of newspaper, he or she has assumed the role of publisher (producer) and consumer. The same might be said for home pregnancy tests (doctor and patient), and pumping your own gasoline (mechanic and driver).

So, over the next 20 years, the adoption and embracing of technology in healthcare will increase at an accelerating pace. The process of healthcare will become substantially digitized and electronically enabled. Managed care will switch from a gatekeeper concept to one of highly automated care management.

Dream Come True

The wired world of healthcare in 2020 isn't just a dream. Recent breakthroughs in remote surgery, gene manipulation, cloning, and molecularization of microchips have opened a world of possibilities. Questions of morality, government intervention, and the cost-benefit tradeoff between health and illness are the issues facing the nation in the new millennium of healthcare.

There is a concern that technology will accelerate the emergence of a two-tier health system. Uniquely personalized high-tech treatments such as gene therapy may not be covered by health insurance. These services will be available at a cost. Some patients will have the discretionary resources to pay these costs, but others will not.

A public policy debate on high-cost technology is likely in the next two decades (see October issue of HMT). Over time, the debate may ease as the technology have-nots eventually reap many of the benefits of those who pay, since the technology cost curve tends to drop off quickly.

As technology becomes more important in people's daily lives in the next century, it will become virtually invisible. In terms of consumer acceptance, the concept of "technology" is generational. Ask people over 80 about technology in their generation and you are likely to hear about the advent of radio. Ask a 60-year-old and technology is television. A 40-year-old sees technology as the computer, while a 20-year-old may not have yet witnessed anything he or she would refer to as technology.

The patients of the new millennium will have access to virtually all of the same knowledge as the providers. But will they understand what they read off the Internet, and can they trust it? Content providers such as drKoop.com and WebMD can supply valuable, peer-reviewed, and valid information. But there will always be unverified medical information on the Internet presenting treatments that may not have been subjected to the rigors of clinical trials.

A New Breed of House Calls

As healthcare entities move away from the medical center concept to one of a virtual community, consumers of healthcare will acquire the real ability to compare the quality and costs of care. Virtual healthcare will provide more alternatives for patients, and cost-competition will increase. Through Internet and two-way video connections, remote home visits by physicians and nurses will become practical.

Physicians and technicians will be able to perform routine tests and physicals in the patient's home or office via connected EKGs, EEGs, and portable telehealth units, which will include diagnosis via helmets or hats, and gloves with tactile ability. Expert systems and artificial intelligence will present caregivers with best practice options to the delivery of care.

Patients can query the health system or health plan at any time of day or night. Communication will grow increasingly digital and virtual, with multiple providers integrated to deliver care beyond anything we experience today.

Best Product Pricing

The desire to control costs and increase efficiency in the healthcare industry will motivate employers and insurers to purchase products at the best price for the best health benefits, even if those products are on the other side of the country, possibly the other side of the world.

Although it will be a controversial issue, global information technology can enable many tests and procedures to be performed "off shore" at the lowest cost site, whether out-of-state or even across national borders. The ability to source the most cost-effective health service from anywhere on the planet may be the most effective strategy in bringing the cost of U.S. healthcare under control.

Technology will enable managed care to finally coordinate treatments in the most cost-effective way. Health plans and capitated provider organizations struggle to coordinate various professionals (e.g., chiropractor, physical therapist, neurologist, orthopedist treating a patient for back pain) in a manner that is best for the patient. As commerce in the rest of the world becomes immediate, so too will patients seek providers who can coordinate and deliver services quickly and effectively. Electronic medical records will follow the patient.

Newly Focused Managed Care

Clinical pathways and protocols will be automated. In the future, managing care will be real-time, electronically monitored, and evidence-based. The focus of managed care in the millennium will be high-risk people who are not acutely ill and high-cost patients who are already under care.

A major barrier to entry of competition in healthcare is risk. Employers or insurers assume risk for the costs of care under a health plan and a growing number of providers are assuming risk in some markets. Aging of the population, new technology, higher pharmaceutical use, and Medicare budget cuts are blamed for rising health costs.

Health plans that capitate providers are controlling their costs, and shifting risk. Information technology can enable healthcare providers to assess, assume, and manage global risk for the entire costs of care under a health plan. As better information and connectivity become available, providers can begin to prospectively identify the likely costs of treating their patients, and capture the savings from prevention, health promotion, and early intervention.

Differential Premiums

With access to deep pools of patient information in data warehouses, the concept of differential premiums may become accepted. Experience can quantify the expected cost differences in providing care to a 30-year old vs. a 60-year old, although both may work for the same company and be covered by the same health plan. This may require that commercial health plans, employers, and government pay more for some patients, but at the same time other patients may be treated for considerably less than the current rates. The treatment of patients at lower prices is one of the trade-offs when health plans and providers have access to databases of patient cost and disease experience.

Quality will continue to be the watchword for the next millennium, and technology will be the enabling force. In tomorrow's information-enabled health system, it will be possible to monitor and manage high-risk or high-cost patients as it they were receiving full-time dedicated care.

An estimated six to eight percent of younger patients and 12 to 15 percent of Medicare beneficiaries who are higher risk could be monitored more closely. Information networks can quickly and accurately make decisions about a multitude of symptoms and prescribe treatment for them as well. This futuristic scenario is possible today, for example, with new generation insulin pumps and automatic pacemaker/defibrillators.

Technology and the Digital Highway

The Internet is growing from its current "garden path" state to a true information superhighway. The highway will have at least 100 lanes. Possible? No waiting for this future. A global competition is emerging between digital subscriber lines (DSL), broadband modems (through the cable company), and direct broadcast satellites. Information service providers promise a "firehose" of information and two-way communication in nanoseconds.

Healthcare IS/IT specialists are their organizations' trend-spotters when it comes to emerging technologies. Every hospital, health plan, physician office or health services provider will be connected. Entrepreneurial companies and health plans in America will be competing to be health information providers.

These will be an explosion of information sources and databases. Information systems specialists will be the guides to this new world of electronic technology. The fundamental question they will need to answer is how to use tomorrow's information technology to better serve their patients and the public.

Russell C. Colie, Jr., and Brett E. Trusko are the co-authors of this series. Russ Coile is vice president/national strategy advisor, and Brett E. Trusko is an executive director, both with Superior Consultant Company, Southfield, MI. The authors invite comments from readers: russell_coile@superiorconsultant.com, and brett_trusko@superiorconsultant.com.