Medicine Storm Clouds

Trying to connect the dots in healthcare delivery can be a lot like stringing beads in a windstorm: the time spent getting even a few in place often comes at the expense of losing track of many others. Over the past few days I came across three articles that feel like they should be strung together because they share an unintentional common theme: what will the practice of medicine look like in a decade from now as more and more medical knowledge is captured and made available in the cloud: the Medicine Cloud.

The cloud I refer to of course is a metaphorical description of electronic computing resources (i.e., data storage, hardware and software) that are accessed by users through web browsers and light-weight desktop and/or mobile applications. There are significant advantages to healthcare providers leveraging cloud-based computing, notably a significant reduction in upfront investment – both in terms of time and capital. Lower maintenance costs, improved reliability and the facilitation of greater data sharing that can enable more efficient integrated care delivery and provider interoperability are also big advantages.

The three articles I reference above include:

    Through a Scanner Darkly: Three Health Care Trends
    for 2013
written by Dr. David Shaywitz in the
    Healthcare Blog;

      Brain Awareness, by Dr. Thomas Insel, Director of the
     National Institute of Mental Health; and

      the third was an article shared by Dr. William Palmer
      in our HCPolicy online discussion group:
     learning: Campus 2.0
 by M. Mitchell Waldrop in
     the March 13th edition of Nature Magazine.

From different perspectives each of these articles represent key trends and drivers likely to impact how Medicine is practiced in the future – and in particular, the impact information technology will have. And while there are reasons for optimism in how advancements in technology can lead to improved access, efficiency and productivity – information technology has so far not proven to be the panacea many practitioners had hoped for.

Sourcing, capturing and aggregating medical-based knowledge – and then making that knowledge readily available to clinicians (e.g., including physician extenders) can be incredibly enabling and empowering for both the clinician and the patient, particularly when it is made available in real time. But there are hugely challenging concerns and substantial public policy issues that I think we should be discussing.

For example, one major challenge – as shared by Dr. Shaywitz in his blog post – is finding balance between the current push toward practice standardization that information technology naturally enables and maintaining the valuable non-standardized realities of practitioner experience. Dr. Insel’s article succinctly explains just how far we are from understanding how the human brain functions. To the extent we come to view an electronic knowledgebase as replacing a trained and experienced clinical practitioner’s brain, I think we do so at great peril.

On the other hand, making more medical-based knowledge available at a lower cost (i.e., as shared in the Nature Magazine article) has the potential to address the looming challenge of primary care physician access. Indeed, knowledge is power, and we should never be afraid to pursue any opportunity that empowers more people with knowledge.

Of course, online courses cannot replace medical practicums, and we must not be led to believe that the accumulation of didactic knowledge can replace practice and experience. There are two ways to view this: as an obstacle that inhibits expansion of provider availability – especially the expansion of physician extenders – or as a reality that requires proactive planning to try and ensure practical alignment between provider capabilities and patient needs. And then we have to assess whether this is a phenomenon that should be addressed through public policy, and if so how.

Now throw into this mix the markedly different attitudes and perceptions of younger clinicians on the role information technology can (and should, in many of their minds) play in the future practice of medicine – and you have the makings of a public policy maelstrom. Even in the face of the recent recession, Gen Xers and Millennials still are looking at work-life balance as one of their primary concerns. While there is a lot to be said for the benefits to society in taking more time for the family and less for the fortune, I do fear the potential implications this can have if it precipitates an overreliance on the Medicine Cloud as a replacement for the Medicine Man/Woman.


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