One of the biggest upsides to mHealth tools might be their ability to help providers use health care resources more efficiently. But at the mHealth Summit 2012, one speaker said he believes mobile technology can do a lot more than that, and potentially could replace physicians in up to 80% of the tasks they currently perform. The comments sparked reaction from conference-goers.
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In his address, Vinod Khosla, founder of IT investment firm Khosla Ventures, said doctors spend too much time on clerical tasks. Additionally, the human brain isn't adequately equipped to maintain knowledge from the vast number of clinical studies available or to crunch all the data in a human genome sequence in order to make a diagnosis.
Computers can be objective cost-minimizers. The practice of medicine will become the science of medicine.
founder, Khosla Ventures
Machines -- in particular, mobile health tools -- would be better at these tasks, he said. Replacing physicians with technology would increase the efficient use of health care resources by freeing up physicians to engage with patients. Eventually, Khosla predicted, up to 80% of doctors' current responsibilities will be performed by devices. "Machines are better at integrative medicine across all systems," he said. "Computers can be objective cost-minimizers. The practice of medicine will become the science of medicine."
Machines don't always improve information transfer
The idea that 80% of doctors' responsibilities will be performed by machines has some currency for Joseph Smith, M.D., chief medical and science officer at West Health, a Washington, D.C.-based health policy initiative. The vast majority of the value patients receive from care visits is in the transfer of information from their doctor, he said. Medical professionals have information that can improve the health of patients. Getting that information from the doctor to the patient is what health care is all about.
But there are many different ways information transfer can be accomplished. Smith said it doesn't necessarily have to happen in the doctor's office, particularly as new mobile health tools are emerging, but he stopped short of saying that doctors can be replaced by machines in all cases.
The health care system needs to get better at offering options to patients who want to engage in person or remotely, Smith said. Making sick people travel to what he referred to as the "cathedrals of care" is not always the best way to get that person the information they need to get better.
"I think it is about information transfer, but then it's about how you do that best," Smith said. "Is it best done face-to-face? It probably is for most patients, but are there other vehicles that are probably better for others? I think so."
The coming data deluge
The health care system is generating more data than ever before, as physicians adopt electronic health records and mobile monitoring tools, and patients increasingly track information about themselves. This inevitably raises the question of what to do with all that data.
Fred Holston, chief technology officer for Intermountain Healthcare, said organizing all this data and distilling it into meaningful information may be one of the most important uses of mHealth technology. This won't replace doctors, he said, but it will enable providers to use their health care resources more efficiently. "Machines do have the power to pare down that data to the most important things [doctors] need to know," he said.
Patient use of mHealth devices to track their own health raises another issue. Patient-generated data may have holes in it that make it less trustworthy, Holston said. Additionally, some patients are now coming to their doctor with a bucket of data and asking the doctor to incorporate it into their record. Far from eliminating doctors from the picture, this trend may actually cement the need for physicians, as interpretation of information and quality control become paramount.
Less time on clerical tasks, more time with the patient
Jonathon Dreyer, director of mobile health solutions marketing at Nuance Communications Inc.'s health care division, said he sees the ability of mHealth devices to free up physicians to spend more time with the patient as their most important benefit. Well-designed applications can allow doctors to spend less time on data entry. "It's taking out a lot of those manual steps and helping to identify certain cases and findings within those cases for analysis, billing and coding," he said.
For example, Nuance has worked with application developers who have produced record-keeping software that automatically populates fields where information for a patient is recorded, Dreyer said. Additionally, developers are working on apps that can take information recorded as free text and output it in standardized formats like SNOMED or RxNorm. This enables technology to replace doctors in doing data entry and other clerical tasks.
This kind of reduction of time spent on tasks that are not directly related to patient is exactly what the health care system needs now, said Joe Kvedar, M.D., director of the Center for Connected Health at Partners Healthcare, in an address responding to Khosla's comments.
Kvedar pointed out that about 60% of health care costs are related to labor. In order to get spending under control, machines will have to start taking over more of the tasks currently performed by doctors. "We have to move in that direction in health care," he said. "We really don't have a choice. We don't have enough providers right now to take care of all those people. We have to do it differently."
Kvedar acknowledged there is some pushback to this idea right now. Some think there will be no people around to help patients when machines break down. Doctors don't like it because they are afraid decision support systems will take their jobs. Patients find being constantly connected to their providers through mHealth tools to be an invasion of their privacy.
These worries are not valid to Kvedar, however. Other industries in which technology replaced workers still have people available when things go wrong, machines would only replace doctors on clerical tasks, and most patients welcome more connection with their providers, he said.
"I think there's a more positive view," Kvedar said. "We can spread [doctors] across patients, we can automate more tasks and in the end, we'll all feel more cared for. Let's all embrace the notion of automation."