Editor's note: David Ellis has been a bimonthly contributor to H&HN OnLine, H&HN Weekly and H&HN Daily nearly since their inception, for which the H&HN staff is profoundly grateful. This is his last regularly scheduled column for H&HN. He will be sorely missed.
In April 2004, fully three years before the introduction of the iPhone, I warned in my debut bimonthly column for H&HN that health care institutions could go the way of recording studios, abandoned in droves by customers favoring sophisticated but inexpensive and easy-to-use recording suites that fit in a laptop. Health care institutions could end up as derelict as the music recording studios, I wrote, unless they took control of their own future: "In an era of daily breakthroughs in biotech and medtech, the only thing surprising is surprise itself."
The goal of that column was to reduce the hospital leader's "time to insight," a phrase coined by Craig Mundie, Microsoft's senior adviser to the CEO, in assessing the impact of the acceleration in the understanding of, inter alia, disease conditions and processes due to accelerating computing power and networking. The method I used to achieve this goal was first to track and clip those daily breakthroughs, through the media; summarizing them from time to time; placing them into the context of an overarching trend; and wrapping it all up in an article in which I usually tried to provide some semblance of a timeline, though I must admit that more often than not, it was as vague as "soon" or "within the next 10 or so years."
A Short List of Health Care Trends
The trends that coalesced through this process included new forms of medicine — digital, regenerative, bionic, genetic and mitochondrial — which I dubbed the trend to "postmodern medicine." This trend highlights the need for an extreme makeover of medicine from art to science, from the noble lone physician hero to one member of an extensive patient care team, from reliance on education, experience and intuition to reliance on the vastly accumulating and increasingly reliable evidence of what works.
The knowledge of what works eventually has to be applied at the individual patient level. Personalized medicine means that increasingly, statistical evidence of what works on a population of patients will need to be transformed into parametric proof of what will work for Mrs. Smith, through genome mapping and in-silico clinical trials of a therapy on Mrs. Smith's simulated body, organ or tissue.
Other trends discussed:
- the globalization of health care, including medical research and clinical trials;
- the rapid growth in the business of medical tourism and the offshoring of some hospital clinical and business processes;
- consumerism or market-driven care as evidenced by growth of retail clinics and the simplification of sophisticated medical technology and knowledge;
- more extensive adoption of health information technology, or HIT (and the computer and communications hardware and software technologies that continue to make HIT ever more powerful and in many ways simpler), which subsumed many of the trends already mentioned and included some of its own.
The spread of the electronic health record was a frequent topic in HIT, and the advent of big data and advanced analytics (made possible in part through EHR and the massive data sets that are accumulating thereby) is a major topic right now.
Passing the Torch
By presenting and discussing these trends, I think I may speak for the enlightened editorial staff and leaders at H&HN that they and I hoped to reduce or eliminate the element of surprise from the harried hospital leader's day. I am not the one to say how well I have succeeded, but I see no reason to change my mind about any of the trends about which I have written.
Indeed, I can point out with some relief from my perspective, and perhaps also from yours, that staff writers at H&HN and columnists brighter and more distinguished than I have begun over the past year or so to write about some of these trends. John Glaser is a beacon of light on HIT in general and on the EHR and increasingly on big data in particular (see, for example, "Managing Complexity with Health Care Information Technology" in the Oct. 8, 2013, issue), as is H&HN senior writer Paul Barr (watch his short video interview of Anil Jain, M.D., who describes how systems such as the Cleveland Clinic, part-owner of Jain's company Explorys, can better manage care using big data: "Health Care Growing as User of Big Data" [Oct. 2]).
Also notable are H&HN staff writer Marty Stempniak's articles about retail clinics. His Oct. 9 video interview "Retail Clinics: Threat or Opportunity?" provides a good overview of the current state of the industry and confirms much of my prediction in 2007 that it was destined to become a significant sector of, and become integrated with, the health care industry.
I am not suggesting that these writers have in any way based their articles on my ramblings — I am sure they arrived independently at their knowledge and viewpoints. The important thing is that you are in good and probably better hands. You may yet hear from me from time to time (and you can always hear from me almost daily on Twitter @hfdigest, and I shall soon be re-starting Health Futures Digest, which has been moribund for some time), but I am being drawn deeper into other exciting pursuits, including a project to build an individual patient simulator at submillimeter resolution, starting with the liver and other organs but eventually progressing to a whole-body simulation at nanoscale resolution.
So, don't be surprised when your surgeons — and your patients — start asking you to buy one for them. And think about what the digital simulation of your patients at the molecular level is going to mean for the future of health care and of your institution.
Thank you for reading.
David Ellis is a futurist, author, consultant and publisher of Health Futures Digest, an online discursive digest of news and commentary on long-range, leading-edge technological innovations and their consequences and implications for health care policy and practice. He is a member of Speakers Express.