This is the final post of a five-part series titled “Diagnosis Overkill.”
“It isn’t enough to eliminate unnecessary care. It has to be replaced with necessary care.” – Dr. Atul Gawande
Given the forces of business, technology, and science that are expanding medical diagnostics, more overtreatment is inevitable. But, as the saying goes, every problem is an opportunity. Here are several areas where digital health companies can introduce improvements that may help to chip away at the $750 billion “inefficiency tax” the US pays every year—the cost of doing too much.
Stop me if you’ve heard this one. Patients’ healthcare data needs to be available to every doctor they see so that treatment decisions can be made in the most appropriate context. The ACA-driven wave of care coordination programs is a good start, but those are focused on high-risk patients, not the general public. For the latter, care coordination simply means data needs to be easily available between a telehealth app, a primary care doctor, a pharmacy clinic, a specialist, and so on – the easiest way to do that is to let data live inside a patient-controlled app. Hospitals, almost universally, have the technology in place in the form of an integration engine, which has the capability to send data to any application. Beyond clinical data, a patient’s claims data should also follow them from health plan to health plan as they switch jobs, move, and live their lives.
More patient context
Can a medical history taken for a few minutes in an exam room really capture a person’s full healthcare journey? Arguably, it can’t really come close. Medicine can benefit immensely from motivational interviewing, shared goal-setting, between-visit check-ins and data capture, and so on. Philosophically these tactics fall under the category of empathy. Practically they will depend on a host of factors, from better medical school training to more self-determined and activated patients. And realistically, they will require new business models that propagate quality in relationships, not just quality in measurement.
Patient decision support
As access to care expands into new frontiers both digital and physical, it will become more important to ensure patients are given the information they need, at the level they need, to make the best clinical decision for their short- and long-term outcomes. We should continue to empower people to diagnose themselves, but make sure to tie emerging tools into insurance programs, outpatient, and specialty care.
Virtual checkups can be better tethered to real-world clinical guidance and alternative treatment options, based on a patient’s medical factors (prior history) and lifestyle factors (affordability). Companies hawking consumer chatbots can make sure their products have digested the latest clinical guidelines for common ailments, or that they’re able to consider portions of a patient’s self-reported medical history, and so on. Finally, we can do a better job ensuring that patients have access to the right people (e.g., genetic counselors, pharmacists, clinicians) who can answer (or solicit) their questions in a way that is cost-effective and time-effective for patients.
Health system behavior
There is no silver bullet to fix the dysfunctional culture of healthcare systems. However, there are plenty of policies that can help minimize misdiagnosis and overtreatment. With regards to genomics, Children’s Hospital of Philadelphia’s examples can be duplicated and scaled nationally to prepare primary care for the impending wave of genomic testing.
Another example is simply how we treat lower back pain. Healthcare systems can do a much better job implementing the latest medical guidelines into the trenches of their provider networks. This means discouraging use of the unnecessary pain medication that has spilled over into an opioid epidemic – potentially through physician-facing bots. It could mean reducing imaging orders, and partnering with practitioners of dry needling, massage, physical therapy, and so on. Health plans can easily curate the best options for a given patient based on their benefit policies, location, and stated preferences, and match them with low-cost, high quality alternatives to the orthopedic surgeons lurking in PPO directories with a scalpel.
Ultimately, our obsession with new tools and techniques does not have to be at odds with a scientifically and technologically revamped medical system. But the learning curve of adopting these new technologies in a responsible way, combined with the existing dysfunctions that pervade our health care payment and delivery organizations, mean that overdiagnosis and subsequent overtreatment will get worse before they get better.