The book Superfreakonomics describes a problem rocking the late 19th century developed world: horse poop. With horses the major transportation source in urban centers, cities were beset with waste management problems of a kind unknown today.
“The average horse produced about 24 pounds of manure a day,” Superfreakonomics reads. “With 200,000 horses [in New York City], that’s nearly 5 million pounds of horse manure. A day.” The book describes manure lining streets, sometimes piled 60 feet high, spreading disease, and seeping into basements. An 1898 urban planning conference on manure management ended a week early with no solutions to be found.
And then? “[T]he problem vanished… The problem was solved by technological innovation.” The advent of the automobile suddenly rendered the dung-producing horse obsolete. Problem solved.
The United States’ health care problems don’t reek nearly as bad as urban centers’ horse-related ones at century’s turn. In fact, our imbalance between health spending and health outcomes compared to other industrialized nations suggests our problems can be addressed within today’s constraints, without relying on what the future might bring.
But given today’s political climate, maybe we need something to break through the gridlocked arguments between those advocating single-payer and those who want to privatize Medicare, between those looking to control costs responsibly and those raving about death panels.
Rather than waiting for one side to win out, perhaps a technological innovation could break the deadlock by revolutionizing our health system?
While reliance on a future innovation to magically solve our problems is dangerous, it’s worth asking what might be on the horizon.
First, it’s important to identify the horse-dung corollary clogging America’s health system. Right now, it’s unnecessary care. A Rand Corporation study found only 55% of patients receive recommended care, with overuse driving up costs and underuse potentially causing complications which could also add to costs.
Groups from the U.S. Preventive Services Task Force to the newly-minted Patient-Centered Outcomes Research Institute examine care practices to identify unhelpful ones and dissuade patients and doctors from using them. But the problem extends further: For many medical conditions, no one knows which care method will be most effective for an individual patient, so physicians use trial-and-error to find the strategy that works for a given patient.
What if we could change that?
Step One to front-loading personalized care solutions is ensuring proper diagnosis.
“As Atul Gawande wrote in The Checklist Manifesto, ‘the ninth edition of the World Health Organization’s international classification of diseases has grown to distinguish more than thirteen thousand different diseases, syndromes, and types of injury.’ And that doesn’t take into account all the possible symptoms and recommended lab tests and side effects of, and interactions between, various medications,” Ezra Klein explains. “That’s complexity beyond any human’s capacity to handle. But it’s not beyond a computer’s ability.”
That computer comes with a name: Watson, famous for taking down two acclaimed Jeopardy! champions on that game show last year.
Watson has already turned his electronic gaze toward the medical world. Earlier this month, the computer defeated two teams of cardiologists in a Jeopardy!-like game at the 2012 Medical Innovation Summit. Health plan provider WellPoint Inc. has already announced plans to develop IBM’s Watson technology for commercial use. Watson is attractive for health diagnoses because not only can it comb through mountains of data to offer solutions, but it can interface with regular human dialogue and provide a list of possible conditions ranked by probability of accuracy.
With Watson on the case, medical diagnoses could become much more accurate and reliable, reducing health costs and ineffective treatments related to misdiagnoses.
Step Two to personalizing care solutions is to increase the odds a prescribed strategy for addressing a diagnosed condition will be effective for each individual patient.
Imagine that following your diagnosis, a doctor is able to pull up an aggregated account of individuals with a similar diagnosis to yours who share with you a similar medical history, family medical history, perhaps even DNA sequence. The doctor can then examine which methods of care were most effective for patients most like you, skipping much of the guessing game sometimes involved in selecting a treatment strategy.
It might sound like science fiction, but the medical IT world is currently working toward such a tool. CONNECT is an open-source software model created by dozens of federal agencies working together to create a system for interoperable data-sharing across clinics.
If CONNECT or a similar health record gateway could be implemented in hospitals and clinics across the country, medical histories could be easily evaluated, avoiding duplicated treatments or situations like the prescription of two drugs that are harmful when taken together. Furthermore, by providing the opportunity to aggregate patient data and compare it to individual circumstances, a health record gateway could lead to personalized care like we’ve never seen before.
What’s holding us back from this health care world of tomorrow? Right now, only ten percent of doctors have moved to electronic medical records. And since the federal government has set only voluntary standards for putting medical records in a state where they can be easily and securely shared, transformation will occur as quickly—or slowly—as the medical industry moves.
We can’t rely on Watson, CONNECT, or other technological solutions to materialize and solve our health care problems, so it’s still important to find savings within the system we have. But we can help these changes along, especially considering that from railroad lines to telephone infrastructure to the internet, government has often played a major role in funding tomorrow’s connective technology.
To remove waste and inefficiency from our health system, it’s worth thinking about the miracle that removed horse waste from the streets of New York, then seeing what we can do to proactively replicate such a miracle in the health world.