Tuesday, July 03, 2018

Productivity Paradox and EHR

Bob Wachter and Michael Howell are optimistic about the future improvements in health information technology and its impact on physicians. I share their enthusiasm and I am optimistic about an increase in productivity in healthcare sector. And why not? Its about time.

Productivity in every other sector has resulted in decreasing utilization of human resources and increasing production of goods. However, such is not the case in healthcare. A physicians still sees about the same number of patients in a day as he/she used to see 50 or 100 years ago. It is quite possible that the number patients seen might have dropped due to documentation and other requirements. The result is evident; healthcare sector now accounts for almost one-fifth of the GDP in the US. Much of this has to so with the lack of growth in productivity in healthcare sector as compared to other sectors.

What is promising is that artificial intelligence will likely to increase productivity in the healthcare. I don’t think that this will come through improvements in health information technology (HIT). I believe it will come with better utilization of HIT as data repository for learning algorithms. Technology will also help in data capture, and it does so in many ways even now, but most importantly in data inference. However, it will not be good for an average physician.

Remember, productivity can increase only if more patients can be seen by fewer physicians (or healthcare workers). That is not possible with one physician simultaneously seeing several patients. It is possible only when machines see most patients and physician sees patients only in those situations where algorithms have not gotten enough data to develop a routine.

And what those situations will occur in relatively rare conditions. These will not our usual common diseases, what we might call ‘bread-and-butter’ medicine. Rather these will be either rare diseases or rare manifestations of common diseases. A physician overseeing such a highly productive healthcare delivery system will have to be a master clinician and a superb diagnostician.

In other words, an increase in productivity in healthcare sector will spell the doom for majority of physicians ….. happy to hear what you think……….

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