I’m back from the Connected Health Symposium 2011 (20-21 October, Boston) but it’s only now that I’m getting a chance to try to distil out the key messages from the event. The whole thing might be summed up by a William Gibson quote I heard uttered by an entrepreneur: “The future is already here – it’s just not evenly distributed yet” – insofar as the likely future of innovation in healthcare is already taking shape and being (patchily) implemented.
The opening talk was given by Brent James, Chief Quality Office at Intermountain Healthcare. In a 20 minute talk he synopsised the current challenges facing healthcare delivery and emerging responses to them. He opened by stating that, whatever else might be said of it, medicine categorically works. This can be seen from the relentless rise in life expectancy over the past century. However, for individuals, healthcare delivery and outcomes can often fall short. There is massive variation in the quality of healthcare, high rates of inappropriate care and treatment associated injury and death. Healthcare systems have high levels of waste, often 50% or more, for a variety of reasons; building unusable tools and facilities, providing unnecessary treatment, recovering from medical mistakes and straight up inefficiency.
The sources of falling short on best possible medical care offer a route to understanding the interventions that might best remedy this situation. The reliance on the clinician as a standalone expert is a key factor. This issue was revisited later that day by Atul Gawande who gave a provocative talk about how healthcare provision should move from the lone “cowboy” to putting together “pit crews” to holistically treat the patient. Other factors include payment structures that incentivise procedures and clinical uncertainty about what is evidence-based best practise to treat each condition.
This latter point of clinical uncertainty was elucidated at some length and was, in many respects, the most fascinating. There appears to be many studies into garnering evidence as to what constitutes the best approach to often complex multifactorial conditions, often with many divergent reccomendations. Furthermore, there is an exponential increase in the amount of information we have in terms of the aetiology of disease and the number of treatments available. All this must be channelled through the all too human expert mind of the clinician. The working memory capacity of the brain is 7±2 items at any one time. James felt that, from his work, clinicians often had to be aware of many more items or indicators when making a decision on what to do in any given clinical situation. This often leads to clinicians relying on subjective recall as aid to fast decision making.
The talk wrapped up with what James and Intermountain Health Care felt was a way forward. The creation of bespoke teams to care for patients, the generation of evidence-based treatments and incorporation of emerging best practise into current clinical workflow were among the lessons imparted. The evidence of their success is in having the lowest mortality rates at Intermountain in the US and delivering this success at 35% less cost. The hopeful take-home message seems to be that it is possible to deliver higher quality healthcare at less cost.