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Brookings Paints New Health System

By October 16, 2009November 2nd, 2009Commentary

The Brookings Institution has released a paper visualizing a health system in which patients utilize wireless, telehealth, internet and other technologies to monitor their own health, store that information in online health records which can be shared with providers and receive feedback and reminders via email or text messages.  (Brookings Report) Patients would manage much of their routine care and see doctors only for serious needs, theoretically creating significant savings.  Much of this technology is currently available.

Brookings identifies two primary barriers that need to be addressed to aid generalized use of such a system.  One is reimbursement–today there is very uneven and scattered payment for telehealth and similar services.  The other is creating incentives for providers and patients to change behavior and to focus on health outcomes.

The Brookings paper doesn’t contain much that is original; this is now a common vision.  It is not clear if or when the entire health system might be transformed in this manner.  Yes, the technology is available.  Yes, there are many consumers, and some providers, using and willing to use it, so there is substantial market opportunity for vendors.  But the supposed cost-savings may be illusory.  All this technology and associated services are going to cost a fair amount and the companies providing it will expect to make good profits.  Health care providers will still expect to make significant incomes.  And perhaps most importantly,  medical cost is concentrated in very sick patients who spend a lot of time in the hospital; those patients are unlikely to be able to participate in the system envisioned by Brookings.

There also is not yet clear evidence that such a system will improve actual health outcomes and that needs to be demonstrated.  Relying on social networking to help patients manage their health, as Brookings suggests, is fraught with peril.  Will patients really want to take advice from some chat room acquaintance about how to handle a chronic illness?  Extensive sharing and communication of information in such a system creates a possibility of gaps in the data getting to the right person at the right time.

Notwithstanding these problems, there will be increased use of mobile and telehealth capabilities, and for many consumers and patients, these will facilitate improved outcomes and satisfaction.  But it is best not to create excessive expectations that might actually hinder the growth of otherwise valuable new approaches to health care.

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