The Case for Computer-Based Health Care

A participant works on a computer during the Algorithm competition at the Imagine Cup 2006 in Agra, some 200 kms from New Delhi, 08 August 2006. University students representing 42 countries participated in a Microsoft technology contest showcasing innovations they hoped would help people live healthier lives.
National Journal
Darius Tahir
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Darius Tahir
Oct. 16, 2013, 5:37 a.m.

The vic­tory of Wat­son, an ar­ti­fi­cial-in­tel­li­gence sys­tem de­signed to dom­in­ate the quiz show Jeop­ardy!, over the coun­try’s best nerds in 2011 may not be the equal of John Henry strug­gling against a steam-powered drill in the an­nals of man versus ma­chine. But the re­place­ment of Jeop­ardy!‘s hu­man com­pet­it­ors with a com­puter al­gorithm may sig­nal a trend that could soon spread through the health care sec­tor as Obama­care is im­ple­men­ted.

That’s the proph­ecy of ven­ture cap­it­al­ist Vinod Khosla. Khosla, a prom­in­ent Sil­ic­on Val­ley in­vestor, has pre­dicted that com­puters will re­place 80 per­cent of what doc­tors do in a couple of dec­ades. The shift could counter an­oth­er health-sec­tor trend: stag­nant pro­ductiv­ity, which the Af­ford­able Care Act aims to ad­dress with fin­an­cial in­cent­ives for ef­fect­ive, ef­fi­cient care, and which could en­cour­age a move to­ward di­git­al doc­tor­ing.

Between 1990 and 2010, pro­ductiv­ity in the health care sec­tor de­clined by 0.6 per­cent an­nu­ally as em­ploy­ment in­creased by 2.9 per­cent, ac­cord­ing to Robert Kocher, now a ven­ture cap­it­al­ist at Ven­rock, in an Oc­to­ber 2011 ed­it­or­i­al in the New Eng­land Journ­al of Medi­cine. In­creas­ing pro­ductiv­ity might bridge this dis­con­nect, and com­puters could be part of the solu­tion.

Khosla, who sup­ports the move to com­puter-based health care, notes the hu­man frailties that weak­en doc­tors’ dia­gnoses and treat­ment: The brain is biased, for­get­ful, and lim­ited. As a res­ult, dia­gnoses are of­ten in­con­sist­ent. Khosla cites a study in which psy­cho­lo­gists were asked to dia­gnose pa­tients’ ma­jor de­press­ive dis­order. On a scale where 0 rep­res­en­ted total dis­agree­ment and 1 rep­res­en­ted total agree­ment, the psy­cho­lo­gists rated 0.3.

Hu­man brains take in less data than their di­git­al coun­ter­parts. “It’s a simple fact that most doc­tors couldn’t pos­sibly read and di­gest all of the latest 5,000 re­search art­icles on heart dis­ease,” Khosla writes. “In fact, most of the av­er­age doc­tor’s med­ic­al know­ledge is from when they were in med­ic­al school, and cog­nit­ive lim­it­a­tions pre­vent them from re­mem­ber­ing the 10,000+ dis­eases hu­mans can get.” As the amount of in­form­a­tion in­creases—there’s more re­search, and more sensors to col­lect it—di­git­al sup­port pro­cessing the data could be a big help.

Khosla pre­dicts that com­puters will take over large por­tions of the med­ic­al pro­cess, leav­ing hu­mans to do em­path­ic tasks, such as re­as­sur­ing and coach­ing pa­tients. The be­gin­nings of that trend are here already. Sev­er­al start-ups of­f­load doc­tors’ tasks onto com­puters; Eye­N­etra, which Khosla has in­ves­ted in, uses soft­ware and a device that at­taches to a smart­phone to de­term­ine the strength of pre­scrip­tion lenses a pa­tient re­quires.

This sum­mer, the Na­tion­al In­sti­tutes of Men­tal Health fun­ded a round of grants to ex­plore us­ing mo­bile devices to treat men­tal health prob­lems. Akili In­ter­act­ive, a video-game maker that re­ceived NIMH fund­ing, com­bines tasks that re­quire fine mo­tor skills and visu­al at­ten­tion. The games “ac­tu­ally be­come a very sens­it­ive meas­ure of cog­ni­tion,” com­pany cofounder Ed­die Mar­tucci said at a May con­fer­ence. Akili is also hop­ing to treat ma­jor de­press­ives, who tend to struggle with prob­lem solv­ing. Solv­ing prob­lems in a game might con­di­tion these pa­tients to bet­ter solve prob­lems in real life, without a doc­tor’s in­ter­ven­tion.

Oth­er al­gorithmic soft­ware aims to aid phys­i­cians’ de­cisions rather than re­place them. “Clin­ic­al de­cision sup­port soft­ware” ana­lyzes data, of­ten from a pa­tient’s elec­tron­ic health re­cords, and ad­vises doc­tors as they pre­scribe a treat­ment course. The soft­ware could note, for ex­ample, that two drugs shouldn’t be ad­min­istered to­geth­er due to their harm­ful in­ter­ac­tions.

Soft­ware can also be used to im­prove doc­tors’ ad­her­ence to clin­ic­al guidelines. The Health­Part­ners hos­pit­al sys­tem in Min­nesota found lim­ited suc­cess with a soft­ware tool that showed doc­tors how well their or­der of a scan for a pa­tient stacked up to Amer­ic­an Col­lege of Ra­di­ology guidelines. The tool brought only mod­est in­creases in the doc­tors’ or­der­ing of evid­ence-based scans, ac­cord­ing to a study pub­lished in the Amer­ic­an Journ­al of Man­aged Care in 2010, but there were no in­cent­ives for the doc­tors to or­der more of these ap­pro­pri­ate tests. Hos­pit­als could of­fer more re­wards to en­sure ad­her­ence to best prac­tices.

Health care work­ers have also star­ted per­form­ing em­path­ic tasks based on al­gorithmic ad­vice. Jef­frey Bren­ner, ex­ec­ut­ive dir­ect­or of non­profit Cam­den Co­ali­tion of Health­care Pro­viders, re­ceived a Ma­cAr­thur Found­a­tion “geni­us grant” for his ap­proach to de­liv­er­ing bet­ter care at lower cost. Bren­ner sent so­cial work­ers to cer­tain “hot spots,” which were iden­ti­fied by soft­ware as places where a small minor­ity of pa­tients con­sumes a dis­pro­por­tion­ate amount of health care re­sources. These pa­tients of­ten have chron­ic dis­eases that aren’t treated prop­erly, and these pa­tients fre­quently end up in the hos­pit­al. The goal of “hot spot­ting” is to in­ter­vene early be­fore prob­lems flare, mak­ing the pa­tient health­i­er des­pite us­ing few­er re­sources. So­cial work­ers can as­sist by form­ing re­la­tion­ships with pa­tients and help­ing them man­age their ill­nesses.

Pro­viders are ad­opt­ing this ap­proach in re­sponse to new pay­ment in­cent­ives ushered in by the 2010 health re­form law, which im­poses pen­al­ties on hos­pit­als with high read­mis­sion rates. Mount Sinai in New York is one in­sti­tu­tion send­ing so­cial work­ers to troubled pa­tients. A 600-pa­tient pi­lot study cut emer­gency-room vis­its in half between Septem­ber 2010 and May 2012, the hos­pit­al says.

So in­stead of be­ing re­placed—what John Henry fought against when he raced the steam drill—health care work­ers can per­haps work along­side the new com­puter over­lords.

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