Vision 2025: What Health Care Could Look Like a Decade from Now by Dr. Vicky Parikh, @ParikhVicky

Value-based care, coordinated care, information technology integration . . . healthcare is undergoing transformation.

Sweeping changes are putting pressure on the entire system, particularly from an administrative standpoint. With all the paperwork and logistics to worry about, it's easy to grow frustrated and lose sight of what we are working to achieve: economically viable solutions for providing the highest level of care to all our patients.
Sometimes it helps to take a step back, to forget the red tape and day-to-day grunt work of overhauling a 2.8 trillion dollar industry. For a moment, let's allow ourselves to focus only on the possibilities. Looking ahead, we'll explore one patient's journey through health care in the not-so-distant future. This is a story about health care in the year 2025.
Introducing Mr. Average Patient
Our patient - we’ll name him Philip - is a 35-year-old man in average health. Like many Americans, Phil tries to eat right and exercise, but enjoys rich foods, fails to sleep adequately, and relies on calorie-laden designer coffees, energy drinks to keep him energized. For months, he's been ignoring symptoms of frequent urination, fatigue, and dry mouth. But when Phil’s smartwatch repeatedly alerts him of high blood pressure readings, he decides to speak with a doctor.
This is 2025, so Phil won’t be taking any time off work for an office visit. Instead, he logs into his personal health management system - a cloud-based program accessible via web browser or specialized app - for a video chat with a member of his care team (let's call her Dr. McCoy).
While Phil describes his symptoms, the user interface provides Dr. McCoy an overview of his medical history. Phil’s vitals have been uploaded from his smartwatch and 20 pounds of weight gain have been registered by his smartscale over the past year. Dr. McCoy notes a family history with genetic predisposition of heart disease and diabetes, and that Phil's most recent blood work, drawn over a year ago, showed an elevated blood glucose level.
Suspecting diabetes as the source of Phil’s woes, Dr. McCoy uploads an order for a CBC and A1C while sending Phil instructions for scheduling his outpatient appointment.
Exploring the untapped potential of mobile health
In this scenario, two trends diverge with promising results. First, we are taking advantage of the increased popularity and decreased cost of the Internet as a way to passively monitor patient health. Familiar devices already track heart rate, sleep quality, activity levels, weight and BMI for non-clinical purposes. Before long, these technologies will advance, allowing us to discreetly record temperature, blood pressure, pulse oximetry, and maybe even blood chemistry. Like crash avoidance systems on a car, these devices can act as early warning systems, alerting patients of brewing health problems and encouraging them to contact a health professional.
Secondly, we are combining this with the growing availability of “doctor on demand” services. Telemedicine companies such as Teladoc have seen exponential growth in recent years, largely fueled by changing reimbursement schedules. Currently, this low-cost alternative to traditional office and urgent care visits is limited to addressing the most common of health concerns (runny noses, etc). But, we envision telemedicine as an integral part of coordinated patient care. An on-call doctor with access to telemetry from wearables and a complete medical record could remotely diagnose and manage a wide variety of medical issues. In this futuristic system, patients benefit from convenience, doctors from increased efficiency and reduced overhead, and payers from lower costs.
Mr. Average Patient skips the waiting room
After Dr. McCoy signs off, Phil follows the link she sent him to make his outpatient appointment. Scrolling through the list of available providers, he sorts by location, price, patient ratings, and earliest availability. He chooses a location near his home and schedules a same-day appointment. Before logging off, he pays his copay and downloads directions to his phone's GPS.
At the outpatient clinic, Phil checks in by tapping his smartphone to the reception kiosk. It provides him on-screen directions to the lab. There, he is greeted by his nurse who performs a quick physical examination before drawing Phil's blood. All told, the appointment takes no more than 30 minutes out of our patient's day.
How patient self-service benefits everyone
Consumers today are accustomed to booking airline flights, hotels, rental cars, even haircuts online. There is no reason health care providers shouldn't benefit from this same technology. Early adopters have discovered that online appointment scheduling simultaneously reduces administrative burdens (and associated costs) while increasing patient satisfaction. The Oregon-based Zoom+ health system, for example, has established a positive reputation for itself by providing on-demand health care services with transparent pricing and online appointment scheduling. As more patients and providers join in, we foresee sites like ZocDoc evolving into Expedia-like clearinghouses complete with payment and review functions.
Further automation will take place on-site at medical centers. Already, some hospitals have discovered that both patients and staff enjoy the shorter lines and reduced wait times that check in kiosks accommodate. In our scenario, these kiosks have evolved to incorporate technology borrowed from modern mobile payment systems. With a tap, encrypted information is exchanged between the patient's smartphone and the provider's practice management system: uploading doctor's orders, insurance authorizations, patient records, and payment information. The result is a near instantaneous check-in, freeing up staff, virtually eliminating paperwork, and dramatically speeding up appointment turnover. Once again, patients benefit from convenience while providers increase the number of patients they can see in a day, which lowers per-patient costs for payers.
Mr. Average Patient learns about self-care
The day after his appointment, Phil receives an email notification that his test results have come back. The email contains a link for another video chat with Dr. McCoy. She informs Phil that his labs indicate diabetes; she'd like to have a nurse practitioner come visit with him, or, if he'd prefer, she can schedule an appointment with his PCP. Phil opts for the nurse practitioner.
When Beverly, our local nurse practitioner, receives Dr. McCoy’s order, she calls Phil to schedule their face-to-face meeting. She brings with her his new medications and supplies (including a bluetooth-enabled glucose meter which will automatically record readings in Phil’s health management system). Together, she and Phil develop a care plan that includes follow up labs and visits with his GP. They set up reminder texts that help Phil remember to take and refill his medications on time. Phil also agrees to use his smartwatch to better manage his activity level and a nutrition diary to help him (and his care team) watch his caloric intake. Before leaving, Beverly leaves behind her contact information and informs Phil she’ll be checking in with him by phone once a week for the next several weeks.
Furthermore, Phil's diagnosis automatically adds him to an email list for patients with diabetes. Unless he opts out, Phil will receive daily educational emails with informational articles, videos, healthy recipes, as well as lifestyle tips and challenges. He’s invited to attend local diabetes classes and to join an online forum for diabetics and their families.
Personal attention keeps patients out of hospitals
Patient non-compliance is currently costing the American health care system an estimated $290 billion every year. That number will only grow unless we improve patient engagement in self-care. Many factors have been identified as contributing to patient non-compliance. In this scenario, we tackle several of these issues.
Poor communication between patient and provider has been identified as one component in patient non-compliance. This is why we have given our patient a choice between visiting his GP or meeting a nurse practitioner in an environment where he feels more comfortable. The nurse practitioner serves the dual role of educating the patient and providing one-to-one support for someone who has just received a life-changing diagnosis. By staying in touch over time, she fosters a positive patient/provider relationship that can lead to greater trust and hence greater compliance.
Next, we are making sure to involve our patient in his own care planning. He is provided tools such as electronic reminders and an app-based nutrition diary to help him stay on track. By monitoring medication usage, diet, and exercise via the health management system, Phil's care team is able to intervene if he is not following his care plan.
Finally, we are taking full advantage of modern multi-media resources for educational purposes. Being well-educated about one’s condition, medications, and long-term prognosis can help patients stick to their care plan. Since not all patients absorb information in the same way, our scenario uses a mix of articles, videos, game-like challenges, live classes, and online interactions with peers to keep him motivated.
The future of health care
Health care is looking to technology to boost efficiency and thereby lower administrative costs. Some in our industry worry this will detract from doctor/patient relationships, forcing doctors to spend more time staring at computer screens and less time interacting with patients. However, our scenario demonstrates how technology can actually increase personalization, contributing to higher patient satisfaction and better clinical outcomes. Nothing presented in our story is far-fetched; in fact, most of these technologies are already in use or under development in pockets across the nation. Our challenge is to identify and proliferate those innovations that most benefit the health care system as a whole: patients, providers, and payers alike.

The article is republished here with the authors' permission. The article was first published here
Author
Dr. Vicky Parikh
Healthcare Executive who combines clinical, public heath, and data management knowledge and success, transforming healthcare systems and improving delivery and quality. Leads continuous improvement processes, creating fundamental change in healthcare industry with new value-based care delivery systems, innovative collaborations, and partnerships for a sustainable healthcare model. Strives to improve quality of healthcare while lowering costs. Specializes in advancing efforts in population health and care delivery models, addressing increased healthcare costs and improving quality of patient care.
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