Waiting and Innovating for 21st Century Healthcare

Eric Dishman

I rushed home in crazy, foggy traffic Tuesday evening to see the President’s State of the Union address. I had left work hours earlier to head to a doctor’s appointment that had taken me four months of delay to get. I showed up fifteen minutes early, knowing that I would have to do the “New Year” fill-out-the-paperwork-all-over-again-routine upon arrival. Sure enough, the woman at the front desk handed me a clipboard and a germy ballpoint pen, saying, “James, please fill this out and let me photocopy your insurance card.”

Once again, she called me “James” even though I have explained to them for nine years running that I go by my middle name “Eric.” Once again, I corrected their medication list that was at least five years out of date–which is baffling to me since I have corrected it each time I have come to the clinic. Once again, I sat in a cough-and-hack filled waiting room for over an hour after my supposed appointment time came and went, with the attendant’s voice repeating “the doctor will be with you as soon as possible” like the droning security announcements one hears at the airport.

Finally, I had my seven minutes with the doctor, who asked “James” a few questions, fumbled through a yellowed folder of paper lab work looking for my latest bloodwork numbers (which he never found), and typed a bunch of stuff in what appeared to be a software program from the 1970s. He never physically touched me during the entire visit. It could and should have been a five minute phone call. But this was the price to pay to get my prescriptions renewed, which he dutifully handed to me as I rushed out the door to the awaiting traffic jam.

I got home in time to miss all the pre-punditry and pageantry, just as President Obama was starting to speak, and just as my wife was finishing up a frustrating call with her own doctor’s office trying to find the results of some routine tests she had gone through the week before. My wife sat beside me in a rage because the nurse had finally told her that one of her test results was abnormal–but that this test is “often abnormal” so the doctor wants to do a series of other tests–but that my wife would have to schedule an appointment with the doctor for any further information because the doctor doesn’t have time to do phone calls.

Then we sat together listening to President Obama lay out his vision for American competitiveness and the need for innovation and investment for us to compete in the global economy. And I about literally fell out of my chair at the point in which he talked about the importance of building out a next generation internet infrastructure: “This isn’t about faster Internet or fewer dropped calls. It’s about connecting every part of America to the digital age. It’s about a rural community in Iowa or Alabama where farmers and small business owners will be able to sell their products all over the world. It’s about a firefighter who can download the design of a burning building onto a handheld device; a student who can take classes with a digital textbook; or a patient who can have face-to-face video chats with her doctor.”

On any day of the week, I would have celebrated this important soundbyte, given my ongoing advocacy for using 21^st century technologies to redesign our healthcare relationships and responsibilities. Electronic care–or “e-care” as many of us have come to refer to it–must be a part of reforming our healthcare system, and there is enormous potential in leveraging information and communication technologies to drive better healthcare quality, cost, and access. But to hear that sentence from the President on a day in which both my wife and I struggled to be educated, empowered, proactive patients up against a healthcare infrastructure still stuck in the days of fax machines and a healthcare business model premised upon face-to-face visits for every care encounter…well, it was lucky serendipity at least, and I’ll take it as a more fate-full sign of positive things to come!

The speech may not have been the President’s “most inspired”, but looking back on it, I think it may be one of the most important and serious. We have to wake up as a nation to the fact that we are not on a path to compete in a global economy for inventing the next generation of transportation, education, or healthcare systems. We have to recognize that, at this moment, we no longer have the educational base, the scientific edge, or the economic power to be the leader of “what’s next” as we have so often been in the past. We can get there again, but not without changing our plans and attitudes.

In the case of healthcare, we’ve got to stop the polarizing and misleading rhetorics around “government takeovers of healthcare” versus “evil insurance companies” and realize that America has to get its competitive act together to invent and invest in a 21^st century healthcare system. Much as we face Global Warming, we must deal with Global Aging, which presents us with both threats and opportunities. We have the opportunity and, indeed, the strategic imperative ahead of us to invest in new technologies and industries that will enable a global, 21^st century healthcare system. We can and must reform our own healthcare system amidst serious economic crises we will face due to Global Aging; we can and must create a lot of new jobs and industries for ourselves along the way.

What concerns me the most in the media cycle following the President’s speech is the cynical characterization of his call for “investment” as merely a smokescreen for “spend, spend, spend.” There is no doubt that we have hard decisions to make about how to deal with the deficit, how and where we allocate our resources, where we cut spending, and where we increase spending to invest in strategic capabilities that help our country grow new industries, markets, and jobs. We can certainly neither “tax and spend” endlessly, nor “slash and burn” recklessly.

But investment means more than spending. It means choosing key areas to try to grow–informed by data, a strategy, a plan, and a means of determining returns on that investment over time. As we revise and improve the health reform bill, we need to move from a “reform” mentality to an “innovation” mentality about healthcare. We need government, education, industry, and the not-for-profit sectors to develop an investment plan and strategy that achieves our urgent cost, quality, and access goals for healthcare while also opening up new markets for American goods and services. Innovating 21^st century healthcare–the largest sectorof every economy and an issue important to every one of us–can generate our next Sputnik moment, if we decide as a nation that we want to lead again–and hold our elected leaders accountable for showing great returns on our national investments.

Meanwhile, I’m going to go search for a new doctor–one who is ready to do secure email and video visits with an empowered patient. I’m tired of waiting.