Patient Perspectives: The system is squandering value in medicine

3 min
July 16, 2014

Times like these call for real disruption

Getting disrupted teaches you a lesson about power dynamics and value. Thirty years ago I was disrupted. I was a hotshot in typesetting machines. We made great machines, we were good at it, we knew fonts, we had software that put hyphens in words(!), and we knew page layout. Then along came the Mac, Pagemaker and LaserWriters. The product quality was appalling, used by ignorant people who didn’t know a thing about typesetting. Yet within ten years the industry as we knew it was dead, replaced by a radically restructured ecosystem of software, hardware, vendors and workflow. The value system of our day was replaced by a new one, which evolved in response to consumer values.

To understand and predict a consumer driven shift, look for a genuine change in the flow of value. This is a diagram from the 2012 Institute of Medicine (IOM) report Best Care at Lower Cost of healthcare delivery value today – a leaky pipeline:

Our current healthcare pipeline spills way too much. If you’ve had a subpar experience as a patient there’s a good chance it could have been better, but our system dropped the ball – potential value leaked out before it got to you. Or your child. Or your mother. In economic terms: value is too often not reaching consumers. And that’s why, in that same report, the IOM said our future system must be “anchored on patient needs and perspectives.”

In healthcare, patients are the ultimate stakeholders.

If you’ve ever had a medical crisis, you don’t need to be told that outcomes matter. You know how important it is that value reaches a patient’s bedside, but often fails to do so. Interoperability – the ability to move data around – has the power to spawn innovation and create a new market power in service of patients.

Here’s a different view of the flow of value in our healthcare system, a parallel approach to the previous figure from IOM. Look how information and awareness drive a completely different path:

IOM Figure 2

  • Consumer self-awareness lets patients know their status by using Glucose monitors, smartphone EKGs, wireless sensors and even pocket diagnosis devices. When you understand your health data, you’re empowered to act.
  • Peer-to-peer discussions about options and benefits will increase.
    • This is no threat to leading providers. It’s a threat to laggards.
    • It will be fueled by more data – on price and consumer likes. Yes, I said consumer likes. That’s not the same as industry-defined “quality.”
  • When consumers control their records, it gives them the opportunity to go where they want. This one’s a long way away, but it’s the big kahuna that will let value flow.

While the endpoint in this flow is patient-defined value, it’s also about rewarding providers who do their job at an honest price. That’s the dynamic that motivates innovation and transforms value.

Interoperability lets ecosystems grow – around patient needs.

To disrupt the healthcare industry you must start by standing in the shoes of the ultimate stakeholder and asking “What do I need? What could make a difference?” Right now, the answer is interoperability, and it’s impossible to achieve a smart healthcare system, complete with coordinated, connected and automated systems of care delivery, without first enabling seamless sharing of the vital information that surrounds the care of today’s patients.

As I say in my book, Let Patients Help, “People perform better when they’re informed better.” It applies to patients and clinicians. Interoperability lets your data, your child’s data and your mother’s data seamlessly connect to apps and other providers so that you, the consumer, are more aware and better informed. It also lets clinicians across health systems and provider networks access patient data all in one place.

Disruption hurts, but you don’t need to be blindsided. “Smart” evolves. As a patient, you can demand more value and less waste from our healthcare system. And if you’re in the healthcare business, you can see the future, understand what’s changing and get there ahead of the game.

Dave deBronkart (e-Patient Dave)
TED Talk: