June 11, 2019

Why don't we have robo-doctors yet? Blame 'nostalgia,' these researchers argue.

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    "It seems nearly everyone believes U.S. health care needs some transformative change to improve quality, expand access, or lower costs," but efforts to bolster access to primary care doctors is "the wrong path," David Asch and colleagues write for the Harvard Business Review. The right answer, the authors contend: Bots.

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    Asch, a professor and executive director of the Penn Medicine Center for Health Care Innovation co-authored the article with Sean Nicholson, professor of policy analysis and management at Cornell University, and Marc Berger, former VP of real world data and analytics at Pfizer.

    How bots could change health care

    To make their point, the authors point to changes in the banking industry. They explain that banks in recent years have made their services more accessible to consumers not by increasing access to human bank tellers—who used to handle the bulk of interactions—but by adopting ATMs.

    This same principle can be applied to health care, the authors write. "There's no technical reason why a variety of common medical conditions—high blood pressure, diabetes, high cholesterol—can't be managed by a bot and overseen by a nurse with support from a physician only if needed," they write.

    This would allow physicians "to direct more of their time to where they're really needed," the authors write.

    The key problems to solve

    The authors write that they believe the main resistance to "bots" in health care is based in "social conventions rather than our technical limitations," and that there are at least three problems to solve to facilitate bot adoption.

    First, the insurance industry needs to be better-equipped to reimburse hospitals based on new approaches, the authors write. As it stands, insurers have a difficult time determining whether care was actually needed or delivered appropriately, so they use "proxy process measures," such as whether the care was face-to-face, or whether the right kind of clinician was present.

    "Without a measure of what's good, insurers have found it easier to insist that care be delivered in traditional ways," the authors write. "It's hard to explore new and potentially better models of care when only old approaches get reimbursed."

    Second, the regulation of insurance and clinician licensure needs to change to reflect the fact that the best care is not always the care delivered locally, the authors write. For example, someone in Wyoming may benefit from care delivered by someone outside the 1,000 providers in that state, the authors write, potentially by a bot that isn't necessarily a doctor licensed to practice in Wyoming.

    Third, the standards of safety and efficacy applied to pharmaceuticals should also be applied to automated health care approaches, the authors write. "Even if we think a bot can help manage hypertension, it doesn't mean any bot can do that," they write. "The organizations that credential clinicians might find they are well suited to credential robots."

    "If there is a fourth problem," the authors write, "it is our sense of nostalgia." While some doctors may find the appeal of a time when they would care for the entire family, new approaches to health care would "shift [the appeal of that image] toward those elements of care that can't as easily be handled by machine."

    There are "a combination of technical limitations and social conventions" preventing the introduction of these changes to health care, the authors write, but "social conventions present the greater obstacles," the authors write. If we are to have transformational change within the health care industry, "we must find ways to move past approaches to facilitate care with doctors toward approaches that facilitate care without them," they conclude (Asch et. al., Harvard Business Review, 6/4).

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