The Future of High-Tech Health Care — and the Challenge

Demos, talks and a paper-plate dinner buffet were the fare last Friday evening at the Computer Museum in Mountain View, Calif., and the subject was the high-tech future of health care. The gathering was hosted by FutureMed, a health-care program that is part of Singularity University, a networked organization dedicated to exploring how disruptive technologies can sweep across whole industries and society.

The technologies on display were impressive, often inspiring — like the wearable-robots, or mechanical exoskeletons, made by Ekso Bionics, to enable people with spinal cord injuries to walk again; or I.B.M.’s Watson question-answering computer that is being morphed into a doctors’ smart assistant.

Dr. Daniel Kraft, executive director of the FutureMed program, pointed to a series of fast-changing technologies including biotechnology, nanotechnology, robotics, artificial intelligence and the surge in new data to mine for insights, or Big Data. “Exponential technologies are all around us,” Dr. Kraft said.

Dr. Martin Kohn, chief medical scientist at I.B.M. research, sketched out the future path in health care for the technology behind Watson, the computer that last year outwitted the best human players of Jeopardy!, the TV question-answering game. “You’ll not be surprised to learn that the executive leaders of I.B.M. fairly quickly decided that playing Jeopardy! was not a long-term business model,” Dr. Kohn told the audience of a few hundred people.

But the core transferable technology, Dr. Kohn explained, was the artificial intelligence software that made it possible for Watson to read and understand 200 million digital pages, and deliver an answer within three seconds. In health care, Dr. Kohn said, “we are overwhelmed by information. And we’re only as good as what we know.”

So Dr. Watson, it is.

Watson, he added, is not going to make diagnoses, not give a physician a single answer, but make suggestions, recommendations and determine probabilities. The more information Watson is fed, Dr. Kohn said, the more it learns and understands, in its way.

One area where the technology’s learning and recommendation capabilities may be particularly useful is in determining treatment regimens for patients with more than one chronic condition. And such patients account for a large share of the nation’s health care costs.

There are well-defined treatment guidelines, Dr. Kohn said, for individual conditions like heart disease, diabetes, asthma and emphysema. But the guidelines are far less helpful for patients with more than one condition. For example, a beta-blocker drug is good for heart disease, but bad for asthma, Dr. Kohn noted. What are the trade-offs and what are the probabilities?

Watson, Dr. Kohn said, can “really help us learn about these multiply-challenged patients.” In general, he added, Watson can be a powerful tool in moving toward the long-sought goal in health care of making more decisions based on data and a surer grasp of the relevant scientific evidence — so-called evidence-based medicine — instead of experience and intuition.

The Watson technology, Dr. Kohn added, has the potential to be a “profound enabler of the transformation of health care.”

As do some of the other technologies displayed at FutureMed. But whether that happens or not, I’d suggest, has at least as much to do with economics and policy as technology.

Let’s take Watson as an example. It’s first big test-run in health care is with Wellpoint, an insurer. I know, I know, there are no “insurers” anymore, only health management organizations. But an insurer makes money by maximizing revenue — premiums — and minimizing expenses — procedures, lab tests, hospitalizations and treatment.

Watson will do what it’s programmed to do. Eliminating unnecessary, and often repetitive, medical tests is a big cost-saving target — and a good one, for patients and for health-care budgets. But the research on this subject has concluded that about half of patients get too much treatment and about half get too little.

The notion that a technology like Watson, if unbiased, is going to reduce health care spending significantly seems misguided. But such technologies can make a useful difference if the right economic incentives are in place. And that, of course, is what the drift toward “accountable care organizations” is about. That is, a system in which doctors, hospitals and insurers are paid for helping people live healthier lives.

If that happens, the nation’s health care bill won’t necessarily fall. People living healthier and presumably longer lives will be consuming health care services for more years. But at least the money would be spent more wisely.

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