Are doctors an endangered species?

Probably not, but at the 2012 mHealth Summit's Tuesday morning Super Session, two presenters offered visions of a future of healthcare that, at the very least, might make some doctors nervous.

In “Pushing the Limits of Mobile Health – Can We Have Health & Healthcare Without Doctors?” Vinod Khosla, founder and CEO of Sun Microsystems, and Joseph Kvedar, MD, who launched Partners Healthcare's Center for Connected Health, painted compelling pictures of how mobile technology can and, in their view, will be used to render our healthcare system more efficient, more effective and much more consumer-driven.

Khosla began building his case for change by citing three problems with the current system.  First, he said, there is presently a great deal of misdiagnosis. Second, most Americans understand their health information at about a 5th grade level.  And, third, approximately 50 percent of doctors are below average.

As if he hadn’t painted a bleak enough picture, he also argued that humans have inherent cognitive limitations and are prone to a number of cognitive biases. In short, then, how could a system more reliant on computers not be an improvement?

Pointing to examples of companies that have begun to use technology to bypass doctors, he claimed “80 percent of what doctors do can be replaced by computers.” That said, he suggested that the first real wave of computer replacements will both be “trained” by the best doctors and serve as “toddler MDs,” or assistants to human providers.

In the end, he said, “computers can be cost minimizers while also being cost maximizers.” And he predicted that while he expected to be wrong on the specifics – the details of the future always turn out a little different from what futurists predict – he was confident that he was “directionally right.”

Kvedar approached the current need for change from a more pragmatic perspective, pointing out that “60 percent of costs in healthcare are labor,” and that the amount of, and growth in, chronic illness will inevitably lead to a shortage of doctors.

Moreover, he argued, computers are simply better at the algorithmic tasks that constitute a large share of a doctor’s activities, and greater reliance on technology will allow providers to spread their services across a larger population of patients.

One example of technology he considered promising are so-called “computerized relational agents.” In essence, these are robots used for administrative tasks such as reviewing discharge instructions with patients. Kvedar said that in early reviews of these technologies patients have preferred the relational agent to live humans, as they don’t feel pressed for time or embarrassed about asking multiple questions.

In a follow-up Q&A session, both Khosla and Kvedar predicted that change in the direction of “automated healthcare” was apt to come more from consumers than from within the healthcare establishment.