| | December 20208UTLOOKHealthcare Tech By Chris E. Stout, PhD, College of Medicine, University of Illinois at Chicago, Vice President, Department of Clinical Research and Data Analytics, ATI Physical TherapyMany years ago, I wrote a book on technology applications in the practice of healthcare. My! How times have changed--in some ways. One evergreen point that I'd like to reprise herein should be as much of a mantra as it is a cautionary tale. It is a quote from H. James Harrington, wisely noting that "automating a bad process not only ensures that we can do a bad job every time, but that we can do it faster and with less effort than before." Indeed. I have been my experience that it is not unusual that in medical practices that members may be split between Luddites and Evangelists (a.k.a. Early Adopters). That is, some may get giddy with the feeling of downloading the latest app, buying the newest gizmo, or establishing a following on the current social medial platform du jour, while others may prefer paper ledgers and an abacus. Thus, it's crucial for clinical leaders to both recognize such compositions/divisions in their practice as well as manage them. I have been a part of an acquisition of a smaller practice what relied on paper medical records, and (honestly) were fearful of using a computer. In fact, in trying to orient and train them to our systems, we found they did not have a "technology vocabulary" as we worked to help mitigate anxieties and provide training to our systems. (I suspect this is thankfully on the decline, but practice managers and leaders should be sensitive, aware, and empathic to differing technological skills and familiarity. Not every clinician is a power-user of all technologies.) I have worked more than three decades in healthcare and medicine, and throughout all that time, it has been pretty much a mess when it comes to third-party payment. I'd wager a guess that the hourly reimbursement for psychotherapy is pretty close to the same as it was when I started clinical practice. On the bright-side, most everything else has improved--technology, evidence-based practice guidelines, training, and so forth. The phenomena that are getting people's attention, as well as headlines, are the curious potential disruptors of Walmart buying Humana or the seemingly odd triumvirate of Amazon, Berkshire Hathaway and JPMorgan getting into the healthcare business. RetailizationYears ago, I recalled making the shift from going to my optometrist's private practice to a franchise chain. I experienced a greater selection of frames and options, ubiquitous locations that were all easy to get to and could access my optometric health record, and do all that at a lower cost. The fees are transparent, and in my case, I pay out of my (HSA) pocket as I do not have insurance coverage for such. Honestly, I did not miss having "my" optometrist versus the tradeoff of all the other features, and cost savings to boot. These kinds of "practices" can be viewed medical practice threats or opportunities depending on a practice's positioning and ability to innovate--or disrupt, a la Clayton Christenson. In a related vein, the President signed into law the Food and Drug Administration Reauthorization Act of 2017 which included the Over the Counter Hearing Aid Act (also known as the "do-it-yourself model for hearing care"). This, for the first time in history, allowed individuals the ability to directly buy their hearing aids without having first to visit a physician IN MY OPINIONData Transparency, Retailization and Disruption in Contemporary Medical Practice
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