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THE END OF FACE-TO-FACE DOCTOR VISITS?

Intel Medical Director Calls for Disruptive Change

Over the last decade, Intel, the world's largest manufacturer of computer chips, has been aggressively expanding into the business of virtual health care delivery and coordination both here and abroad.
In a partnership with GE, the chipmaker now offers hospitals large-scale remote health management systems for regional populations; has joined with the Mayo
Intel telemedicine
For the last decade, Intel has been pioneering telemedicine systems that substitute virtual connections for face-to-face doctor visits for entire patient populations.
Clinic to launch a telehealth home-monitoring system for chronically ill patients; and uses its own workers as a test bed for interactive workplace wellness centers where digital sensors collect and upload employee workout data.

The company is the co-founder of "mPowering Frontline Health Workers," a US Agency for International Development project that fosters increased use of mobile health technologies in developing countries. And, in related projects in China, India, Brazil and the Middle East, Intel is involved in telemedicine pilots focused on refining "high volume routine care" systems that largely eliminate the need for face-to-face visits between doctors and patients.

Intel is not so much focused on developing any one of the broad array of digitally-based products now being used throughout health care. Rather, it is pursuing the business of combining all those computer systems -- from central IT operations and medical records systems to the web, email, smartphones, iPads and remote body sensor technology -- into a single coherent electronic environment through which all elements of the patient/delivery system relationship are tracked, controlled and coordinated across entire patient populations.

It was against the backdrop of this strategic vision and marketing activity that Intel's Worldwide Medical Director Mark Blatt, MD, MBA, appeared as a panelist on the "Physician Restructuring" session of the 2012 Wharton Alumni Health Care Conference.

He kicked his remarks off with a homey anecdote detailing how he was personally able
A 5:06 video excerpt of Mark Blatt's remarks at the Wharton Health Care Management Alumni conference. Or, click here for larger video format.
to cut health care costs 90% by dealing with primary care patients over the phone.

The former managing partner of a five-physician family practice in Connecticut remembered back to the mid-1990s and the first time he worked on-call to cover for 12 primary care doctors during a holiday weekend.

"I probably had 200 phone calls between seven a.m. and noon and you basically have to figure out how to triage these people," Blatt said. "By noon I had 'taken care of' more people than I did in a whole week in the office. I had probably done something substantive for about 80% and around 20% of them needed some sort of followup test or care. I sat back and realized this was not a bad idea. It wasn't just improving cost savings by three or four percent -- it was actually changing the care into an affordable product."

'unaffordable product'
"The fundamental issue we're all facing with healthcare is that the product we offer is unaffordable," said Blatt. "The entire healthcare industry is in a bubble and America is the worst example of it. I don't want you to think about how we can bend the curve and grow from 18 percent to 19 percent of GDP more slowly. Tell me how we're going to grow from 18 percent to 14 percent of GDP. That's innovation -- and while you're doing it, double the number of people you care for. I'll call it Moore's law for healthcare. Let's double the number of people we see and cut the cost in half. That to me would be innovation and that fundamentally means we have to redesign the system."

"Our doctors are going broke," he continued. "They are the biggest consumers of small business loans to maintain their lifestyle. Even at consuming 18% of GDP, they still can't charge enough to pay for their fixed cost infrastructure. We have the world's most unaffordable fixed cost health care infrastructure. So it makes me crazy when people say 'The IT has to support the workflow.' The workflow is broken. Let's throw it out. Let's start all over again and redesign what might be a sensible workflow for actually dealing with patients."

The workflow approach Blatt advocates is one that merges nearly all of digital technology's evolving trends into coordinated communications and control matrices engulfing and connecting entire communities of clinicians, care facilities and patients across any given region.

Superiority of computers
"Coordination is the fundamental problem," said Blatt. "In the National Committee for Quality Assurance (NCAQ) standards for patient centered medical homes, 20 of the points are about care delivery, 80 others are about how to coordinate care, how to empower patients, put in tracking systems, establishing e-prescribing and communications systems. And quite frankly, tools like computers are going to help you do it more effectively. They're better at pattern matching and they're better at remembering than we'll ever be and they're better at giving you the knowledge you need."

"To make this all work, he said, "we need a team approach but we don't teach doctors to be team members. We don't even teach most nurses to be team members but we're starting to get the idea that coordinated teams, comprehensive information and data exchanges, and data available everywhere is what's important. We need to keep people out of the hospital, out of the emergency room and probably even out of a family doctor's office and treat them in a more virtual setting."

"We already have the tools to do that," Blatt said. "Most of you have a smartphone which is capable of video communications with anyone anywhere on the planet. How many times have to you been to the doctor in the last year when he didn't touch you?"

Confusion at your doctor's office?
"Did you ever show up to a specialist and he doesn't know why you're there because the primary care doctor didn't tell him?," said Blatt. "Did your doctor's office ever call you and say 'Come in and I'll tell you your test results,' but when you get there no one can find the test results?"

"We practice healthcare the same way we did -- not in the twentieth century but the nineteenth century," said Blatt. "We can't afford to continue to see patients one at a time face to face. It's a completely outmoded method. We need a disruptive change."

"You don't lower the cost of delivering the service by building bigger and bigger buildings," he said. "Let's really redesign the care -- but that will be painful; the jobs people do are fundamentally going to change and people hate change. They certainly don't want to change what they think they went to school to become. I went to med school because I wanted to be Marcus Welby and I'm here to tell you Marcus Welby is dead and I'm over it and I can deliver care differently."

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Hoag Levins is a journalist and managing editor of The LDI Health Economist. hoagl@wharton.upenn.edu

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