February 2013

Volume 28 Number 02

Don't Get Me Started - What's Up, Doc?

By David Platt | February 2013

The Internet hasn’t notably cracked the health-care industry yet. It’s nibbled around the edges a little bit—for example, I can renew prescriptions online instead of phoning them in—but it hasn’t fundamentally changed the business model or the relationships between the players as in other industries. I’ll begin my fourth year as MSDN Magazine’s resident Diogenes (bit.ly/Xr3x) by predicting how it soon will.

The forces currently tearing apart the structure of higher education are also gathering in the medical industry. Health care in the United States consumes about $3 trillion per year, approximately one-sixth of the U.S. gross domestic product. The providers are partying like it’s 2006 and costs are spiraling. The population is aging and getting fatter; the boomer bulge is making its way through the demographic snake. Disruptive technologies are ready to rock. Unstoppable forces are slamming into immovable objects. Something is about to give.

Why hasn’t it happened yet? Partly because of the medical establishment’s famed inertia. Consider Ignaz Semmelweis, the 19th century Viennese obstetrician who lowered maternal mortality by 90 percent, simply by insisting that doctors wash their hands before examining childbirth patients. As reward for this spectacular improvement, his colleagues threw him into an insane asylum where he quickly died (see bit.ly/SO3jd4).

Perhaps faster technological change in medicine had to wait until kids who grew up with the Internet had finished medical school. That’s starting to happen now. A young doctor who attended a class I taught on Microsoft HealthVault told me: “My kids’ babysitter makes better use of the Internet in her business than we do here at [a major teaching hospital]. I’m here to learn how to fix that.” The tipping point where these guys accumulate enough power to change things is not far off.

Last month I explored how massive open online courses (MOOCs) are successful in education because they combine higher quality with lower cost. This virtuous combination is now approaching for the medical industry. Consider your child waking up saying, “I don’t feel good.” Instead of schlepping to the doctor’s office, suppose you could talk to a nurse on a Skype video link.

The world’s finest doctors would work out the diagnostic protocols for a sick kid, and a software wizard would walk the nurse through it. She would have trained extensively on this specific scenario, using excellent simulators, so she’d be an expert on it. The programs would continuously update the diagnostic probabilities based on the latest results seen in the local area, making her more current and precise than an unaided pediatrician today. Yet her time would cost far less than that of an MD.

What’s more, you would own a small instrument to measure and transmit your child’s temperature, blood pressure, pulse oxygenation and other vital signs. A camera on the instrument would transmit pictures of the throat or ear canal or skin rashes, and a microphone would transmit breath sounds and heartbeats. All this is under development, with prototypes already emerging and first commercial releases within the year (see econ.st/X5mq3e). Perhaps algorithms could compare the pictures and sounds you transmit to every other captured sample. Doctors wouldn’t misdiagnose diseases such as measles (which is rare in the United States) because they had never seen a case.

Patients with viral infections would be told to stay home, keep warm, take Tylenol and call back if they didn’t improve. Patients with bacterial infections or more severe symptoms would have prescriptions transmitted to a pharmacy for delivery that day. You wouldn’t have to take the whole day off from work to drive your kid to the doctor and exchange germs with everyone in the waiting room.

Patients with more serious conditions, or conditions that can’t be evaluated over the wire, would get appointments with the doctor that afternoon. Each doctor’s time would be far better utilized as well—mornings for follow-ups, afternoons for new cases from the Web nurses.

Just as the education industry will still need mentor classes for advanced topics, the medical industry will always need specialists and surgeons for when people get really sick. But the mass of day-to-day grunt work will be automated faster than anyone imagines, in the same way and for the same reasons as the teaching of freshman calculus is being transformed today.

The medical industry’s dam hasn’t yet cracked the way the education industry’s has. But there’s far more force building up behind the medical dam. The burst will be all the more spectacular when it comes, with concomitantly larger profit opportunities for developers and companies who are thinking forward. Call me if you’d like to discuss it.

David S. Platt teaches programming .NET at Harvard University Extension School and at companies all over the world. He’s the author of 11 programming books, including “Why Software Sucks” (Addison-Wesley Professional, 2006) and “Introducing Microsoft .NET” (Microsoft Press, 2002). Microsoft named him a Software Legend in 2002. He wonders whether he should tape down two of his daughter’s fingers so she learns how to count in octal. You can contact him at rollthunder.com.