Emerging Healthcare Delivery Paradigm for the 21st Century

6/30/08

The current U.S. healthcare system faces serious challenges on multiple fronts. Although the United States is considered the best place for patients to obtain accurate diagnoses and high-quality treatment, nearly 45 million Americans do not have health insurance. Healthcare expenditure in the U.S. has more than doubled from $966 billion in 1994 to $2.2 trillion in 2007. New and increased use of prescription drugs, imaging, and other therapeutics has contributed to a substantial rise in healthcare expenses in the last several decades. These expanding costs, along with the rapidly increasing number of retirees and people with chronic disease, make the current healthcare system unsustainable. Thus, transformation is direly needed. New technology and advances must not only improve care but also be cost-efficient. The delivery system must increase its emphasis on prevention and screening rather than end-of-term care.

Distributed Diagnosis and Home Healthcare (D2H2) is a new delivery framework to transform healthcare from a central, hospital-based system to one that is more patient-centered, distributed, and home-based. The vision is that D2H2 will benefit patients and society by improving the quality and convenience of care—controlling healthcare costs and increasing access to affordable and effective healthcare.

Technology will be the pulling force into this new era of healthcare and its delivery. How to address key non-technical challenges in D2H2 (e.g., stakeholder’s resistance and insurance reimbursement) and manage the process of unleashing technological advances will be critical to its success. Moreover, success is dependent on bridging the “valley of death” in technologies for D2H2 and creating a dynamic and entrepreneurial environment and support system for translational research, and closer ties and collaboration between researchers, engineers, industry, clinicians, and healthcare organizations.

Point-of-care diagnostics is one of the key technologies that will enable the realization of D2H2. Its benefits include its portable nature and use of smaller volumes of reagents as well as shorter wait time and the possibility of home use. To fully support the new healthcare vision, the point-of-care diagnostic technology must be accurate and economical, both in production and use. Also, a necessary feature of these point-of-care testing devices will be their interoperability with electronic health records (EHRs).

Another enabling technology at the forefront of the new era of distributed healthcare is home devices. Home monitoring is becoming a necessity today (and increasingly more so in the future) partly due to the aging population and the rising number of patients with chronic conditions. Home devices should be designed to help in prevention of unhealthy behaviors as well as crisis detection and monitoring the health of chronically ill patients outside of the clinical setting. In order to be used by the consumer effectively and correctly (e.g., patient, home nurse and relative of patient), these devices should be easy to operate and robust against environmental variations, operator dependencies and errors.

The Internet is another enabling technology that is critical. It is sometimes seen as the link between other D2H2 enabling technologies and the clinic. Integrating these systems into the clinical workflow has been projected to be a large contributor to the transformation of the current healthcare system. Other major pulling forces behind the need for distributed diagnosis and care in the form of EHRs and personal health records (PHR) are the need for faster diffusion of medical knowledge, the need for reduction of medical errors, duplication of tests and misdiagnosis, and the need for more comprehensive knowledge bases of healthcare information. Although there are many EHRs and PHRs already developed, most require the manual, repetitive input of information, which can lead to no or slow adoption due to the increased workload and the workflow impediment of system integration into the clinic.

This new healthcare delivery system will introduce a new patient-doctor relationship based on partnership, where the patient will be involved in their healthcare more actively by being responsible for data collection and managing their health along with the provider, and where the provider-patient interactions in the clinic will have room for more decision-making and discussion. The overall healthcare system will be patient-centered, where the provider can be an overseer and aide to the patient in his/her more informed healthcare decision-makings and proactive management.

The era of a new healthcare delivery system is on the horizon, and stakeholders from government, industry, and academia as well as employers, insurance companies, care providers, and individuals need to come together to define a smooth path towards D2H2. By various stakeholders collaborating on D2H2 and its implementation and deployment, this new paradigm can be realized faster and rising healthcare costs contained, along with improved quality of care for the increasingly aging and chronically ill populations. To facilitate a smooth transition into increasingly distributed healthcare delivery from existing hospital-centric care and to balance the resources and care, carefully thought-out incentives, policies, and strategies need to be developed, tried, and optimized. Emphasis on early detection and prevention needs to be valued as well as ease of use and monitoring in the development of enabling or disruptive technology and integration into clinical systems. Interdisciplinary research and collaboration needs to be encouraged and supported in various ways to facilitate a quick transfer from clinically-useful technology developed in the laboratory to widespread clinical use via commercialization.

I believe that D2H2 is the most reasonable solution to overcome the crisis in current healthcare delivery, and that this new paradigm—with all the stakeholders working together toward the common and societal good—will aid in developing a sustainable 21st-century healthcare system with the potential to improve accessibility to healthcare, increase care quality, and control healthcare costs.

Dr. Yongmin Kim is Professor of Bioengineering, Professor of Electrical Engineering, and Adjunct Professor of Radiology and Computer Science and Engineering at the University of Washington, Seattle. Follow @

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