Break the doctor-patient visit stranglehold on health care innovation

TThe electric motor, invented in 1834, was touted as a performance stimulator that would revolutionize manufacturing. However, it was three decades before it had a real impact.

When factories replaced steam engines with electric motors but left in place systems built on the old steam transmission, electricity did not offer new efficiencies. Only when factories were designed from scratch, with production lines deliberately built for the electrical era, did manufacturers achieve tremendous productivity growth – up to 90% – with the introduction of new production lines.

In health care, the equivalent of replacing a steam engine with an electric motor is to relieve the compression of doctor and patient visits.


Say you are a single mother trying to cure your diabetes. For you, routine health care is sporadic and time consuming. Going to the doctor often means a break from work; payment for parking or public transport or Uber; waiting; passing a series of tests that give a single picture of your condition; and look forward to more. The grand finale is a short conversation with your overworked doctor who has little time to discuss everything you have encountered since your last visit.

For the “privilege” of visiting a doctor-patient you may face significant out-of-pocket costs if you have a high deductible.


Now imagine a scenario based on technology that already exists: after your initial diagnosis, your provider can remotely monitor your blood sugar. If a pre-programmed tool detects an increase, it would send a ping to a member of the care team who could call you or start a text discussion to find out how you are doing without having to bring you to the clinic. The nurse can decide if you are taking the medication, call if needed, and discuss options for how you can pay for it. If you need information about taking medication, your pharmacist can call and consult at a time convenient to you. The nurse can also ask you about things like stress and diet, and give recommendations for online resources or referrals to nutritionists online.

If your blood sugar is not back under control, only then would you need to go on a personal visit to the doctor and patient.

Creating a path to digital innovation

Allowing a simultaneous doctor-patient visit to maintain healthcare means losing tremendous opportunities for digital innovation. The health care system should make the most of new technologies that allow clinicians to communicate with their patients on patient terms, meeting them where they are. This means making the most of new data sources that can be passively recorded using sensors that measure movement, respiration rate or blood sugar, and use the power of modern computing to analyze and get an idea of ​​unique patient experiences.

Using the full range of communication and digital health technologies available today, care can be built around the patient rather than the clinic. Interrupting the focus of a personal visit means being able to measure health care by how little people need and how much they can stay healthy, rather than how much health care is consumed and even how good clinicians help cure patients. Reengineering clinical workflows and health care systems can get the most out of each member of the medical team by minimizing the time patients have to spend in physicians ’offices and ensuring that they receive the best care.

The pandemic has added to the urgency of addressing the issue of time spent in doctors’ offices. Covid-19 has led to overcrowding of emergency departments and overcrowding of physicians, and has demonstrated that a more data-driven approach can improve the lives of patients and clinicians caring for them. As the pandemic continues to rage, now is the time to use these tools and skills to make a more permanent commitment to more holistic patient health management and the health of clinical staff.

Production had to wait decades to turn into an electric motor because the effects of this innovation were blunted by the preservation of existing systems. There is no such time in healthcare. Under the long shadow of a pandemic, it is urgent to build care around patients, not clinics. This requires a shift to a continuous, team-based model of care that uses technology together with relevant clinical and preclinical professionals to address crises of quality, safety, access and equity.

Innovative providers are leading this transformation, gaining growing investment in digital health to re-create care systems in the digital age. But while leading innovators will put pressure on the traditional system to evolve, fundamental changes will require new payment incentives that match this approach to health care and recognize the value in new approaches to care provided outside clinics.

Health care is at a turning point, which could leave behind the people who need it most, and further deprive the rights of doctors who have borne the brunt of this crisis. The scourge of the pandemic provides not only an opportunity to act, but also a shared responsibility to create new, sustainable structures that allow both patients for whom the system exists and the professionals on whom it depends to live healthier lives.

Jennifer Goldsack is the CEO of the Society for Digital Medicine. Sudjanya (Chini) Puluru is a family physician and senior director of clinical transformation at Walmart Health and Wellness.

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