Will Future Medical Technologies Make Hospitals Obsolete?
Edition: September 2001 - Vol 9 Number 09
Author: Jennifer Hense Moorehouse
To get an idea of how technology in development now may change health care in the future, think about tuberculosis. The development of streptomycin and isoniazid in the 1940s completely changed the medical protocol for treating TB, and most tuberculosis sanatoriums closed. Now TB is typically treated at home. Could open heart surgery be the tuberculosis of 2006? Could stroke?
Yes, according to futurist Joe Flower. ''Hospitals are now in the position of tuberculosis sanatoriums of 50 years ago, because new technology may render large parts of their mission unnecessary,'' he says.
Flower, a speaker at the Health Industry Group Purchasing Association 2001 Medical Technologies Forum earlier this year, is the founder and principal of The Change Project.
Although skeptics scoff at the idea of a ''silver bullet'' for any given diagnosis, Flower cites four bona fide revolutions in health care: antisepsis, anesthetics, X-ray imaging and antibiotics. ''Everything else has been incremental,'' he says. ''But these four times, it was something so big that it changed the way medicine was practiced.''
And there's more to come, he says. Here are a few examples of the advances Flower is monitoring:
Genome-Based Medicine. Of all the technologies in development, cell biology, including genome-based medicine, may have the largest effect on the greatest number of people, says Flower. ''We are looking at the possibility five years out 10 years out of a no-judgment diagnosis, where we can run a sample from you through a gene chip through one of these protein machines and tell you absolutely that you do or don't have a specific disease.'' Flower also notes the possibility of patients getting a customized prescription based on their gene card and the life-long health profiling that becomes possible as a result.
Heat Shock Proteins. Heat shock proteins will potentially enable creation of a therapeutic vaccine customized for an individual cancer patient. What makes it a vaccine is the fact that the agent killing harmful cells is not the chemical, but the body's own immune system in response to the chemical.
AGI-1067. AGI-1067 is a molecular agent that has completely prevented atherosclerosis, or hardening of the arteries, in clinical trials with monkeys, says Flower. ''With that effect on humans, it could prevent most heart disease and half of all strokes,'' he says. Flower adds that AGI-1067 is now doing well in the second stage of human testing.
Information Technology and Robotics. The range of IT options is vast from CyberKnife® stereotactic radiosurgery technology, now available for otherwise untreatable brain tumors, to wheelchairs that climb stairs, messenger robots, robotic vacuums and continuing development of the pharmacy robots now available to count and pour pills with flawless accuracy. Flower also mentions ''bots,'' which can use the Internet to do procurement work. ''The robot can dicker, haggle, and turn its nose up to a deal and walk away.''
Many of the technologies mentioned by Flower may be developed for home use. For example, advances in nanotechnology (building technologies on a tiny scale) and molecular electronics may allow development of a home-health device like the Star Trek ''tricorder'' within a few years.
Implications for Hospitals
''Health care administrators need to become knowledgeable about areas like bioinformatics, genomics, life extension such as artificial hearts, and nanotechnology,'' says Tracy E. Strevey, M.D., a physician consultant at Cape Girardeau, MO-based Health Services Corporation of America, who followed Flower's presentation with a panel discussion on ''The Cutting Edge of Physician-Preference Items.''
Strevey predicts a major shift from surgery to catheterization labs, with increasing use of stents. ''The incidence of surgery will go down, even as the population ages, because of other ways of treating problems,'' he notes.
Even outside of cardiac services, hospitals may see many areas of current business change or disappear. One area Flower expects to stay in-house is imaging. ''Imaging is a natural business for hospitals, because it takes big iron, staff and institutional capacity,'' he says. ''It could be the glue that keeps the hospital of the future together with the physicians.'' But, he says, traditional imaging is getting smaller and moving off-site, as are other types of diagnosis and treatment, especially chronic disease management.
Adds Strevey, ''What's a hospital going to look like when it has no diabetic inpatients anymore?''
Early Warning Team
''Imagination is much more significant than knowledge if we are trying to think about the future of health care,'' Flower says. ''We have to begin to imagine what impact these technologies are going to have on us.''
To prepare for revolutionary changes, providers should establish a strategic early warning team, says Flower. This team consisting of the CEO, another high-level staff member, and a consultant whose job is to research developing technology need to talk regularly and provide a quarterly report to the board and top officers. Strevey suggests a similar model, including practitioners, administrators, an outside consultant and possibly a genetic engineer or nanoengineer.
Flower says the team then needs to answer some key questions:
How real is this technology?
What can we tell from the research so far?
How far out in the future is it and what form might it take when it arrives?
Furthermore, the group needs to evaluate strategies for each specific technology, such as:
Should the provider adopt the technology?
Should it create a new organization around it?
Should it establish regional access to it?
A hospital that has done an early strategic evaluation will be much more prepared than its counterparts, which may see business erode as a result of key new medical advances, according to Flower.
Jennifer Hense Moorehouse is an Eau Claire, WI-based correspondent for First Moves Magazine, the new, materials-management magazine published by MDSI, publishers of Repertoire. This article first appeared in First Moves 8/2001.