"I have a small lump on my arm," you say. "I'm worried it might be a tumor."
So begins the video house call of the future, by a virtual doctor.
"Would you mind rolling up your sleeve and hold your arm up to the camera? ... I see, yes, I see it. Does it hurt when you press down on it?"
Step by step, the family doctor guides you through the steps to diagnose the bump under the skin of your forearm. Fortunately, it turns out to be a lipoma, a fatty and benign deposit.
"It's safe to leave it alone. Often lipomas will go away on their own. If it starts to grow or causes you any discomfort, let me know."
"Thank you, doctor."
You tap the screen to end the call. A text transcription of your doctor's visit appears in your medical records, along with a summary of the symptom and diagnosis.
Relieved, you scroll through your medical history, to convince yourself there really is nothing else amiss. You note the flu you had last year, identified by strain. Next to the strain ID, you tap on the map icon. A regional map appears, showing the spread of the virus, mostly located in your part of the country, with a scattering of incidents elsewhere, concentrated in metropolitan areas. You touch the back button.
At the top of your medical profile, your health status appears. Following the arrow beside it, you expand the display. Yes, you're in good health. Recommendations: get a little more sunlight. The GPS in your phone indicates that you've been spending too much time indoors during daylight hours. Also, you missed your workout three days in a row and have been sitting down too much.
To improve your personal health score, you can take 15 minutes right now and add another 15 points. Your hyper-competitive officemate has shared his score with the others on your team, because he's trying to lose weight. You can see that he's only a few points ahead of you. If you do go for a walk, you can pull ahead of him. He won't know, because you haven't shared your health score with him. Unlike him, you prefer to keep yours private. Chances are, he won't guess that you're paying attention. If you do get a little exercise, you can chide him for slipping up over the weekend. He has set a personal goal to raise his score by another 100 points by the end of the month.
House calls via video chat, detailed medical records, disease outbreak maps, health status reports, motivating games to help you exercise more: These are just a few of the medical innovations that technology could bring in the relatively near future. What others?
Amidst all of the ideological debates and policy minutiae surrounding healthcare costs, it's easy to focus on the present and immediate fixes. And that's where the biggest share of attention probably should go. But longer term technology trends will have dramatic impact on medical care and human health. Here are a few possibilities:
- Video house calls: The days of the home visit will return to medicine. With video conferencing, there's no need for a patient to come to an examination room until being screened via video. Save the drive, the check-ins, the waits.
- Self-service: Patients can take their own blood pressure and weigh themselves with inexpensive equipment. With phone cameras, they can also take photographs. Just as automated teller machines replaced human interaction in banking, so software and simple devices can move the basics of healthcare from people to inexpensive software.
- Outsourcing: Radiologists can live in India and review images from afar at much lower cost. Any type of care where data collection can be separated from decision making is open to outsourcing.
- Intelligent software: With advances in image processing software, radiology may become an extinct profession. Other decision making processes will be automated over time.
- Payments: After your virtual doctor's visit ends, you can pay on the screen. You can also view your payment records over the past months and years, and compare your spending to the national average for someone your age.
- Data: Doctors have been laggards in using computers and even email. Getting patient data into digital form can make it available with Google-like ease. There's no excuse for not knowing the basics of a patient's history. It should appear on a tablet screen.
- Portable data: When patients change jobs, they often change medical providers, leaving all of their accumulated medical history behind. The new provider is back to square one and can't benefit from the prior records. Either health care needs to decouple from jobs, or data needs to be standardized and portable. And patients should have access and control privacy.
Medical innovation isn't without its unintended consequences, however. In addition to the threat of hackers and privacy breaches, there may be larger scale side effects.
As in the U.S. economy as a whole, the healthcare industry may "hollow out", so that we see more low-skilled workers, and fewer doctors. Eventually, high-skilled medical informaticists -- Big Data experts with both medical and software training -- may earn more even than doctors.
Public health consultants may become experts in health psychology, studying carefully what nudges in the way software and dialogue can encourage healthier eating and more exercise, tailoring the advice to your personality to avoid nagging.
These are only a few possibilities. As software and computer technology continue to improve exponentially, these predictions will likely come to seem quaint, both overly optimistic in some ways and foolishly skeptical in others.
What do you think? What's the future of high tech healthcare?
Medical Costs: The Good and the Bad
Three Paths to Personalized Medicine
Unintended Consequences of Medical Innovation