What can health care learn from Amazon?

There’s that line about art, “good artists copy, great artists steal.” There’s some debate about if Picasso said it first, but most of us geeks know it from Steve Jobs.

Often, I see things from companies and industries outside of health care  – processes, products, best practices — which inspire me. I like these little inspirations because they often aren’t rocket science, but nonetheless fuel some creative thoughts about their applicability in health care.

The other night, around 9pm on a holiday Monday, I ordered some obscure aviation stuff from Amazon. I needed a new headset, a leg-mounted chart holder, a paper calculating tool called an E6B computer and a portable canister of oxygen.

I have Amazon Prime, their subscription service which provides expedited 2 day shipping, so I expected to see my stuff on Wednesday afternoon. I was blown away when there was an Amazon box outside my door by 9am the next morning, Tuesday.

A box showed up early, big deal, right?

Here’s what I think happened and why I’m so impressed. I had been browsing for some aviation stuff for a few days. Amazon clearly knows and tracks my window shopping. It’s how they suggest items when you come back to the site.

I believe they preemptively moved some of those obscure aviation items to the closest distribution center in anticipation of my purchase. In fact, Amazon was awarded a patent for exactly that process last week.

By predicting my purchasing behavior, Amazon was able to beat my expectations for delivery — a known threat to their model is the instant gratification of local retail — and get my package to me in 12 hours.

We’ve got a lot of data in health care. That’s to the lagging but persistent implementation of electronic medical records, doctors and health systems are beginning to apply some big data science to their patient populations. For instance, any credible EMR can tell a physician how many of her patients have asthma.

More advanced systems, including bolt on solutions can look at disease panels and cross sample against last visit date. Mr. Smith, we see it’s been a year since your last visit, how’s your arthritis? Can we schedule you and appointment with Dr. Jones?

While those types of systems are starting to gain traction, the Amazon solution, despite its apparent simplicity, is far more advanced. Amazon is thinking ahead, they are predicting behavior. And with the tools we have in health care today, there’s no reason health systems and providers cannot do the same thing.

For instance, Google’s Flu Tracker looks at searches for things like flu symptoms, remedies and clinics and can accurately determine and even predict outbreaks. Providers would follow suit and move flu shots into communities before outbreaks hit. Retailers call this just in time inventory. And we don’t have to stop there.

What about actual behavior modeling? Mr. Dawson, we see from Twitter you are training for another marathon and have been skiing a lot. Studies show that preemptive sports massages can help prevent more serious injuries, can we make an appointment for you to see our physical therapist?

Yeah, ok, I secretly really want that one. But it doesn’t have to be based on leisure activities.

The point is, we have the tools and data to do some pretty impressive predictions for both populations and individuals and we’d be wise to start prototyping some of these approaches right away.

So, why aren’t we?

It’s easy to point the finger at our payment system, or internal red tape. And, I’m certain those things are a factor. But I think there’s a greater inertia at work, a sense of overwhelming change and uncertainty weighting down the industry. We’ve become cautious to the point of immobilization. If it’s not evidence based and tested by Johns Hopkins, Massachusetts General Hospital or Mayo, then we aren’t trying it.

And that’s a shame, because once Amazon figures out how to deliver a self-administering flu shot, or asthma inhaler in 12 hours, it will be too late for health care’s traditional players to catch up.

Nick Dawson is principal, better.  He blogs at NickDawson.net, where this article originally appeared.

Comments are moderated before they are published. Please read the comment policy.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Amazon’s goal is to make you buy more things from Amazon, more things than you really want, more things than you really need, and that you do that as frequently as computerly possible. Amazon doesn’t care if whatever you buy from Amazon is in your best interest, if it will make you sick, bankrupt you, or kill you. All the cute stuff Amazon does for you is intended to lower your resistance to mindlessly transferring your hard earned cash to Amazon, and the bewildering array of trinket suppliers it services.

    I seriously doubt that this should be the goal of a health “care” system or any individual doctor.
    But then again, it seems that at the insistence of high-tech fortune seekers, this wholesale consumerist, or locust, mentality is what we should use for transforming a system intended to alleviate suffering and heal the sick, into a system intended to maximize convenience based exploitation of all people with a nickel in their pocket, whether healthy or sick.

    • Deceased MD

      it is always a relief to hear your POV. There is a sense of momentary sanity. Sometimes people’s thinking get a little scary like health apps that do little but help some business persons pocketbook.

  • doc99

    On the other hand, you’d have thought that the folks’ contemplating setting up an online health insurance exchange would have consulted Jeff Bezos.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Hi Nick, thanks for replying, and please understand that I don’t doubt for a second that we want the same thing. I do, however, think that methodology, and terminology too, matter a great deal.
    For example, I don’t want us to have “providers”. I don’t know what that is, and I don’t want one of those anywhere near my kids when they are sick. I want a doctor. I suspect that the “provider” terminology is just one part of an effort to obfuscate the fact that we are creating a tiered system of care. Some of us may be doing this inadvertently, but the “system” is very purposeful in this matter.
    Speaking of “system”, I don’t want a system of care. I don’t think systems are capable of caring. People are. So I want hundreds of thousands of individual doctors, doing the best they know how, to care for people they can recognize when they step into a room. I trust the intentions and motives of individuals infinitely more than I trust the motives of “systems”. That said, I do want universal health insurance, which in my opinion has little to do with health care delivery (health care as opposed to healthcare, which I also don’t know what it means).
    As to the predictive abilities of Amazon or some equivalent for profit (or for revenue, or for power) surveillance system for health, thanks, but no, thanks. We need to find better ways for curing or preventing disease, other than having the “system” monitor what we do, what we say, what we buy, and where we are, at any given moment.
    We are in complete agreement about the forced march to EMRs, so I guess that’s pretty good :-)

  • http://www.mightycasey.com/ MightyCasey

    How did I miss this for almost three weeks? Who cares, I’m here now.

    I’m really intrigued by this idea, because I *think* this sort of system is what healthcare dreams of being. However, the “it takes 17 years for medicine to put new science in practice” thing (see ePatient Dave for more on that: http://www.epatientdave.com/2013/03/10/source-for-17-years-for-new-medical-practices-to-be-adopted/) makes it really difficult for medicine to be an agent of swift deployment.

    Then there’s the whole regulatory thing, and its hits’n’misses (can you say Vioxx? Or even…thalidomide?), which I think have become an excuse for the very slow roll we’ve got in putting new science in play in medical care.

    But … I’m *so* interested in having my q-self/digital world be a two-way comms channel with my medical partners in staying upright and on this side of the grass. I’ve read all the comments below, and I get why @MargalitGurArie:disqus is so passionately NOT excited about the stuff that excites me in your idea. I too do not want “providers” – I want partners. Everyone from my primary care doc to my onco to [whomever] all tuned to the same frequency.

    What a day THAT will be …

Most Popular