Bill Frist writes about a utopian future of medicine in ten years
“I would like you to meet a patient from the year 2015. He lives in a world in which years ago America’s leaders made tough but wise decisions. They built on the best aspects of American health care and unleashed the creative power of the competitively driven marketplace. These changes resulted in dramatic improvements to the U.S. health care system “” lower costs, higher quality, greater efficiency, and better access to care.
The patient, Rodney Rogers, is a 44-year-old man from the small town of Woodbury, Tennessee. He has several chronic illnesses, including diabetes, hypercholesterolemia, and hypertension. He is overweight. He quit smoking about eight years ago. His father died in his early 50s from a massive myocardial infarction. In 2005, Rodney chose a health savings account in combination with a high-deductible insurance policy for health coverage.
Rodney selected his primary medical team from a variety of providers by comparing on-line their credentials, performance rankings, and pricing. Because of the widespread availability and use of reliable information, which has generated increased provider-level competition, the cost of health care has stabilized and in some cases has actually fallen, whereas quality and efficiency have risen.1,2 Rodney periodically accesses his multidisciplinary primary medical team using e-mail, video conferencing, and home blood monitoring. He owns his privacy-protected, electronic medical record. He also chose to have a tiny, radio-frequency computer chip implanted in his abdomen that monitors his blood chemistries and blood pressure.
Rodney does an excellent job with his self-care. He takes a single pill each day that is a combination of a low dose of aspirin, an angiotensin-converting”“enzyme (ACE) inhibitor, a cholesterol-lowering medication, and a medication to manage his blood sugar. That’s one pill daily, not eight. He gets his routine care at his local clinic. He can usually make a same-day appointment by e-mail.
Unfortunately, chest pain develops one day while Rodney is on a weekend trip several hundred miles from home. The emergency room physician quickly accesses all of Rodney’s up-to-date medical information. Thanks to interoperability standards adopted by the federal government in 2008, nearly every emergency room in the United States can access Rodney’s health history, with his permission. The physician diagnoses an evolving myocardial infarction by commanding Rodney’s implanted computer to perform a series of rapid diagnostic tests. The cardiologist in the “nanocath” lab injects nanorobots intravenously, and remotely delivers the robots to Rodney’s coronary arteries. The tiny machines locate a 90 percent lesion in the left anterior descending coronary artery and repair it.
The hospital transmits the computerized information about Rodney’s treatment, seamlessly and paperlessly, to Rodney’s insurer for billing and payment. The insurer pays the hospital and physicians before Rodney returns home. Payments are slightly higher to this hospital than to its competitors because of its recognized high quality and performance. Rodney’s hospital deductible and co-insurance are automatically withdrawn from his health savings account. Because Rodney has met all his self-management goals this year, he gets a 10 percent discount on the hospital deductible.”
