When medical historians write about the coronavirus pandemic, they’ll likely focus on the slow U.S. response and failures of leadership that led to a tragically high death toll. But that will be only part of the story.
From the wreckage and devastation will emerge something few contemporary observers would expect: a brighter future for American health care.
Five technologies, all previously underappreciated and underutilized, will help our nation move past the coronavirus crisis into a new, golden era of medicine. Like the seedlings of the eucalyptus tree, which sprout only after a forest fire, these technological solutions will blossom in the aftermath of the COVID-19 pandemic — turning U.S. health care’s outdated and broken system into one that is more convenient, effective and affordable.
Until the 1920s, the overwhelming majority of doctor-patient meetings took place in the home. But as medicine became too sophisticated and complicated for house calls, doctor’s offices began sprouting up in cities and towns across the country. Soon, little brown buildings, filled with doctors, all practicing independently of one another, became the epicenter of care delivery. This fragmented approach to health care has stood in place, largely unchallenged and unquestioned, for nearly a century.
Telemedicine (virtual care) has been around for decades. Yet, until physicians faced a viral pandemic that forced them to close their offices, less than 1% of doctor-patient meetings took place virtually. As the pandemic spiked in summer 2020, that number ballooned to 69% and turned companies like Docs on Demand and Teledoc into major players in American health care. As the deadly virus spread, video allowed physicians to deliver effective health care without the risk of being in the same room (and potentially infecting) patients. This experience opened the eyes of doctors and patients alike, helping them recognize that telemedicine is more convenient, more affordable and more capable of high-quality outcomes than a single physician seeing patients in an office.
Video-based telehealth allows physicians in one location to provide medical care to patients at a distance. It thereby grants people access to care 24/7, without delay and without overwhelming individual doctors. As a result, patients don’t unnecessarily wind up at the emergency department, waiting hours for routine care that costs multiples more than it should. And with the ability to call on specialists across the country, virtual care can connect patients with the most knowledgeable physician, not just the nearest one. After the pandemic is over, telemedicine will continue to serve as an essential part of a value-based system of health care — a major improvement upon the fragmented, fee-for-service approach of today.
2. Drug development
No industry felt a greater sense of urgency during the coronavirus pandemic than drugmakers.
As a result of kickstart efforts like “Operation Warp Speed,” vaccine-development technologies accelerated at an unprecedented pace. In the past, the traditional biologic approaches for creating vaccines required at least five years of development and testing prior to receiving FDA approval.
Pfizer and Moderna’s COVID-19 vaccines were created in a matter of weeks, after researchers in China published the exact genetic code for the virus. Scientists quickly figured out a “shortcut” of sorts, using a lab-created messenger RNA to deliver a unique set of instructions to the human body. Those instructions led to the production and replication of specific virus-associated proteins — similar to the way a computer virus instructs an operating system to make copies of itself. In response to these foreign proteins, the patient’s immune system creates antibodies, which lead to immunity.
Though Moderna had been working on mRNA drugs for a decade, it hadn’t produced an approved or effective product until now. Having achieved success, it won’t take 11 months for leading drug developers to produce and manufacture the next life-saving vaccine. As it happens, we may not even have to wait for the next pandemic to apply this technology.
Recently, epidemiologists identified a major mutation in the coronavirus, one that could have a sizable impact on both the effectiveness of current COVID-19 vaccines and the number of people who will need to be immunized to achieve herd immunity. Should this mutant strain be even partially resistant to current vaccines, drug makers like Moderna expect to be able to alter the composition of the vaccine and modify the injected mRNA, accordingly. Based on its previous approval, the FDA could grant emergency use authorization sooner, saving thousands of lives in the process.
3. Data analytics
The coronavirus shined a bright and uncomplimentary light on chronic disease in the United States. According to mortality reports, of people who’ve died from COVID-19 had a chronic disease and 88% had two or more. Health experts have long understood the consequences of chronic diseases like diabetes and heart disease. In the United States, they account for 7 in 10 deaths and nearly 75% of aggregate health care spending.
And yet, prior to the pandemic, these types of illnesses were seen as something Americans just had to live with, like gravity or traffic. That misperception is started to change as a result of the current pandemic. The United States is on pace to reach its grimmest milestone yet — 500,000 COVID-19 deaths — by this summer. The mounting death toll is helping Americans see chronic illnesses not as a common nuisance, but rather as a coconspirator, as guilty of death and destruction as the virus itself.
Fortunately, technology provides a solution. To explain, consider the threat of hypertension, the No. 1 cause of stroke and kidney failure. Doctors are capable of helping 90% or more of patients control the problem and reduce the chances of life-threatening complications. In fact, the nation’s leading medical groups are 35% more effective than the national average at helping patients control this deadly disease.
How do they do it? Technology and science play key roles. Most physicians, particularly specialists, focus on treating the strokes, kidney failures and heart attacks that result from high blood pressure (through surgery or expensive drug-treatment programs). But the most effective approaches involve prevention and optimal disease management, both of which are facilitated by comprehensive electronic health records (EHRs) and powered by evidence-based treatment algorithms. In these settings, EHR data is rigorously analyzed, giving doctors clear and effective guidelines for treating patients with chronic conditions.
In the past, pandemic planning and preparedness focused primarily on how to treat the virus itself. In the future, should another pandemic threaten the health of millions, data analytics will allow more doctors to maximize the health of patients with chronic illnesses, thereby reducing mortality before a vaccine is available.
4. Patient decision tools
In 2020, our nation applied a one-size-fits-all approach to managing the coronavirus. As a result, we over restricted some groups, like elementary school children, and under-protected others, particularly people in nursing homes. The consequences were lethal.
This kind of assumptive error happens in health care settings, too, where doctors fail to personalize their clinical approaches and treatments for patients. As a result, they overtreat some and undertreat others. Whether patients have high blood pressure or atrial fibrillation, their physicians are likely to see all of them on a routine basis, usually every three or four months. That model makes no sense.
What patients with a chronic disease need to know is whether they should continue taking the same medications at the same doses or alter them. If nothing needs to change, they may not need to see their doctors more than once a year. In contrast, if something is askew, they should be seen in a matter of days, not months. Technology offers a better and more precise approach.
Today’s health-monitoring devices can reliably measure blood pressure, heart rate, blood oxygen, blood sugar and other physiological signs. But without interpreting the data for the wearer (and without dispensing medical advice), the information is of little value.
The next generation of home-monitoring apps will solve this problem by comparing the patient’s data with the most up-to-date treatment recommendations, thus informing patients whether everything is fine (and there’s no need to see a doctor) or whether their problem needs immediate medical attention. Why doesn’t this already exist today? It’s not that Silicon Valley’s largest companies lack the technology or know-how to manufacture such a device.
They simply don’t want to accept the medical liability should a deadly error occur. In the future, the opportunity to drive quality up and costs down will be too great for companies to resist. What remains is to be seen is who will have the courage to be the first.
5. Artificial intelligence
Like the other technologies, artificial intelligence (AI) has been talked about for years as a “game-changer” in medicine. And yet, AI has not improved American health care so far.
It won’t stay this way for much longer. The COVID-19 crisis highlighted a problem for which AI offers a unique and powerful solution. There is a false perception among doctors that they treat all patients the same. The pandemic has proven otherwise. Throughout 2020, Black patients’ chances of dying were three times higher than that of white patients.
Part of the problem began in the diagnosis stage. When two patients came to the emergency room with symptoms equally likely to be COVID-19, the white patient was tested far more often than the Black patient, according to national studies.
Biased treatment is not a new phenomenon in medicine. For decades, studies have shown that white physicians regularly undertreat Black patients for pain, prescribing less medication than they do for their white patients.
Research has shown that part of systemic racism in health care results from “implicit bias,” a set of prejudices and stereotypes doctors carry around without even knowing they’re there. But even when they’re subconscious, biases have a direct affect on a person’s thoughts, actions, and decisions.
AI can help identify and address this problem by assessing each doctor’s patterns of diagnosis and treatment. When AI determines the care provided to any group is discriminatory, doctors can be alerted in real-time and, consequently, learn from their mistakes. With the shift in presidential and Congressional leadership, health care equity is likely to be high on the national agenda.
In the era before COVID-19, technology was used as a tool to attract patients, generate income, and maximize billing opportunities. In the post-coronavirus world, the United States will be reeling from the economic consequences of the pandemic. Health care technology can and will provide cost-effective solutions that improve our nation’s overall quality of care.
Robert Pearl is a plastic surgeon and author of Uncaring: How the Culture of Medicine Kills Doctors and Patients. He can be reached on Twitter @RobertPearlMD. This article originally appeared in Forbes.
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