Wednesday, July 02, 2008

Using “Virtual Reasoning” to redefine Healthcare

by Dr. Marlene Beggelman

The Internet is redefining the health care industry. Major transformations can be expected because Internet-based technology will deliver certain health care services more effectively and at lower costs. In the near future, much of the information that is currently imparted to consumers by clinicians will be delivered through and by web-based technology. If the web-based tools that deliver this information mature to the point of becoming reimbursable, beyond their current usefulness as value add-ons, the health care industry could experience a dramatic shift.

Early stage Health 1.0 information has predominantly been available in the form of an “e-pamphlet” with a one-size-fits-all approach. Subsequent generations of Health 2.0 tools are interactive and deliver personalized, and therefore more valuable information that is geared specifically to the user’s input. With the advent of advanced tools, consumers are no longer limited to being passive recipients of pamphlet-style information; in these milieus they interact with each other or with sophisticated software that analyzes cases on an individualized basis. Advanced tools are being used by Internet entities as bait both to drive traffic and to capture detailed user profiling data.

Several categories of interactive Health 2.0 tools are available, including advanced search engines that deliver more accurate results; social media sites in which individuals hone their medical knowledge through interactions with each other; and finally, expert systems - sophisticated software programs that analyze a consumer’s profile and, based on the analysis, pinpoint the most relevant educational information necessary to support the consumer’s health care decisions. Expert system tools basically simulate human reasoning.

Virtual Reasoning – a New Model
Speculation about where Internet health care might be taking us can be approached, in part, as a projection of the next generation of the most advanced web-based health care tools. If what consumers and payers want from health care is an acceptable cost-quality trade off, assurance that care is appropriate for the situation, that the diagnosis is correct, and that errors of commission and omission are kept to a minimum, web-based tools need to move beyond simple information retrieval to the level of analytic services – expert systems that are virtually capable of reasoning, rather than only presenting facts.

If Health 2.0 products bring you cholesterol guidelines, then virtual reasoning tools, in counter-point, should calculate your LDL (bad cholesterol) goal based on your level of risk for heart disease and assess whether or not you are taking the right medicine. If Health 2.0 delivers personalized information, virtual reasoning systems offer the equivalent of a virtual second opinion.

As virtual reasoning tools reach a greater level of maturity, they will represent cost-effective alternatives to certain health care services traditionally performed face-to-face by health care professionals. At some point, they will cease to function merely as value add-ons and become reimbursable, revenue-realizing businesses in their own right, augmenting some of the educational and analytic services now in the purview of health care providers.

The logical end-point of expert system and decision-support adoption will be a new reimbursable segment of the service industry in which lower cost services are rendered through technology solutions. When physicians are reimbursed to use expert system technology, they will have sufficient incentive to adopt electronic medical records (EMR/EHR) as well.

For tools to replace certain traditional face-to-face services they have to be integrated into the clinician’s normal workflow and electronic medical records systems. EMR/EHR companies will first incorporate expert system tools for much the same reasons as the PHR initiatives do – for the value-added benefits they offer to the customer base. In future models, though, fully integrated tools will sit “under the hood” of an EMR/EHR, continually combing the medical record data for errors and oversights as new data is entered. They will compare treatment to evidence-based recommendations, follow response to treatment over time, generate outcomes data, and generally function as an automated quality assurance system.

Physician Adoption
Physicians will ultimately be reimbursed for the time they spend administering care through the medium of information technology. Early pilots will likely be initiated by payers (large, self-insured employers) who believe that the potential for improved, more appropriate care will result in significant cost-savings. These technology adjuncts will free health care professional from the mundane functions of data gathering, recording, and administering; they will enable physicians to focus on the more rewarding cognitive aspects of medical practice. With more free time, physicians can move squarely into a consultancy role in which they help their patients assimilate and analyze increasingly complex choices.

Significant activity around tool adoption is already underway: Microsoft, Google and other Internet companies have been acquiring advanced search and expert system tools; programs in which web-based service delivery is reimbursed are being piloted; and Google Health has taken the first steps to make a large number of tools available on their platform. How quickly the process eventually unfolds depends on a number of factors that mostly revolve around any upcoming changes in health care financing and in the political climate. No matter how health care financing is structured, however, the need for tools that enhance health care quality and efficiency still applies.

Dr. Marlene Beggelman is the CEO of Enhanced Medical Decisions, which is the company behind

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