Monday, July 21, 2008



The American Economist web site offers this pessimistic view on what is happening to our health care system.

My response is at the end.

"If you haven’t read Alvin Toffler’s book, Powershift, you probably have no idea what has happened to us in the last decade with regards to the information era. In this historic book, Toffler talks about the “Powershift” which is the information era and how knowledge and information will be the most valuable currency in the world. While traditional economic transformation progressed from agrarian to industrialized societies, the next wave was the information era. “Third World” economies could actually leapfrog the industrialized economy from a rural/agrarian one to an informational society with the advent of computer networks and the internet.

In the healthcare system, such a “powershift” is occurring within the walls of hospitals. Archaic hospital systems are using paper charts and paper prescriptions. Physicians must hand sign an order book which then gets faxed to the pharmacy. A courier then runs up the medicine to the patient’s room. All charting is done on paper and record keeping rooms are enormous. Medical transcriptions are done on a typewriter and placed in the patient’s paper chart.

In the second wave of medical informatics, the electronic network came about. Orders were allowed to be filled electronically. Medical transcriptions of dictations were outsourced to transcription companies who typed these out and they appeared electronically. Physicians could edit, verify, and sign electronic records and transcriptions. Computerized vending machines on the hospital floors could electronically document the use of supplies for the indicated patient. The second wave of medical informatics cuts costs and dramatically improved things and brought us out of the dark ages.

It appears that we are starting the third wave of medical informatics. “Going Live” is the concept where the electronic record is completely “live” and “online” and always being edited. Laboratory and diagnostic results appear real-time; doctors dictations, nurses notes, medical orders, and prescriptions are all done online and appear real-time. Transcription software allows the physician to dictate his note which uses voice recognition and speech transcriptions software to transcribe the note instantaneously where the physician can edit. If he so desires the doctor can electronically type his notes if he likes. There is no paper chart.

“Going Live” is the third wave of medical informations. Gone are the outsourced medical transcription companies. Gone are the paper charts. Gone are the electronic notes that indicate that a dictated note is “pending.” There are no gaps in the care or documentation of the care of the patient. The laptop or PDA-toting physician is here to stay.

As in the global powershift, hospitals and healthcare systems who “Go Live” early on will win more business and thrive. They will be more profitable and be more efficient and thus more effective in the delivery of healthcare.

If you’re interested in other works by Alvin Toffler, read Greg Beatty’s review of Revolutionary Wealth: How It Will Be Created and How It Will Change Our Lives by Alvin and Heidi Toffler.

medical informatics, health care economics, health care, alvin toffler, powershift, electronic medical records, electronic health records, medical IT, health care IT, health care informatics

Tags: electronic health records, medical industry, medical informatics

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One Response to “The Future of Healthcare Is Here”
  1. 1 Gary Levin M.D., on July 21, 2008 at 10:00 am, said:

    Alvin Toffler also authored “Futureshock”, the story of how human beings and society can only absorb certain rates of change, then become overwhelmed and dysfunctional leading to deterioration of coping mechanisms.

    We see this occuring in health care for the past 20 years, some of it driven by technology innovations, but much of it from outside bureaucracy in it’s mis-directed attempts to control cost escalation. Managed care has been a misnomer for managed costs, and control of health care by non medical personell (ie, physicians). Physicians have been wrongly held accountable for ordering too many tests, too many treatments,while paradigm shifts occured without benefit of careful evaluation by physicians of their net effect, other than to reduce reimbursements, decrease access,, increase administrative paperwork and overhead.

    Health information technology is the next “Pandora’s Box” currently being promulgated by political leaders, insurance companies and the massive bureaucracy now surrounding your visit to the provider’s office (used to be’s office)….Patient’s are now called “consumers”.

    Most physicians remain highly skeptical of Health IT.
    Most younger providers look forward to adapting it to their practices, because they have grown up in a school system that now promotes IT for everything, examinations, applications, research, The word processor has replaced script. Email and the web are replacing the telphone call to make an appointment at the office. Economics and time factors are credited with this new shift.


    Economic change is driven by these evolutionary and revolutionary sea-changes..

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