An MD&DI July 1998 Column
The vice president of Eastman Kodak Company foresees licensing agreements between manufacturers and healthcare networks as a possible consequence of technological advances in the medical device industry.
Imagine it's the year 20-something. Ian Mackenzie visits a dentist for the first time after moving to town following college. The receptionist scans his health information network subscriber card. In seconds, the office accesses Ian's personal medical database, organized by icons like a well-designed Internet home page. His complete written and visual medical history plus links to his immediate family's medical records are accessible with a few keystrokes or clicks of a cordless mouse.
X-rays reveal a small cavity that needs immediate attention. In this 21st-century dental office, the tooth's image is displayed digitally on a high-resolution thin-screen monitor on the examination room wall. The tooth's structure and exact location of the cavity have been analyzed using advanced diagnostic algorithms. Fluorescent dots superimposed on the screen pinpoint the recommended position for the computer-controlled high-speed drill that limits tooth damage and postprocedure discomfort.
The entire office visit is chronicled in the database, which is also linked to the billing system and Ian's dental plan insurance carrier. As a paying subscriber to a premium service package in what we will call the Alpha Health Information Network, Ian enjoys a number of privileges, including access to this new smart x-ray and dental drill system. The manufacturer signed an exclusive agreement with Alpha network member providers for three years. Depending on the contract, the health information network subsidizes, in part or in full, monthly equipment leasing payments. The medical device supplier participates in fee distribution to supplement concessions it made to reduce the purchase price of the equipment or for accepting contractual limitations on its ability to sell the same device to competing networks.
Ian joined the Alpha network after reading its advertising and promotional material and concluding that Alpha was the best choice among health information networks because that plan had the most doctor and dentist member providers in his area. Ian's medical and dental insurance carrier not only approved of the Alpha Health Information Network, it offered discounts on his insurance premium for enrolling with this particular vendor.
Six months later, Ian undergoes a routine checkup with his personal doctor, who monitors a lifelong functional heart murmur through EKG and echocardiogram tests. Ian's test results and risk factor data are compared with the test results of every other patient in the system to predict future consequences based on the medical history of subscribers with similar profiles. Using these predictions, supplemented by the knowledge of renowned researchers and practitioners under contract to the Alpha network, the expert system issues a recommended treatment or preventive-care regimen.
This futuristic system leverages digital storage capacities plus data and image transmission capabilities far exceeding the scale that is currently practical or commercially feasible but well within the reach of today's networking computers. Insurance carriers and health maintenance organizations are the likely sources of a drive to create such a health information networking system, as their emphasis on cost containment and attracting new customers could be well served by establishing the right strategic relationships.
Specialists in medical informaticsa 1970s-generated term for medical computing and information processingalso have much to gain by incubating what could be the new giant industry segment in the first half of the 21st century. These health information network enterprises could assume some of the business risk of developing markets while actively engaging in a spirited recruitment war to sign up desirable medical practices or individual practitioners to attract the broadest consumer franchise. Information network companies will scrutinize local market demographics to form exclusive relationships with practices that have large patient bases to maximize fee income.
Here's where it gets potentially troublesome. Health information providers will also vie for the talents of researchers, specialists, and medical schools to create proprietary expert systems. In this global high-stakes game to keep the competition at bay while obtaining the staggering investment to bring such a system into existence, it is quite possible that the profession's top minds may be limited in their ability to share knowledge outside the framework of their contractual obligations. Medical device manufacturers could easily be faced with an entirely new business paradigm in which revenues are linked to equipment usage patterns and patient outcomes, not unit sales. Such was the case in the example of the smart dental system.
There's little doubt the medical device industry has the potential to raise competency and improve patient outcomes, helping overburdened health-care professionals accomplish more with less. What remains to be seen is the degree to which branded health-care alternatives will provide packaged solutionsand at how many service levels and price ranges. One thing is certain: the quality, availability, and cost of medical information flow will govern the rate at which advanced health care is democratized across social, cultural, and governmental boundaries. This places all of us with an interest in these developments on a direct collision course with an individual's right to privacy and confidentiality.
It's one thing to say we need safeguards. It's another to find ironclad ways to protect information from prying eyes, knowing that public confidencenot technological capabilitieswill limit marketplace acceptance. Looking into the future, we have cause for both concern and celebration, as we aim for a balanced coexistence between a healthy profit margin and a desire to make life more fulfilling and healthier for everybody.
Martin M. Coyne II is president of the health imaging division and vice president of Eastman Kodak Co. (Woodcliff Lake, NJ).