Intel Inside: Andy Grove’s Solutions for Health Care
Andy Grove argues that simple technology could provide some solutions to the current ‘epidemic of inefficiency’. On April 10th, the Intel co-founder gave a major lecture on technology and health care at the University of California at Berkeley’s School of Public Health. The lecture was covered in CNET by a Stanford Innovation Journalism fellow, Miriam Olsson, and now has been picked up by Wired in a piece by Kristen Philipkoski.
Grove’s key point is that patients need portable medical records – preferably on a chip. In addition, electronic medical records systems should be internet-based so information can be exchanged seamlessly. Currently, systems are hospital-based and have many different providers. Medical errors are increased when patients interface with a new system, as crucial medical history is not transferred, especially complicated prescription regimens and medical conditions the patient may overlook or not reveal when asked in a workup. Let’s not even begin talking about the pitfalls of paper-based folders, which are still in use in a majority of the world.
“If anything is going to happen, we need something more simple than cracking a framework,” Grove said. The system has to be taken apart–what he calls a “strategic triage”–and IT solutions applied strategically to the system’s various ailing parts. He pointed to three critical weaknesses in the health care system: the large number of U.S. uninsured–46 million, or around one third of the population; the deteriorating state of emergency care; and the proportion of the population that is elderly.
As a solution for ER overuse, Grove points to HBS guru Clayton Christensen’s disruptive innovation of ‘retail’ clinics. These clinics would be the first stop for a restricted number of common conditions, where proven diagnostic algorithms would be developed and would allow nurse practicioners and health workers to treat patients. If the case is found to be more complicated, the patient would be referred to specialist care.
Wired goes into more detail with an interview with Grove:
Will reliance on retail clinics increase the chance of incorrect diagnosis and generally result in lower-quality care?
Grove: You have to ask: as compared to what? The current system has 50 million people who have no insurance and therefore no primary care provider or clinician at their disposal. Relative to what those people experience, the risk is greatly reduced. Relative to going to the Mayo Clinic or the Cleveland Clinic or UCSF (University of California at San Francisco), it’s obviously riskier.
My comment on this is that if you can adequately design a diagnosis algorithm and rigorously monitor outcomes, it is more likely that you will be receiving quality care than in the current system, where evidence-based medicine is not a universal standard.
Secondly, to cope with increasing numbers of patients, as baby boomers age and if the 50 million uninsured are brought into the system, Grove introduces a “shift left” conceptualized by Eric Dishman of Intel, where people receive treatment at home, with medication reminders and hospital interaction mediated by the internet. Patients would give providers real-time digital updates on their condition, and medical information would be shared efficiently.
When asked about prevention being better than cure by Wired, Grove demurs, “I haven’t seen any evidence of any techniques, electronic or otherwise, that change behavior reliably in a cost-effective fashion. Smoking and obesity are very unfortunate examples of what I’m talking about. Theoretically, (preventive medicine) is absolutely the right answer, but I’m looking for things we can actually do instead of wish we could do or should.”
As he says before when discussing universal health care, he’s a pragmatist on the track of what can be done right now “Altogether I’m obsessed with doability as compared to desirability.”