Massive Open Online Healthcare

Simply eliminate the human element, and costs will plummet toward zero.
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Hark, a new age dawns in healthcare! No longer must we tolerate long waiting times for a doctor appointment or service in the hospital emergency room. No more will we suffer inequities in access to healthcare. Relentlessly climbing healthcare costs will become a thing of the past. Herald instead a brave new world, in which cutting-edge information technology will solve once and for all the core problems that have plagued US healthcare for decades.

MOOH follows on the heels of a number of other technological revolutions, including radio, motion pictures, closed-circuit TV, and video conferencing.

Just as the MOOC (Massive Open Online Course) has revolutionized education at all levels, so the MOOH (Massive Open Online Healthcare) is about to revolutionize the nation's healthcare system, putting out of work most of the businesspeople, politicians, and pundits who have for so long profited from its afflictions. At last, we stand on the threshold of not just "the next big thing" in medicine, but the final and biggest thing of all.

The MOOC was born in 2008, when prophets of the new information technology finally realized that the real purpose of pedagogical accessories such as teachers and classrooms is educational content delivery. The MOOH is emerging just five years later, as healthcare leaders finally realize that the real purpose of physicians and hospitals is merely to deliver medical content. To achieve massive increases in efficiency, we simply need to get rid of most teachers and physicians.

Consider the following analogy. In the old days, people contracted infectious diseases such as measles or smallpox, which often left their victims permanently scarred or even dead. Then onto the scene burst vaccination, from the Latin for cow, because the first vaccination was derived from cowpox. Suddenly, people no longer contracted such diseases. The MOOH does the same thing -- transforming medical care from a highly labor-intensive, expensive process into an efficient type of inoculation.

Like the MOOC, MOOH follows on the heels of a number of other technological revolutions, including radio, motion pictures, closed-circuit TV, and video conferencing. It solves the problem of healthcare access by making it available to anyone with an Internet connection. It solves the finance problem by making it available almost for free -- an hour of a physician's time can be beamed out to thousands, even millions of patients. And it can be delivered anytime, at the patient's convenience.

In other words, the MOOH dramatically increases the efficiency and reduces the costs of the healthcare industry by largely removing its greatest source of inefficiency and cost -- human beings. Once physicians have recorded their consultations, they cease to be needed. After all, how many times each day do physicians around the country say the same things? "What seems to be the problem?" "Take one of these every six hours for ten days." "You really should drop a few pounds."

Direct costs go down, because we need far fewer physicians, nurses, and hospitals. Indirect costs, such as time off from work and the costs of transit to and from healthcare facilities, also decrease dramatically. This will permit a huge reallocation of the nation's labor pool, from maintaining and repairing the workers to actually making more things. Someday people will look back in wonder and amazement at all the time and effort we once frittered away tending the sick and injured.

Experience with MOOCs suggests another potential cost advantage of MOOH. Many MOOCs enroll huge groups of students, numbering into the tens and even hundreds of thousands. However, the percentage of students who actually stick with the course throughout the semester and complete all the assignments is often in the low single digits. If this patterns recurs, the number of patients the healthcare system needs to deal with long term could be dramatically reduced, causing costs to plunge.

To capitalize fully on the bovine analogy, may I suggest as the logo for robust MOOH the image of a strapping golden calf?

Just as there were once never enough chairs in the classrooms of schools and universities, so there were never enough seats in physicians' offices and hospital emergency rooms. Now, however, we can do away with the seats entirely. And patient choice is dramatically expanded -- we can choose which physician we want to hear, tune out what does not please us, and absorb information at our own pace, even replaying over and over parts that we do not get the first time.

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(bhikku/flickr)

The advantages for healthcare administrators will be huge. First, they need no longer waste time cajoling and threatening their recalcitrant medical staffs, a task often likened to herding cats. In addition, they will be able to exert more direct control over healthcare, removing intermediaries such as physicians and nurses, who often fail to get with the program. Finally, it will make it possible to slow down the often bewildering pace of change in healthcare, giving leaders valuable time to adapt.

What we are talking about here is the replacement of medieval models of medical care, which rely on quaint and frankly obsolete notions such as the patient-physician relationship, with an evidence-based, data-driven, information-rich, and leaner approach to healthcare. Plus it will be crowd-sourced, enabling participants to take full advantage of peer-to-peer education and evaluation. In effect, it can turn the waiting room into a treatment room, fully capitalizing on the wisdom of the crowd.

Once medicine was physician-centered. Now medicine will be truly patient-centered, with us the patients in control of where we receive care, how the care is delivered, who delivers it, and what care we receive. Patient dissatisfaction with physicians and hospitals will become a thing of the past, since there will be virtually no physicians and hospital to be dissatisfied with. The triumph of MOOH seems all but inevitable, like a tsunami of technology rolling across the nation's healthcare landscape.

Of course, the change in our healthcare business model will be profound and irreversible, spawning unexpected benefits. For example, as costs plunge toward zero, healthcare providers will no longer need or even be able to compete on costs. No longer treated as commodities, they will compete strictly on the basis of quality, and the excellence of U.S. healthcare will necessary rise at an ever-quickening pace. Only the very best will be able to survive.

Inevitably, some problems will arise. For one thing, a small number of backward patients will still want to see and be seen by their physicians in person, just as a few Luddite students still insist on attending classes with live professors. Some accommodation will need to be made, at least temporarily. On the bright side, however, the fact that such patients will be receiving care in an outmoded and discredited model should hasten their demise and speed the universal proliferation of MOOH.

A second problem concerns procedures that cannot be delivered digitally. For example, some patients will still need broken bones set and inflamed appendixes surgically removed. When such circumstances arise, however, procedure centers operating on a self-service basis will be available, much like a quick oil change. Patients will simply schedule the procedure on line, present at the appointed time, and then undergo the procedure with a minimum of wasteful human interaction.

Finally, there is the problem of time and effort. While physicians and other health professionals will be relieved of a great deal of work, the burden will shift to a large extent to patients. Like the MOOC student, MOOH patients must devote time and effort to healthcare, into whose pilot seat we will now be thrust. Happily, however, this should not be much of a problem, since it will be our own life and health on (the) line, which should provide more than adequate incentive.

In sum, we stand at the precipice of healthcare's promised land. The New York Times declared 2012 the "Year of the MOOC." The time has come for the nation's patients and physicians to declare 2013 the "Year of the MOOH." To facilitate the unification that will be necessary, it would be helpful to have some symbol to rally around. To capitalize fully on the bovine analogy, may I suggest as the logo for robust MOOH the image of a strapping golden calf?

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Richard Gunderman, MD, PhD, is a correspondent for The Atlantic. He is a professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy, and vice-chair of the Radiology Department, at Indiana University. Gunderman's most recent book is X-Ray Vision.

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