Massive Open Online Healthcare

Simply eliminate the human element, and costs will plummet toward zero.

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.


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.

Presented by

Richard Gunderman, MD, PhD, is a contributing writer 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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