Deep (Rambling) Thoughts on Health Care and Health Informatics

Lately I've been thinking a lot about health care and health insurance, partially because I'm reading "Better" by Atul Gawande (I'm hoping to post a review soon). The health care, or, more accurately, the health informatics industry, definitely has potential as an industry (or at least a project) that I'd like to work on next. Before I could do that, though, I'd have to learn quite a bit about How Stuff Works in that field. There are a ton of really interesting issues that are just starting to be dealt with as health care starts to become more modern. A few are mentioned in this post that I recently read.

There is also a shift toward giving the user a lot more control over their records and their health care plans - I recently heard a commercial on the radio for Kaiser Permanente that went through a litany of things that they want to give the average subscriber to their plan, for example, the ability to email their doctors and have access to their health information 24/7 were just two of the items mentioned.

This would certainly be a welcome change. I consider myself a pretty smart cookie, and I think I can usually figure things out if they are relatively straightforward. And yet I find it so complicated to file a claim and actually get money that I decided to just pay for my contacts myself, even though it's definitely a benefit under my plan. The the hassle of filing for money and continually following up on it just wasn't worth it.

If people took full advantage of their health care plan, would insurance companies go bankrupt? Or at the very least have to change they way they did business or their business model? How many people take 'full advantage' of their health care plan now? I don't mean fraud, I'm just talking about taking the time to ensure that any time they have any sort of interaction with a doctor or pharmacy, their plan gives them what they are entitled to.

Google, of course is making a run at the health informatics game, setting up a pilot program with the Cleveland Clinic. Medical records are clearly going to get digitized, but what are the roadblocks to that happening? Are they primarily technical (integrating systems)? If so, that would be good for me since that's likely how I would be able to find work in the industry. Or are the issues more social and political - Are people too scared to have so much medical information in digital form and accessible online? Are *doctors* too scared of such a situation because it will make the whole system more transparent and easier for people to self-diagnose (or think that they can self-diagnose)?

And also, a huge reason people even go to doctors in the first place is that they want to be reassured that someone with some idea of what he's talking about and a decent bed-side manner is taking some time to listen to what's wrong and make a recommendation. Because in many ways and in many cases, doctor's recommendations are bested by very simple algorithms (I'm thinking of the APGAR score for newborns, the Glasgow Coma Scale, and Malcolm Gladwell's thought on doctors diagnosing heart attacks - they use too much information). We're always going to need surgeons, are we always going to need the people that tell us whether to get the surgery?

What might be the best use of non-medical technology for doctors - in other words, what would be really useful for doctors to have in terms of better data on patients and new medications? What area has the most room for improvement? Is it profitable to pioneer a product or service in this area?

Is it a viable business to charge people $4.95 a month (or a percentage of their health care premium) to help them 'get the most out of their health care plan'?

Sigh. Much to ponder.