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How innovation, telemedicine, and a changing marketplace are affecting health care

Yale Medicine Magazine, 2014 - Spring


Walk-in kiosks at shopping centers could soon become an integral technology in the delivery of health care. In the kiosks—stocked with simple medical devices and a video connection to a health care provider—patients can measure their own height, weight, BMI, and blood pressure, then pass that information along to their doctor, making routine testing just another errand at Walmart.

Telemedicine, a groundswell of innovation, and changes in the marketplace, said management expert Richard Foster, Ph.D. ’66, will change the way hospitals and physicians deliver care. Foster, special advisor to President Peter Salovey for health care innovation, presented his view of the health care industry to a group of Yale School of Medicine alumni during reunion weekend in May. Health care, he said, is the only industry that has altruism at its core. But, he added, it is enormously complex. No fewer than 12 committees in the U.S. Senate and 15 in the House of Representatives have oversight over the industry. And there is a competition between the desire to provide higher quality care at lower cost and the need for stability of quality in the current system.

“The change in leading health care institutions will be as profound as in electronics in the ’60s in the transition from leaders in vacuum tubes and radios to leaders in solid state electronics, TVs, and computers,” Foster said. Drawing on the work of the Austrian economist Joseph Schumpeter, Foster said the companies and institutions that survive will be those that can adapt to the rapidly evolving industry. “The future is going to belong to those institutions that can change without losing quality.”

Foster highlighted several new companies vying for those top spots, many of which boast market valuations in the billions: ZocDoc helps patients find doctors; Castlight makes health care cost and quality information available to consumers; Epic makes electronic health record software for medical groups; and Airstrip Technologies develops mobile medical software applications.

One technology poised to directly affect the way physicians deliver care is telemedicine. According to Foster, medical schools should begin thinking about how to train doctors to deliver care through telemedicine devices like HealthSpot Stations—the walk-in kiosks that may one day replace a visit to the doctor. They could begin cropping up in retail stores in the near future.

“I’m not advocating any of these things, I’m reflecting what is happening in the world,” said Foster. “But I do believe they’re going to happen.”

Some in attendance questioned Foster’s vision of the future. If telemedicine and electronic health records are the future of health care, the Yale-trained physicians wanted proof that those technologies will benefit their patients. “What works? What improves care?” asked Alan H. Morris, M.D. ’69, professor of medicine at the University of Utah. “Health care is being changed by people other than physicians.”

But Yale physicians and entrepreneurs have the opportunity to change that. Foster believes that New Haven is uniquely poised to lead the technological revolution occurring in the health care industry. Yale-New Haven Hospital is one of the biggest in the country, Yale University and the School of Medicine churn out a rich talent pool every year, and new companies can set up in New Haven at lower costs than in cities like New York and Cambridge. According to Foster, all of these factors could attract health care startups to the region. “New Haven is a magnet for entrepreneurs,” said Foster.

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