News From CHEST® Physician

Environmental Scan: Drivers of change in health care


CHEST Inspiration is a collection of programmatic initiatives developed by the American College of Chest Physicians leadership and aimed at stimulating and encouraging innovation within the association. One of the components of CHEST Inspiration is the Environmental Scan, a series of articles focusing on the internal and external environmental factors that bear on success currently and in the future. See “Envisioning the Future: the CHEST Environmental Scan,” CHEST Physician, June 2019, p. 44, for an introduction to the series.

Chest physicians are witnessing a revolution within the environment in which they practice. Information technology, changing consumer behavior, and the social imperative to contain costs are coming together to transform health care.

Innovation in the prevention, diagnosis, and treatment of health-related issues is being fueled by the emergence of accessible and affordable technology-based solutions and changes in patient approaches to health care. Consumers and employers are increasingly motivated to look for cost-effective options for health in care delivery and for economical access to innovations.1 Organizations will need to respond with a strategy that aligns with the changing environment and position physicians to lead these trends in the direction of improved patient care.2

Enabling technologies like electronic health records, blockchain, and artificial intelligence will increase connectivity among all the stakeholders in the health-care system. The exponential increase in connectivity means growing engagement of health systems, health plans, patients, and families in all aspects of health care. For health-care providers, these technologies will mean an acceleration of the requirement to generate data in clinical settings and utilize data for clinical decision making. Easily available data on outcomes and, most importantly, cost of treatment will be expected at point of service.3

Access to information will continue to empower consumers to take an active role in their own health care. More patients will be comfortable with delivery of some health care via digital devices, apps, and virtual access to treatment. The market will respond with technology that helps consumers navigate health-care systems, explore options, and communicate directly with providers. The use of apps and virtual encounters is expected to transform the role of primary care providers: patients will increasingly utilize nonphysician resources in outpatient settings, bypassing primary care physicians and reaching out to specialty care as needed.4

David A. Schulman, MD, FCCP, Professor of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, and Editor in Chief of CHEST Physician, has seen the transformation of patient behavior and attitudes in his own practice.

“In general, they have done far more research about their health problems before seeking my counsel than patients did previously. Many use the internet not just to read about their symptoms and diseases, but also to connect with others having similar issues, sharing experiences, treatments, outcomes, and emotions; in some ways, this is the new ‘crowdsourcing’ of medicine.”

Patients who do their own “research” can present a challenge for physicians. Dr. Schulman noted, “I am often surprised about the misconceptions about disease that derive from information gleaned from a web-based source. One need not look any farther than the groundswell of misinformation being spread about vaccinations to see the potential downside of the pervasive availability of medical ‘facts’ online. Since we are unlikely to convince our patients to avoid the online milieu entirely, our role as health-care providers is to help our patients process and appropriately weigh the information that they receive, potentially partnering with our national societies to help curate such information.”

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