Commentary

2025: A Health Odyssey

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Randy Danielsen paints a picture of what the health care system will look like just 13 years from now, in 2025.


 

From The Jetsons to 2001: A Space Odyssey to the Zager & Evans hit “In the Year 2525,” humans have long pondered what life will be like in the future. Zager & Evans painted a bleak picture. Rather than jumping that far ahead, I’ll ask: What will health care be like just 13 years from now, in 2025?

We know we will live longer and enjoy a better standard of living. By the year 2025, average life expectancy will be 80—compared to 48 in 1955, 65 in 1995, and 78 in 2012. A major report published by the WHO predicts that life in 2025 will be significantly different from today and almost unrecognizable even from the year 2000.1 Technological advances and progress in medical research, treatment, care, and rehabilitation will further enhance quality of life, especially for the elderly.

At the same time, despite falling birth rates, the world’s population will increase from 5.8 billion now to 8 billion in 2025. There will be more than 800 million people older than 65, compared to 390 million now. Deaths in those younger than 5 will fall dramatically, from 21 million in 1955 to 10 million now down to 5 million, principally due to effective immunization, improved prevention, and treatment of hereditary diseases. Cancer will continue to be a scourge, but it will begin to take fewer lives.

Come with me in my time machine to the year 2025 for a look at a typical health care encounter. Dr. Joe Jonson, the health care team leader, shows up at 0730 in his office at the 21st Century Primary Care Conglomerate and Medical Home. He has no patients scheduled but sits down at his technology workstation, where he faces seven plasma screens. He places his palm on one and all seven screens come to life, booting up the comprehensive electronic medical record and patient care system. As he sips on his protein nutraceutical drink, he thinks back to when his practice was fraught with too many unhappy patients and he was a tired and dejected physician at the end of the day.

Thanks to significant changes in health care management, he now gets to do what he was trained to do—solve significant health care problems. Since a major government overhaul, in which reimbursement moved away from individuals to new not-for-profit integrated networks on a capitated basis, Dr. Joe has been much happier and more fulfilled. The health care system shifted years ago from an autonomous physician self-governance paternalistic model to co-creation and partnership with patients based on mutual respect, trust, transparency, and shared decision-making.

Dr. Joe views the screens, looking at the 48 patients scheduled that day who will be seen by multiple team members who are physician associates (called physician assistants until 2014, when a simple stroke of a pen changed that) and nurse practitioners. Health care facilities are much more efficient than they were even 10 years ago. Efficiency is measured in energy consumption and work performance metrics. Technology, especially robotics, is utilized as best-practices and labor-saving devices.

Just then, Ms. Jamella Anders shows up at the center’s reception kiosk for her scheduled appointment, which she made from home through a secure patient portal. She places her palm on the plasma screen and is shown a map of the facility that illuminates the way to the patient care room assigned to her. (Since the new system started five years ago, waiting rooms have become archaic.) She is directed by a soothing computerized voice to the appropriate room, where she sits in a comfortable chair and places her left arm in a tube that has a magnetic glove at the end.

This is connected to a computerized system that determines her height, weight, blood pressure, pulse oximetry, and blood chemistry—particularly glucose. The computer also has a camera that is able to do a quick fundoscopic examination and general overview. She also breathes into a mouthpiece that measures her FEV1 and screens for toxins. Her genetic profile is pulled up from the master file for reference. Another pleasant computerized voice asks her additional questions, with the answers then shown on the screen, and additional information is obtained about her present complaint.

Once this data gathering is completed, she touches a button on the screen indicating she is ready to be seen. A PA or an NP enters and conducts a focused examination. (Even in the face of advanced technology, hands-on examination is still deemed important.) In addition, the PA or NP uses a handheld ultrasound device to assist in the examination. The PA or NP enters additional information on the plasma screen and also reviews with the patient additional safety and metric information regarding her health.

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