Economist: In the future, big institutions will provide healthcare at lower costs but with less of a personal touch

We've heard about how healthcare should be more like the airline industry or customer-friendly online retailers such as Amazon or Zappos.com. But a new article in MIT Technology Review argues that after the information technology revolution, medicine will be more like superstore Walmart.

Author David M. Cutler, professor of applied economics at Harvard University, writes that infusing IT into hospitals and physician practices will make healthcare more like retail or finance. "Healthcare will be provided by big institutions, in a more standardized fashion, with less overall cost, but less of a personal touch," Cutler writes.

He points to increased electronic health record adoption by physicians, up to nearly 80 percent in 2012. Walmart replaced the small drugstore and Amazon put book stores out of business, Cutler says, because they were using IT better.

"With an electronic backbone in place, one doesn't need to see a doctor for every issue," Cutler writes. "There is little the primary care doctor does that can't-and increasingly isn't-being done by a nurse practitioner, perhaps in a clinic in a Walmart or CVS."

Cutler thinks the biggest changes will come from making patients participants and contributors to care. Home monitoring and do-it-yourself decision support software will give patients the power of greater choice.

"Information technology is going to change the game because it will affect how people view themselves, their illness, and the people who care for them," Cutler writes. "Amazon's loyalty comes in no small part because it uses our past searches and the searches of people like us to predict what we will want. The customer is part of Amazon's memex."

An example of how current IT systems are hindering care integration and decreasing efficiency was reported yesterday, pointing out that few systems were designed to keep track of patients over a full care cycle and give all caregivers information, two healthcare specialists argue in a Harvard Business Review blog post.

"Most clinical information systems have been designed around specialties, procedures, or care sites, and focused on scheduling and fee-for-service billing," Harvard business professor Michael E. Porter and Thomas H. Lee, M.D., chief medical officer for healthcare management consultant Press Ganey, write in the commentary.