Browsing the Future of Healthcare

During a recent “staycation” spent exploring small-town Maryland, I happened on a very pleasant bookstore where I happily whiled away the afternoon. My family and I are all readers, and love books of all kinds – new, used, print, electronic. We try to shop locally to help keep retail stores in operation.

That visit prompted me to think about some of the similarities between what has been happening in the book business, and what is happening in our healthcare system.

The format of our reading material has changed radically. In 2020, E-books were almost a quarter of the US market. Audio books represent $1B in US book revenue. Many print books are published on demand rather than being kept in stock. Similarly, healthcare has long since ceased to be a matter of “stick out your tongue and say ah.” Genomic testing, X-rays read by AI algorithms, implantable devices and telehealth visits have transformed the face of care.

Bookstores now come in many forms, as do healthcare providers. Subscription book services, online orders from small local independents, big chains, E-tail. And competing with your local outpatient clinic is an app on your phone. Similarly, your therapist may be a bot, your primary care may be delivered by your local megastore, and you may have surgery in an office park. Amidst all this competition, how do we ensure we still have healthy, full-service hospitals when we need them?

Analytics and predictive models are now almost as important as personal recommendations. It used to be, when I wanted a book suggestion, or a doctor, I asked a friend. While I still do, I’m also just as likely to look at Goodreads, or check online physician reviews. And when I do a search, Amazon, or Apple, or Google are just as likely to offer up their suggestions regardless of whether I ask for them. They know who I am, what my buying patterns are, what diseases and symptoms I’ve checked, and what the wait time is to order a book or see a physician in the local emergency department.

Change or die is the watchword, whether you sell books or medical care. One of the big Barnes & Noble stores near us moved recently to a space less than half its previous size. Most independents sell as many gift items as books, and many sell both new and used stock. Sites like Alibris connect small local operations with buyers around the world. Likewise, according to PWC, healthcare mergers and acquisitions grew 56% in 2021, and the trend is expected to continue in 2022. An IQVIA Institute report finds there are some 350,000 digital health applications on the major app stores. And the largest US retailers are all investing heavily in the healthcare sector. For example, Amazon, a major player in the disruptive electronic book business, and which now has brick and mortar bookstores, is moving aggressively into healthcare delivery, both virtual and in person.

What are the implications for the future of care? Interestingly, both businesses evoke considerable nostalgia for a perhaps mythical past. While there are fewer brick and mortar bookstores than there once were, books are actually more accessible than ever. The kindly family doctor who made house calls was never that available to a large percentage of the population, and the highly variable standards of care employed locally didn’t necessarily deliver the best outcomes.

The convenience and choice of the new world order are incredibly appealing, whether I’m purchasing a book on my phone, or popping up the street to my neighborhood CVS for a Covid booster. But it can also be confusing navigating all those choices, and I don’t want to be left without the option to browse the shelves of my local store or have ready access to an inpatient bed for my elderly mother.

There aren’t any tidy strategies for moving forward. So, as a consumer, I’ll keep patronizing local businesses to help them stay afloat. As a health IT professional, I’ll keep looking at how information can be used to guide the future. And I’ll look to the future with a bit of trepidation, and a lot of excitement.