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Anniversaries are a good time to consider past accomplishments and future possibilities. To mark Health Data Management’s 15th anniversary, we asked five of the nation’s leading health care futurists for their reflections on the past 15 years and their predictions for where health care information technology is headed in the next decade and a half.

Leland Kaiser President Kaiser Consulting Brighton, Colo.

In the past 15 years, health care has made great strides in applying computers to a wider variety of tasks, Kaiser says. “We used to see computers as tools—instruments to help us do the job,” Kaiser says. “But computers are not just fancy typewriters or a way to keep track of data; they’re a way to manage knowledge.”

Today’s ubiquitous computerization and global connectivity via the Internet will lead to “decentralized communities of interest that advance the state of the art,” the futurist says.

For example, academic medical centers and their “centers of excellence” will lose power because small groups of experts from around the world will hold virtual meetings to tackle problems interactively.

“Artificial intelligence, which is coming very quickly, will have the ability to know everything that’s known and suggest hypotheses and possess reasoning capacity,” he adds. “So we will become more computer-dependent.”

Once the payers for health care, including the federal government, mandate that all caregivers collect data on all aspects of treatment, this “transparency” will make it easier to weed out incompetent providers, the futurist predicts. Computers will enable total accountability, which will make it far easier to control health care costs, he adds. “Doctors who fail to practice good medicine and document it will not get paid,” he states.

Kaiser points to several important emerging trends, including:

* Computers will read a person’s neural impulses to compensate for a disability, such as the loss of a limb. For example, a computer will read brain signals and give instructions to a prosthesis to move.

* Implants will transmit a patient’s vital signs to a satellite. When the implant sends information that indicates an emerging health problem, a monitoring computer will alert an emergency team to respond before the patient even knows there’s a problem brewing.

*Ultimately, computers will be able to take commands from human thoughts. “There’s a theory developing that there’s a particle between mind and matter, and if we learn how to use it, we can use thought as an input device.”

Joe Flower CEO Imagine What If Inc. Sausalito, Calif.

“Charles Dickens stepping into a hospital at the turn of the 21st century would not feel uncomfortable with the way we keep records,” says Flower, lamenting the fact that someone from the 19th century would find handwritten notes are still the norm. “What we know as the medical record was invented in the mid-19th century, and the movement to an electronic version is the first really significant change in all those 150 years.”

In addition to ongoing efforts to digitize records, the most significant developments in health care I.T. in the past 15 years have been the development of standards for data and the refinement of data monitoring, the futurist says. By mining the data in standard electronic records, health care organizations soon will be able to pinpoint treatments that actually work, he contends.

This “data transparency,” he argues, will be “the most revolutionary force ever in the history of medicine.”

Those who pay for health care have not been able to gather the necessary information to pinpoint the quality and cost of care, Flower says. By using data mining, “we will be able to determine what works and what doesn’t and compare the costs of individual procedures as well as entire solutions to health care problems, like replacing a hip.”

Data transparency will enable the U.S. health care system to slash costs in half by eliminating wasteful, ineffective care, he predicts. The key factor, he says, will be to require doctors and hospitals to gather data and make it public. “The industry is going to resist having to put data out there,” he says. “But payers will demand outcomes data.”

Jeffrey Goldsmith Owner Health Futures Inc. Charlottesville, Va.

A new generation of CEOs in health care will pave the way to widespread adoption of information technology, Goldsmith contends. “The cultural and organizational constraints on I.T. adoption are a lot more significant than the cost of the technology itself,” he adds.

The current generation of executives views I.T. “as a series of extraordinarily painful capital investments and learning experiences,” the futurist says. “The generation of leaders 15 years hence will not have experienced I.T. as disruptive. They will have grown up with computers as an enabler of communications.”

The emerging theme for I.T. is instantaneous communication and decision support, leveraging such technologies as instant messaging and social networks, Goldsmith says. Remote clinical management technologies are already enabling some pioneering clinicians to manage dozens of patients in multiple locations, he points out. Soon, computers using sophisticated speech recognition will be able to carry on structured conversations with the user, he adds.

But physicians won’t make electronic health records a common part of their routines until they are easier to use, the futurist contends. “They are still too complicated, with too many moving parts, a tough user interface and high cost,” he contends. Employing the application service provider model of computing will help make EHRs far more affordable, he adds.

Health care can achieve massive savings in the years to come if it successfully eliminates all the paperwork associated with adjudicating medical claims, relying on real-time transactions instead, Goldsmith says.

Today’s efforts to build health information exchanges will prove fruitless, just like the community health information networks of the 1990s, Goldsmith argues. Instead of building networks to share data—what the futurist labels as a “1970s-type idea”—he says health care should capitalize on “the revolution in data storage.” He predicts we’ll wear high-capacity data storage devices as jewelry or perhaps tattoos that will accommodate complete medical records. “If you need the information when somebody is there, doesn’t it make sense that they are the bearer of the information?” Goldsmith asks. “That would be a truly ‘personal’ health record.”