Is Tech THE Agent for Change in Healthcare

As much fun as Twitter is, 140 characters just cannot do justice to the complexity of real life, and so this longer post in response to @SusannahFox's discussion in response to @jayparkinson's post on "can tech be an agent for change/generational divide."

As with all complex social institutions, the answer to the question of whether or not technology can be an agent for change is, Yes, with caveats.  It can of course be an agent for change, and is an agent for change, but I think the real question that's being debated here is whether or not technology is the primary agent for change in healthcare.  And because this discussion is framed as a generational divide issue, it becomes a question of whether or not we think a younger generation will let technology do its change-agent thing on healthcare.

Having worked with health insurers, community health centers, specialized health services organizations, and small business physicians, my take is that in healthcare in the US (being made up of lots of sometimes-interoperable systems), change and/or stability is impacted by more drivers than in other countries.  The larger financing mechanisms, the reimbursement systems, privacy regulations, and even the straight-up ease-of-use of new technical infrastructures are all hugely important for shaping change or stability within a given area of American healthcare.  Layer under that competing value sets and worldviews (and here's where generational differences become even more important) and you've got a wonderfully complex turbulence.

So, structure matters.  Just replacing all of the America's current crop of congressional representation with under 40 individuals, but leaving all else in government and civic life constant, would not by any means necessarily produce significantly different outcomes.  So suddenly replacing all physicians (and we're not yet talking about all of the other people who actually make healthcare happen) with under 40 individuals, but keeping all the current systems and relationships in place, would not necessarily and magically produce new health outcomes.

Technology is a major driver of social change (which is why trained American futurists are normally so focused on it), but its impacts, and its trajectory, can be altered by the very social institutions in which we expect changes.  We can resist, delay, and deflect change.

So, our question is really, "will a younger generation (of physicians) unleash technology to truly transform healthcare?"

And my answer to that question right at this moment is, No.

Part of my answer comes from my belief that structures matter and that we need much more institutional and systemic change than, say, ACA is able to command into existence.  And part of my answer comes from my belief that the very centrality of the allopathic physician in our modern conception of health and healthcare is one of the elements that needs to change in order for real transformation to occur.

Put another way, if younger Gen X physicians and Millennial physicians age up into leadership positions, but the rest of the systems underpinning healthcare in the US don't significantly change, then I don't expect real impressive transformation emerging under their watch.

On a minor note, it's interesting (and perhaps refreshing) to note that Jay marks a 40 year-old dividing line, which places Baby Boomers squarely on one end, Millennials on the other, but rather nicely splits Generation X across that line. Interesting...