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.
Once a diagnosis is made, it is shown on the screen. Patient directives are simultaneously emailed to her home computer and mobile device. The treatment information is sent to the computerized pharmacy, where appropriate prescriptions will be delivered to her home within hours. Medications ordered will be checked for contraindications and interactions. The computer’s artificial intelligence interface will suggest appropriate doses tailored to Ms. Anders’ age, sex, and genetic makeup.
Back in the main control room, Dr. Joe has noted a digital flag: One of the patients, complaining of shortness of breath, has a blood pressure exceeding current standards. He also sees a request from the NP to see the patient. He leaves the room, after reviewing the digitized CT of the chest, and is able to spend as much time as necessary with the patient.
(With patient safety and preventive medicine the major strategic goals, the physician-led team focuses on multiple metrics during each visit. All caregivers are members of an integrated network and are held accountable by the government to submit quality and safety data to verify they are meeting national standards of care and meaningful use of the health information system.)
There has been a true shift to a prevention-focused, evidence-based model, with a national risk pool providing coverage for all citizens to reduce the overall cost and workload of the health care system. This all started in 2020, when important processes were developed that resulted in the elimination of 90% of adverse events, including virtually all infections, postoperative complications, and medication errors.
Health care quality improvement has reduced waste, redundancy, and nonproductive time of highly skilled clinical staff. NPs and PAs—touted in 2012 as the solution to the current physician shortage and necessary to the integration of quality, accessible health care—are finally abundant. Why? Because of the foresight, in 2012, to not only increase the number of education programs but also to re-examine and change accreditation standards that support quality and growth, as well as significant legislative changes (both federal and state) allowing increased utilization of these important clinicians.
In 2025, there are 600 NP programs and almost 300 PA programs, many of them linked through technology with shared curricula. NPs and PAs number almost 400,000 in this country, compared to about 750,000 physicians (including 400,000 in primary care), because of the huge number of physicians retiring from practice in the past decade.
In 2025, substantial improvement in both quality and safety outcomes is accomplished using “smart” devices wirelessly linked to the patient’s computerized personal health records and also to the clinician’s database. In the past decade, the single most important contribution to the development of safe and efficient health care is the widespread adoption of evidence-based design with an accompanying investment in clinically relevant research. Also, alternatives to the tort system have been created that are honest, fair, reliable, and equitable, which affect safety in health care.
Regenerative medicine surged, with body parts that are damaged from disease or aging being replaced with new, healthy ones—including tissues and organs such as hearts, lungs, bones, and muscle structures—grown from stem cells. Nano devices have been developed that enter cells to remove pathogens and toxins or replace faulty DNA.2
Returning to the present, I have attempted to really step out there, through a somewhat unconventional exercise, to expand our thinking about the possibilities of future health care. Is this science fiction? If so, perhaps Robin Cook or even Stephen King could use this in his next novel. Or is it just bad fiction? Entertaining but wishful thinking? Improbable? A pipe dream?
In closing, I’d like to remind you of something Casey Stengel once said: “Never make predictions, especially about the future.” Send your comments to PAeditor@qhc.com.
1. World Health Organization. The World Health Report. www.who.int/whr/1998/media_centre/press_release/en/index1.html. Accessed February 13, 2012.
2. Henriksen K, Oppenheimer C, Leape LL, et al. Envisioning patient safety in the year 2025: eight perspectives. In: Henriksen K, Battles JB, Keyes MA, Grady ML, eds. Advances in Patient Safety: New Directions and Alternative Approaches (Vol 1: Assessment). Rockville, MD: Agency for Healthcare Research and Quality; 2008. www.ahrq.gov/downloads/pub/advances2/vol1/Advances-Henriksen_104.pdf. Accessed February 13, 2012.