The InnovatorMD Global Summit 2024, January 11-13, is the largest physician innovation event in the country with a prestigious line-up of speakers, including colleagues like Amanda Goltz from AWS Healthcare at Amazon and Harvey Castro, MD, author of several books on generative AI in medicine.
I had the privilege to keynote this important event. In my talk, I emphasized that our nation stands at a pivotal moment in medical history, and I presented a vision for Healthcare 4.0.
A history of milestones and missed opportunities
The passage of time is marked not just by years and decades, but by generations and milestones. American healthcare has evolved through a series of important eras.
Spanning from the mid to late 20th century, Healthcare 1.0 marked the advent of modern medicine. Scientific progress over this half century revolutionized how doctors diagnose and treat disease. This period witnessed significant medical and technological advancements that extended life expectancy by a full decade.
Antibiotics emerged as a game-changer, turning once-fatal bacterial infections into treatable conditions. Vaccines against devastating diseases like polio, measles, and smallpox not only saved countless lives but also reshaped public health strategies. Innovations in surgical techniques and medical technology further defined this era. The introduction of the cardiac bypass machine opened new frontiers in heart health, making cardiac surgery possible. Similarly, the development of metallic artificial joints and laparoscopes signaled great progress in orthopedic and minimally invasive surgeries. Organ transplantation and interventional cardiology blossomed in clinical practice.
As we transitioned into Healthcare 2.0, emerging at the end of the twentieth century, the promise of a more interconnected and efficient healthcare system loomed large. Patients now had a fighting chance against traumas and illnesses that would have been fatal in the previous era. As a result, life expectancy saw a brief surge. Even more promising was that the era began with the rise of the internet and the initial stages of digitization in healthcare. This gave hope that doctors would be more connected—and medicine more patient-centric—than ever before. Despite advancements, this era fell short of expectations.
The digitization of health records, while a significant step forward in terms of technology, failed to prevent misdiagnoses or make medical information more accessible to patients. Similarly, EHR manufactures built applications to maximize revenue generation instead of clinical outcomes.
Today, American patients and doctors are equally frustrated by the lack of progress in the era of Healthcare 3.0. Though the potential of technology-led improvements in healthcare seems boundless, the promise of patient-centric care remains unfulfilled. In this era, expensive technologies like operative robots and proton beam accelerators, which increased revenue and profits, became popular picks for doctors and hospitals but failed to significantly improve life expectancy for patients. Despite a surge in consumer monitoring devices like the Apple Watch, the core issues plaguing the healthcare system persist. Telemedicine, which boomed during the pandemic, has fallen from favor and is once again a rarity for patients seeking greater convenience and access.
The contrast between the convenience of technology in other industries and its application in healthcare remains stark. Families can effortlessly book global travel online, yet simple communications with doctors remain cumbersome. In Healthcare 3.0, we find an industry trapped in the past, with high-potential technologies failing to realize their full potential due to archaic regulations and clinician resistance.
The failures of Healthcare 2.0 and 3.0 have left American medicine far behind other wealthy nations in terms of life-expectancy, maternal mortality and infant deaths. Half of all Americans report not being able to pay medical bills with healthcare now the leading cause of bankruptcy.
Under these ominous circumstances, it is difficult for most Americans too see how the future of healthcare will be any different from the past. As I explained at the InnovatorMD Global Summit, the gamechanger is generative AI.
Beginning with the launch of ChatGPT in November 2022, large language models have quickly taken whole industries by storm. From retail and entertainment to finance and law, it seems every profession is racing to harness this exciting technology to improve productivity, increase product quality and bolster service.
The advent of generative AI is what will make transformative changes possible in healthcare. It will usher in the era of Healthcare 4.0—marked by “value-based care” that simultaneously delivers higher quality, convenient access, and increased affordability—and it will reshape the doctor-patient dynamic.
At its core, this new era is about leveraging the immense potential of new technologies to maximize all three requisites of value based care. The focus of Healthcare 4.0 is not merely on treating diseases but proactively managing health and preventing complications from chronic disease, misdiagnoses and medical errors, thereby reducing overall costs. This approach represents a paradigm shift from traditional healthcare models.
Generative AI will empower patients with medical expertise (not just knowledge) so that they can be effective partners with clinicians to an extend not possible today. GenAI will drive a shift in reimbursement from fee-for-service to capitation and incentivize increased collaboration and cooperation among doctors. Success, however, will depend on the excellence of leadership whether it comes from inside or outside the current medical system.
The journey of American healthcare through these distinct eras—from the miraculous advances of Healthcare 1.0 to the disappointing Healthcare 2.0 and 3.0 eras, and now to the promising dawn of Healthcare 4.0—highlights the ongoing challenges and opportunities American medicine faces today. Often, people discover that the darkest hour is just before the dawn. I believe this will be true for American healthcare once our nation acknowledges the shortcomings, embraces the possibilities of generative AI and enters the era of Healthcare 4.0.
I extend my gratitude to Uli K. Chettipally, MD, MPH, and Ruchi Sood for organizing this superb and enlightening conference.
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Dr. Robert Pearl is the former CEO of The Permanente Medical Group, the nation’s largest physician group. He’s a Forbes contributor, bestselling author, Stanford University professor, and host of two healthcare podcasts. Pearl’s newest book, “Uncaring: How the Culture of Medicine Kills Doctors & Patients,” is available now. All profits from the book go to Doctors Without Borders.
