Another Khosla pronunciamento: self-promoting but myopically correct?

click to enlarge The Gimlet Eye returns and delivers some hefty weekend reading…. Like General Douglas MacArthur, The Eye had to return from my Remote Pacific Island sometime. What better reason than to deliver to our readers Mr Vinod Khosla’s, tech investor and now Health Futurist, latest pronunciamento via VentureBeat.

It is, as they said in 1950, a beaut. It’s apparent Mr Khosla need not even speak at conferences anymore, because he can publish on his investment company’s website a ‘Draft’ entitled ’20 percent doctor included: Speculations and musings of a technology optimist’. It is being treated in certain quarters like Moses toting The Big Tablets down Mount Sinai; at the bottom the DH3 (Digital Health Hypester Horde) swoon in the usual places.

Mr Khosla reiterates some of his bomb-thrower memes from a couple of years ago: 80 percent of doctors could be replaced by machines, doctors were clinging to ‘voodoo-like practices’ and eventually we will not need doctors because we’ll be weller through technology and Big Data anyway. But the Eye’s Review of the ‘Draft’–which Eye was prepared to give the Gimlety Treatment–is that his prior attention-getting statements are not only more qualified (or stated more gently), but also backed up with real data, examples and mostly memorably, legitimately forward thinking whch largely avoids blaming doctors and shifts it onto the laggard Medical Establishment. “In fifteen years, data will transform diagnostics, to the point where automated systems may displace up to 80-percent of physicians’ standard work. Technological developments will AMPLIFY physicians’ abilities by arming them with more complete, synthesized and up-to-date research data, all of which will lead to better patient outcomes.” He also predicts new definitions: “The consumer’s health as “wellcare” will start to merge with today’s “sickcare” to move towards a broader definition of healthcare. What may seem surprising today but will seem usual in the future is the regular emergence of new medical practice. Heart monitoring systems will use all this available data to predict heart attacks hours if not days or years in advance. You won’t have heart disease or not or “have diabetes” or “not have diabetes” but will be classified in the continuum between the two.” In between are some very apt stories of how ‘standard practice’ may not be the best practice, the ‘whiplash’ of studies du jour and some unnerving stats on the cost of patient-doctor miscommunication and misdiagnosis. Mr Khosla does return to slam-mode on doctors not understanding ‘thinking machines (pages 15-16) (but then who does anyway? Not even Google or Amazon have figured out What They Have Wrought…Yet) and “the regulatory, profit interests and human elements will slow adoption to a substantially larger degree” (he could have emphasized the first).

Spoiling it a bit is the Khosla Ventures advert in the middle with his investments: Lumiata (real-time analytics), Gamgee (digitized hospital discharge handouts), AliveCor (mobile ECG), Cellscope (mobile otoscope), Ginger.io (behavior analytics) and others.

Towards the end (pages 27-32) is an interesting exploration of how this could develop in stages from v2 to v7….so far in the future it’s hard to consider. Eye was prepared not to like it…but it’s worth your time (well, chunks of time) on a spring weekend. Your thoughts?

Editor Donna note in counterpoint: Earlier in the day, I was ‘doing homework’ on the largest medical house call organization in New York State. It serves what’s euphemistically called the ‘underserved’ and the homebound–immigrants, lower-income people and older adults in New York City, where to be poor, old, disabled, homebound and with English as a second language puts you at a massive disadvantage for nearly everything, especially when caught in the maze of healthcare. What the doctors and nurse-practitioners carry is effectively an ‘office-in-a-box’: diagnostics, lab sampling, meds and an EHR with the patient’s record. They then help the person maintain wellness through monthly house calls, guidance for caregivers and also to help the patient and caregiver negotiate the labyrinth of insurance, obtaining assistive services/equipment and other providers. Two striking things: the technology, and the crying need both patient and caregiver have for the human touch of the visiting practitioner. That person, while delivering healing and human contact, is also assessing the total picture in the home–the context that person is living in–not just the tests. Care is at once enabled by technology, and not replaceable by it…yet. Will the Khosla-Weltanschauung push away the human factor, inevitably?

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