Decentralized Healthcare — Part I. Cooler than Bitcoins, But What Is It?

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Throughout history, advancements in science and technology invariably resulted in new societal power shifts. Because of technology, groups aggregated, and countries formed.

Similarly, as technology progresses, the challenges posed by cultural differences, language barrier, and physical distance are now disappearing. The birth rate is dropping in the developed countries, and individualism is prevailing in many cultures. There has been a time when only major universities are equipped with giant computers, which could only perform a fraction of work what can be done in our palms today.

Concurrent with this observation is the impact of technology on healthcare delivery system. At the beginning of this century, doctors typically took house calls and treated patients at home. [1] They carried just a bag filled with whatever herbs or instruments available to treat their patients. There were few complex operations, much less surgical teams, or subspecialties. With the advancement of medical technology, hospitals became the latest most sensible care delivery financial models, where more sophisticated coordination among care providers can be accomplished and more advanced (and expensive) equipment can be housed. Increasingly, as a result of both population growth and technology advancement, there is now a daunting challenge to meet growing demand based on this financial model, and the pendulum is swinging to the other direction. Healthcare delivery system will need to be more decentralized (or distributed) to meet the demand.

It is no longer hard to imagine that soon we can get 90% of our healthcare at home, from a physical exam, diagnostic tests, personalized pharmacy, to minor procedures. 3D Printing, artificial intelligence, cloud computing, wearables, telemedicine, the blockchain, and more can all play a role in this future as the enabling technologies. This vision can be summarized as decentralization of healthcare delivery system. Similar concepts on “centralized”, “decentralized”, and “distributed” systems are often discussed in computing and bitcoin industry. The following diagram is commonly referenced [3]:

(Often, in healthcare, the term “decentralized” and “distributed” are used interchangeably.)

Decentralization, as opposed to a centralized process, “is the process by which the activities of an organization, particularly those regarding planning and decision-making, are distributed or delegated away from a central, authoritative location or group.” [4] One can also argue that there are many kinds of decentralization in healthcare by borrowing concepts from other decentralized systems [3]. Namely:

· Architectural decentralization

· Political decentralization

· Logical decentralization

To give a few examples of existing decentralized care delivery system:

1. Urgent care centers (often staffed with nurse practitioner) scattered throughout a city reduces the demand for ER visits.

2. Digital health apps that allow for automated prescription (or via telemedicine) without an actual doctor’s visit.

3. Smile Direct Club allows cheaper dental aligner at home without high cost and time spent with the orthodontic profession.

4. 3D-print prosthesis can be made in third world country where traditional prosthetists are not readily available or enough to meet the demand.