Day Two Morning: Tuesday, 25 March 2003

Making Healthcare Work with Advancing Technologies

Plenary Session: Innovation in Care Delivery

One of the very few constants of care delivery has been the adherence of physicians to the sixteenth century injunction of the great French military surgeon, Ambroise Paré who wrote: “Primum non nocere – “first do no harm.”

While there is no law in biomedical science analogous to Moore’s Law in information technology, medical innovation nevertheless continues to accelerate at such a rate that the practice of medicine and surgery today only vaguely resembles that of fifty years ago. What is experimental today is state-of-the-art tomorrow and routine the day after.
The question therefore emerges: Can the social engineers of medical innovation – those who have assumed a major role in its development through its management and funding - keep pace with these changes and understand what it takes to introduce them into society in an effective manner?

This plenary session will seek to learn what is the real impact of medical innovation on the medical infrastructure and healthcare costs (where “real” refers to the cost to society as a whole and not just to the hospital charges) and to propose new systems that might facilitate accessibility while reducing costs. Questions such as the following will be addressed: Why has healthcare been slow to adopt the efficiencies that are achievable by the rational use of information technology? Why are overhead costs as a percentage of charges so high in the modern teaching hospital? Once the patient is informed, who should be the ultimate decision-maker in the determination of what constitutes appropriate therapy? This list is neither totally inclusive nor exclusive, but serves as a guideline in the attempt to understand and improve the venue in which the most important discoveries are first and most often utilized, and in which the greatest percentage of healthcare costs are incurred: the modern hospital.

Seminar 1: Debating the Form and Funding of the Hospital of the Future

The modern hospital is the clearest test case for the questions posed above. It is the stage onto which innovation must be introduced both scientifically and cost-effectively. The complexity of the modern hospital is matched only by a nuclear-powered aircraft carrier – a flight crew of 125 supported by a crew of 5000 or, in this case, a senior medical staff of 300 supported by a staff of 6000. The doctors treat patients, teach residents, run laboratories, raise money, and attend endless committee meetings. In addition they must keep abreast or ahead of the vast scientific literature in their field in order to ensure that their patients receive the latest and best therapies and that their basic and clinical research pursuits make sense and will be funded.

Is this system sustainable in its current form? What are the most innovative concepts in the evolution of the current hospital system and funding?

Seminar 2: The Technology Drivers of Care Delivery

Beginning in the early 17th century, comparisons with man-made machines began seriously to invade biological science; Descartes’ attempt to compare the workings of the nervous system with those of the clock created a metaphoric system of analysis which is today standard in the world of medical technology.

In recent times, the desire to study living systems has driven the creation of powerful new imaging systems that are in turn applicable to inorganic systems. As a result, the physician and surgeon have become progressively inundated with ever more complex patient data. The practicing doctor is confronted with a dilemma: At what point does more information become irrelevant and confusing? Is too much technology counterproductive, or is this simply the view of a Luddite and an inefficient vision of medicine and science?

Oliver Wendell Holmes, Dean of the Harvard Medical School, in the second half of the nineteenth century, said that “the art of being a good clinician is making the right judgment on inadequate evidence.” This seminar will explore the validity of that statement in the context of the use of modern medical technology - the sine-qua-non of the modern hospital.

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Day One, Morning
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Day Two, Morning
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Day Three, Morning
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