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The Russell Transcript 

Feb. 11, 2005 | Last month, Senate Majority Leader Bill Frist (R-Tenn.) laid out his vision for healthcare in the 2005 Shattuck Lecture, which was published as a special article in The New England Journal of Medicine ("Health Care in the 21st Century") literally on the day President George W. Bush was sworn in for his second term.

It is fascinating reading, laden with predictable "privatization" economic arguments, but also laying out a sweeping vision of how technology will transform healthcare and the drug industry.

Frist's article begins by introducing a fictional 44-year-old patient, Rodney Rogers, who is overweight, a former smoker, and diabetic. We meet him in 2015, but Frist writes that by 2008 Rodney is already interacting with his medical team in a variety of electronic means (video, e-mail, etc.) over the Internet. He has an RF computer chip implanted in his abdomen, which monitors his blood chemistries and blood pressure. He owns his privacy-protected electronic medical records, and takes a single daily pill that manages his blood sugar and cholesterol.

When — despite all this — Rodney suddenly suffers a heart attack while 100 miles from home, doctors at a remote hospital easily call up his electronic medical records, command Rodney's implanted computer to perform some diagnostics, and then inject "nanocath" robots intravenously, and the tiny machines locate a 90- percent lesion and repair it.


The only things missing were a tiny crew, a tiny submarine, and international intrigue (apologies to the late Isaac Asimov, Fantastic Voyage author). Rodney, of course, has to pay the piper, and this too happens automatically. Interoperability standards permit the hospital to transmit treatment information to his insurer for billing and payment.

"During the next decade, the practice of medicine will change dramatically," Frist writes, "through genetically based diagnostic tests and personalized, targeted pharmacologic treatments that will enable a move beyond prevention to pre-emptive strategies. A whole new frontier of medicine will open, with a focus on delaying the onset of many diseases such as cancer, cardiovascular disease, and Alzheimer's disease. We need to re-focus our federal research entities to take full advantage of these breakthroughs."

"Electronic health records must contain all necessary health information, from medical histories to billing information; must be accessible from any Internet portal; must be capable of seamless use among all hospitals, doctors' offices, and clinics; and must be protected by strong, national privacy laws from inappropriate, unethical, or unauthorized use. Widespread adoption of electronic health records will reduce errors, improve quality, eliminate paperwork, and improve efficiency. Once fully implemented, electronic records will dramatically reduce cost and improve quality."

This is a truly a fantastic worthwhile vision. Turning the fantasy into reality is a huge challenge. Many observers think we are decades — not a decade — away from what Frist describes. He recognizes many of the challenges.

Frist argues that the United States has made massive investments in medical research but dramatically under-invested in the research and infrastructure necessary to translate basic research into results. Currently, physicians take an average of 17 years to widely adopt the findings from basic research. The healthcare sector invests dramatically less — some 50 percent less — in IT than any other major sector of our economy, he writes.

So how do we get from here to Frist's vision, in which, "Rodney selected his primary medical team from a variety of providers by comparing online their credentials, performance rankings, and pricing. Because of the widespread availability and use of reliable information, which has generated increased provider-level competition, the cost of healthcare has stabilized and in some cases has actually fallen, whereas quality and efficiency have risen."?

Is it the right vision? It is grand. But it's likely to emerge slowly. And government has a role. The battered FDA, for example, needs to step up and provide guidance on many of the technologies Frist cites.

No doubt Frist has half an eye on the next inauguration, thinking it might be his own. What’s your view of his plan? Write me at* 

For reprints and/or copyright permission, please contact Angela Parsons, 781.972.5467.