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P2P Health Care

Last Friday, I was the designated “legal implications” speaker at a University of Pittsburgh conference on Technology and Aging. The conference kicked off with a keynote by Eric Dishman of Intel, who gave a rousing talk about the coming move from the “mainframe model” of health care delivery (for all your health care needs, go to the huge, expensive medical center) to the “personal computer” model of health care delivery (technology-supported, individually-controlled information monitoring and management). Eric took special care to distinguish technology development in this space from the (obviously less important) problem of the “blinking VCR.” And all of the presentations that followed were excellent demonstrations of the idea that personal empowerment is the endgame for independent living as we age.

I was on the last panel of the day. I began my remarks with the observation that while Eric Dishman was a great researcher, Eric Dishman’s framing was wrong. The rest of my remarks went something like this:

Eric is wrong in two ways. First, he’s wrong to use the VCR as the baseline emblem for the health care technology space. Instead, he should use the TIVO. And second, the reason he should use the TIVO is that he’s wrong to look for a metaphoric shift from mainframe health care to PC health care. After all, in the computing world, the PC era is over. PCs sat on your desk and were plugged into only one thing — AC. There aren’t a lot of those left today, and there are fewer of them by the hour. Today, it’s a networked world. If you’re looking for the right paradigm for the next generation of health care technology, think peer-to-peer health care. P2P health, not PC health.

The P2P metaphor works better as a slogan than as a model; what I mean is that in health care as in entertainment, it’s all about the network. What’s going to happen in health care is the same thing that’s been happening in music and movies, that is, a steady devolution from centralized production and hierarchical distribution to decentralized, distributed, integrated production and distribution. The old model is from the top down. The new model is across networks. Networks of people: older Americans and their families, friends, and caregivers; health care providers and insurers. And networks of technology: sensors and monitors and databases and devices connected to them. Independence is a noble goal, but an impossible one. Even the most independent among us will be linked to others.

That means that the developers of health care tech should learn some lessons from the last decade’s worth of battles over entertainment tech.

What are those lessons? First, that the move to a decentralized networked world is inevitable and inexorable. That’s the good news for the forces of empowerment. Second, that independence and empowerment comes with a price, which consists precisely of that connection to the network and concerns that people or firms will exploit that connection in inappropriate ways — drawing down resources, for example, and drawing down privacy. And third, that there will be active, bitter resistance, primarily from older institutions that were at the centers of the older, hierarchical production and distribution function, and secondarily from people whose professional and social roles will undergo radical transformation. How many of you have seen the trailers in the movie theaters that feature the stuntman who’s afraid that his job will disappear if people can download movies for free? Okay: now imagine the workers in the independent living centers who will argue that electronic monitoring technologies will take their jobs away.

The takeaway is that it’s all well and good, and right, that we should invest in developing and distributing these technologies. There is hard work ahead, however, in managing the transition from the current world of centralized health care delivery to the brave new world of P2P health.