In the history of medical innovation, advances in technology have been inextricably linked to increases in cost. But we are at a unique moment in which the insular world of medicine is about to be penetrated by the remarkable digital infrastructure. Think about the cost of computing. Over the past two decades, cost has been relentlessly reduced while capacity and performance have dramatically increased. How and when can this trend reach the practice of medicine, where costs often go up with little real improvement?
Let’s consider the icon of medicine—the stethoscope draped around the doctor’s neck or in the pocket of a white coat. Invented by René Laënnec in 1816, the stethoscope didn’t see routine use by the medical community for another 20 years. The lag in acceptance reflected the conservative nature of physicians, who objected to having to learn heart sounds and let an instrument get between their healing hands and the patient.
Now, nearly 200 years later, economic forces are greatly slowing the adoption of a powerful replacement for the stethoscope in cardiac medicine. Instead of listening to the heart of a patient, I can now watch it on a device no bigger than a cell phone—a high-resolution miniature ultrasound probe. In fact, in my clinic I have not used a stethoscope to examine a patient’s heart for the past two years.
Why would I listen to the “lub-dub” of heart sounds when I can actually see everything relevant about the heart in real time? Exquisite ultrasound images of the heart muscle—showing its contraction, its thickness, the size of the chambers, the valves, the sac around the heart—can all be obtained within seconds as part of a routine physical examination. I can share and discuss the images with the patient as they are being acquired, put video recordings in the electronic medical record, and send them to the patient or referring physician. The up-front cost of the pocket ultrasound device is about $7,700, but there is no extra cost for an unlimited number of readings.
That makes these small devices a formidable challenge to business as usual in American health care. Each year in the United States more than 20 million echocardiograms (ultrasounds of the heart) are performed, and so are a similar number of abdominal and fetal ultrasound examinations. Each of these diagnostic procedures is done in a dedicated laboratory setting, either in the hospital or in a doctor’s office, with expensive equipment—and a combined professional and technical charge of $1,000 to $2,000. The math is straightforward. If a pocket ultrasound device were incorporated into routine physical exams the same way we use a stethoscope, several billion dollars in unnecessary charges would be saved each year.