Open Letter to Amazon: 3 Ways to Build Trust via Shared Results

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Dear Amazon Leaders,

I am writing an open letter to thank you for entering the world of healthcare innovation and to make some modest requests.

We live in a time of great opportunity to improve outcomes, lower costs, and simultaneously support essential relationships. Let’s start with the most essential relationship in that I know: the patient and the doctor.  We are all patients. We all value knowledgeable, caring providers who take the time to make an accurate diagnosis and work in a system of care that guides us in the next steps. Unfortunately, the time constraints currently embraced by the provider community make this less likely and may be resulting in increased initial misdiagnosis and wasteful treatment plans.

We also live in a time where the promise of digital healthcare has yet to be realized by the majority of providers and patients. Given the dramatic adoption of electronic medical records as part of the HITECH Act stimulus dollars, many of us hear every day about the unintended consequences of moving from an analog to a digital world. These include provider distraction, alert fatigue, and the introduction of new types of automated errors in our systems. Bob Wachter’s Digital Doctor book provides a comprehensive analysis of our current state.

“For $30 billion, the federal government succeeded in digitizing a $3.5 trillion industry,” he said, referring to the HITECH Act, which helped fund the digitization of health records.

But the thing that heartens Wachter the most these days is that we’re starting to see examples of this idea of reimagining the work. “The technology is very important,” he said. “But to me, this is where the critical issues are, he said. To me, the key issue is how will this really work for real patients, real doctors, real organizations.”

Source: Healthcare IT News March 2018

My three requests:

  1. Please consider how to partner with frontline providers, especially primary care physicians who have established relationships with their patients and families. This may require “going slowly and creating shared results to build trust”. Amazon has built its success on serving and empowering consumers with its IT platform over the past 2 decades.
  2. Announce your initiatives AFTER you have achieved public and peer-reviewed results to build trust from both patients and providers. There is nothing like shared results to build trust. The recent CNBC article creates marketing hype about cancer care which may be achievable. However, the doctor in me wonders if this too much hype, too early given the challenges IBM infamously experienced in their efforts to improve cancer care.  CNBC article: “The company’s senior leader in health care and artificial intelligence, Taha Kass-Hout, told the Wall Street Journal on Tuesday that internal tests showed that the software performed as good or better than other published efforts to extract data on patients’ medical conditions, lab orders, and procedures.”
  3. Offer inexpensive, scalable solutions to independent physicians who have demonstrated the capacity for innovation. This may seem counter-intuitive given the healthcare industries move to consolidation and growing provider employment by large systems. However, I would point to the success of physician-led ACOs (NEJM) and the Independence at Home (IAH) projects as 2 examples of success by independently minded and innovative physician leaders. Their ability to decrease total costs for Medicare patients: “Research suggests that physician leadership plays a key role in the success of ACOs. In 2015, smaller ACOs and those led by physicians were performing better than ACOs led by hospitals and other large medical organizations. In addition, estimated cost savings do not appear to be linked to financial integration with a hospital.” NEJM.

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