Professor Randy Pausch, in The Last Lecture (Hyperion, 2008), taught that barriers are put in front of us to see how much we want what is beyond them. Here are some of the challenges facing the Healthspital 5.0+ paradigm.
- Legal issues: Many modifications of current laws will be needed, especially in the areas of information use and availability at point of care. Issues that will need to be addressed include HIPAA (Health Insurance Portability and Accountability Act), patient dumping, conflict of interest, and discrimination. HIPAA, in particular, was originally enacted as a privacy guard. I contend, based on daily interviews with my own patients, that the American population is more comfortable sharing personal healthcare information than current legislation indicates, so long as they have confidence that the information will be used responsibly and for their coordinated care. With 500 million + people already utilizing Facebook, I believe the vast majority of people (therefore, patients) would make health-related data available to providers and researchers in the interests of preserving and promoting health, their own and others.
- Financial issues: Compared with building new hospital buildings and expanding uncoordinated expanses of bricks and mortar, the Healthspital model and re-visioning offer potentially tremendous cost savings ($5.64 TRILLION at current calculation annually), but care must be taken that these savings are reinvested into more healthful projects rather than shifted to various nonhealth-related special interests.
- Political issues: The creation of the Healthspital 5.0+ concept will require substantial commitment, investment, and will on the part of politicians. The paradigm shift is monumental, so it is certainly appropriate to work at the experimental project level (pilot and proof-of-concept) where results can be analyzed in terms of cost savings and improved health care. However, politicians with appropriate foresight would also be helpful in providing leadership and serving as champions for these concepts.
- Educational issues: As with all major changes, educational ramifications of a health system paradigm shift are tremendous. Health awareness should be taught at the earliest levels, starting in pre-school. Science and nutritional coursework throughout formal schooling is imperative, as well as example setting. Patients currently receiving treatment in the older delivery model will need tools that the local community Healthspital will provide. Lifelong education could thus enable individuals to become more involved in their own health future, allowing them to assist responsibly in the delivery of care to themselves and family members.
- Punitive and unconstructive programs: Bashing and the blame game must be eliminated throughout the health-delivery ecosystem. No one—individual or institution— functions well with a stick at the back. The current pay-for-performance model does not allow the raising of all boats toward improvement, but rather widens the gap between the great performers and the health programs and systems that are performing poorly. Health and wellness are a COMMONS - all benefit from improvements in common health and productivity (World Economic Forum 2015 white papers). Our global COMMON - HEALTH is our new COMMON - WELL - TH.