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The future of healthcare requires risk reduction, by orders of magnitude.

Healthcare is transitioning again. This time the transition will be measured in light-years.

Managed care is so mainstream that it is no longer called managed care.

Corporatization of healthcare, the large scale replacement for local physician managed organizations, for example, Optum Healthcare - United Healthcare is mainstream. Insurance companies like United Healthcare and Kaiser have long recognized this evolution and are driving it forward.

Consequentially, commoditization and consumerization are next.

Consumers routinely connect directly with providers online for a full range of previously office-based services:

- to obtain a diagnosis

- to obtain prescription medications

- to arrange treatment of medical problems.

- to diagnose and treat psychiatric problems

The Covid19 pandemic has accelerated this progression, but it has been evolving for well over a dozen years.

Moreover, patients today can select surgical procedures almost as quickly as menu items at a fast-food restaurant. Furthermore, with this facilitation comes increasingly demanding expectations of outcomes.

Risk is no longer acceptable.

Healthcare must evolve to meet these expectations, a lot like how the 1960’s airline industry evolved to achieve >10-fold greater through-put with >10-fold decreased accident rates. [1960's: 5,196 accidents with 13M flight hours vs 2018: 1275 accidents / 180M flight hours.

If the airline industry had not evolved, the annual accident rate could be as high as 72,000 per year. With accidents rates this high, it is unlikely that the industry could have grown the way it has.

How this was achieved is relevant but beyond the scope of this article. Suffice it to say that it involved far, far more than the implementation of checklists.

The future is here today:

Surgeons must be able to provide better care with greater efficiency and quality than ever before.

Gone are the days when a surgeon's instrument slipping into a vital structure are accepted as “just one of the dangers of doing surgery.” This type of failure mode has no place in surgery. Surgeons must and will abandon instruments and techniques that allow for this kind of failure mode.

Better tools are required for consistently good results. Surgeons must evolve beyond steam gauges to intelligent, anatomy-aware robotic solutions as quickly as possible.

BiPAD® is an example of such an evolution. We need to replace or improve every instrument or device that presents with a significant failure mode, such as distracting the surgeon from maintaining 100% attention to the surgical field.


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