Industry Voices—To fix America's healthcare system, start small

Would-be policy reformers on both the left and right always seem to want major overhauls of the American healthcare system.

In the absence of consensus about seismic changes, nothing much gets done and costs keep climbing. It's time for a different approach, one that seeks to make many small and uncontroversial—but still impactful—improvements.

Fortunately, we have technology at our fingertips that can dramatically improve patients' health while reducing long-term spending. But the technology alone won't make a difference unless we ensure doctors can make the best use of it—and that we don't overlook individual patients' needs in the process.

Technology can improve health systems in a variety of ways that help patients get and stay healthy. The first is by making it more convenient to access care. One-third of Americans don't have a primary care provider. They wait almost a month on average to get an initial appointment. When they get to the doctor's office, they often sit in the waiting room for longer than the length of the appointment. Even patients with good insurance spend hours on the phone to straighten out a billing mistake.

This has real health impacts.

Patients without reliable primary care are significantly more likely to be hospitalized.  They're half as likely to get a flu shot. They fill fewer prescriptions. The U.S. could save $67 billion annually if patients relied on primary care providers, rather than emergency rooms or other expensive sources, for routine care.

Technology makes booking appointments and communicating with your doctor much less of a headache. Telehealth visits allow people to get care without leaving home, allow physicians to take care of more patients than they could in person and save money by diverting patients from more costly care settings.

Platforms like Amazon Clinic enable patients to message doctors about a range of conditions, like high blood pressure, migraines and sinus infections. Patients don't need to go through insurance, and pricing is listed upfront.

Second, tech tools help doctors and patients take a more proactive approach to preventive screenings and tests that can improve overall health.

Undiagnosed Type 2 diabetes significantly increases a person's risk of stroke, heart attack and kidney failure. Cervical cancer typically doesn't present symptoms until it has spread to other parts of the body. When doctors catch it at an early stage, the five-year relative survival rate is 91%, compared to 19% at stage 4. Automated follow-up messages "nudge" patients and doctors alike into preventive screenings based on patient-specific risk factors.

Prescription medications keep manageable chronic conditions from turning into costly, life-threatening health emergencies. One study concluded that reminding patients with cardiovascular disease to refill their prescriptions made them 12% more likely to do so. Automated "fill your prescription" reminders could feasibly save tens of thousands of lives annually.

The potential of technology to make lasting positive changes for our nation's health is exciting.

But we must stay on guard for potential pitfalls.

For instance, many healthcare organizations already employ tools like automated follow-up messages, but in a fragmented way. A pharmacy pinging a patient about a prescription refill that their doctor no longer recommends can frustrate everyone involved. Importantly, new tech platforms should not paint patient care with a broad brush. Instead, they should complement authentic doctor-patient relationships where personalized care is the focus.

For example, a new app that can analyze tens of thousands of patient charts and identify which patients should receive mammogram reminders could do wonders for preventive healthcare at scale. But such an app must be used with attention to individual patient circumstances. Erroneously sending a mammogram reminder to a woman who has already received a double mastectomy could damage her relationship with her doctor.

Giving practicing physicians a role in deciding how health systems integrate new tech can help avert unintended consequences—and ensure clinicians receive appropriate time and training to use new systems optimally.

That requires a change to the leadership of health systems. Physicians occupy just 5% of leadership positions at U.S. hospitals. Giving doctors—and nurses, patients and administrative staff—a seat at the table will help tech implementation plans account for the realities of patient care.

At the same time, doctors need to lean into such leadership opportunities and find ways to overcome change fatigue. As clinicians, it's critical for us to be open and accountable for adopting technologies and processes that can help us better serve our patients while meeting the needs of the business.

We can't expect to transform the healthcare system overnight. But small changes can deliver big results. And we can start achieving them by using technology we already have.

Sunita Mishra, M.D., is the chief medical officer for Amazon Health Services, which aims to make it dramatically easier to find, choose, afford and engage with the services, products and professionals needed to get and stay healthy through offerings like Amazon Pharmacy, Amazon Clinic and One Medical.