A patient recently asked me why doctors don't spend more time communicating over email or by videoconferencing.
There's a simple answer: Medicare hasn't created a billing code for these services.
I would love to stand up and cheer. But I think this is not a good example. If email and videoconferencing are what doctors and patients want, then we should see it in widespread use in the sectors of the health care system that are not tied to fee-for-service: HMO's; concierge medicine; Canada; etc.
Look, I absolutely agree that third-party payment systems, including Medicare and private health insurance (or what I call insulation) are dysfunctional. They may be particularly dysfunctional with regard to cost-saving innovation.
However, in the particular case of videoconferencing, I think the problem is that this is still perceived as bleeding-edge technology. I brought this up during the video conference with Hal Varian and Nick Schulz. Hal and I remember the 1990's, when corporations first connected to the Internet, and managers dealt with email by having their secretaries print it out for them. They were wary of the new technology and unwilling to really dive into it. That is where most people are with videoconferencing right now.
When that changes (assuming it does), a lot of habits will change. People will spend less time going to and from meetings. Instead, they will hop from meeting to meeting with a click of a button, sitting at their computers. This will save a lot of time.
Yes, I know that videoconferencing is not a perfect substitute for face-to-face. But on some margin, it is more cost-effective. And I think what is holding it back the most is lack of comfort with its use. People aren't using it very much because they think it is bleeding-age, and they think it is bleeding-edge because people aren't using it much. If this analysis is correct, then the situation will tip rapidly. The evolution away from printed-out email took only a couple years.