What will the future of health look like? Will it be a utopian vision of clean hospitals, digitized medical records, and embedded displays? Will it take a more preventative approach, encouraging education, exercise, and fitness? Or will it go the way of outsourced IT and programming as the US experienced in the early 2000’s?
In the past few weeks, I’ve seen all three visions and I thought it would be interesting to review and compare concepts from Microsoft and Apple, and see how they measure up to what is really happening in other parts of the world in the face of rising healthcare costs in the US.
Microsoft’s Vision of Health Care
This video, though posted to YouTube in March, is actually over a year old. There’s a description and more information in this blog article on Microsoft’s site, or you can watch the video here:
In terms of aesthetics, the video holds up pretty well. The UI doesn’t look too dated, and the technology (for the most part) is definitely something within the realm of a 7 to 12 year time frame, as described in the blog post. It’s all quite believably presented, and a nice, coherent story emerges which makes me feel a bit warm and fuzzy about technology’s potential for improving our everyday lives.
There are also some really nice touches: the digital tablet which recharges by the door and displays the room number when not in use, and the bedside table surface which uses colored circles to indicate whether medication has been taken.

However, while watching this I found myself becoming exceptionally critical of it.
In many ways, this video reminds me of those films from the 1950s: you know, the kind which purport to show the future of cars and forget about gridlock? In the case this video, I couldn’t help but think of the major oversight:

This is not something which most of us think about, but in 10 years there will be almost 1 billion more people on the planet. Consider that number for a moment. And consider that the world population in 2018 is projected to be double what it was in 1970. The Phillipines alone sees 300 new babies per hour.
So this raises at least one question in my mind (and hopefully yours as well): Where are all the people in this video? I’m reminded of architectural renderings which present abstract representations of people milling about in the tens, not hundreds. Where are the shared hospital rooms? Where are the crowded hallways which would make any floor-based way-finding solution impractical, if not impossible?
The danger of presenting this kind of vision without sufficient reference to real-world circumstance is that it comes off as unhinged: I can’t help but think that this is where design begins to go off the rails and abandon all sense of reality. Do you really believe that in seven years hospitals will look like what is depicted in this video? Call me cynical or jaded, but I’ve seen enough proposals for flying cars which, on the face of it, looked very rational and in reality remained broken promises. Whether or not infrastructure can change sufficiently to deliver the physical environment depicted is one thing, but the lack of consideration for the social condition in 10 years makes this video seem almost…quaint.
To remain relevant, it seems to me that these kinds of visions need to integrate some kind of social or environmental component that serves to connect these visions with the reality that we all know and experience today, and can anticipate as living in tomorrow. It’s tempting to believe that the future will be all flying cars and household robots. But in the face of climate change, rising gas prices, and precipitous population growth I think we also need to consider the other extreme of a more dystopian environment, one which poses a host of wicked problems.
I truly believe that design as a discipline can step up and make a substantive contribution to these problems, but only if we acknowledge a common point of departure that more closely resembles what we know from everyday life. In fact, I am convinced that Design (and by association, designers) can take a leading role in this process. The question is whether we want to apply ourselves to the task at hand and incorporate more of “what is” and “what we anticipate” into our visions of “what could be”.
Apple+Nike’s Fitness System
In contrast to Microsoft’s vision, Apple and Nike offered a glimpse of their vision via some patent filings (also made about a year ago) of a more contemporary lifestyle application. That is to say, an application which could be implemented today, rather than in 7-12 years.
More details here and here, but the basic approach is to combine the video capabilities of the iPod with a more sophisticated version of the Nike+iPod running system to deliver a service that helps you with strength training and other exercises. What’s particularly compelling about this system is the promise of incorporating educational elements into the overall service.

If you’ve used the Nike+iPod running system, you know how surprisingly well-executed the service is. Seemingly from nowhere, Apple and Nike teamed up in 2006 to produce what I would consider a benchmark in service design and delivery. What’s even more surprising to me is that (as far as I’m aware) nobody else has copied this approach, which blends a seamless hardware and software combination with social networking.
But that’s old news. The new vision that these patent filings reveal is that Apple and Nike are looking to tackle full-body health and fitness regimens. The addition of video to the iPod enables clear instructions for technique, and I could imagine this would provide a very nice platform for personal coaching. Connect this data collection and feedback system to the internet (either via the iPhone or WiFi) and obtaining real-time feedback from a live coach, or engaging in real-time competition with a friend, is not inconceivable. This is all relatively obvious stuff, though.
What’s interesting to me is to see how Apple is orchestrating a shift in how we think about the iPod. Since its inception, the iPod has been about music. Now, Apple wants the iPod Touch to be the first mainstream WiFi mobile platform. This is not a minor refocusing, considering the iconic status of the iPod. So instead of going on at length about this shift and doing a lot of hand-waving, Apple is following a little more subtle (subversive?) path by simply providing functionality in such an attractive way that people rush to adopt the new mindset without really thinking about the shift itself.
So of course the iPod is more than a music player. Of course it is part of a running system. Of course it helps you lift weights. And suddenly an iPod is not just about music: we’re using an integrated, persistent, participatory device that seamlessly assists us with our primary tasks. Apple makes this stuff look easy, but I suspect this type of transition actually a very difficult path to navigate successfully.
It’s ironic that Microsoft’s vision of the future revolves around a clinical trial for diabetes, when one of the preventative measures for diabetes is exercise. Microsoft’s vision details a reactive (and traditional) approach of medical intervention and medication, while the Nike and Apple vision proposes a more preventative approach that enables personal lifestyle management. Treating and managing, or preventing and empowering? Which one do you think is more forward-thinking?
More importantly, the Apple and Nike vision illustrates the value of education as an enabler in service design. In this system, people can conceivably “graduate” after learning all the techniques. Perhaps they will stay on to remain part of the community or to receive feedback on their progress, but ultimately they are not dependent upon the service for their continued success. The same cannot be said about medication.
Medical Tourism in Bankok
In sharp contrast to both of these visions of health lies the reality of impossible deductibles and declining quality of healthcare in the US. Taking cues, ironically enough, from the tech industry, a steadily-growing contingent of so-called “medical tourists” have begun arriving in Bankok for an out-sourced take on the future of medical care. A photo from an article in the most recent issue of Fast Company (Fast Company: Medical Leave) sets the tone nicely:

This is not a hotel, but the lobby of the Bumrungrad hospital in Bankok. There is a concierge desk which can help you to renew your visa should you need to extend your stay, and a Starbucks brews coffee in the corner. Different floors accommodate and cater to varying nationalities. The front desk collectively speaks 24 languages.
According to the article, around 430,000 patients from overseas were treated in 2006 for everything from knee replacements to triple bypasses. And one possible direction for this trend is a move towards what can be seen as even more outsourcing. As the spokesperson interviewed for the article states:
Health care, in his mind, is not necessarily a social compact or a universal right, but a quality product to be packaged and sold at a sensible price; he assumes patients are much savvier consumers than their doctors give them credit for.
Among such phrases as “just-in-time patients” and the “Toyota-ization of healthcare”, one can sense a shift in how we’ve come to expect and experience the delivery of medical services. Is this good or bad? Hard to tell, but here’s the vision:
“In order to ensure continuity of care,” he goes on, “you’ll never leave the system. What could be better than telling an American patient they’re going overseas to an American-owned hospital? They’re going to discover the same supply-chain advantages Toyota did when it created just-in-time manufacturing. We’re going to have the same thing — just-in-time patients. Hospitals are not going to spend any more money or any more time in the movement of that patient through the system than is necessary. They’re going to get the patient in, get them on that global platform, and get them back. Now, how do they do that in a fast, efficient way where quality is kept, efficiency is gained, and prices don’t go up? It’s classic manufacturing and logistics.”
The big question is whether patients will be able to adapt (or even accept) the notion of flying 24 hours around the world to undergo surgery from a doctor they’ve never met in person before. As it turns out, money is a big motivator, both on the insurers’ end and the patients’. Some early trials have split the cost savings between patient and insurer, with the patient pocketing a part of the difference. Of couse, one concern lies in whether insurers will compell patients to choose the outsourced option, or if they can rely on incentives to lure particularly expensive procedures overseas.
Final Thoughts
So, I think this issue of outsourcing has relevance to the previous two concepts in two ways. First, the Microsoft vision of the future retains a familiar dynamic between patient, doctor, and physical space while exploring some new technologies. The scenario’s omission of social context is detrimental, but even more so in the face of outsourcing’s disruptive impact in service delivery. When confronted with the possibility of outsourcing, Microsoft must consider an uncomfortable question: the hospital and systems of the future as depicted in the scenario may exist, but will there be any patients in it?
More insidious still is the notion that perhaps we are not prepared for this type of change as presented by both the realities of Bumrungrad or the vision of Microsoft. Instead, we may be more willing to accept an approach more along the lines of the Apple iPod transition: stepping-stones which entice us towards a new future and instill a new mindset as we follow them. In this sense, Microsoft’s vision is a non-sequitor.

Ultimately, all of these visions and realities may be trumped by changing environmental and economic conditions: rising fuel costs may impact both air travel and imports (those shiny iPods have to be imported from somewhere), as perhaps will an increasing awareness of environmental costs associated with air travel. Rising populations may demand services locally which might have been directed at a more international clientele.
While such contextual influences may negatively impact the visions described above, they may also spur investment and reconsideration of more local initiatives. We will no doubt see more proposals for the future of health, and the more closely they consider the incorporate social, environmental, and economic considerations (not just technological) the more likely we are to see them realized.