The future of the pediatric practice

During the 4 decades that I have practiced pediatrics, our specialty has evolved in many ways. Thirty years ago, we gave epinephrine injections for children coming to the office with asthma attacks, recommended ipecac for poison ingestions, and often would perform septic workups in the office prior to hospitalizing febrile babies.

During this time, pediatricians made rounds at the hospital, attended cesarean deliveries, and were frequently paged during days and nights on call. After an office visit, parents would pay at the time of service and submit receipts for reimbursement. We performed strep and urine cultures in the office. In all, it was far less complicated than it is today.

What does the future hold for pediatric practice?

I wrote my predictions for the future of pediatric practice over 20 years ago in the January 2000 issue of Contemporary Pediatrics®.¹

I correctly predicted that pediatricians would adopt electronic health records (EHRs) and patient portals. However, this did not occur until the enactment of the Health Information Technology for Economic and Clinical Health Act (HITECH), which was part of the American Recovery and Reinvestment Act (ARRA) of 2009.² Likewise, I predicted touch-/stylus-enabled computer screens and the ability of computers to populate fields in an EHR, either via patient or staff input, and the ability of “connected” devices to rapidly take vital signs and perform patient screens. I also correctly predicted the use of biometrics to confirm the identity of patients— although few practices have implemented this—and the availability of a nasal vaccine (which was introduced for influenza in 2003).³ However, I was incorrect in predicting that people would begin carrying a medical card containing their health care related data. At the time, I did not foresee the impact of smart devices on health care, the rise of cloud computing, and how patients would utilize patient portals to make office visits, ask questions, and pay their bills.

Additionally, like so many others, I certainly never saw a global pandemic coming, or that insurance companies would continue to wreak havoc on health care. I’d like to think that the COVID-19 pandemic will lead to an overhaul of our present health care system, and hopefully expedite much needed health care reform.

Looking forward

As an optimist who has seen how technologies have slowly improved health care over the course of many years, I believe that future pediatricians will have many new tools at their disposal that will improve patient care. For example, we will see Drs Alexa, Siri, and Google evolve and have the ability to remind diabetic patients to measure and record their sugars, suggest healthy eating habits and exercise for children who are overweight, and remind families of upcoming health care visits. They will facilitate booking appointments and facilitate telehealth visits, if needed. Translation systems are improving and soon will let you converse with foreign language-speaking patients in real time, with both users merely wearing headphones.

I am hopeful that in the future we will have a patient-focused health care system where government involvement has been minimized and providers can direct patient care with limited oversight by insurance companies.

Clearly, the best is yet to come.

Dr. Schuman's predictions

References

1. Schuman A. Beyond 2000: tomorrow’s office technologies today. Contemp Pediatr. 2000 Jan;17(1):116-127.

2. US Department of Health and Human Services. HITECH Act enforcement interim final rule. Revised June 16, 2017. Accessed August 5, 2021. https://www.hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement-interim-final-rule/index.html

3. Piedra PA, Gaglani MJ, Kozinetz CA, et al. Trivalent live attenuated intranasal influenza vaccine administered during the 2003-2004 influenza type A (H3N2) outbreak provided immediate, direct, and indirect protection in children. Pediatrics. 2007;120(3):e553-e564. doi:10.1542/peds.2006-2836