In his latest book, The World is Flat, Thomas Friedman, the New York Times Foreign Affairs columnist, describes the dazzling and rapid technological and social shifts spearheaded by the Internet that effectively leveled the economic world, and “accidentally made Beijing, Bangalore and Bethesda next-door neighbors.” Today, “individuals and small groups of every color of the rainbow will be able to plug and play.” Friedman believes the world is flat in the sense that the competitive playing fields between industrial and emerging market countries are leveling. According to Friedman’s analysis these changes created a flat world, which is based on a global, web-enabled platform for multiple forms of sharing knowledge and work, irrespective of time, distance, geography and increasingly, language. Hundreds of million new workers from India, China and the countries of the former Soviet Union entered the new global market, contributing to outsourcing, which resulted in a net loss of manufacturing jobs in the US. New knowledge-based jobs are being created in India and China, affecting each and every aspect of our economy. This new flat world has changed the way we conduct business utilizing resources not only nationally, but also globally. In order to survive in this global market place we all have to adapt to the changes. Friedman calls those who can adapt “Untouchables”. Those “Untouchables” are workers who offer specialized knowledge of their particular field, who are anchored (face-to-face jobs like doctors that can’t easily be exported), or who are really adaptable and constantly learning new skills to stay ahead of the flattening “curve.”

What has that to do with medicine and information technology? Well, these changes are already affecting the delivery of health care and health information technology (HIT) is playing a major role. Those changes include outsourcing of radiology services to India, where board-certified and US licensed international medical graduates interpret diagnostic tests that are being sent from US hospitals in digital format via high-speed internet access to India, interpreted and signed and sent back for the fraction of what it would cost to obtain the same service in the US. Furthermore, consumers are now used to receive products and services manufactured abroad at Wal-Mart prices and demand similar low-cost customer service from the US health care system, one of the largest and most expensive service industry in the world. In-store health clinics in pharmacies and major retail stores are one expression of the changes looming on the horizon. Those clinics offer 24/7 medical services at discount prices rendered by nurse practitioners and physician assistants supervised by doctors that are residing at off-site locations and use computers to check and monitor the health care delivery. This is the exact same model large US companies apply when they are outsourcing their call centers to India or Asia. Even doctors are not untouchable any more! How can we change that? How can we protect our profession? How can we become untouchable? There is a simple solution. We must learn to adapt to the ever changing market place utilizing medical information technology tools to optimize and maximize our customer service. How can you do that? Well, these are the steps I suggest to reach your untouchable status:

• Build or reconfigure your medical practice according to customer service centered principles including expanded office hours and weekend services.
• Design and integrate dynamic web sites into your practice model, which can provide: on-line appointment scheduling service, automated lab result retrieval features with explanatory comments by the physician, direct access to physicians via voice- and e-mail, patient triggered electronic prescribing service and a fully integrated electronic health record with interface to hospitals and other physician practices.
• Develop new access opportunities for your patients including online consulting utilizing telemedicine modalities (video, audio, remote vital sign monitoring)
• Maximize patient safety by implementing software assisted medical decision making and treatment planning tools supervised by a board-certified physician. This represents another value-added benefit for your patient.
• Computer assisted chronic disease monitoring with automatic patient reminders for repeat visits and testing.

These are just a few of the many opportunities you can create to change and adopt your medical practice to the new global business model. This will require hard work and dedication. We need to educate our medical students, residents and practicing physicians to be fully prepared to respond to an ever changing medical market place. Those who succeed to adapt will belong to the cast of the “Untouchables”. Those who resist will loose their market share and eventually fail. Don’t miss out on the exciting opportunity to transform your medical practice into a thriving and viable medical business. Don’t forget that every journey begins with a first step.