5. What if HIT were to follow the PayPal model?
One speaker at SXSW pointed out that when the PayPal online payment service started, it was with the full knowledge that many of the things it enabled – such as sending money electronically across state lines – were tightly regulated by the federal government.
PayPal overcame this by starting with small merchants in a single state, California, and by the time state regulators had discovered what state regulations PayPal was violating, the company had a base of small business supporters. They were willing to lobby the legislature to change the laws to accommodate PayPal, in California, and eventually across state lines as well.
In healthcare, apps and services that diagnose (see #3 above) are acquiring their own constituencies so quickly that by the time the FDA tries to crack down on them, there will be growing pressure in Congress from consumers and the new service providers to allow more lenient regulation.
That has to be one of the most disruptive possibilities of healthcare IT—the capability to break down the licensing requirements of who provides care, and how. This power is sure to fly in the face of medicine as it has been practiced ever since our current system came to be.
I am certain that the AMA and a host of other interested parties will fight it, but just like the bankers who tried to stop PayPal and are now trying to stop Bitcoin, the battle may be lost before they realize there was one.