I don't know who first suggested the phrase "Knowledge-Based Society". There is no doubt that Alvin Toffler popularized the concept in his still-relevant book, The Third Wave. Other writers picked it up, and soon many were talking about The New Economy, The Service Economy, The Next Economy, or The Post-lndustrial Society.
All these refer to a phenomenon set in motion by the computer in 1946 and greatly accelerated by the personal computer in the '80s--namely, that we have moved into a new era in which knowledge will have increased value. It isn't as though we had revered stupidity in the past, because knowledge and intellect have always been prized and useful, and usually advantageous. But the New Age is a time when almost everyone in an enterprise will need access to and understanding of the pertinent information regarding the delivery of a service or the manufacture of a product. This is vastly different from the industrial model, with its straightline hierarchy leading from a chief (doctor?), who alone possessed the grand strategy, to the bow-and-arrow boys, who simply carried out the chief's desires.
The industrial age gave us the assembly line and the divisional corporate structure and the greatest prosperity this nation has ever had. But by the '70s, it was clear that this industrial management technique--popularized and epitomized by Alfred Sloan of General Motors--was no longer equal to the task of satisfying customers and meeting stiff competition. There is good evidence that many American companies understand the new imperative for greater productivity through knowledge-based systems, and that they are now successfully working smarter--not harder.
It seems to me that the health sciences have adapted less readily to the clarion call for change. To wit, the unrelenting acceleration of costs now threatens the entire system of health care. It is true enough that the rise in cost of dental services has been more moderate, but that is mainly because we have been a fairly unsophisticated cottage industry--without the stultifying hospital and insurance bureaucracy that accompanies medical practice--not because we are such great managers.
In the past decade I've read often that the Information Age demands a change in the way we conduct our practices, but in all honesty, I don't think the idea fully sank in until I studied the interview with J. Patrick Tracy in this issue of JCO. Tracy correctly sees the patient as the center of any good orthodontic database, and suggests that the comprehensive information system originate from patient needs. This simple yet elegant thought should relieve any anxieties on the part of computer-phobes that patients will be reduced to abstract numbers.
If I understand Tracy correctly, he envisions information systems that permit us to customize our diagnoses and treatment plans with more precision than ever, and that then provide us with accurate and timely feedback about how patients are progressing. Such integration of data can only grow in importance, because competition and the threat of reduced profitability will force us to respond by one means or another.
Some of Tracy's suggestions seem impractical at first glance--such as scheduling all of a patient's appointments at the beginning of treatment. Certainly modifications will be necessary in any particular practice, but the main idea is to determine the care, skill, and judgment a patient will require and then integrate that information with other data so that the cost of providing orthodontic services can be calculated accurately.
I doubt that there are many orthodontists right now who can rationally explain their fees. Typically our fees are anything but customized--probably because we aren't naturally inclined or trained to think about productivity and profitability, or about the simplification and integration of data. Most of us were raised with Euclidean concepts in which the whole is equal to the sum of the parts. In the Information Age, orthodontists as well as others will need to learn that the whole is the sum of its parts plus their interrelationships. And these interrelationships will be the keys to understanding productivity and profitability.
In the past this unchallenged, almost careless, approach to orthodontic office and treatment management worked well enough to provide a predictably good return on investment. But there are clear signs that such a cavalier approach doesn't work too well any more.
Simplified, fast, accurate, and timely information systems should permit health professionals to plan the way Harold Geneen, former CEO of ITT, suggests in his book Managing: "A three-sentence course on Business Management: You read a book from front to back. You run a business the opposite way. You start with the end and then do everything you must to reach it."
A comprehensive information system will allow this kind of management, but as Einstein once explained when asked about a concept, "Simple, yes. Easy, no." It won't be easy to pay for such a system, and no matter how simple it is, it will still involve change--which agitates most primates. It will also require far more thought, anticipation, and planning by orthodontists than we've done in the past. But right now it seems to offer us the best hope for having a truly patient-centered practice that lets us rationally and competitively customize diagnosis, treatment, and fee.
Stanley Davis, in his seminal book Future Perfect (JCO, May 1988), pretty well sums up the role of computers in the New Age: "Technology gives us a conceptual bridge that links rules of science and the universe with those of economics which dictate how we must manage." It might just turn out that comprehensive information systems will usher in a renaissance for dentistry--at least for those willing to change.