Here are three more ways to make healthcare cheaper by making it better. These three are about smart medicine.

First: It’s a dirty little secret, and if you’re not in healthcare, you might not know it, but most doctors still don’t use simple things like email in their practice. This is the 21st century – most of us use computers at work all the time. Most doctors still write prescriptions and orders by hand – and you know what doctors’ handwriting is like. We need to help them, and it’s time to tell them to get up to speed. Simple things like using the internet and software for things like scheduling and billing, adapted for doctors’ use. Seems obvious, but most doctors have not yet done it. There’s a whole movement to do this, called the Ideal Medical Practice model. Costs go down, so do mistakes.

Second, we need to support standardized, evidence-based medicine, and stop paying for medicine that is not supported by the best evidence. I am not talking about having some bureaucrat second-guessing doctors’ every decision. But if solid evidence in repeated studies shows that a particular procedure is ineffective and unwarranted (like certain types of back surgery), why are we still paying for it? Today, if you take your child to the doctor with a cold and demand an antibiotic, which doesn’t work and is a bad idea, most doctors will give it to you. Why? So they won’t lose your business. If they could truthfully say, “No one will give this child an antibiotic for a cold,” they would not feel forced to give inappropriate medicine.

Finally, we should go beyond email and electronic records in doctor’s offices. We should put everything on computers throughout healthcare. Digitize and automate everything. Every healthcare action that can be done by a machine or computer should be. It’s amazing how much is still done by hand. We don’t have banks adding things up by hand anymore, or airlines writing out tickets by hand. And the airlines made that change, to online electronic tickets and kiosks, even though most of them were bankrupt at the time, because in the end it costs less, and there are far fewer mistakes. Why do we depend for our lives on people writing prescriptions, doing lab tests, and communicating by hand, by voice, with paper and pen? Far too many healthcare environments look like a Charles Dickens story.

So three ways to make healthcare cheaper by making it better are: get doctors offices into the 21st Century, use evidence-based medicine, and automate everything, the way the airlines have.