????在其它一些我們認(rèn)為需要由人進(jìn)行判斷的領(lǐng)域，由人力向自動(dòng)化的轉(zhuǎn)變已經(jīng)發(fā)生了。比如大多數(shù)民航飛機(jī)現(xiàn)在都是自動(dòng)導(dǎo)航的，而不是由機(jī)長駕駛。大多數(shù)股市交易都采用算法交易。谷歌（Google）的無人駕駛汽車已經(jīng)在普通街道上安全行駛了30萬英里。機(jī)器取代人力的革命也同樣會(huì)發(fā)生在醫(yī)療領(lǐng)域。它將有助于更全面地了解病人病情，通過更加個(gè)性化的療法提高治療效果。醫(yī)生將有更多的時(shí)間與病人進(jìn)行交流，以找到那些難以精確度量的信息，因?yàn)樗麄儾槐卦傧襁^去那樣，把大量時(shí)間花在收集數(shù)據(jù)和看病例上。現(xiàn)在他們可以同時(shí)處理更多的病人，降低成本。

醫(yī)療創(chuàng)新的源泉

????這些創(chuàng)新來自哪里？有人認(rèn)為，我們應(yīng)該在現(xiàn)有醫(yī)學(xué)成就的框架內(nèi)進(jìn)行努力。我不同意這種看法。

????創(chuàng)新很少從內(nèi)部發(fā)生，因?yàn)楝F(xiàn)有機(jī)制的設(shè)計(jì)往往并不鼓勵(lì)顛覆性的創(chuàng)新。制藥企業(yè)總是推出各種藥物，而不是研究更好的治療方案，因?yàn)樗麄兿胍悴粩嗟刭I藥，讓他們盡可能長久地賺取利潤。醫(yī)療設(shè)備公司也不想提供更便宜、更易用的監(jiān)測設(shè)備，這樣他們生產(chǎn)的那些昂貴的儀器就賣不出去了。這些傳統(tǒng)玩家會(huì)用各種手段軟磨硬泡，使醫(yī)生和監(jiān)管機(jī)構(gòu)對創(chuàng)新說“不”。讓這些醫(yī)療機(jī)構(gòu)創(chuàng)新，就是讓他們降低自己的利潤。當(dāng)然，這是泛泛而談，社會(huì)上也有許多出色的、有良心的醫(yī)生和機(jī)構(gòu)。

????幸運(yùn)的是，現(xiàn)有的這些成功的醫(yī)療機(jī)構(gòu)是否帶頭創(chuàng)新并不重要，因?yàn)閯?chuàng)新無論如何都會(huì)發(fā)生。而且創(chuàng)新可能會(huì)從外圍發(fā)生，比如美國有4,000萬人沒有保險(xiǎn)，印度有成百上千萬人看不起病。醫(yī)療創(chuàng)新使得投入到固定設(shè)備上的資金得以減少，削減了成本。它使我們可以向那些看不起病的人提供基本的醫(yī)療服務(wù)。它可以幫助我們減少失誤。而且它可以避免小病拖成大病。

????企業(yè)家可以擔(dān)當(dāng)起這些挑戰(zhàn)，為創(chuàng)新打開新的視野。他們提出的一些貌似天真的問題有時(shí)直指問題的核心，有時(shí)還會(huì)發(fā)現(xiàn)一些尚未被人們察覺的問題。他們可以利用許多醫(yī)學(xué)界人士為他們提供對醫(yī)學(xué)的理解。他們可以打造智能的電腦程序，在削減醫(yī)療成本的同時(shí)，優(yōu)化醫(yī)療服務(wù)。

????這次革命需要一些時(shí)間，但不會(huì)像人們認(rèn)為的那么久。它可能沿著好幾個(gè)方向開始，其間經(jīng)歷多次修正、后退和失誤。也許我們很快就會(huì)看見顛覆性的創(chuàng)新了。許多天真的創(chuàng)新人士，甚至他們中的90%，都會(huì)在嘗試創(chuàng)新后失敗。但是少數(shù)人將取得成功，改變整個(gè)系統(tǒng)。對于那些支持企業(yè)家和企業(yè)進(jìn)行變革的人來說，大多數(shù)投資也會(huì)以失敗告終。但是仍有少數(shù)投資者會(huì)獲得成功。總的來說，掙到的錢將比損失的多。沒人知道這個(gè)領(lǐng)域會(huì)變成什么樣，但無疑有一個(gè)巨大的機(jī)會(huì)正擺在科技人士、企業(yè)家和其他高瞻遠(yuǎn)矚的人面前。同時(shí)，這也是一個(gè)降低醫(yī)療支出、提高醫(yī)療服務(wù)質(zhì)量的好機(jī)會(huì)。

????本文作者Vinod Khosla是位于加州的門洛帕克市風(fēng)投公司Khosla Ventures的創(chuàng)始人。

????譯者：樸成奎

????A transition to automation has already happened in other areas where we once thought human judgment was required. Most commercial flying is now done by auto-pilot, not by the captain. Algorithmic trading now drives most stock market volume. Google's (GOOG) self-driving car has had zero accidents driving?300,000 miles?on normal streets. The same replacement of human involvement by computers will also happen in healthcare. This will create a more comprehensive understanding of patients and improve health outcomes with more personalized treatment. Physicians will have MORE time to spend talking to their patients, making sure they understand, socializing care, and finding out the harder-to-measure pieces of information because they'll spend a less time gathering data and referring to old notes. And, they will be able to handle many more patients, reducing costs.

The source of healthcare innovation

????Where will all this innovation come from? Some believe we have to work within the constraints of the medical establishment. I disagree.

????Innovation seldom happens from the inside because existing incentives are usually set up to discourage disruption. Pharma companies push marginally different drugs instead of potentially better generic solutions because they want you to be a drug subscriber and generate recurring revenue for as long as possible. Medical device manufacturers don't want to cannibalize sales of their expensive equipment by providing cheaper, more accessible monitoring devices. The traditional players will lobby/goad/pay/intimidate doctors and regulators to reject innovation. Expecting the medical establishment to do anything different is expecting them to reduce their own profits. Granted, these are generalizations and there are many great and ethical doctors and organizations.

????Fortunately, it doesn't matter if the establishment tries to do this or not, because it will happen regardless. And it may start at the periphery, e.g. with the 40 million uninsured Americans or the hundreds of millions of people in India with no access. This shift in healthcare delivery will allow for less money to be spent on capital equipment, cutting costs. It will allow us to provide care and basic service to those who can't afford it now. It will help avoid errors. And, it will prevent simple things from getting worse before being addressed.

????Entrepreneurs can come at these challenges and inject new insight. They can ask na?ve questions that get at the heart of pervasive and sometimes unperceived assumptions. They can leverage the many insiders to provide real understanding of medicine at the right time. They can build smart computers to be objective cost minimizers?while?being care optimizers.

????This evolution will take time, but it won't take as long as people think. The move will happen in fits and starts along different pathways, with many course corrections, steps backward, and mistakes. Maybe we'll start seeing disruption at the fringes. Many na?ve innovators, maybe even 90% of them, will attempt this change and fail. But, a few will succeed and change the system. For those of us who support entrepreneurs and companies that create this change, most investments will be lost, but more money will be made than lost through the few successes. None of us knows how this space will turn out, but there's a huge opportunity for technologists, entrepreneurs, and other forward-thinkers to reduce healthcare expenditures and improve patient care at the very same time.

????Vinod Khosla is the founder of Khosla Ventures, a venture capital firm in Menlo Park, CA.