By Design: Health Systems Facing Challenges

It is hard to believe we are in the second half of 2026. In the Northern Hemisphere, the heat has taken its toll and time marches on. The design of a health care delivery system is predicated on several factors that drive the final product or service. Social determinants of health should be one of those key factors, but they are often minimized in favor of the operating budgets provided, leadership, governance, needs, or detractions. These are and must be influenced by technology and innovation.

We see in the news daily how artificial intelligence (AI) is rapidly growing in stature, capability, and influence. We also see plenty of errors with this approach as well. With innovation comes change and change is moving individuals out of jobs. Is this by design, in the sense that cost-cutting is the imperative? Perhaps! Is the education system preparing the next generation of critical thinkers or are we destined to be governed by the nonhuman system? That is not so much science fiction but a pathway we will or must travel on—at least until it leads humanity into some new hubris.

AI in medicine appears to be a significant adjunct to managing health and health systems, which may be of great value. A recent news report indicated Meta (formerly Facebook), which has revolutionized or at least has impacted the social fabric of society, will be introducing a “training academy (America’s Workforce Academy)” for the skilled trades. ¹ After all, high-tech companies and AI are pushing many career pathways and therefore jobs out. However, the skilled trades cannot physically be done with AI. It might provide some advantages in design or planning, but physical work is physical work.

So, shall we conceive of new approaches to our academic institutions? If AI and large language models like Claude or ChatGPT are infiltrating every aspect of our lives, does education mean as much? Can medical school be shortened? Are some degrees and career pathways still valid? Perhaps and perhaps not.

I am currently working on some articles centered around the ethics of commercial spaceflight and the challenges they bring to the paying public. The U.S. Congress has not put significant guardrails (regulations) on this burgeoning commercial sector yet. The same can be said about AI. So, by design and in order to encourage competition, the regulatory arm(s) are not well defined yet. To further illustrate, when the automobile industry began churning out cars and trucks before the 1920s, there were no traffic laws. They evolved from the mid-1920s into the 1960s. The aviation industry was not well regulated worldwide until 1944 with the establishment of the International Civil Aviation Organization.

Telemedicine and telehealth have guidelines established through professional associations like the American Telemedicine Association as well as other professional clinical entities. However, AI and commercial spaceflight are moving at a much faster pace than the aforementioned industries.

Health care delivery systems face many challenges, and we have proven that telemedicine and telehealth and other innovative approaches can be of value if designed and implemented correctly. The transformative nature of these tools and technologies can be of great value in designing effective systems that can reach all. We just need to be educated, educate others, and prepare for the transformation—lest we be left behind.