Healthcare Reform and Technology.

Human blood magnified 600 times

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Disclaimer:

When it comes to discussions about nationalized healthcare, cost reductions, and other major political issues – I generally don’t feel qualified to comment. With this post I’m stepping out on a limb – and my qualifications[1] for doing so are probably still lacking. I welcome your feedback. I’m more than happy to be proved wrong – this is just want seems logical (and obvious?) to me.

Delimiters:

In this post I am not going to argue for or against nationalized healthcare, rather I am will discuss alternative methods of reducing costs/improving treatment. This is not because I disagree with nationalized healthcare[2] but rather because I see these steps as being a natural starting point in any attempts at cost reduction/treatment improvement.

Automation:

Each year I (try to) go for a physical with my doctor. I don’t enjoy it – but it allows me to find out if there is something major and obvious wrong with me. It takes a lot of time to see a doctor. After setting up the appointment one generally has to leave work and travel to the doctor. Being the anti-travel person that I am, that isn’t too big of a hazard – my doctor is five minutes drive from my house, ten from work. Still, its a nuisance.

Once I arrive, no matter how early or late, I always end up waiting and waiting (and waiting and waiting). Generally I am surrounded by others like me who are healthy and present for routine maintenance as well as those who are ill. Unfortunately, this means I am in a enclosed space with several individuals who are hacking and sneezing – throwing contagious germs around the room. I don’t harbor any hard feelings – I do the same when I am ill and I go to the same place to get treatment…but still, the risk is that I will leave with more wrong with me than when I entered.

The doctor’s examination includes fairly routine processes. He checks my height and weight. Checks my blood pressure, listens to my heart beat, pays attention for any abnormalities in my breathing, checks my mouth, ears, and nose – amongst other questions and proddings. Much of this process is actually carried out by one or more nurses (including the occasional bleeding for blood tests).

Now, my suggestion is simple, why not work on devices like the Zeo[3] which can perform most of this sort of monitoring automatically? Granted, the Zeo is only for sleep – but why can’t we make multi-functional devices that can monitor our blood pressure, heart rate, breathing, and any of dozens of other health factors? It seems that both the Apple iPhone and the Verizon/Motorola/Google Droid would be able to serve as perfect multi-functional devices for such a purpose (in addition to their many current uses). I’m not a big fan of having something implanted in me but I see no reason why such devices could not be used once a day/week in a few moments or with a small wireless band-aid type patch to monitor our health.

This automation would provide us with numerous benefits such as:

  • Reduced visits to doctors for regular physicals, increasing our work productivity/time off for recreation.
  • Increased monitoring of our vitals – alerting us to health issues in days instead of weeks or months.
  • Reduced exposure to environments with significant amounts of communicable health issues.
  • Advanced analysis of our health vitals to determine patterns of health that are disconcerting and need review.

Let me give a few examples of how a device like this might function:

  • Jane is fairly healthy. She uses her multi-function device once a week. It gives her peace of mind that her main vitals continue to operate within normal bounds. She doesn’t spend as much time worrying about whether this or that minor issue might be part of a bigger dilemma.
  • John uses his device daily. The device notes over a months time that John has significant blood sugar spikes around noon every Friday and this is accompanied by extreme bouts with sleepiness throughout the day. The device alerts John and John is able to change his dieting habits to reduce the sugar intake reducing his sleepiness.
  • Mary has chronic heart problems. While family bought her one of those devices that calls 911 if pressed they still worry about her constantly…until she received a multi-function device. She keeps a wireless patch on her all the time – which covers her vitals. It lets her know when she is working too hard and in danger of bringing on a heart incident and will even call 911 if she keels over – without her interaction.

Analysis:

I know some people are afraid of having their records kept electronically. I could explain why I don’t think this is a major concern but perhaps another time[4]. The keeping of electronic records instead of traditional paper records would offer several significant benefits:

  • Medical offices could (with permission) share information instantaneously. No more waiting days or weeks to get paperwork transferred from one office to another.
  • Medical offices could communicate with one another electronically and share results to coordinate better treatment plans.
  • A significant reduction in the amount of paperwork could be made. Individuals could give HIPAA consent via an e-sign form rather than through the useless bundles one receives at each doctor.
  • The data could be analyzed anonymously to garner important health information and to look for patterns invisible to the naked human eye. Think about it – we could find that individuals who now live in every state in the union and are suffering from stomach cancer all originally lived in the small town of sometown. While this might not solve their health problems it could launch an investigation to discover that (name toxin) is present in (name location – e.g. elementary school).
  • Further, the efficiency of treatments, the possibility of causes, the analysis of diseases could all be significantly expedited by such a process. The data could be anonymized and then made available for legitimate researchers to utilize in performing research (e.g. such as World Community Grid projects).

Pre-Treatment:

A lot of expense and time is caused by the inability to discover issues before they occur. What if we could monitor our health? What if we could be alerted (and allow our medical professionals to be alerted) before a major issue arises? If our spiking cholesterol levels were managed before they became a crisis? If our hearts failing functionality was noted before it resulted in a heart attack? If our liver and kidney function could be monitored?

Severity Monitoring:

I get sick somewhat often with minor bugs – a stomach bug, a cold, a virus. Annoying but not life threatening. In my line of work (IT) sometimes its really important to get a project done and while I personally am of the opinion that it is better to stay home and heal before returning to work many others in my field (and the American culture in general) are not. Sometimes even I succumb to the pressure to be present when feeling under the weather. What if I could cough into a small device attached to my multi-function and receive feedback on what sort of cold or virus I have? If its just the common cold I take some dayquil and am good to go – but if its strep, bronchitis, or the flu – well I stay home and see a doctor. How many epidemics could be prevented or reduced?

Conclusion:

I am not arguing for or against nationalized healthcare. I do wonder why there is not more effort in the areas I have outlined above – by governmental and private agencies – to utilize technology to solve these issues. I recognize that these solutions will have minimal effect on what some are especially concerned about (I am concerned as well) – the masses who are unable to receive affordable healthcare coverage. I suppose my thought is that if we can reduce the burden on the overall system, reduce our costs overall, this would provide more time and finances to direct towards those who have a need (whether that is on a governmental, religious, local, or personal level) while creating a sustainable system for future generations.

I eagerly await your thoughts and feedback. Thanks for your time and consideration of my ramblings!

  1. [1]In this instance my qualifications consist in their entirety of (a) reading Newsweek weekly, (b) keeping current on major headlines [including healthcare] via Yahoo, and (c) reading/skimming a wide variety of rss feeds covering a gamut of tech/health topics.
  2. [2]I disagree with those who utilize (Christian) Scripture as a argument against socialized medicine. I see no such impetus in Scripture. On the other hand, I find myself less optimistic about the effectiveness of governmental organizations than many more liberal minds (in Christian circles, Jim Wallis comes to mind).
  3. [3]Since defunct.
  4. [4]In brief, (a) privacy is an illusion – our information is already available, perhaps just not centralized and (b) I have nothing to hide – so why hide it? You want to know I struggle with Obsessive-Compulsive Disorder? Now you know. Finally, as outlined above I think the benefits are huge (and outweigh the negatives).

2 Responses

  1. Margaret says:

    Interesting thoughts, David. I think there was one small step in this direction with the installation of blood pressure monitoring devices in places like Walmart. Definitely a savings in time and money to be able to check it yourself. Also definitely a plus in preventative medicine since some people who might not have gone to the doctor and had their blood pressure checked would do it at Walmart and then could decide to followup with their doctor. Even the fact that people can purchase blood pressure cuffs and perform blood pressure checks at home is an improvement…I remember when only doctors and nurses had them.

    I think more centralized areas like this where people could perform screening free of charge would be a good idea. For people with specific complaints some sort of monitoring like you suggest would be good, too. They have automatic implanted cardiac defibrillator devices that can shock peoples hearts if a tiny computer implanted in the patient senses that their heart rhythm has become irregular. Here’s a link to an interesting article on them – http://emedicine.medscape.com/article/162245-overview

    I think your thoughts are good and that we have the potential to move more in this direction. I think that health is very complex and that there are many, many problems that need the input of a human being to evaluate, but that automated screening could definitely be a plus.

    I also support electronic medical records. I recently went to a surgeon and described adverse reactions to anesthesia with 3 other surgeries. The doctor did not have access to those records and so I was left trying to remember what anesthesia was used for each procedure and what my reactions were and now I’m in the process of providing written consent to those 3 doctors so my records can be mailed to the new surgeon so he has a complete view of my history. Given an emergency situation time wouldn’t allow for the gathering of this data and he would have to rely on my imperfect memory and my recollection of what I was told as opposed to actual data. centralized electronic medical records would have all that information readily available and could prove lifesaving.

    So, I thought this was an interesting and thought-provoking article, especially as someone in the healthcare field. I think some of your ideas may be impractical, but others definitely worth considering. I think one thing you have to remember is that medicine today is all about money, in many ways. The pharmaceutical companies fund the colleges that educate the doctors who treat us with their drugs. What is income generating is often the bottom line, not for the individual doctor, but for the drug companies and hospitals.

  2. Andrew Vogel says:

    They would need to add the Zeo on along with physicals in your scenario. The doctor is doing more than just recording a few stats. If he wasn’t, then a nurse would handle the procedure. But it’s his experience looking for things out of the ordinary that our iPods or whatever have no ability to do.

    It’s like giving someone a program for their PC that makes sure the firewall stays on and pings keep working and too many errors are not recorded in the event logs.

    You will result with
    1) most problems NOT being reported
    2) a lot of FALSE positives as well

    This is not to say the tool couldn’t be helpful, but with a physical body I don’t really believe a device could be trained to know YOUR physical body well enough to spot abnormalities the way a doctor could. Or even come close.

    Physical visits also are not really a problem with doctors as far as I am concerned. I don’t have to wait when I get a physical. Nor do the physicals charge the crazy charges that drive up healthcare costs. Instead suppose I get an MRI – ($2000 I think?), or an infusion for some drug – ($8,000 about). Much more significant numbers.

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