A version of this article was originally published February 21, 2011 in The Health Care Blog
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mHealth – otherwise known as mobile healthcare – sounds like just what the doctor ordered to help make healthcare delivery cheaper and more effective. And since the Internet today essentially resides in everybody's pocket, we have what amounts to a last-three-feet problem. So I'm not sure mHealth is ready for primetime, mostly because I don't think our conventional healthcare system is ready or capable of embracing it.
The goal is to have patients wirelessly send appropriate clinical information to their healthcare providers in a timely manner. This would save time-consuming trips to the doctor on their part and, for doctors, ultimately make it easier to retrieve key patient clinical data. Such a system could detect events just before they happen and allow early critical intervention. The problem is that at this point this is just a goal, not reality.
I have looked at a half dozen startups in this space but haven't made a commitment to fund any of them. In many cases, their technology looks promising, but it isn't clear how the company would actually generate consistent revenue. Would the healthcare system reimburse mHealth? Would the doctor know how to interpret the flood of real-time data? Would our system drown under a deluge of alerts, many of which resolve naturally? There are a wealth of questions around these issues.
And this is just the start of the challenges. Unfortunately the human body doesn't have a USB port. Low power, rugged sensors would have to be developed to monitor the body for medically actionable information, a non-trivial task. And while the infrastructure is in place to transmit the data to the doctor, the technology doesn't really exit to massage it in a form he can readily see and interpret in his office, or on his smart phone.
Lastly, even if all the obstacles are surmounted, the question remains whether doctors would actually use this technology. My doctor, for example, uses a state-of-the-art electronic record-keeping and patient management system and is relatively sophisticated, but he is just getting used to working with a computer terminal. He candidly doesn't quite know how he would, for example, use a mobile application that monitored heart rates. It's almost as if a new generation of medical school graduates is needed to recognize the value of this technology.
Frankly, the promise of mHealth suggests an even larger line of thought. Today our nation is trying to figure out how to convert everyone to an electronic medical record (emr). The hope is that when every patient is linked to their EMR, then every doctor that sees that patient has full access to their medical history, and can make better and more cost effective decision regarding that individual's care. But with mHealth you now have a source of real-time medical data. The right way to think of it is that your EMR goes live. It is a real-time status monitor of your health and prognosis. It knows when your health parameters diverge from optimal. It can correlate them to your behavioral choices and your genetic heritage. It knows everything about your body and can help your doctor deliver much better and more personalized health care.
So I believe mHealth is part of a larger revolution in healthcare delivery, a revolution that is real-time, personalized, autonomously monitored, and potentially much more cost-effective. This revolution may well happen. So would say it is inevitable. The timing, however, will rely on our healthcare system moving on from its old ways of delivering and pay for itself.
David Eastman says
Of course, monitoring a patient’s health, like a cardiac at-risk patient, and sending the information to the primary care physician remotely from the patient is not a new concept. Instrumedix developed transtelephonic
heart monitoring systems years ago linking patients to their cardiologists.
The real problem is creating a standard that works for every one. The computer and software industry, to their credit, basically involved seamless creation, transmission and storage of information, simply because they developed IEEE standards for all. IT medicine, electronic patient medical recordkeeping, remote medical monitoring, wireless transfer of medical conditions, is being developing with little standards that govern the creation, storage and the most important element, transmission, and therefore it is not working. As you rightly comment, medical health professionals are just taking baby steps in using the available technology and so adding sophistication and elegance to the technology probably is premature, at this stage. What is needed is a standards board for medicine, like IEEE, that will determine what information is needed and can overcome some of the obstacles to the system design, such as HIPAA and protecting privacy while transmitting vital signs to prevent medical problems and save lives. Like the country doctor of the 19th century, medicine with a few wonderful exceptions, is still a horse and buggy operation.
Ted Driscoll says
I agree with your comments and definitely think we need standards to facilitate this revolution. It is made much more complicated by HIPAA Privacy regulations and looming malpractice liabilities. And I believe certain actors in the space have an incentive to keep the system inefficient. Change is always resisted by those with a vested interest in the existing system. But the opportunity for value in this revolution is too great to ignore. Thanks for commenting.