In this MedGadget interview Ravi Parikh asks Dr David Blumenthal, Former National Coordinator for Health Information Technology and current Chief Health Information and Innovation Officer at Partners Healthcare System, about his thoughts on the role and future of Healthcare IT.
“If you ask me in 50 years, I have no doubt that mobile medicine will be an important movement. However, if you ask me where we will be in 5 years, I am skeptical that large numbers of consumers will be using mobile health devices or information to manage their own health”
After a decade that was defined by a mobile brand (Nokia) I think Dr Blumenthal’s got some doubts to put to rest. To get a sense of the change that’s happening look back just over 5 years to time when Apple was still a “computer” company (Apple Computers became Apple with the launch of the iPhone in 2007) and compare that to it’s value today (more than $630 Billion):
To help you get the picture of the disruptive change that is happening (as opposed to the incremental changes that Dr Blumenthal is expecting) let’s fast forward 5 years and take Dr Blumenthal into a mobile store where he can pick up a mobile connected smoke/CO monitor/alarm for his home (and one for his parents of course), a security/care monitor for his home, his new smartphone will have integrated ECG sensors built in which together with the 2 front facing HD cameras smartphone will not only secure his mobile phone (including financial, personal and patient data) but also record and monitor his Heart Rate Variability, Breathing Rate, etc, etc to calculate completely new ways of looking at health and optimising our lives.
“Surveys show that the overwhelming majority of Americans believe the best source of information about healthcare is still people’s physicians, and that is where people tend to look for direction. I have seen no evidence other than a tiny fraction of an elite part of our population that there is any great appetite of people to collect, steward, and maintain their own information through mobile technology right now; however, that may certainly change”
We’ve noted in the UK that there is this same lack of appetite amongst patients to manage health information however Kaiser Permanente have clearly shown that when it’s twinned with a mobile first strategy AND the ability to access the advice of their care providers it’s a runaway success.
Here’s some evidence that I would suggest David (and those who share his outlook) check out:
Eight in ten internet users look online for health information
The NHS’s Direct premium rate line has nurses (and call handlers reading scripts) answering more than 8 million calls per year.
Adoption of Kaiser’s mHealth service has set new records in rate of patient adoption.
“(in reply to a question about apps that generate diagnoses) That question reminds me of a patient I saw 3-4 years ago who emailed me – a very intelligent man. He had decided based on his symptoms that he had a gallbladder-related disease. He had several reasons to conclude this based on what he learned from websites. When I actually saw him, however, I was convinced based on a thorough history and physical exam that he had pleuritic chest pain (based in the lungs) and not abdominal disease. He actually ended up having viral pneumonitis confirmed by chest x-ray. What stories like this show is that self-administered diagnostic algorithms are not going to be sufficient to substitute for a thorough history and physical combined with laboratory tests. People will put their symptoms into these algorithms and say “Doctor I think I have this.” And maybe 40-50% of the time, they will be right. However, we still need the appropriate diagnostic tests to confirm this. Most people will not be content with a 50 percent likelihood of a correct diagnosis based on the incomplete information available to them”
I think this simply highlights the value that is created when software can be used to take information from patients and share it securely with registered Doctors who can then make the further investigations they deem necessary before making the right diagnostic judgement within a fully documented process.
Thankfully there’s lots of evidence to support this more sensible approach eg. Dr John Bachman, Professor of Primary Care at the Mayo Clinic, has already published an exhaustive analysis of how he has already used such tech with thousands of patients in a primary care setting to improve access to care, saved resources, avoided unnecessary care, improved effectiveness of clinicians, saved patients days of wasted time and effort, etc, etc.
“MedGadget: How did you become involved in the effort years ago, and did it take a significant amount of foresight on your part? Dr. Blumenthal: It wasn’t because of foresight – I was never interested in the technological aspects earlier in my career. I was actually forced to use an electronic medical record as part of my practice, and I came to the conclusion that this was a very important change in healthcare. Then I began studying it as a policy issue. It was because of that policy interest that I became a figure on the national scene”
I’m not suprised Dr Blementhal is a sceptic about the mHealth opportunity. The biggest determinant of success that I’ve seen is when change is being led by clinicians who have tried to bring IT to work.
Even if this just amounts to something as seeming small as wanting to “use this iPad at work” or “receive my CPD on my smartphone” or “edit these patient records using my BlackBerry”.
In my opinion attempts to force change on clinicians is a waste of time and funds – you might as well try to flog a dead horse – and there is lots of evidence to support this in terms of tech adoption by US Healthcare providers.
“I came to appreciate the importance of it not because of my fascination with the technology, but because of my understanding of the power of information in all areas of human endeavor – particularly in the medical arena where information is the core resource”
While I can see the downside of clinicians who are led by a fascination with technology, I’d think it’s preferable to have someone familiar with technology and the value it can provides as it’s often these people who are best placed to see the opportunity we have to enhance the patient and provider experiences.