Will apps save the healthcare system?
I love starting the week off with a bang. The topic of this morning’s symposium, hosted by the Institute on Urban Health Research, just totally gets my engines going. Four experts in personal health technology came from all over the country to talk shop. As IUHR Interim Director Alisa Lincoln said, there were people from as far away as Wisconsin and as nearby as the building next door.
So, first of all what is personal health technology and why should you care about it? In it’s most mainstream form, it’s things like the Runkeeper and Lose It! apps on the iPhone. But these only begin to scratch the surface of what’s possible when you bring technology and preventative medicine together.
Sensors are everywhere nowadays, even if we don’t realize it. We carry a slew of them around in our pockets with our smart phones, which are equipped with GPS sensors, movement sensors, and timers, just to name a few. David Gustafson of the University of Wisconsin — Madison is leveraging those systems to help people recovering from addiction stay on track. In a short video, we saw how the iPhone could recognize when it’s owner entered a “high-risk” area – -a park where he used to buy, perhaps — and pushed him content (like a video of himself before he was clean), to help remind him why he wants to stay on track.
Another system embeds sensors in the home of an elderly patient, instead of using those native to the iPhone, since she likely doesn’t use an iPhone on a regular basis. All of the sensors are integrated and connect to various technologies, from the computer at her pharmacist’s office, to her at-home touch screen (which also allows her to connect with her grandchildren), to her car’s GPS system which only gives her routes that don’t take left turns onto busy roads.
“Healthcare is a visitor in the life of a patient,” said Gustafson. “If we’re trying to improve peoples’ quality of life, we’re fooling ourselves to focus only on the medical field.” There are so many other things that need to be considered in order for systems like these to actually be successful. Healthcare is only one of them. In fact, one of his studies showed that a system developed to help family caregivers of lung cancer patients actually extended the life of the patient by 40%. The system was not used by the patient at all.
Nonetheless, the healthcare system is an important piece of the puzzle that can benefit from these technologies. Especially when it comes to those patients with low health literacy, said Michael Paasche-Orlow of Boston University Medical School. He pointed out that the systems being developed by entrepreneurial commercial entities (like Runkeeper and Lose It!) target a population that is already very motivated and health literate. “They aren’t going to work for my heroin addicts,” he said. Along with Northeastern’s Timothy Bickmore, Paasche-Orlow is developing computerized “relational agents” (like Tanya, the lactation specialist avatar I wrote about in the spring), that walk patients through complicated bureaucratic processes and stay with them after discharge. It turns out that patients tend to feel more comfortable getting the information from these kinds of systems over a real live nurse or doctor, because the latter is often rushed and so the patient doesn’t feel comfortable asking all of his questions. It’s also possible to make these systems “empathetic” by giving them the nonverbal skills that real doctors and nurses use. In fact, they may even be better than the real thing: Paasche-Orlow said that in 600 patient conversations he analyzed, internal medicine doctors delivered an empathetic comment once every four visits.
The final speaker, Kerry Evers, comes from the commercial industry, where she works at a small research and development firm called Pro-Change, which is actually trying to bring these systems to the community. She’s worked with tribal leaders in South Africa, inpatient psychiatric clinics in and US Veterans organizations–all with the goal of improving behaviors through a tailored, computer-based systems approach. “We’re not all the same,” she said. Thus, our treatments shouldn’t be the same. These systems need to be based on strong research evidence and data and they also need to employ dynamic tailoring that adapts to the stage the user is currently in. For instance, if they start using the system when they’re still smoking and then they move into a phase where they need to maintain their abstinence rather than achieve it, the system needs to know that and adapt to it.
Evers’ work remains one of the most important pieces, as voiced by the audience members, many of whom are working in various aspects of this research space. There are lots of great ideas and ultimately the healthcare industry and taxpayers will benefit from them, as they keep people healthy instead of treating them after they get sick. But as Paasche-Orlow said in the discussion afterwards, community health clinics are afraid of being walked away from after pilot studies are completed and big healthcare organizations are in such a state of transition right now that they can’t accept new programs unless they’re going to immediately bring in massive savings. So, it’s in the hands of academicians, entrepreneurs, and, in some cases, patients themselves to make this all happen. I look forward to seeing where the field goes in the next five years. There’s so much potential…and it’s just so cool!