Will apps save the healthcare system?

Photo by Intel­FreeP­ress via Flickr

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!