July 2011
To say that the telecom advancements over the past decade have been mind boggling is an understatement. The cell phone of 10 years ago was an analog phone that could barely make a call let alone offer all the fabulous connectivity and functionality of current PDA devices (e.g. email, texting, camera, games, GPS, web browser, music player, flashlight, e-reader, etc). The visionary writers for Star Trek had nothing on what most of us carry around and take for granted everyday!
We all know how mobile technology generally, and these devices specifically, have changed how we live and do business, but we should all be asking ourselves…What’s next? How can we as a society and as individual stakeholders in the telecom, technology and healthcare sectors catalyze the convergence of all that is happening in wireless technology to better support the patient, optimize care delivery, reduce costs, and enhance patient outcomes? Where are the opportunities for us to leverage technology to make healthcare better, faster and cheaper?
Perhaps we can more clearly frame this initial dialogue by looking at the various challenges and stakeholders that are a part of the mix. There is little debate on the critical challenges that we face in the healthcare sector, such as:
Ballooning costs and unit consumption that is driving the overall national spending figure for employers and payers. The US easily outspends other nations on healthcare, to the tune of ~16% of GDP (Switzerland is #2 at ~11% and the average for developed nations is ~9%)
Convoluted financial flows, which makes it challenging to create incentives toward change
Lack of integration across the various sectors of the healthcare landscape, which hinders the data compatibility required to create a cohesive system
Inefficient drug development processes and outcomes
Lack of mechanisms to support behavioral change (e.g. poor physician compliance to established standard of care protocols, suboptimal patient adherence and persistency to prescribed medicines)
Either misinformation or asymmetry of information across healthcare stakeholders, which affects ability to make informed decisions
Unimpressive therapeutic outcomes for the amount of money we spend (e.g., the US performs worse than the OECD country average on life expectancy at birth and Infant mortality metrics)
The HIT (healthcare information technology) visionaries will proselytize that even with the current generation of technology platforms, if efforts are coordinated and focused, we can unshackle the old care delivery paradigm, transform the way we provide care, and ultimately move the needle on many of these longstanding healthcare challenges. In many ways, precedence has been set and anologues abound in other industry sectors (e.g. think about the security and privacy issues that the banking sector has tackled with mobile financial applications). Ultimately, healthcare is merely lagging in its efforts to tap into the power of these platforms.
For instance, the following could very reasonably be core components of the “wireless health” value proposition:
Enable better information sharing so physicians and other healthcare stakeholders make better and faster real time decisions (e.g. full electronic medical records at a specialist’s fingertips when they get a referral for a consult)
Facilitate better information tracking, documentation and synchronization, with fewer and fewer pieces of paper necessary along the way (i.e. less chance of error and enhancing workflow and throughput)
Optimize diagnosis, treatment and healthcare system efficiency with clinical decision support tools, potentially relieving some of the shortages and constraints that are trending in certain sectors of the provider industry (e.g. MD shortages, hospital space shortages, reduction of hospital admissions)
Support convergence of patient-level monitoring and tracking protocols with the connectivity power of mobile to enable alternate sites of care, patient adherence, medication monitoring, patient responsibility for their health, and treatment protocol optimization. This ultimately makes the process seamless and user-friendly while optimizing care delivery and overall outcomes
Create real time decision support for managing patient needs…disease prevention, disease education, therapy support, out of pocket expenses, reimbursement processes (e.g. formulary apps)
Enable the creation of databases which aggregate massive amounts of blinded data defining symptoms, treatments, outcomes and patient characteristics, ultimately leading to a more nuanced understanding of patient segments and best practices, and defining more discretely those areas of high unmet need on which drug and device companies should focus development efforts
As with most things worthwhile, significant effort will be required to realize the promise of HIT. Electronic health records (EHRs) are a cornerstone of this effort, yet their penetration into the US healthcare system has been quite slow due to cost and complexity, data compatibility issues, patient privacy concerns, and general resistance to change. CMS has created an incentive system that rewards physicians with payments for “meaningful use” of EHRs, but also begins to penalize for lack of “meaningful use” of EHRs by 2015 in the hopes of incentivizing technological adoption.
More likely than not, there will be a need to coordinate across many previously unconnected players to drive the momentum. For example, technology and telecommunications, financial institutions, entertainment, government as payer, commercial payers, healthcare practitioners, patients, device/diagnostic companies, pharmaceutical/biotech companies, etc. The momentum and full value capture of HIT efforts will be best served with an evolution of the incentive system in healthcare today, from a unit-driven reimbursement system to an outcomes-based system. In addition, significant thinking and dialogue is needed regarding the business model (s) that can be structured, including the basic economics of HIT and dollar flows (e.g. who invests/underwrites the development, who pays, how is money made?). Furthermore, discussion is required regarding who determines the standardization issues that are required to facilitate scale up, among many other more tactical issues. The Healthcare Information Technology Standards Panel (HITSP) was commissioned by the HHS to assist in the development of a standards-based network to support the nationwide exchange of healthcare data, but funding stopped in April 2010 and it is unclear who is directly tackling these questions. In addition, patients need to embrace these technologies, and drug/device/diagnostic companies must develop algorithms to mine massive and complex databases and extract unobvious insights that can guide development efforts.
Overall, there is a need to articulate a clear value proposition and positioning of any HIT initiative, clarity around customers and target audience, as well as the economic model/investment case for investors to ensure long term viability.
Will we be able to overcome the implementation challenges? At some point, we must. So, what do YOU think… Is wireless health “Ready for Prime Time” or “Quixotic at Best”?
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About the author: Lester Cheng is a Managing Director and Doug Pfaff is a Principal at the Frankel Group. To contact either of them regarding this post, email blog@frankelgroup.com.