Imagine a smart refrigerator that keeps track of how much juice you drink or how many eggs you have for breakfast. How about a toilet that conducts a urinalysis or a bathroom mirror that monitors your vital signs and reminds you to take your meds? Now imagine that all of this information is transmitted to your doctor, who would review the data, share it with you and use it to give you feedback about how to stay healthy—in real time.
We’re not there yet, but we’re close. Both Whirlpool and General Electric offer a variety of appliances that can be controlled by apps, from dishwashers that send text messages when the dishes are clean to ovens with app-based temperature adjustment. And that hypothetical “smart” fridge? It’s not so hypothetical. GE has partnered with a small tech startup called Quirky, and one of their early products is the Egg Minder—a smart egg tray that alerts you if the eggs are no longer fresh and you're running low.
Beyond the world of appliances, individuals now have the ability to generate new data about themselves. For example, smartphone and tablet applications can track calorie intake and exercise patterns. Wearable monitoring devices like Fitbit or Jawbone continuously record data on activity levels.
If you could scale up one remarkable health care idea, what would it be?
"A new model of chronic care delivery that provides patients every day, not just during a routine doctor’s appointment, with the tools, connectivity and data they need to become ‘apprentices’ of master clinical coaches, so they’re working together to set and achieve health goals over the long run."
- Frank Moss, former head of New Media Medicine at MIT Media Lab and co-founder of Atelion Health, a cloud-based platform aimed at helping doctors and patients work together to manage chronic diseases
Dr. Frank Moss, former head of New Media Medicine at MIT Media Lab, sees a way to use that data to turn patients into “health apprentices” and doctors into “clinical coaches.” Moss continues to collaborate with MIT’s New Media Medicine Group, where one of the guiding principles is: “Patients are the most underutilized resource in health care.” Indeed, with growing support for patient-centered approaches to health, what better way to engage patients in their care than to make them living, breathing hubs of information about themselves, empowered to work together with their care team?
To date, the assumption is that doctors know almost everything and patients know next to nothing. It helps explain ever-increasing health care costs: patients want to get better but don’t know how. So, they follow the orders of their knowledgeable physicians and let insurers pay. Meanwhile, physicians are paid based on how much care they provide and not whether the patient actually gets better.
In the information age, technology is beginning to chip away at this asymmetry, with both good and bad results. Patients can now get online and become what has only half-jokingly been referred to as “microspecialists”—experts in their particular condition. Sometimes, their knowledge of a specific disease is more up-to-date than their physician’s.
Now, patients who want more of a role in their care can go beyond searching the Internet. People generate enormous amounts of data every single day, and technology allows them to capture it. By doing so, patients give life to another principle of the MIT approach: “The revolution must take place in our everyday lives, not in the doctor’s office or the lab.”
That's because our daily choices accumulate into health care outcomes. When you go to the doctor for a checkup and are told to lose weight, you may hear that message, and you may even act on it for a time. But, like most New Year’s resolutions, these pledges are hard to keep and you soon resume your old habits.
If a “clinical coach” cues you to make better choices, you may be more likely to see sustainable change. The Media Lab framework envisions patients who learn how to collect, discuss and interpret their health care data, and doctors who use the data to teach patients how to make better health care decisions. In addition to providing clinical coaching, physicians will share patients’ data with them. How they do this is vitally important.
Information transparency, not just access, is also key to bringing the patient into the process. That means offering people data about their health that they can readily understand. A spreadsheet full of numbers has enormous potential, but it's meaningless to most people. By contrast, powerful visual displays of information in the form of graphs and charts—think of the types of visually appealing infographics currently used to market ideas to the public—can communicate volumes to individuals about trends in their health.
A key challenge with this model is physician pay. Doctors and health care providers are not paid for communicating with patients on the phone or via email. With the shift from volume to value in health care, physicians could receive a per-member, per-month payment to coach patients.
Despite the concerns, there is tremendous potential for technology to revolutionize the way we deliver health care. Technological development has long been a defining characteristic of U.S. health care, but never before like this. By working together with the aid of new technology, doctors and patients will soon have the ability to collect, analyze and track more patient data than ever before. In turn, patients will be able to communicate with providers about their health in entirely new ways that place patients firmly at the center of their care—and, ultimately, promise to improve health outcomes.
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