Connected Health

Interesting keynote from mHealth Summit on the perils and potential for connected health (mHealth to some).

Connected health (through mobile devices) has the potential to allow individuals to take control and improve their health.  However, there are powerful forces which have the potential to prevent this as they co-opt these powerful tools into their existing health care delivery paradigm, thus preventing individuals from realizing the benefits.

Are we about to make the same mistake again?

December 02, 2012
Robert B. McCray, President and CEO, Wireless-Life Sciences Alliance

For the past 50 years, lives have been extended in industrialized societies, but in the past 20 years rates of obesity and certain chronic diseases have skyrocketed in rich and poor countries. The prime culprit seems to be behavior-driven damage to our own bodies. Starting with the discovery of antibiotics, vaccines and antivirals, medical technology has saved millions of lives. Too many of us have a mindset that technology will save us from the consequences of our own behavior. This assumption threatens our lives, our pocketbooks and our social contract.

The physician community is full of wonderful individuals, many of whom have devoted all or portions of their careers to improving the health of populations in need. As a medical industry, though, the profession has promulgated the notion that the physician-patient relationship is nearly sacred and that virtually no other individual or entity should be able to monitor or manage the physician’s actions. Key institutions representing doctors and other providers have devoted most of their efforts to protecting the prerogatives and enhancing the incomes of their members. The medical industry has claimed intellectual leadership for healthcare, but the system it has built is failing to serve most of the world’s population, and it's getting further behind the growth of human need and medical knowledge. New technologies have saved many lives but have not addressed the large-scale shortage of services in most of the world, nor has it maximized population health benefits in the rich world.

mHealth offers the promise of saving this situation, but we cannot leave it to the medical establishment to lead this change. We as citizens and consumers, not as patients, must step up individually and via the institutions that we control to take charge of our own health and to set the expectations for the institutions that deliver healthcare and health supportive services.

(A note on the terminology: The term “mHealth” is used out of deference to the mHealth Summit sponsor, though I believe it is too limiting – this is about much more than mobility – and is being overwhelmed by thousands of "mHealth apps" on the market that are developed without grounding in science and for which totally unsubstantiated claims are made. I prefer “connected health” as the term that best describes the value of the convergence of technology and healthcare, including mobile communications infrastructure, digitized information, big data, cloud-based systems and behavioral economics.)

Blame can certainly be allocated, but most pertinent is Pogo’s observation at the dawn of the environmental movement in 1970: “We have met the enemy and he is us.” Our twin enemies are transaction-based medicine and inertia (personal and institutional). Residents of rich countries like the United States have adopted lifestyles that are destructive, and they have ceded responsibility for fixing their health to institutions paid by third parties. Neither the individual nor the provider has responsibility for outcomes in this model, though the patient, his or her family and fellow taxpayers certainly suffer the consequences.

Consumer-directed health (not just healthcare) can save this situation. The tools of “mHealth” include access to all the knowledge that is needed to reduce the need for healthcare and to select the best healthcare approach when it's necessary. As a movement, we can also reset public and private priorities so that they are supportive of healthier communities. We can also demand transparency in healthcare so that financial sponsors of services, be they individuals, employers or governments, can make informed choices about their expenditures and hold service providers accountable for outcomes.

So what is the role of physicians and the medical community in this effort? Individual physicians are in a unique position to improve our world. They retain the confidence of the public and have the power of both persuasion and the pen. Specifically, physicians can take an interest in improving the health of their patients, rather than just caring for their diseases, and “prescribe” healthier living habits by directly addressing the harmful lifestyle choices that their patients present. These approaches are being institutionalized by practices ranging from the largest (e.g. Permanente Medical Group) to individual practitioners. As a politically influential industry, the medical community could become a major force for positive change. This is unlikely, given the pending disruption to the medical businesses of those who have succeeded in transactional medicine.

The mistake citizens and consumers must avoid is to assume that someone else will take care of the problem. We must embrace the responsibility and demand the tools that are needed to discharge it. This is not easy. It is difficult to change personal habits and the public’s mindset about health and healthcare. Entrenched bureaucracies, professions and institutions will continue to fight to maintain their positions. While difficult, technology and the knowledge that it's creating make it possible to identify and implement the changes that are necessary to achieve my goals of improving life and creating wealth globally.

Rob McCray is the president and CEO of WLSA, a member association (http://www.wirelesslifesciences.org/). The mission of the WLSA is to remove the barriers described in this essay, and we will do so by continuing to bring together the most committed organizations and thought leaders from all sectors of the community.  Please contact us if your share our goals.