An Ounce of Prevention is Worth a Ton, Not Pound, of Cure

Yesterday's Wall Street Journal had an article about how insurance companies are starting to pay for remote treatments, and this off-site consultation is the beginning of an important revolution of remote care.  Why is this so important?  Well, we know that one of the largest, if not the largest problem in all of healthcare is compliance to medically approved protocols.  Put another way, people need to stick to the rules.  The potential health and financial impact is staggering.  The Joslin Diabetes center in Boston performed a study that showed that short interval blood sugar management for a diabetic could decrease the ultimate cost of care by orders of magnitude, while elongating life, and decreasing the change of blindness or other complications like amputation.  Given the fact that diabetes care probably represents something like 1% of our entire GDP (diabetes and related problems is estimated to be as high as 10% of all medical costs, and medical costs are 12-18% of our GDP), it is a critical problem.  Compliance -- which drives behavior change -- is the key to solving it.  An ounce of prevention is much more than a pound of cure avoided. Talking to a doctor, or relevant nurse practitioner is a vital part in care.  It is both a means to monitor the patient as well as to improve compliance.  One of the critical questions is will patients accept this remote care?   In a study done by the University of California, in which there was a video robot, that could "come into" the patient's room and their doctor would appear on the video screen.  The data showed that 80% of patients preferred a virtual visit from their regular physician than an in person visit by a doctor covering for the other physician.  Given the option, patients will often take the virtual visit.

Furthermore, as we begin to be able to "instrument the patient" through telematics, and other means, we can increase compliance to existing protocols and discover new ones.  I know of one trial being proposed by a Boston university in which a large population of young pregnant mothers would agree to have their scales, their blood sugar, their blood pressure, and overall activity (by motion sensor) monitored.  This would occur for a population of women married to service men who are on duty.  If this goes through, it will be the biggest single study of young women's pregnancy and its relationship to their health, or problems such as high blood pressure, toxemia, and other pregnancy related maladies. 

This is all possible because we now have an interconnected, cheap, standard network of the internet, and a whole new class of computing devices that are both cheap sensors, and have on board communications.  Motes, that class of computing devices that are only a few millimeters cubed, can use cheap sensors, usually drawn from other small devices.  For example, motion sensors are taken from air bags, sound sensors from hearing aids, temperature sensors from thermostats, and so on.  These devices often use standard communication tools like the communications chips from wireless handsets in the home (e.g. the 900 Mhz handsets).  Intel labs has a whole series of motes you can buy for $10 apiece that run open source software that allows anyone to create a sensor network, which can be programmed to communicate with each other, and then to send a signal to a base station hooked to the internet.  This means it is cheap to wire up just about anything. 

In medicine, this means that it is not only technologically possible, but now fiscally supported (due to the reimbursement of remote treatment) to begin to see a day where the patient is part of the grid, jacked into medical monitoring and care.  The financial implications are potentially huge, for it is proven that an ounce of prevention maybe worth not just a pound, but a ton, of cure.

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