M-Health and Edge Innovation: Why the stimulus package must refocus its healthcare spend

No one disagrees that we need to take doctor's records from their 17th century, paper-based, folio state into the electronic world, and the stimulus package signed by President Obama contains approximately $20 billion dollars for the creation of electronic medical records.  Of that huge sum it is my prediction that little or none of it will be spent on the most important problem in all of healthcare: patient compliance.  Patients don't take their pills, they don't stay on a diets, they miss critical doctors appointments, and avoid preventative treatments.  This non-compliance causes the vast majority of our healthcare expense, and a mere three disease categories: heart disease, diabetes, and asthma, account for a staggering portion of the budget.  For example, according to a study done by the Army as reported to me by my friend John Henderson, an asthmatic who follows his or her protocol of drugs and inhaler use, costs about $500 per year to manage, and those who don't follow the regiment cost $15,000 on average! What we need is funding to experiment on how to change compliance behavior.  Furthermore, we have two relatively new tools which have the potential to radically improve the cost of healthcare: the cell phone and behavioral economics.  Many behavioral economists including our Diamond Fellow Dan Ariely have shown that there are powerful, non-rational, ways to shape behavior toward health.  Moreover, everyone carries a cell phone; in fact, I was talking with a senior executive of one of the country's largest payer organizations, and he said that in managing Medicare patients, the cell phone is the most reliable way of contacting the insured - much better than a physical address because it changes less frequently.

What could we do?  Well, my company did a project last year with the government of Gauteng, the most populated state of South Africa, where we installed a cadre of methods to help manage diabetes care: web information, social media, clinics and cell phone reminders.  By simply reminding people about their appointments we increased patient's compliance from 31% to 73% in our pilot group. We know from other studies that disease management companies have a hard time getting people to change their behavior, but when the patient's doctor is looped in to remind patients to take their medicine, they are much more likely to comply.  Imagine a decision support system for doctors that gave them a dashboard of patient compliance - on pills, exercise, even attitude.  This kind of telemetry on the patient has been thought of before, but we have not implemented it using the lowly cell phone, by adding to it text messages, accelerometers, glucometers, and other phone connectable messaging and instrumentation devices to help people do the right thing.

In order to change our healthcare system we may have to stop thinking about fixing it from the inside out, and start thinking about it from the outside in.  John Hagel and John Seely Brown have written brilliantly about the need to look to the edge to find sustainable innovations - and their logic applies here too.  Mobile, or M-Health, could allow us to create a direct attack on compliance, and if well designed, loop the doctor into the treatment plan - being cognizant of the fact that the design must be efficient for the time-strapped physician, who spends less than 10 minutes with the average patient.  Yet, it can be done.

Overall I wish the stimulus package had more emphasis on the core problem, and a willingness to fund new and interesting experiments to change compliance behavior, not unlike the way that Defense Advanced Research Projects Agency (DARPA) funded many innovative groups who invented the internet.  If we could move to the edge, we'd have a shot to making the country richer and healthier at the same time!  What's not to like about that.

The Zagat's Guide to Doctors: Reputation management in the digital age

What Would Darwin Do?: Musings on his 200th Birthday