Wednesday, October 10, 2012

A 60 year old Physician at Health 2.0

As I walk around Health 2.0 here in San Francisco, I am struck by the number of “kids” walking around with the title “CEO” on their name badge.  I met someone I have known for years who is with an exciting new start-up company and said to him, “I see your CEO is 12 years old”.  He laughed in response and said that the founder’s youth made him pause before joining the company however the idea behind the company and the enthusiasm of the young staff was so compelling that he signed up and is happy that he did.  The uniform of the day here is jeans, a backpack slung over one shoulder and an iPad in your hand.  It is not considered rude to look at your iPad or iPhone as you speak to someone as it would be in a different setting with a different age group.

But is there substance?  What is being showcased and discussed here?  There is clearly a focus on the person as consumer and trying to find the right combinations of wizardry and entertainment to motivate people towards doing what is right for their own health.  Once you get beyond that, much of the technology is still focused on self-help programs that help you track your weight, track your diet and track anything else that may help with lifestyle induced illness.
There are apps that have you enter your own data, there are companies that apply gaming and incentives to your losing weight, and there are companies that offer  discounts and coupons for the correct activities.  There are those companies that attempt to connect you to communities, usually via Facebook to create camaraderie around specific issues, such as weight loss and healthy competitions within those communities. 

There are those companies that have devices you wear with the goal to make tracking your own body activities more automatic starting with those that focus on pedometers and activity meters and progressing to the elegant sophistication of Body Media with its in depth monitoring of multiple parameters including activity, diet and sleep.  I heard the Chief Medical Information Officer from Vanderbilt talk about the need for physicians to have real time information on patients as they walk around and live their lives in order to better treat them.  He used high blood pressure as the example of an illness/risk factor that could be better controlled through this type of monitoring.  Even with the Vanderbilt example, most of the technologies in this, consumer focused segment of Health 2.0 is for people who are basically healthy with no illness or the hidden illnesses of hypertension, metabolic syndrome, and other lifestyle impacted illnesses and risk factors.  While this can also be applied to the people with insulin dependent diabetes or other active and chronic diseases, that was spoken of much less during the presentations and demonstrations that were consumer oriented. 

There are those companies that are addressing the issues of in-hospital care that needs to be transitioned to outpatient care.  They tend to be more internally focused to the health systems and to the physicians than to the broader community.  I sat and listened with fascination to the Chief Technology Officer for Athena Health talk of the current efforts by health systems to retain everything under their own control, even the patients, to “Biosphere 3”.  For those of you who don’t remember, "Biosphere 2" was an effort in the Arizona desert to create a self-contained world within a geodesic dome that shut out the entire outside world.  It failed miserably.  His point was that free movement of ideas, technology and ultimately patients in the health system and the loss of the type of control these health systems crave will actually lead to better ecosystems of health care using technology.
There are physician search companies that appear to have given up on trying to define “quality” in those physicians and instead focus on convenience, service, and cost.  There are a bevy of physician search companies focusing on the International market and seemingly avoiding the US completely at this juncture.
I listen and learn and do see certain technologies that may apply more to people my age.  These include technologies that remind people to take their medications and thus can increase compliance; technologies that help physicians have up-to-date information at their fingertips as they are seeing patients.  It often appears that the technology with the least whiz-bang graphics and the most simplicity holds the greatest promise of being incorporated into everyday use. 

So I find myself surrounded by very bright, enthusiastic, idealistic young men and women who see the promise of technology to help people and to help health care become more consumer oriented, more in touch with tools of social media and gaming, and potentially more efficient.  I do worry however.  I also see a certain amount of the arrogance of youth in believing that technology is the entire answer.  I see “neat” technologies that are not as simple as are needed for a person who is truly sick or disabled.  I see little concern and attention really to privacy and confidentiality.  I sit here and wonder if the wisdom of age has to somehow be added to the youthful exuberance that is pushing this Health2.0 movement forward. 

Whether it is wisdom of age or just an outdated view of the world, I worry about a few specifics:

Human Dignity:  I worry that little to no attention is given to privacy and confidentiality and the ethical issues involved in having health information, sometimes from sensors that you wear, floating out there in cyberspace and available to so many people.  While the promise of better coordination and better clinical results is exciting and compelling, we need to be thoughtful and start discussing and debating how to keep privacy and individual human dignity in all of this.

Confusing Diagnosis and Treatment with Healthcare:  While many of these programs make the clinical elements of diagnosing and treating more efficient, they seem to leave out too much of the human element that is so critical to health care.  Standardization and automation is good except when it fails to account for human individualization based on social, psychological, and even spiritual aspects of that person’s life.  Complexity in health care is not just a function of the complexity of human physiology.  In many ways that is the simplest part of the equation.  Good healthcare must include all of those human elements that make a person a person and make a family a family.  An app may certainly have a place but I suspect that human complexity often needs human interaction. 
Understanding that people who are sick are also consumers:   So many of the technologies that were built for people with active illness was focused on use by doctors and health professionals.  I listened and thought that more of the consumer tools had to be applied to people with illness and not reserved just for those who were fundamentally healthy and with risk factors and hidden illness.  People as patients need to have more control while they are in the health system clutches and when they are transitioning between parts of the health system.  There must be a democratization of health care and technology can facilitate that.  In that perspective I may be more radical than the younger generation that predominates here.
Point of View:  So many of these efforts appear to reflect the point of reference of a smart, twenty-something who wants to change the world when the point of a forty-something truck driver who is overweight, has kidney stones and metabolic syndrome, has three kids one of whom has special needs, and a wife with diabetes who must work as a waitress for them to make ends meet, is ignored.  How do we create apps, programs and bring Health2.0 to people who are heroes in supporting their families, working hard and also coping with health problems that are, in their minds, secondary to the everyday battles that they must fight to be the types people they want to be.  I don’t know if Health 2.0 fully understands that need yet. 

So I try to incorporate the best of Health 2.0 to bring back to Accolade where we remain focused on the human elements of health care decision making; the often messy but also often noble lives that people live every day as they try to deal with their health while also dealing with issues that are potentially much more important to them such as their children, their spouses and even the pride they have in their everyday work.  I only hope the prospective I bring as a 60 year old does not get in the way of seeing the brilliance that is around me this week in San Francisco but does allow me to see it through eyes that have seen the pain and suffering that good people overcome each day.