How the Internet and wireless devices can revolutionize medicine
Published: March 10, 2006
In the past few years, worries about healthcare costs have evolved from persistent but easily ignored background noise to the decibel level of a 747 engine in the next room. Healthcare costs are blamed for economic problems at General Motors and Ford, have become a political football in Washington, D.C., and are a source of significant anxiety for millions of Americans whether they are currently insured or not.
Retirees are feeling especially vulnerable as more and more corporations cut back or eliminate their healthcare benefits.
But the worst might be yet to come. The real money issue in our healthcare system is not that it costs too much to perform life-saving coronary bypass surgery or repair a torn knee ligament—although these procedures are hardly inexpensive. No, the elephant in the room is the cost of chronic care: Treating millions of people with diabetes, cancer, congestive heart failure, asthma, and other debilitating diseases.
These diseases threaten to bankrupt our economy because they go hand-in-hand with the two dominant trends in American demographics. The first, of course, is that the Baby Boomer generation now has one foot in the 60s (the age, not the decade) when health problems naturally begin to accelerate. The second trend is the growing problem of obesity—60 million Americans are now regarded as obese. This in turn makes people vulnerable to diabetes, heart problems, high blood pressure, degenerative joint disease, and a host of other ills.
Managing these illnesses in a hospital is insanely expensive: $23,000 US for a typical hospital stay, or more. No solution to the cost crisis there. But leaving people on their own where they can forget to take their medications or ignore dangerous symptoms overlooks the possibility, for example, that their blood sugar may be out of whack or that fluids may be building up in their lungs and that makes equally poor economic and medical sense. This only turns chronic but manageable problems into emergency room crises and even more hospital admissions.
Wireless technology, new products provide less expensive ways to practice telemedicine
One very real way to help mitigate healthcare costs can be found in telemedicine, broadly defined as reaching out electronically to dispense medical advice and even make a diagnosis from a remote location, using telephone lines, high-speed Internet, or other communications modalities. The typical image this conjures is of a physician and patient many miles from each other, each sitting in front of a video camera and connected by a high-speed, fiber optic cable. You can still find this scenario in academic medical centers and specialty clinics, but it's an expensive and hardware-intensive way to reach out to patients. And it doesn't necessarily tackle the really big issues in healthcare today.
Fortunately, there are equally effective and less-expensive ways to handle many of the routine tasks involved in preventive care and health maintenance. Advances in technology during the past few years have been so great that anyone with a notebook computer, a PDA, or even a wireless telephone can do what just a few decades ago required a multimillion dollar broadcasting facility to do: Link up individuals or groups with rich media, text, graphics, audio, video, and interactive applications. Call it “telemedicine light,” a way to help patients remotely without the need for expensive equipment and infrastructure.
Here's an example of how things have changed. Dr. Joseph Kvedar, founder and director of Partners Telemedicine and Vice Chair of Dermatology at Harvard Medical School, tells me that 10 years ago he began researching the role digital imaging might play in dermatology, his specialty. His camera was a Kodak model that sold for $12,000 US and took photos with 1.5 megapixels of resolution. "Plus," Dr. Kvedar says, "at the time, we didn't have a clear path to digital storage, hard drives were relatively small, we didn't have burnable CDs, and Web browsers weren't yet really prominent.
"Now you can pick up whatever flavor cell phone is available from Nokia, with a great lens and 2 megapixels of resolution, and it's about $400, with the network built right in."
What does this mean for medicine? Potentially, everything. In the case of Dr. Kvedar's specialty, it means that anyone with a wireless phone has more imaging and transmission capability today than a decade ago. Patients and physicians can quickly and easily exchange photos of a healing wound, bedsore, or rash, possibly eliminating a trip to the doctor's office.
How wireless devices are being used in healthcare
And that's just the tip of what can be done. Here are a few examples of how wireless devices are being used today.
| • | A company called CardioNet makes a small device similar to what athletes use to measure their heart rates. Worn on a belt clip or around the waist, it transmits a patient's heart rhythm to a wireless phone-like device that fits in a pocket or purse and that transmits ECG information to a CardioNet monitoring station. Should a patient experience an arrhythmia, information about the heart's condition is beamed to CardioNet for evaluation, and a doctor can be consulted. |
| • | A Korean company called HealthPia embeds glucose-monitoring electronics into a wireless phone. Diabetes patients insert a blood test strip into the phone. The phone reads the test strip, and then sends blood-sugar levels to a doctor, nurse, or even a parent. |
| • | Switzerland-based Card Guard makes a line of telemedicine devices that uses wireless networks to beam patient information (from blood oxygen to weight to blood pressure) to a central evaluation center. |
| • | Scientists at Microsoft Research have developed software to connect inexpensive physiological monitors to Smartphones by using Bluetooth. The Smartphone serves as both computer and communicator as it records, analyzes, and displays relevant data. |
Wireless technology is a natural for healthcare applications and services. The technology is proven and reliable. It is adaptable for use in recognizable cell phone form factors or embedded in any number of other devices from weight scales to blood pressure monitors to emergency defibrillators that, if needed, can alert medics, nurses, or physicians that the patient using it needs advice or medical assistance.
This is technology that people need little convincing to use. Vice president of business development for Qualcomm, a manufacturer of wireless hardware, Don Jones says, "A wireless phone is the personalized computer that is always connected, is time-sensitive and location-aware, and that people are willing to take with them everywhere. I like to say that people won't leave home without their wallet, their underwear—or their wireless phone."
Cutting healthcare costs with wireless devices
How can wireless devices help cut healthcare costs and help deliver medical services more efficiently? Several ways. First and foremost, wireless devices promise to make it feasible and less expensive to keep an eye on people who require more frequent attention. So patients who need a gentle reminder to exercise or check their blood sugar can get that reminder without an expensive office visit. Patients in need of rapid intervention can be summoned to a hospital or doctor's office in a timely fashion. The technology makes better use of healthcare resources. A home-care nurse who might otherwise need to visit certain patients on specific days, regardless of their conditions, might now watch over many patients at once using wireless technology and remote monitoring devices: Talking with some patients by telephone, performing video visits with others, or holding virtual meetings with groups of patients who are dealing with a common, chronic disease.
Wireless devices might even become active participants in a patient's healthcare. For a teenager with diabetes, why not offer a free ring-tone download if she can keep her blood sugar at a certain level for a solid week? For a heart patient, why not reward him with a discount on his wireless phone bill if the pedometer built into a wireless phone reports that he's achieved his fitness goal of 10,000 steps per day?
Creating a business model for telemedicine
Still, if there's a hurdle to overcome to make these services a reality, it's how to find a business model that helps to ensure healthcare providers are fairly paid. Today, healthcare is overly focused on sick-care delivered by appointment in hospitals or doctors' offices. Preventive medicine, which is the most cost-effective way to go, is also the most difficult to fit into a reimbursable business model for healthcare providers. So, for example, the New York Times reported a case in New York City where a groundbreaking diabetes-care program had to largely shut down because insurers weren't clear on the benefit and refused to reimburse patients, many of whom later rang up huge bills when their illness spun out of control. The healthcare industry must work with private insurers to develop realistic payment systems so that cost-effective healthcare delivery is rewarded, not punished.
More federal funding to give telemedicine a boost also can be useful. In December 2005, Congress approved $3 million US for telehealth. Senator John Thune (R-S.D.) originally requested $10 million US for telehealth spending, but that amount was reduced during conference committee. Much more is needed. I know the federal deficit is swelling, but this clearly is a case where money spent to deliver healthcare services more efficiently is money wisely spent.
Providing the technology and standards
Microsoft is doing its part by developing the technology and standards that can make telemedicine and e-health services a reality nationwide. Smartphones and Pocket PCs using Windows Mobile software already are becoming widespread in the medical world, helping physicians, nurses, and other clinicians track patient visits, communicate, collaborate, and deliver services more efficiently. With Windows Mobile, developers and wireless providers have a flexible and powerful tool to provide applications and services that can help people live better and longer, all while helping to control the skyrocketing costs of healthcare.
Having these wireless devices, standards, and tools is just the start of how Microsoft can help healthcare organizations provide better and easier access to healthcare.
Dr. Bill Crounse, M.D., is the global healthcare industry manager for the Microsoft Corporation. Dr. Crounse is responsible for working with industry partners and healthcare organizations to help them benefit from using Microsoft technologies and solutions. Prior to joining Microsoft, Dr. Crounse was vice president and chief medical information officer for Overlake Hospital Medical Center and the Overlake Venture Center in Bellevue, Wash. |
