Amplyifying how my body talks to me (and others)

It doesn’t take much insight to know that the current method of delivering (and paying for) health is broken and not sustainable. Making changes at the margins won’t work. Aside from current (and obvious) inefficiencies, we have a population that’s living longer, has more medical conditions and more methods for treating them. Even if you believe your personal health care support is doing OK, you have to know that there’s a crisis in the future. If you believe we’re already in a crisis, you know we’re heading for a catastrophe.

 

There is a school of thought that crises have a way of solving themselves. There’s a great story about how at the start of the 20th century, with the growth of the telephone, there was a fear that the number of switchboard operators needed for manual switching systems would soon exceed supply, and that the problem was solved (just in time) by the invention of automated switching systems. This story was repeated as recently as 1998 in a letter to the NY Times. Unfortunately, this story is not true. The first automatic switch was invented in 1889 by Almon B. Strowger who developed it because he believed the operator was deliberately routing calls to his competition. In fact, as late as 1920 Bell in Atlanta continued to use operators and only changed when there was an operator strike.

Recognizing, therefore, that most crises are not self-resolving, and at our request, the Center for Future Health at the University of Rochester convened a diverse group of thought leaders interested in real-time personalized health monitoring. They came to discuss how people might benefit from personalized self-care systems, how such systems might enable people to take more responsibility for their own health and what RWJF might do to advance the field. What we learned is that there are amazing things taking shape that hold the promise of technologies that are both useful (in terms of their ability to improve our health) and unobtrusive, that there are lots of single point experiments and that there are major obstacles to coherent development. The challenge remains finding activities that can be transformational in accelerating the field while avoiding, or at least mitigating, some of the costly dead ends.

Comments

[Cecelia Horwitz]

The Thought Leaders’ dialogue groups identified the following “ Factors Hindering Progress” which need to be addressed. This may be a good starting point for discussing leverage opportunities.

Adoption
• Untested value proposition
• Technology not yet ready
• Current reimbursement system

Self-care research and clinical development
• Insufficient proof of concept that longitudinal data is better clinical evaluation approach
• Insufficient access to useful interoperable data exchange
• NIH doesn’t fund development of technology
• Disease silo approach of NIH needs to be integrated

Standards and interoperability
• HIS vendors have a vested interest in non-interoperability, because…
• Major providers are not compensated for collaborative care model, because…
• Payers reward poor quality and non-collaborative care model.

Health care environment
• University work lacks sources of funding to go from concepts to testing in real-world settings

[Edward Amber]

"We have a population that’s living longer, has more medical conditions and more methods for treating them." and less population coming on-line to support them. Add to this, changing global economic distributions - and we clearly have to change while we can. We must escape the mindset of the last 20 years that it will be easier in the future. The economy will not be stronger and that means NOW may be the best and only time to take action to maintain our current lifestyle.

We may have no options by the time it becomes clear that the consequences of our inaction are an economy derailed and destroyed by health costs, and a society demoralized and weakened by health issues. Before this is dismissed - consider Russia today and how it came to be that way. Endless plans that threw resources at problems without properly understanding the underlying forces and relationships of the health industry to the rest of the nation.

I would suggest that the point in the article was not that solutions don't solve themselves - its that the ecology of the health industry (government, patient, care providers, solution providers) requires understanding and attention so the consequences of inaction are not only understood by visionaries in the health field, but the correct actions are clear to the decision makers in Washington as well as the man in the street - otherwise we may find ourselves switching places with the Chinese as far as our longevity and quality of life.

If money is not invested in development of preemptive technologies and practices immediately then we may be left with later options that will be little more than health-for-wealth or universal health that is equivalent to universal misery.

A country with decreasing health (don't assume that these health problems will only belong to the boomers - it will surely spread far beyond the boomers and rob everyone in the nation of health support)is also a country with education problems, economic problems and political problems. These interrelationships are NOT well enough understood (although when the same is said about individuals - its perfectly obvious that you're ok as long as you have your health). You cannot have a healthy nation composed of sick and frightened people.

The true cost of health neglect and true benefit of the solutions are improperly measured and represented - and therefor remain inadequately addressed by government.

We must have the right insight and make the right tools and processes to clearly see the problems, design the national industry solutions (such as those identified Cecelia's comments), and justify the needed expenditures (versus security, the economy, education etc)to implement.

I hope someone takes up the challenge to formulate and properly research a national strategy for making the health industry what it can be.

We can see how well that "ostrich head in the sand" tactic has worked in light of the current economic situation.
fin