Saturday, July 7, 2012

How Connected Health, Public-Private Cooperation, And Big Data Can Revolutionize Health Care

Guest Post by Dr. Jody Ranck

As we contemplate the fallout from the Supreme Court’s decision in NFIB v. Sebelius on the Obama Administration’s Affordable Care Act, it is useful to think beyond the din of the punditry on what the decision means in an electoral cycle and consider seriously the looming crisis in healthcare.

Our health system—or better, anti-system—consumes nearly $2 trillion annually and does not deliver the value that it should.  Those who think we have the best system in the world come up against the cold hard facts (if they matter in political debate anymore) of health outcomes, which indicate that we’re ranked 37th in the world and trending downward, not improving.  Despite one of the most robust ecosystems for innovation in biotechnology and information technology that the world has ever seen, converting this into tangible health outcomes is an “innovation space” that we’ve yet to get a handle on.

There is hope and promising signs that these tools can be mobilized to make a dent in some of the major challenges we face such as obesity, diabetes, environmental health, and a host of other areas if we can bring politics, technology, and both the public and private sectors into the right relationship in the coming years.  Technology can’t do it alone.  Nor will antiquated political hubris of “death panels” and market fundamentalism fix health care.  In my new book, “Connected Health: How Mobiles, Cloud and Big Data Will Reinvent Healthcare”, I explore how this might happen if we can think more strategically and engage in more grassroots efforts to engage with the “Algorithmic Revolution” in healthcare.

Mobile Health (mHealth)

Today we find mainstream publications almost daily reporting on new mobile health, or mHealth, apps to help you manage your fitness, diet or health condition.   There are over 10,000 health apps in the iTunes store, making them one of the fastest-growing categories, and it is estimated that 2012 will reach at least 247 million people who have downloaded at least one app, up from 124 million in 2011, according to the analyst firm Research2Guidance.  The firm estimates that the world market for mHealth apps will reach over $1.2 billion this year.  These apps run the gamut from diabetes, exercise and fitness apps (Runkeeper, Fitbit), dieting (Lose It; the wireless weight scales designed by Withings), heart rate monitors (Azumio), sleep trackers (Zeo), mood trackers (Mood Tracker) and a host of peripherals that attach to your phone to provide everything from diagnostics for diseases to EKGs, eye exams (EyeNetra), and even microscopes.

Some mHealth apps use game dynamics to motivate collective action as in the case of the University of California-based CITRIS’ Pwning Asthma Triggers app that helps residents of high-risk neighborhoods identify the sources of industrial pollution that trigger asthma.  One of the most interesting startups coming out of MIT is, a platform that enables you to combine patient data with passive data collected on one’s cellphone.  Passive data provides insights on how individuals are using the device and can help one better understand social and psychological factors that can determine outcomes.   There are many who are looking to mobiles to help improve one of the sticky problems of healthcare: behavioral change that is often required to manage multiple chronic diseases.  Successful mHealth apps will have to demonstrate the ability to move the dial on behavioral change to warrant investment in coming years.

The Internet of Things, Health 2.0 and Mobiles as Health Hubs

Beyond mobile devices, there is the rapidly growing use of sensors that are connected to the Internet.  The Internet of Things, as it is commonly known, can also play an important role in future health systems.  From real-time air pollution sensors (the focus of a recent EPA Challenge, MyAir, MyHealth) and radiation sensors (Cosm (formerly Pachube)) to the growing market for wearables (Misfit Wearables, Zephyr Technology), we’re increasingly entering the early years of the Health Internet of Things.  That is, sensors connected to the Internet that can transmit data related to health.   When you combine this with the use of social networks for health, including platforms such as, CureTogether, and general use of Twitter and Facebook for exchanging health information or organizing campaigns for health, the amount of health data and networks related to health and healthcare is exploding.

There is also the increasing number of individuals who use a variety of devices and social media platforms to track data about their health and fitness, experiment, and exchange insights.  Widely known as the Quantified Self, this movement is rapidly moving beyond early adopters in Silicon Valley and beginning to have an influence in even how consumer device manufacturers think about future health and fitness devices.  Qualcomm Life, perhaps anticipating the mainstreaming of aspects of the Quantified Self movement, has focused on creating the technology to integrate the range of devices in a simple, easy-to-use hub, the 2net Hub, that can make it easier for consumers to connect devices and data in their homes.

A Tipping Point: Democratizing Health Through Participatory Medicine

The exciting part of this ecosystem is not just the range of devices and impressive range of indicia we can monitor, measure, and analyze with the devices in our pockets, many of which did not exist with this level of functionality even 4-5 years ago.  Increasingly the Health 2.0 movement, or those interested in the use of social media and connected health to radically change the traditional top-down orientation of healthcare, view these technologies as a way to democratize health and medicine.  Calls for participatory medicine, or more patient-physician and even health system collaboration, are frequent, and there is even a Society for Participatory Medicine to debate and share information on the movement.  “ePatients” are challenging the traditional medical encounter armed with data they’ve tracked on a mobile or iPhone app and with the latest research or information gleaned from platforms that provide access to clinical trials and data.  Sometimes referred to as “cyberchondriacs”, the message is becoming clearer that we are reaching a tipping point where the practice of medicine and public health are going to change for good.  Information and data flows are no longer a one-way street.

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