At least one thing is certain about the future of America’s health care system: It will have to do more with less.
The aging wave of baby boomers is starting to stress medical staffs already short of doctors and nurses. At the same time, the governments, businesses, taxpayers and workers that fund health care are at a breaking point, so they’re pushing health care providers to make money by lowering costs, not by performing more services.
That’s why a growing number of companies, in Indiana and across the country, are developing technologies to extend the reach of health care professionals to more patients, reduce the number of health care professionals needed, or both.
Local startups VoCare Inc., Indigo BioSystems Inc., Social Health Insights LLC, MedDiary.com and others are all part of the trend, which also involves giants such as Apple, Samsung, Sony and IBM.
Their collective efforts could have an enormous impact on the daily work of doctors, nurses and scientists. Some even think a combination of super computing and super-convenient mobile devices can replace lots of health care professionals.
“I doubt very much if, within 10 to 15 years, I won’t be able to ask Siri’s great-great-grandchild for an opinion far more accurate than the one I get today from the average physician,” venture capitalist Vinod Khosla said in a January 2012 blog post, referring to the Siri program that runs on Apple’s iPhones.
Khosla, a co-founder of Sun Microsystems Inc., boldly predicted that, within a generation, 80 percent of physicians would no longer be needed.
“Eventually, we won’t need the average doctor and will have much better and cheaper care for 90 to 99 percent of our medical needs,” he wrote on the web site TechCrunch.com.
Few have agreed with Khosla’s specific numbers, although many concur that technological developments are indeed pushing in the direction he suggested.
“That’s probably a little aggressive,” said Dr. Ben Park, CEO of American Health Network, a large Indianapolis-based physician practice, of Khosla’s 80-percent figure.
But Park does expect some health care providers to be replaced by technology. He cited Massachusetts-based EyeNetra, which spun out of the Massachusetts Institute of Technology with an accessory and app for an iPhone that examines patients’ eyes to determine the prescription they need for glasses or contacts.
“I think EyeNetra is going to replace a lot of optometrists,” Park said. In other cases, he added, new technologies will take over routine tasks, allowing health care professionals to focus more time on the most difficult cases.
The developments are driven by:
1. constant connectivity made possible by smartphones,
2. the constant stream of medical information that can be generated and transmitted by those smartphones, and
3. advances in computing that now allow machines to make correct decisions even when given vague or imprecise information, or when there are a range of right answers.
Two of the best examples of that last point are Google’s driverless cars, which have been logging hundreds of thousands of miles on roads in California, and IBM’s Watson supercomputer, which famously trounced a pair of “Jeopardy!” champions in a head-to-head match.
Now, WellPoint Inc. and the oncologists at the Indiana University School of Medicine are working to teach Watson how to diagnose cancer patients.
“The computing capacity that we have now, it’s enabling much more sophisticated algorithms. And they do things better,” said Raul Zavaleta, CEO of Indianapolis-based Indigo BioSystems, which is developing software to read slides with biopsy tissue samples and, in most cases, render the correct decision.
“We’ll be able to increase productivity without adding people. And there are certain things where we can do it better.”
Reaching patients where they are
Six years after the launch of Apple’s iPhone, 61 percent of Americans own a smartphone that keeps them connected to the Internet at all times, according to the Pew Research Center. And now smartphone makers are packing their latest phones with accessories that feed weight, heart rate, blood glucose levels, sleep patterns and other health information into the phone.
That information can then be transmitted to a doctor or health insurance company, or to family members or anyone else a person wishes to help them track their health status.
Health care providers are interested in these technologies because health insurers like WellPoint and the federal Medicare program are pushing them into new contracts that pay the providers to oversee the entire health care needs of patients and reward the providers when they reduce patients’ trips to the hospital for expensive services.
Indianapolis-based VoCare is trying to help health care providers monitor seniors at home who are at risk of falling or who suffer from chronic diseases.
For $100 a month, VoCare gives patients a smartphone with a voice and data plan. The phone has a slimmed-down set of applications—to make it simpler for seniors—with an emergency call button and an activity monitor that can tell when patients are less mobile than usual—typically a sure sign of illness—and alert the patient’s health care provider.
“Our deal is basically to manage a large patient population with a few people in their home remotely,” said VoCare CEO Steve Peabody. “It has to go that way, because there’s not enough money to go around to manage this elderly population.”
VoCare has raised $4.5 million from local angel investors, and has already signed up the local physicians American Health Network, as well as local health insurers Indiana University Health Plans and Advantage Health Solutions Inc., to pay for their own high-need customers to use the VoCare service.
The growing prevalence of smartphones and tablet computers will also further the momentum of telehealth, which uses videoconferencing for consultations between patients and health care providers.
Telehealth has advanced the most in rural areas. For example, Wabash Valley Rural Telehealth Network links 26 hospitals and physician clinics in western Indiana and eastern Illinois, allowing patients at rural hospitals and health facilities to consult with psychiatrists, cardiologists, pulmonologists, nephrologists, neurologists and even occupational health professionals.
The program has reduced the number of patients transferred unnecessarily from rural hospitals to larger ones with more specialists on staff. And it has spared specialists from long drives to do follow-up consultations with just one patient in a rural area.
“Telehealth allows these providers to thrive and be productive despite a shortage of physicians,” said Stephanie Laws, the telehealth and innovative technologies manager at the Lugar Center for Rural Health at Union Hospital in Terre Haute, the organization that created the Wabash Valley telehealth network. “Basically, everybody’s having to do more with less.”
Both Laws and her colleague, Angela Powell, predict telehealth is destined to move into patients’ homes soon and might even evolve from merely consultations to actually a means of diagnosing patients.
“I would say that, over the next three to five years, you’re going to see it across the nation,” said Powell, a nurse who is project associate for telehealth at the Lugar Center. “It’s going to get to the point where you call up your health care provider and say you have a rash, show them the rash [via videoconferencing], and they’ll write you a script.”
Bring your own data
Other companies are looking to generate and harness a constant stream of medical data generated by patients themselves.
Indianapolis-based MedDiary.com, which launched in April, has created a health care app that providers can “prescribe” to patients to help them manage chronic diseases.
Doctors and nurses can set up the app so patients enter only the most relevant information about their condition. Then, as a patient enters that information, it can flow directly into the electronic medical record systems of all the doctors treating the patient.
Mark Repko, founder of MedDiary, said this kind of constant monitoring and patient-provider engagement is critical to controlling chronic diseases—which today account for about 75 percent of all health care spending.
“If patients could have a better quality of life, then you’d end up using health care resources less. That would, in effect, be an efficiency gain,” said Repko, a former marketing manager at Roche Diagnostics Corp. “How do you get patients to improve their quality of life? Well one is, you get them to engage in their own health care.”
Brian Norris is taking a different approach. He figured that, since smartphone-wielding patients already generate lots of information about their health status on Twitter, Facebook and other social media, such updates could be used to give health care providers an early warning about health problems.
So Norris, a nurse by training, started Fishers-based Social Health Insights LLC. He has been helping governments look for spikes in diseases, such as influenza. But soon, he figures, health care providers will also want to tap into similar data to step in with patients at the earliest stages of an illness.
“I think the next five to 10 years are going to be a huge paradigm shift for health care,” Norris said. “Data is going to be a new currency that drives quality and outcomes.”
Titus Schleyer, director of the Center for Biomedical Informatics at Indianapolis-based Regenstrief Institute, said data from community sources is starting to overwhelm the amount of information health care providers could ever get from testing patients at an occasional appointment.
It’s inevitable, therefore, that health care providers will need machines to help them dig through all that information to find what’s really important, he said.
“I call it the end of the brilliant physician,” said Schleyer, a dentist by training. “We are, for better or worse, going to have to rely more and more on machines.”•