The $2.8 trillion healthcare system is drowning under the burden of chronic diseases that account for 75% of the dollars spent on health care. However, these diseases have been resistant to the therapeutic advances, and therefore, we have a dismal return on our investments. According to the Institute of Medicine (IOM), U.S. health spending is twice that of Europe, however, health system performance is down to 41st in the world. Furthermore, the CDC estimates that approximately 60% of cardiovascular deaths under the age of 60 are preventable. In order to achieve improved health care outcomes, we (health care industry) must shift our focus on modifying the environmental and behavioral factors that account for the majority of preventable long term morbidity. Additionally, we must provide patients with the tools to gain insight into their disease process and we must have them engaged in their own health.
As a physician, I am a first hand witness to the lack of insight patients have into their diseases, the lack of tools available at their disposal to gain insight, and how patient engagement (although a hot topic) is essentially paid lip service by health organizations. The following is a typical patient encounter when a patient is made aware of their chronic disease. A diagnosis is made, 15 minutes are spent talking about the disease (including lip service to behavioral and social factors), medications are prescribed, written discharge instructions are given, and the patient is instructed to follow up in three to six months for additional lab testing. In the following six months, the patient may or may not be compliant with medication, (s)he may or may not be following or even understand the lifestyle modification recommendations, and is most likely disengaged from his/her disease process.
Two parallel and synchronous movements, mobile health (mHealth) and Quantified Self (QS), have the potential alter how patients interact with the health care system and impact health care outcomes. QS is a movement that utilizes technology to acquire data on several aspects of a person’s daily life such as calorie consumption/expenditure, blood oxygen levels, heart rate, weight, and blood glucose levels. mHealth will provide the tools to measure and transmit this analysis. The mHealth market can be broken into two broad categories. First, there are the apps and appliances used to monitor the wearer’s physical fitness. Firms such as Nike, Fitbit, Jawbone, and Basis Band all make wristbands and other wearable gadgets that allow people to record their performance. Second, other apps and devices link patients with a medical condition. For example, Google is developing a contact lens containing a wireless chip and sensors that can measure and transmit the glucose levels in a diabetic patient’s tears. The patient’s data will be measured on a day-to-day basis in their natural environments reducing the need for repeat clinic visits. Additionally, this will offer the patient and the provider access to unprecedented data on the social and environmental factors that are leading to disease progression. With this data in hand, the provider can design actionable interventions such as incentives, behavioral modification techniques, biometric milestones with the goal to curtail negative behaviors and reinforce health promoting habits.
Furthermore, this type of intensive data recording and analysis has the potential to increase patient engagement. Patients will have an unparalleled level of insight into their habits (exercise and eating) and will be able to see the effects of these habits in real time via tools such as data visualization dashboards. Added layers of gamification and social networks can also be utilized to further spur engagement levels and impact health at the community or population level. Engaged and informed patients who are active in their health outcomes will lead to improved health literacy, improved dietary/exercise compliance, and ultimately improved health outcomes.
Access to health care is an important first step in improving health care outcomes. However, in order to achieve real and sustainable benefits health care organizations must invest in the QS and mHealth solutions to interact with and engage patients in their natural environments. This is a massive undertaking with a host of challenges ranging from extracting, curating, and integrating data to ultimately developing systems that process and respond to the information. However, if health organizations can successfully implement this infrastructure, they have the potential to uncover considerable value in the form of population health benefits and decreased cost of chronic care.
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