This article is the second in a series of 12 over the next 3 weeks written by Don Tapscott and Anthony D. Williams authors of the newly released book Macrowikinomics: Rebooting Business and the World. The book is receiving a lot of buzz. Mark Parker, the CEO of Nike calls it "A Masterpiece. An iconic and defining book for our times." The Economist says it's a Schumpeterian story of creative Destruction."
The book argues that many of the institutions of the industrial age have finally come to the end of their lifecycle, and now being reinvented around a new set of principles and a networked model.
Today's blog is about rethinking health care.
Now that Republicans control the House, they will try to roll back ObamaCare. The president has said, understandably, that he will resist vigorously. But for all its sound and fury, the debate over ObamaCare is distracting us from a more important discussion: the basic model of health care is no longer viable. Indeed, both parties have different views about funding models, when evidence suggests that only much deeper changes in how we manage our own health and well-being can prevent spending from spiraling out of control.
Despite the advancements of modern medicine, health care's business model has remained unchanged for centuries. It assumes that, medically speaking, physicians are smart and patients aren't. Doctors wait in their office or hospital for sick people to come to them, and doctors treat their patients and tell them what to do, one-on-one, face-to-face. If patients didn't like what their doctor told them, they could shop around for other opinions if they could afford it. Patients play little or no role in deciding their own treatments plans. As one physician puts it: "Today's healthcare institutions are like the old media: centralized, one way, immutable and controlled by the people who created and delivered it. Patients are passive recipients."
So it is no surprise that a growing number of physicians and patients want a better model of health care. They envision a system in which everyone involved, including patients, use the Web as a platform to share information, deliver care and build communities around medical interests and health goals. A main benefit, as studies show, is that when patients are more engaged in managing their own health, they are more committed to being healthy.
Users of MedHelp, a popular online health community, are able to track over 1500 symptoms and treatments on a daily basis using iPhone apps covering both general health conditions, such as weight loss and allergies, and very specific disorders, such as infertility and diabetes. If patients so choose, this information can be shared on an ongoing basis via the Internet with their doctors or caregivers.
This information continuum is much more useful than the readings taken during a visit to the doctor every one or two years. Studies show that constant attention to key indices can help motivate people to change their behavior. People who weigh themselves daily are more successful at weight loss and maintenance than those who weigh in weekly. People on the Weight Watchers diet who attend meetings and use digital tools, such as an iPhone app, to follow their points are 50 percent more successful in reaching their weight loss goals than those who don't.
Several pilot studies aimed at reducing the cost of chronic care confirm that such self-monitoring technology reduces errors, improves communication with doctors and helps patients better manage their illnesses. These advances, in turn, decrease emergency department trips, unnecessary doctor's office appointments and costly home nurse visits. Since patients with chronic conditions absorb nearly 70% of Medicare spending according to the Center for Medicare and Medicaid Studies, equipping patients with tools for self-management would not only improve health outcomes, but also reduce costs.
We also know that loneliness and isolation can be a medical risk factor, another area where the Internet can potentially help. Lonely people get sicker than the population as a whole. They suffer from a wide variety of ailments, ranging from colds to heart attacks. Lonely people with HIV respond less well to antiretroviral drugs. People who are lonely in their old age are twice as likely to develop Alzheimer's than other seniors who are socially active. Socially isolated women have a greater risk of dying once they have been diagnosed with breast cancer.
In the most exhaustive study on social ties and health to date, researchers at Brigham Young University and the University of North Carolina at Chapel Hill pooled data from 148 studies on health outcomes and social relationships -- every research paper on the topic they could find, involving more than 300,000 men and women across the developed world -- and found that those with poor social connections had on average 50 percent higher odds of death in the study's follow-up period (an average of 7.5 years) than people with more robust social ties. The overall boost in longevity is about as large as the mortality difference observed between smokers and nonsmokers, according to the authors. And it's larger than differences in the risk of death associated with many other well-known lifestyle factors, including lack of exercise and obesity.
Of course, you can't legislate social relationships. But according to Dr. Michael Evans at St. Michaels Hospital in Toronto, doctors could do more to encourage patients to seek social support in online health care communities. What's more, he suggests that patients with chronic conditions represent an untapped workforce that is not currently engaged in improving health care. An estimated 30 percent of the American population has a chronic disease and a further 29 percent of the population knows or cares for someone who has one. Bringing these communities together over the Internet to share health care experiences and outcomes, says Evans, can help speed up research and allow superior medical techniques and treatments to spread faster.
Take PatientsLikeMe, a vibrant health care community whose members -- 60,000 and growing - suffer from debilitating chronic conditions such as ALS, Parkinson's and bipolar disorder. Members can share details of their medical history, which many do. They don't mind the loss of privacy when the alternative is to struggle in isolation with the helplessness, lack of control and fear associated with illness. Exchanging information gives them an invaluable source of support and helps them make smarter decisions. Members participate for free, but the data they contribute is rendered anonymous and then aggregated to inform research conducted by doctors, pharmaceutical and medical device companies.
This openness ultimately benefits everyone. New treatments can be evaluated and brought to market more quickly. Patients can learn about what's working and, in consultation with their doctors, make adjustments to their own treatment plans. "People think we are a social networking site," says co-founder Ben Heywood. "But we're an open medical framework. This is a large scale research project."
As the benefits of online engagement become clear, we think the time has come for every American to have their own Personal Health Pages on the Internet, including children and infants. Think of it as the patient's personal window into his or her own health and the basis for participation in a broader health social network. Adults would own and control their own data, but health care professionals (and perhaps family members) could access it as required with appropriate levels of privacy and security. It would serve as each person's portal to health care information, link them to organizations such as Weight Watchers or a local health club, and track relevant medical advancements. Much like Facebook, a patient could create a community or join medical "causes". And just like the App store, low-cost or free applications could help individuals measure their own health, do pre-diagnosis of a sick child or test for possible drug interactions.
In the Internet-centric business model, patients become more like partners -- they self-organize, contribute to the total sum of knowledge, share information, support each other, and become active in managing their own health. This goes beyond the current catchphrase of health care being "patient centric." Not only is collaborative health care focused on the patient; the patient co-creates health care and wellness, producing an outcome that is a more evidence-based and cost-effective, i.e., safer, better and cheaper.
Of course, without the buy-in of the biggest players -- namely government and insurers -- we won't be able to maximize this opportunity and more people will get needlessly sick. Harness these new capabilities, on the other hand, and the medical establishment can join with patients and other stakeholders in making the health care system work for everyone.
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