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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As such it behooves everyone NOT to post your personal information, of any kind on the internet.
Basically any patient can now access the same infomation a physician
can access. It has been a long time since "Patients are passive recipients."
But, I can also look up all the working of an F250 pick-up and easily research via the net how to change the transmission or brake pads. But, I have four young children that ride in that truck, so I'm going to leave it to people that do it every day.
I do agree support groups can be beneficial. But, there is an equal amount of medical information available on the web that is complete and utterly false. Who is responsible if a cancer patient dies because she refused traditional research proven chemo and instead chose IV Vitamin C and coffee enemas because someone on the web told her it worked?
Networking health care information can have real cost containment benefits, and is a foundation for a much more efficient health care delivery system even for insurance companies. Records would be the private property of the user, not of the doctors. If you want to change providers, you don't have to fight to get your records moved to the new provider because YOU control the records. How is that big government?
Speak for yourself. WE DO want government to break the back of insurance companies and health care companies that jack up prices and unfairly restrict coverage. Don't YOU want that? Is the private sector going to fix health care? Government has a role to play. Independent records in an internet based system will HELP, not hurt.
Not a good way to keep me interested in a 12 part series.
However, the parts where patients form social groups for longevity bothers me from a security standpoint. Senior citizens are already targeted by scammers using "conventional" methods. Unless there are security improvements as well as laws to support them, I would be wary.
http://www.phibetaiota.net/summit-11/
I would be very glad to have both of you agree to be co-conveners, Harrison and I are having lunch with Jim Turner (#2 Nader now health policy champion) tomorrow to discuss co-conveners. I can be reached at robert.david.steele.vivas@gmail.com.
You could also ask the question. Where is the study about what is wrong with the healthcare system,and what specifically can be done to streamline, reduce costs, increase effectiveness, reduce waste. If Obamacare had been targeted to specifically address these things, it would have had more credibility.
Health care is really something that is antiquated, and it is antiquated because it is controlled by a few that maintain the status quo. The recent book "Checklist Manifesto" by Atul Gawande, as well as many of his other books shows how entrenched some habits are in the medical field.
Medical mistakes are one of the leading causes of death in the United States, and that we have accepted this when we would never accept this kind of performance in a car maker, or computer maker ... we don't even think of demanding more from out health care system. It is full of holes.
Malcolm Gladwell has written about how checklists have helped the airline industry cut down on human error, but health care is too much int he monopolistic hands of doctors. Doctors who not so long ago would go from house to house delivering babies and passing germs along to the mothers because they refused to even wash their hands or instruments.
I am sure the health care industry can benefit from massive internet collaboration, but what I worry about is that the wiki philosophy and ideas overide just plain common sense.
That statement has become such a blanket statement for the overhaul of health Care, it drives me crazy. It would now take a book to explain to people that it is a gross and simplified exaggeration.
I only know this because as a surgeon for 12 years I have had a single soft tissue infection after a sterile surgery. That is out of about 5,000 cases. Nobody in the end is more concerned about patient care, outcomes and complications than the physicians. I least the ones I trained under and now work with.
"Not so long ago.." is referring to OB's in the late 1800's in Europe. And one of those doctors, Lister, is now considered the "father of antisepsis."
I agree, things are not perfect. But, I also worked in the NHS in England for 6 months. People really have no idea what that system means in regards to level of care. But, agreed,, better care than if you have no Insurance and medical care means bankruptcy.