Slow pace of healthcare innovations. Why?
Imagine: suddenly you feel dizzy. You simply press the button of your smart band, watch, necklace, etc. Your ECG, glucose level or blood pressure will be immediately checked, and Artificial Intelligence (AI) software will recommend simply to sip 20 mg of Cognac and peacefully go to bed. Would it be nicer than calling the emergency?
Indeed, promises of the 3d Digital Wave are breathtaking. With 70 percent of healthcare organizations worldwide investing in consumer-facing technologies, e.g., wearable sensors and related apps, patients are expected to receive virtual medical care anytime anywhere. Artificial Intelligence will compensate the lack of a human one. It will disrupt the existing healthcare system by delivering easily accessible, cheaper and higher quality care to 70% of patients by 2025. Researchers at Stanford University have recently compared 130,000 images of 2,000 different skin lesions into a computerized algorithm discovering that artificial intelligence was just as good as 21 board-certified dermatologists at identifying instances of skin cancer. By 2020, cognitive systems are expected to diagnose in minutes such chronic conditions as cancer and diabetes. 75% of all patients hope to witness such glorious metamorphosis.
According to the studies the second wave of digital health transformation has already provided European citizens with electronic health records (EHR), particularly in Germany.
As a patient, I wonder: where are all those treasures? Who is hiding them from me and other patients, and where? Entering a nearby hospital (by the way, in modern Germany) I have a feeling that those is who are writing futuristic those visions live somewhere in a different world, not in the one most of us, ordinary citizens temporarily grieve in. For sure, EHR has already been implemented somewhere, but as I was searching for an X-ray image buried in one of the hospital’s archive departments (not to be confused with Picture Archiving and Communication System/ PACS) I was, with many difficulties, provided with a printed film. An image depicted a spinal injury with no trace of a cardio operation that was, according to the records, performed upon the patient a week ago. Moreover, it was obvious that an image belonged to a woman, while the patient we were concerned about was unquestionably a male. The authentic image, by the way, was never found.
Meanwhile, some of the technologies able to help millions in diagnostics and treatments have already existed for years. For example, the Canadian company Biosig Instruments has patented the InstaPulse® Heart Monitor that registers arrhythmias without the use of common 12-lead medical devices available only in hospitals, cardiology clinics and, sometimes, in advanced physicians’ offices. One can simply grasp the device with both hands and it will automatically turn on continuously updating your cardio rhythm. Note that irregular cardio rhythms are causing the formation of blood clots in vessels. The blockage of the vessel depending on the location can provoke congestive heart failure, ischemic attack or even myocardial infarction (with necrosis) and stroke. Though the device was registered as a “fitness gadget” (apparently to avoid the FDA hassle) it could be well applicable to cardio patients. Cardiological Clinic Aachen in Germany is now using almost identical device to treat their stroke patients.
The Insta-Pulse® Heart Rate Monitor was invented by Dr. Gregory Lekhtman for a general consumer in 1975 being sold for 128 Canadian dollars. Researchers in Aachen started experimenting with their device in 2016. The calculated distance (airline) between Germany and Canada is approximately 6,750 Kilometer. About 1000 hours walking distance (given the ocean were replaced by the firm ground). It took almost 50 years for physicians to start practicing comparable device in Europe.
Similar fate apparently befalls wearable garments such as Niturit, a seemingly ordinary T-shirt developed by the University of Aveiro in Portugal and the Israeli “Moked Enosh” company. The sensor enabled garment records ECG signals transmitting the results via a smart phone over a number of days directly from a patient to a cardiologist. The T-shirt was offered years ago as part of examinations by the Moked Enosh center at the cost of $ 117. While the European Space Agency was quick to choose this T-shirt to test astronauts, cardio patients are still awaiting it in their nearby hospitals.
No question, there are oases of innovations such as Mayo or Cleveland Clinics, or Kaiser Permanente being on top of the technological edge. Yet patients are less concerned about “best practices”, but rather with the “broader adoption” of innovative methods as part of a routine healthcare procedures.
We consume digital services daily in highly competitive and consumer oriented industries such as banking, manufacturing or retail. But healthcare still remains most highly impenetrable fortress for IT innovations. Just as we see disconnections of IT systems in many of the hospitals, so we observe a disruption of knowledge flows within the medical community. Such methods as “crowd funding” or “crowed testing” so familiar, e.g., in software development practices are not yet widely spread in healthcare environment.
Why the technologies that can make our healthcare more efficient, personalized and accessible are slow to reach the consumers?
To justify the inborn conservatism, medical professionals often refer to the fundamental bioethical principle of “Primum non nocere” or “first, do no harm” every medical student is taught at school. It is better to do nothing, than to risk causing more harm than good to your patients. Of course, healthcare has to deal with subjects much more complex and multifaceted than, e.g., manufacturing or finance. But if Niturit or HealthWatch, 15-lead ECG-sensing T-shirt that can read heart rate, blood pressure, detecting cardiac irregularities, have already been tested on a number of patients including astronauts, why other hospitals at least do not check on them? Are astronauts much more important than the rest of us citizens?
True, new delivery models will demand changes in traditional health bureaucracy and administration. How to combine, e.g., remote consultancy with the traditional face-to-face visits? Who will actually be responsible for the remote monitoring? How those remote services will be compensated by insurances? However complicated all those challenges may seem, solutions can be found. Other industries have coped with those problems rather quickly. Banks have adjusted their administration and personal issues to online payments and even software industries moved rather quickly from licenses to pay for services model.
Maybe the reason for delays is that there are simply too many of us patients around the world, so healthcare organizations have relatively low competition pressure compared to other industries? With population growing older and over 44% of World Health Organization Member States to have less than 1 physician per 1000 population patient, medical providers will hardly be left without jobs. Unlike other industries forced to fight for their customers by offering them better services, the problem in healthcare is reverse: how to reduce the patients overload.
Or maybe the blame is on patients who, despite all the proclaimed efforts to engage them, are still shy to decide on their own health? We consider ourselves professionals when demanding the ban of Nuclear Power stations in favor of a “cleaner and greener” technologies, but suddenly feel ourselves meek submissively accepting the risk of surgical procedures. We obediently swallow medications prescribed according to statistical tests, without asking why the given pill would work exactly for us, and we accept diagnosis and treatments without checking for alternative approaches.
For example, many cardio patients are undergoing expensive bypass surgeries. The bypass procedure is not harmless. The estimations are that following bypass only 75% of patients remain free of cardiac ischemia for five years, dropping to 50% by ten years. Meanwhile there are safer (though more primitive) methods existing for over 50 years for treating angina such as, e.g., External Counterpulsation (ECP) that is completely non-invasive. A computer microprocessor triggers the sequential inflation with compressed air of cuffs that are wrapped around a patient’s calves, thighs and buttocks. As the computer inflates the cuffs, blood is propelled from the lower body back into the heart. This action facilitates venous return of blood into the heart, increasing cardiac output. Does this method work for you? Maybe not, but at least it is worse to check it with your doctor.
So why there is no pressure from us citizens to stimulate medical community to crave for new and perhaps better methods of treatments like it is happening in other industries? To be honest, I do not have an answer, but I think it is time we should feel and behave ourselves less like sheepish patients, but more like citizens and customers of the healthcare system which we are directly or indirectly funding.