DELIVERING ON THE PROMISE OF MODERN MEDICINE:
THE NEED FOR INTEROPERABLE HEALTH & MEDICAL DEVICES
In a system well-designed for improving health, people with heart disease
or diabetes can transmit their vital signs – blood pressure, heart rate,
glucose levels, etc. – seamlessly from home to their health professional,
and get real-time feedback on their condition. A busy professional is able
to receive a daily electronic check-up on the health status of his aging
parent who lives alone, suffers from a series of chronic conditions and is
on multiple medications. A traveling businessperson can have a real-time
discussion about the workout she just completed with a trainer who is
hundreds of miles away.
Today, technologies like these, which can enable more proactive personal
health, exist and are being applied – but not nearly as commonly as needed
to radically improve health and quality of life and eliminate unnecessary
costs from the healthcare system. To become a central component of the way
we manage health, personal health and medical devices must be fully
interoperable with each other and with other information sources. Because
broad interoperability has yet to be achieved, it is an emerging priority
for health systems and for the medical and information technology
industries.
A New Model of Care
Given the rise of chronic conditions and the rapid aging of the population,
there has never been more urgent need to improve healthcare quality while at
the same time reducing unnecessary costs. Because healthcare systems have
evolved around the concept of acute disease, they are organized to perform
when addressing patients’ episodic and urgent concerns.
Yet chronic conditions – defined as health problems that require ongoing
management over a period of years or decades – have overtaken acute problems
to comprise the major health burden in developed and developing countries,
causing significant economic strain on the world’s healthcare systems. As an
acute care model is applied to a population that now suffers primarily from
chronic conditions, healthcare systems run the risk of growing increasingly
inefficient and ineffective. Already struggling systems will be challenged
by an influx of new demands they are ill-equipped to handle, making it
imperative that healthcare leadership today pursue a more sustainable model
of care.
Seniors are the segment of the population that require the most care for the
most common chronic conditions – Alzheimer’s, Parkinson’s, heart disease and
cancer. Many developed nations will soon witness a disability epidemic,
largely driven by increased aging and chronic conditions, which will propel
healthcare consumption to unprecedented levels. In 2000, the worldwide
population of those 60 years of age or older was 600 million. By 2025, this
demographic group will double to
1.2 billion.
Other common chronic conditions such as asthma, diabetes and obesity are
less age-specific but are also on the rise and require long-term management.
One study found that 15 chronic conditions were responsible for more than
half the increase in healthcare spending between 1987 and 2000, and five of
those conditions were responsible for nearly one third of the increase.
Among the young, chronic conditions are on the rise and the number of
Americans with chronic conditions is expected to rise steadily over the next
30 years.
As demands on healthcare systems intensify, technology that connects people
and information in new ways can create a better distribution of overall
health investment and interventions – enabling a shift away from the current
disproportionate emphasis on acute care in an institutional setting when
health is in crisis to a more proactive model that empowers individuals to
continuously protect and enhance health, irrespective of location. Greater
continuity of quality health information not only in the medical institution
but throughout our lives can make it possible to take greater control of our
health, avoid or delay catastrophic events, remain independent longer, and
enjoy greater quality of life.
The Promise of Digital Health – Connecting People and
Information
In an information-intensive endeavor like healthcare, an inability to
connect sources of information to each other and to the people who make
critical decisions compromises quality and ultimately increases costs.
Despite the clear need to move information more effectively into
decision-making channels, healthcare is at least a decade behind other
industries in the adoption of information technology that can better connect
people and information to improve quality and efficiency.
Connective technologies, traditionally referred to as information
technologies, are the essential ingredient that can make interaction and
high-quality information exchange possible throughout the complex healthcare
system.
The Interoperability Imperative
Despite the obvious need to apply our best information technologies in
healthcare, the healthcare industry in many countries remains at least a
decade behind other major industries in terms of innovation and adoption in
this area.
Much of the technology that can improve healthcare already exists in some
form. For example, medical devices that monitor health and fitness – blood
pressure cuffs, glucose meters, medication trackers, weight scales and
pedometers – are on the market; however, these pieces cannot be integrated
into full personal telehealth systems that can send data from multiple
vendors’ medical devices to a health care provider or fitness coach. No
standards exist that fully define interoperability among these devices, thus
the market is unable to invest in interoperable solutions.
The reasons for slow adoption of interoperability standards in healthcare
are manifold:
- Change comes more slowly in healthcare, in part because risk tolerance
is naturally low when human life and health are at stake, and changing
established work patterns introduces perceived risk.
- Incentives are often misaligned, making poor quality unreasonably good
for business in certain instances. Many healthcare systems, for instance,
pay for medical visits and procedures but do not reward for outcomes,
therefore creating incentives for volume but not for quality
improvement.
- Liability and financial responsibility falls upon, a single vendor when
they obtain regulatory clearance for a telehealth system.
- Costs involved with technology adoption are a barrier, and a lack of
standards that discourage investment in interoperability.
Interoperability standards that allow independently manufactured products
to work together are necessary so their unique functions can interact to
advance the entire system. Such standards are the building blocks for
industry-wide innovation and interaction, and allow greater horizontal
integration and ease of information exchange. By making it possible to
connect disparate data streams, standards create opportunities for companies
and providers to innovate in ways that can improve quality of care, improve
efficiency, reduce errors and reduce costs.
As a building block for interoperability, standards are an essential aspect
of healthcare system infrastructure. International interoperability
standards require the collaboration of ecosystem players and the development
of public policy, incentives and regulations, without which such standards
will not naturally emerge. Policy makers, regulators and industry leaders
must collaborate to remove policy barriers to standards development
worldwide and create new policies and incentives to advance
harmonization.
Fortunately, critical mass of interest and political will is building in
this area in many countries – with the ultimate goal of deploying
interoperable technologies to deliver quality healthcare and improve human
health, even as healthcare burden grows.
1 World Health Organization. Facts related to chronic
disease. Accessed via Internet February 2006:
http://www.who.int/dietphysicalactivity/publications/facts/chronic/en/index.html
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3 The Global Embrace Handbook; World Health
Organization, 2001. Accessed via internet February 2006: http://whqlibdoc.who.int/hq/2001/WHO_NMH_NPH_01.3.pdf.
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http://www.cdc.gov/od/oc/media/pressrel/r021231.htm. Accessed February
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(5):1103-1117.
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America. Public Health Reports. May-June 2004 v119: 263-270.
7Health Information Technology Leadership Panel. The
Lewin Group, 2006. Page 29. Accessed via Internet February 2006: http://www.hhs.gov/healthit/HITFinalReport.pdf
8Health Information Technology Leadership Panel.
The Lewin Group, 2006. Page 29. Accessed via internet February 2006: http://www.hhs.gov/healthit/HITFinalReport.pdf
