One of my favorite quotes from last week's Center for Connected Health Symposium in Boston came from Peter Tipett, MD: "Information technology can reduce cost, increase quality, and advance science," said the vice president of industry solutions and security practices at Verizon's business unit. "But other than that it's not worth it."
In so many ways, so many kinds of Health IT make perfect logical sense. Making patient medical records easily accessible in electronic format? A no-brainer. Giving patients access to their own records which, after all, belong to them? Makes sense. Tools that help clinicians make quick and accurate evidence-based diagnoses at the point of care? Well, of course that's a good idea.
There is some research suggesting that electronic health records can have a positive impact on quality. But for medicine, so enamored with empirical evidence, double-blind studies, and peer review, it isn't always enough. Telemedicine, remote health, and m-health are particularly vulnerable to that phrase that concludes so many academic papers: "more research must be done."
Another of my favorite nuggets from the symposium was when Joseph Kvedar, MD, founder and director of the Center for Connected Health, said researchers add that line to the end of their papers because it's in their best interest—they are, after all, in the business of conducting said research.
Tippet noted that it's not just a healthcare thing—there's very little science about the efficacy of technology in any field. Did Watt need empirical evidence before patenting the steam engine? Did Sony do double blind studies to see if consumers would rather listen to music on a Walkman instead of lugging a boombox around on their shoulders? Did the healthcare industry need peer reviewed studies of imaging technology such as CT-scanners when they were new?
OK, so there are some healthcare technologies that demand rigorous study. But do text messages reminding patients to take their medication at the correct time each day fall into the same category? What about wireless scales that send a patients' weight to their doctor's office? An app that helps overweight patients make healthy food choices or gives tips to folks trying to quit smoking?
Again, back to the symposium. In a debate-style session, Kvedar and Sahid Shah, CEO of the health IT consultancy Netspective who blogs under the handle The Healthcare IT Guy, debated whether current approaches to patient self-management improve quality or lower healthcare costs.
Much of their back-and-forth focused on evidence (or lack thereof). Kvedar cited several examples of how his organization and other researchers have shown that tech-enabled patient programs can improve outcomes. "There's plenty of evidence," he said.
But Shah argued there's a need for concrete evidence from large-scale studies for any technology that is prescribed by a physician to a patient regardless of how that technology is used—even if common sense says the technology could help the patient.
Shah noted that although the airline industry lets customers make their own travel arrangements by booking their flights online and checking in at airport kiosks, it hasn't made air travel safer or less expensive.
But there's a flaw in that argument. The airlines didn't make those changes to help consumers save time and money—they did it to save themselves time and money. And they certainly didn't do it to improve flyer safety.
But what if you gave every airline passenger a breathalyzer kit they could use to ensure the pilot is not drunk? Or sent them a text reminding them to buckle their seatbelt before takeoff? Or gave them an app to remind them how to put on a life vest in an emergency? Would those things improve the quality and safety of passengers?
To be fair, Shah was asked to argue that self-management doesn't improve patient safety and quality or reduce costs—the whole premise of the session was to engage in debate. In any other situation, he said, he'd probably concur with Kvedar.
Good. But I wonder about the bulk of the medical profession and whether they're ready to cede even a little bit of control to patients—and the technology that can help them manage their care outside the doctor's office.