The wireless world of healthcare and more

October 11, 2009

patent wall.jpgI work with a team of talented experts that includes programmers, writers and web designers. Three of us attended a Smart Services Leadership Summit at Qualcomm HQ in San Diego (the “patent wall” pictured here) this past summer where the company that makes most of the chip sets for cell phones showed off their partners along with forthcoming projects, including healthcare.
We each wrote independent reports. Twitter King Al Stone had the best title and Data Maven Marianne Ruane wrote the best summary; both are presented below with their permission. I have added my own comments in blue italics.
The future is on the phone, and it’s a black swan.
“Imagine a world in which everyone has an electric smart car. As drivers are about to leave work, their cars ask them whether they will be making any ancillary stops or going straight home. Based on that answer, the cars will decide whether powering up is necessary, and if so, where the cheapest place is to do that. Perhaps the car has enough energy for the ride, and decides to sell some extra energy to the grid while prices are high. The car may even decide to buy power back from the grid in the evening when cost is lower and might even negotiate a better price with the power company.”
[Imagine a Pay For Performance bank with rapid deposits and withdrawals. Think that might convince more physician groups to participate?]
I’m paraphrasing, but he really did use the word “ancillary,” which made me think that the car’s vocabulary might need to be simplified for the general population. My colleagues and I were chatting over lunch with James Avery, Senior Vice President of Power at Sempra Energy. In the current climate of pessimism over seemingly insurmountable economic difficulties, the speakers at Qualcomm’s July 2009 conference offered glimpses into a brave new world full of wireless solutions offering efficiency, savings, and true inspiration.
My colleagues and I attended the Fifth Annual Smart Services Leadership Summit held July 28-29 in San Diego. The conference was hosted by Qualcomm, a leading provider of wireless technology and services. The event was an opportunity for business leaders and technology experts to learn about the development of M2M (machine to machine) and Smart Services across the healthcare, energy, transportation, and consumer industries. With widespread cell phone use (4 billion users out of 6.5 billion total people in the world), almost ubiquitous connectivity, and the technological advances that allow for 3G broadband and smart devices at a lower cost, the world is perfectly positioned for a complete transformation in the way we do everything.
[When presenting a proposal to use Internet technology to overcome a healthcare access barrier have you ever been presented with the digital divide “yes..but”? As in “Yes, but our underserved (fill in an ethnicity and/or age group, usually older) population does not use the Internet.” In the wireless world everyone has a cell phone and many have a 3G smart phone. The digital divide just closed.]
Take reading a book, for example. Russell Baker, the Director for Amazon Kindle, spoke about the business plan for the Kindle, a portable device that allows for reading electronic books. At approximately $10 a pop (at least half the cost of a hard cover book), Kindle owners can download and store thousands of their favorite titles. The wireless component is embedded in the device, so no hook up to a computer or local Internet connection is necessary, and the Kindle ships “hot” (all ready to use). Readers can also download newspapers or magazines, and there is a dictionary feature that allows for instant definition search of unknown words. The development of the device involved a unique approach that started with the customer and worked backwards to the creation of the hardware and software (press release, FAQ, customer experience mock ups, user manual, and then the business requirements to make the equipment).
[Doctors are undecided on how to access an EHR. How about the Kindle model? Using something already in common use is always a good tactic. Believe me, the EHR Kindle is already in play.]
While I have a personal fondness for turning the musty yellowed pages of my favorite dog-eared books, it’s easy to see that this technology promotes ease and economy – particularly for the avid reader who travels. Another plus is the concern for the consumer that does not stop at the purchase of the item. The Kindle staff maintains a forum for users’ questions and comments and has initiated a “See a Kindle in Your City” program that allows potential users to join up with current owners to see if they like the device before purchasing. In a world in which technological advances mean fewer interactions with real people and more communication with signals and machines, it is fitting that the business model should allow for social networking. Two-way communication becomes a necessary way for consumers to feel valued and connected to a part of a bigger whole that may be as invisible and ubiquitous as the networks that make it all possible. Will that be enough? With less and less face-to-face contact in the future, will our brains and communication skills develop differently?
With a similarly consumer-driven model is Zipcar, a shared-car subscription service that is bubbling up in large metropolitan areas that have strong transit systems. “Zipsters,” the members of this service, pride themselves on their participation in this socially and environmentally conscious group focused on responsible urban living. Zipcar Chief Technology Officer Luke Schneider calls their business plan “disruptive innovation in personal transportation.” In this new mode of thinking, standard of living is raised by reducing costs, not raising wages. Zipsters save on car payments or purchase costs, maintenance, storage, and insurance premiums by only paying for the time they actually use the car. Congestion and pollution are alleviated in the cities.
Now subscribers are able to reserve online and enter the car with a key card. Upcoming iPhone applications will find the driver’s location, search out the closest Zipcar, give him or her directions to the car, provide maps to the destination – even help the member find a parking spot (several of which are reserved for Zipcar by the city.) The business plan emphasizes periodic surveys and direct communication with members to gauge their opinions and values. Knowing “who is behind the wheel” allows Zipcar to develop a product and service that revolutionize how our society looks at car ownership.
[Could this be a model for a consumer-driven healthcare market where MDs and consumers match needs, services and pricing? Are you aware that Zagat, the original consumer-driven rating company, has entered the physician rating space?]
I’ve wondered about the future before – whether gas prices wouldn’t get so high and fuel so scarce that every person would not be able to own his or her own car. How would Americans feel about this loss of independence? Will there come a time when driving oneself to run errands after work is a luxury? I used to be afraid of a complete change in society’s priorities and modes of life, but Zipcar makes it look fun. Okay, fun might be too strong, but I can certainly entertain the idea of a world without the hassle of car ownership. If I were a subscriber in a car service that took care of all the insurance concerns, maintenance updates, gas filling – would part of my brain atrophy? Would having no responsibility to remember or monitor upkeep on my own make me … Lazy? Entitled? Irresponsible? Or would it leave more time for me to take on other socially conscious roles that I can’t devote time to now? Would I feel pressure from the group to do my part in improving the system – a Marxist version of The Jetsons?
I also question the practicality of these future products and services. The four billion cell phone users on the planet are not all using smartphones. A June 2009 issue of Business Wire predicts that smartphones will make up 38% of all handsets by 2013. A good portion of the other 62% of the population with simpler models cannot afford their more advanced counterparts. Will that create more of a gap between rich and poor? Are the older generations and the less educated going to be afraid of the new technology? Will the ramification be an even more stratified society? Will those countries with a higher percentage of cell phone use due to the lack of land lines surpass the U.S. technologically and economically? Would that be bad? For those customers who are in the market for a smartphone, how do they decide which one to pick? One participant that I spoke to at lunch was concerned that so many services were focusing on the iPhone rather than the Blackberry; apparently applications for one are not compatible with the other. That fact certainly limits the customer’s range of choices, as does allowing one wireless provider to have a monopoly on any particular product (as in the case of AT&T wireless with iPhone).
Despite these concerns, the future of wireless solutions is looking pretty solid, and the possibilities are truly exciting. Dr. Rajit Gadh, PhD, UCLA Professor and Director of its WINMEC partnership, spoke of future energy supplies being maintained by a “smart grid” whose functions and capabilities would resemble a living organism. He said that people would be able to “talk” to appliances in their homes through mobile devices and that those appliances would be able to communicate their status back. Thermostats would become obsolete, as would living, breathing meter readers that currently make a physical trip to every residence to check energy consumption. James Avery of Sempra Energy told us at lunch that despite all the advances his company has made, it still has no way to know of a blackout unless a customer calls to complain.
A smart grid that could work with households and corporate buildings to come up with individual solutions for a more efficient and economical use of power is something I strongly support. I am a little concerned though about those meter readers and other utility company workers who will be out of work. Will they be the ones trained to monitor the new equipment? Do they have the base education they need to succeed? I am particularly worried in California where all of the proposed versions of the still elusive budget call for massive cuts in education spending. If my state is indicative of priorities elsewhere in the country, the U.S. will be sorely lacking the educated work force that it needs to man these new technologies.
[What would characterize a smart healthcare grid?
Assuming, however, that the American work force is up to the challenge, some really innovative wireless solutions are going to be available across industries. Steve Hudson, Vice President for Strategy and Business Development of OmniLink Systems, spoke about location sensors that could be used to keep track of Alzheimer’s patients who might wander out of a set zone. The same sensors could also monitor criminal offenders. With the current budget crisis in California forcing an early release of prisoners, wireless monitoring might be the more cost effective solution that still allows for public safety.
We learned about another interesting use of wireless devices at breakfast one morning with some employees of John Deere. They use various sensors to monitor the “health” of big pieces of equipment, reducing the time mechanics spend in the field doing manual checks. Ben Goldberg, Client Services Manager at Qualcomm, spoke about this tracking of heavy machinery, which can not only indicate physical problems with the equipment, but also supervise preventive maintenance and keep track of time and gas lost by machines standing idle. Companies owning this equipment can use a sophisticated calculator function to figure out their potential savings from installing the sensors, which changes the way the companies think about the investment.
Most fascinating to me personally was the Arizona-based company eSoles which manufactures custom insoles for sports shoes with sensors that measure speed, distance traveled, pressure, and other parameters important to movement and balance, transmitting the details to a web site that can be accessed on a cell phone. A basketball player could find out how high he jumped during a game, and a golfer could determine from swing to swing how her balance was affecting her movements in order to correct it. I’m not sure whether I could get an insole in a pair of socks for beach volleyball (and I don’t suppose I’d need a sensor to tell me that I don’t jump very high), but it’s fun to think of the possibilities – track, analyze, and optimize. Elderly patients with these insoles could be monitored as well; when the movements indicated an off-balance gait, the sensor could send an alert to a caregiver’s wireless device before a fall took place.
[The same sensors are utilized in beds for long term care patients where the objective is early detection and amelioration of conditions that lead to bed sores.]
My colleague Al Stone and I work on a healthcare consulting team headed up by Steven Stumpf, EdD, and as such, the three of us were most interested in the implications of wireless solutions for healthcare. Dr. Eric Topol, Chief Medical Officer of West Wireless Health Institute, talked about the possibilities for wireless devices in the management of chronic conditions. Though the U.S. spends a large amount on its healthcare system – 16% of the GDP – we are only 19th in the world for quality of care. With such a horribly wasteful healthcare system, there is a lot of room for improvement. With the right wireless devices, every person’s home will have the potential to become a wireless ICU, monitoring a patient’s vital signs and transmitting those signals to a caregiver’s cell phone or data hub. The elderly will be able to stay at home as they age, greatly reducing the need for assisted living and nursing homes. Conditions such as asthma, breast cancer, diabetes, obesity, and sleep disorders are just some of those that are managed more easily with wireless devices, diminishing considerably the time spent in doctor’s offices and labs for routine check-ups and tests. Fewer medical visits, especially to hospitals, have the potential to lead to astronomical savings.
Aaron Goldmuntz, the Director of Business Development for Cardionet, explained one wireless solution for healthcare. His company provides heart monitors that transmit ECG data for arrhythmia diagnosis and evaluation of treatment efficacy. Because atrial fibrillation is fairly common in stroke victims, patients who survive one stroke and are found to have an arrhythmia can be regularly monitored, dramatically decreasing the chances that they will suffer another stroke and spend time in the hospital again. Representatives from the company Brainlike explained that their service can minimize the information gathered from the health sensor to its most essential, thus lowering the drain on the battery of the device. Once individual parameters are set, only the data alerting a caregiver to a possible problem needs to be sent.
The medical advances described made me think about our own Los Angeles Hepatitis Intervention Project (LA HIP). Patients with chronic hepatitis B need to have their liver enzymes checked every six months for indications of cirrhosis or liver cancer. Compliance is notoriously low, mostly because of the high cost and the target population’s lack of insurance. If the amount of blood needed for the screening was low enough that people could gather a few drops at home, they could test it themselves on a sensor that would send the information directly to a clinic or to the doctor. Only when the tests alerted medical staff to higher than normal levels would the patients need to make a visit in person. This would lower costs, increase compliance, and save doctors and clinical staff valuable time. It may not be feasible now, but it certainly seems like something that may be possible in the future.
I’m fascinated with all of the possibilities for wireless technology, particularly in healthcare which is so desperately in need of better, cheaper, faster solutions. I’m a recovering control freak who is thrilled with the thought of tossing out messy jumbles of cables and wires. I feel relaxed when things are organized and efficient, and I love the thought of saving resources, money, and lives. How quickly will these changes come? I think about my parents who can’t seem to figure out how to program numbers into their cell phone and simply don’t retrieve their voicemail messages. As we brainstormed ideas relevant to our own project on the way back to Los Angeles, my colleagues in the front seat decided to test out the car’s rarely used GPS system, in honor of the future as presented to us at the Qualcomm conference. It took a few tries, but they got it to work. I told them they could change the view to have the arrow pointing straight ahead, the way the car was driving, to more accurately simulate our driving experience and make reading the map easier. “No, no, don’t touch anything!” Steve reprimanded, afraid to lose the settings that had been eluding them. “Leave it the way it is.” Change will come, one step at a time.
[Following this conference – and upon reading Marianne’s comments – I broke down and bought a smart phone and now use my GPS to plan routes].

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