Saturday, January 27, 2007

Dragging My Heels in Healthcare

Intel’s Chairman Craig Barrett thinks I’ve been dragging my heels about using information technology in healthcare.

Hmmmm. Dragging my feet over something that represents hours of unpaid labor and exposure to litigation… What could I be thinking?

Yesterday in an interview by CNBC’s Maria Bartiromo at the World Economic Forum in Davos, Switzerland, Mr. Barrrett blamed the medical profession for lapses in implementing information technology in the healthcare arena in the area of chronic health management.
Bartiromo: Where else could technology enable better health care?

Barrett: Well if you look at it from a standard engineering analysis, about 80% of the cost in health care is in people who are chronically ill or old, and the real issue there is in fact, to keep them out of the hospital. That’s remote diagnostics and remote monitoring. Taking care of people who are chronically ill in their home. How do you do that? Information technology. Remote monitoring devices fire that information back to the doctors’ office let them keep track of the individual without having the individual have to go to the doctor’s office. Diabetes, congestive heart failure, all these things are amenable to information technology (and) diagnostics in the home.

Bartiromo: You could have all your information on a chip, I guess.

Barrett: Of course you could. I mean, we could have done this a long time ago if the medical profession would kind of get with it in this space. They’ve been kind of dragging their heels.
Whoa there Mr. Barrett! Are you suggesting that manufacturing of home monitoring devices containing Intel chips is the responsibility of the health profession? Have WE been dragging our feet or have YOU?

And Mr. Barrett, could there be an itsy bitsy reason that we have been dragging our feet? Could it be because no one is willing to compensate doctors for monitoring people using gizmos at home? Is this a trivial piece of information? I would suspect that you, “Mr. Swiss Alps,” don’t do much that isn’t going to compensate you, now do you? Or are you, “Mr. Six-Inches of Powder,” going to lead the charge at bridging this gap given your prescience on this issue?

It’s not about just getting the data to the doctor. That, sir, is NOT healthcare. Instead, it’s about differentiating signal from noise. With a data dump to doctor’s offices, who will sift through the mountains of data (pun intended) to determine which data represent a problem in a particular patient versus a significant change? Data can change in expected ways when certain drugs are administered: like the elevation of a white blood count after steroids are administered. Will your little data processor be capable of making higher-order decisions? Unlikely.

More importantly, if a data point exceeds a pre-defined parameter and a doctor like me is notified by an e-mail using your handy-dandy device, who will follow-up to make sure I received and acted upon the notification? E-mailing data this way, without personal contact, is like planting a sinister bomb on my desk that is waiting to explode in my face. If I don't happen to check my e-mail that week because I am inundated by the scores of aged entering their twilight years, will you take the liability heat, or will I?

Pompous, arrogant sound bites do little to address these critical issues regarding information technology’s application in health care.

I'm sure there's plenty of doctors who'd like to have a weekend in Switzerland to discuss our "economic" thoughts, too, Mr. Barrett. Just ask.


Addendum: Dr. Helen has more discussion and interesting commentary on this post.

1 comment:

Anonymous said...

The VA spent a bunch of money on a home monitoring program for chronic diseases. But in typical govt fashion, did not plan well. At our facility there was a huge rush to place scales, BP cuffs and interactive monitors in the pt's homes to help with CHF monitoring.
Alas, those of us in cardiology find it the bane of our existence. The program is administered via home health, but we have the dubious honor of getting all the alerts from pts. In cardiology we have quit referring pts because it has created more work and does not seem to have improved pt care.