November 14, 2016

The Digital Era Is Here—and Changing How We Manage Our Health

Robert Graboyes

Senior Research Fellow
Summary

As with the Internet, success will come from dealing with problems as they occur, not from trying to prevent every hypothetical risk beforehand.

Smartphones and tablets have radically altered how we read, write, work, cook, exercise, communicate, travel, learn, photograph, shop and relax. The Digital Era is changing how everyone, including older adults, manages healthcare. Patients and providers interact in new ways (through teleconference, email). Patients perform tasks that formerly required physicians (self- administered electrocardiograms, home pregnancy tests). We embed patients in great networks of people and computers, with millions of patients’ data flowing in, combed for patterns, accessible at all times.

New technologies give patients unprecedented control of their health. Increasingly, they, not doctors, determine when and where care is received. Knowledge that once resided only in physicians’ brains is now on websites and apps. And patients can access providers who live far from their homes.

Faster, Easier Access to Care

My mother died in 2016 at 93. Mentally sharp until her final weeks, time wore down her mobility. A nighttime concern typically meant hours of delay before being able to call her doctor, several days’ wait for an appointment, an arduous trip to the office, a long wait for attention and a taxing return trip home.

In contrast, an iPad likely bought Mom one extra year of life. During an evening video chat with her grandson, she mentioned a painful sore. An emergency physician, Ben thought her appearance and breathing suggested the onset of sepsis. Emailed photos of the wound reinforced his impression. Ben and my brother Arnold, also a physician, recommended she go immediately to the hospital. Sepsis was confirmed, and powerful antibiotics saved her. Without the iPad, delays might have proven fatal.

Technological miracles don’t require elders to have grandchildren with medical degrees. In most states, anyone with a smartphone can call Doctor on Demand for a video consult with a physician in under two minutes ($49 for a medical doctor; $119 for 50 minutes of psychotherapy); plug a CliniCloud stetho-scope ($149) into the phone, and the doctor can hear heartbeat and lung function. In San Francisco or Los Angeles, day or night, touch an icon, and a physician from Heal comes to your door for a flat fee of $99. Iora Health clinics are open 24/7/365; members can always speak with doctors by phone, email or video.

The Patient as Doctor

Older adults increasingly do what doctors used to do—and more. Many own digital blood pressure cuffs. A Fitbit or Jawbone (both from $70 and up) records heart rates, steps walked and sleep patterns. My FitBit reminds me to take medications; more advanced wearables like insulin pumps actually administer medications. Other wearables continuously record vital signs, with artificial intelligence alerting users to problems before symptoms appear or a doctor is available.

Patients with atrial fibrillation can conduct their own electrocardiograms in 30 seconds with an AliveCor smartphone add-on ($99). A “normal” reading can avert an unnecessary trip to the hospital; a “possible a-fib” message may prompt actions that avert a stroke. AliveCor can email the EKG to the patient’s doctor (or grandson). Click another button and the EKG is read in under an hour by an AliveCor technician ($9) or in less than a day by a cardiologist ($19). (Note: I’m an a-fib patient, and I carry my AliveCor everywhere.)

If the older adult’s great-grandchild has an earache, CellScope can determine whether or not it’s infected. ResApp, still in testing, lets a patient diagnose whether her cough is asthma, bronchitis or pneumonia.

Networks Responding to Cognitive Issues

Some apps combine patients, providers and computers into information networks related to specific maladies. Depression, anxiety and substance abuse are problems for many older adults, and myStrength uses technology to provide self-management resources to manage emotional health. Recovery Record helps eating disorder patients; 350,000 patients and 10,000 therapists constantly input data; artificial intelligence monitors patients’ health, sending reminders and prompting patients and-or therapists to take action when advisable.

These networks are analogous to Uber and Lyft, whose ride-sharing services store vast amounts of geographical data, overlay real-time information on drivers and riders, and condense that information into an instantly comprehensible form and easily navigable choices.

The Revolution Is Here

Far more apps are visible at sites like My Health Apps, and we’re just beginning the revolution. A key question is when and how generously public and private insurers will agree to pay for these services. While there is some progress, Medicare is slow to act, as are private insurers. Part of the resistance comes from medical professionals motivated by fear of technology or turf protection. For example, Texas Medical Board regulations make it difficult for telemedicine companies to operate in that state.

Paradoxically, this technological revolution may improve patient−provider relationships by making patients less dependent upon particular providers. Next-generation Electronic Health Records (not today’s bureaucratically designed, governmentally mandated, therapeutically useless EHRs) will make it easier for patients to interact with multiple providers, seamlessly change doctors when necessary and access providers while traveling. They’ll integrate data from multiple providers, from patients and from wearable telemetries. They’ll produce outputs that make it easier for a provider to hit the ground running with a brand-new patient.

As with all technologies, there will be risks. An early 1990s technophobe might have warned that the Internet and cell phones would lead to terrifying new forms of fraud, harassment, terrorism and privacy loss. Those dire predictions would have been correct, but the benefits of these technologies have greatly outweighed the costs: 911 emergency services get help to us faster; GPS keeps us from getting lost; and people in remote regions can immediately and inexpensively communicate with the outside world. In the past 25 years, more people have risen out poverty worldwide than in any comparable period in human history, and the Information Revolution has contributed powerfully to this accomplishment.

In the 1970s, many feared home pregnancy tests would lead to suicides, neglect of health and loss of physician income, as explained in a recent New York Times piece. The reality proved much sunnier. Today, new technologies lessen the anxieties and isolation many elders feel. My mother’s iPad gave her immediate lifesaving attention. In coming years, such stories will become commonplace. As with the Internet, success will come from dealing with problems as they occur, not from trying to prevent every hypothetical risk beforehand.