Maybe no one will be astonished if I claim that computer hardware and software are becoming first class citizens in the arsenal of medical research, disease control or patient care. This proposition becomes a little more interesting if I point out that, increasingly, some of this software and hardware will take the form of a Windows PC in the patient’s home, along with some commodity hardware devices that plug into a USB port, along with the device drivers needed to connect to them. This technology makes uploading reliable, objective healthcare data just as easy as uploading pictures from a digital camera to Facebook. In fact, Microsoft provides some software to upload these statistics to a place in the cloud where doctors can collect and monitor them. It’s called HealthVault—hmmm…maybe we should have called it Healthbook instead.
Thanks to the Center for Connected Health (CCH) at Partners Healthcare, this technology may become part of one of the most important healthcare innovations of the 21st century—connected health. The CCH has developed its own a solution called Connected Health Care Suite (CHCS) that uses HealthVault but takes it to the next level. By moving patient health data out of HealthVault and into the hands of doctors, CHCS puts this data where it can do some real good. It seems that for the aging baby-boomers connecting doctors and patients in this way addresses one of the biggest healthcare challenges we face in the near future. Despite the current political hoopla about the cost of healthcare; capacity will be a very big problem too—one which can have a huge impact on cost and patient outcomes alike.
To see what I mean, take a look at type-2 diabetes—sometimes referred to as adult-onset diabetes. Most people who have diabetes have the type-2 kind. As the name suggests, this form of diabetes tends to have an onset as a people get older. In 2002 the National Diabetes Clearinghouse (NDIC) estimated that about 16M in the US have diabetes and it cost in excess of $107B. By 2007, these estimates were revised to 23.5M and more than $174B in cost. Can you spot the trend here?
When you consider that diabetes becomes more prevalent as the population ages and that the aging segment of the population is growing itself—due to the baby-boomers who are fast approaching retirement age—you begin to see why it will create very serious challenges for the capacity of our healthcare system. But there is more.
Due to the nature of diabetes, the amount of care and management also tends to increase dramatically because older people produce less insulin and tend to suffer more symptoms, side-effects, and complications from this disease. In short, they require more care and attention as they age. As scary as this sounds, make no mistake; there are other serious chronic health issues that follows this pattern. Hypertension, obesity, and heart disease follow a similar pattern.
Fortunately, the folks at the Partners CCH are onto this problem and they are pioneering a very promising approach to address it. CHCS is based on the simple but powerful idea of regular, accurate monitoring of key patient vital statistics right at home. In the case of diabetes, for instance, a patient can automatically and routinely upload their blood sugar level using glucometers that are already familiar to them. When this data arrives at CCH, it can be analyzed for trending, rules can be applied, and a timely phone call to a patient can be made if necessary. This is truly “a stitch in time” approach that is already showing great promise, substantially reducing the need for costly home visits and hospital readmissions, as well as improving outcomes for patients with chronic conditions like diabetes.
In addition, CHCS provides patients with access to a reliable source of information tailored for educating and empowering them to participate in the management of their own health. This remote collaboration between doctors and patients means fewer patient health crises; and most importantly, better overall patient outcomes in these long term care scenarios.
HealthVault and the HealthVault Connection Center provide an important supporting technology for the CHCS solution. Together they provide the hub-and-spoke architecture, a central repository for collecting patient data safely and privately. Without these technologies, the CHCS development team would have had to worry about device drivers needed to ensure device compatibility. They would also have had to worry about the deployment and support of data collection software, as well as the infrastructure for data collection, storage, and transport safety. With HealthVault in the picture, they were able to focus their energy and attention on delivering data to both new and existing systems within Partners Healthcare, where it could be used immediately to deliver real care, based on measured information supplied by patients. You could say that CHCS promises to help conserve our capacity for in-patient care encounters that are truly necessary or unavoidable—a very good thing for everyone.
Although HealthVault played a key role in this story, the software-plus-services (S+S) approach also figured prominently. The Partners Healthcare organization is a large and complex collection of hospitals, out-patient clinics, research centers and more. You cannot simply “re-wire” the existing systems in such an organization to accommodate a connected health solution like CHCS; nor is it easy to build the infrastructure that will eventually support thousands or perhaps million of users. The only way to make this work is to develop information conduits between the patient’s desktop and the doctor’s desktop that utilize all the existing systems in between. That’s where S+S makes all the difference.
Each time a diabetes patient pricks a finger, and takes a blood sugar reading from a glucometer, that reading has to find its way from device to PC to cloud to Partners systems and finally to a health professionals desktop. And remember, many of the patients who most need remote monitoring may also suffer from diminished motor skills or they may be less computer-savvy. This means that the process of uploading a reading must be as simple as possible. As you know, software that is easy to use often hides considerable complexity under the hood. That’s why both software and services are indispensable elements of the complete solution. The fact that the CHCS team could use web services to collect data from HealthVault means they could rely on industry standard service interfaces as well as secure and private data transports for gathering patient information and integrating into the existing healthcare systems for further processing and analysis.
It is a prevalent misconception that cloud computing will somehow auto-magically help to address interoperability issues, but it simply is not true. You have to design and build services and service-enabled software to address interoperability. Think of S+S architecture as a strategy for cloud-enabling you applications. It is interesting to know, for example, that the designers of the CHCS solution began with an S+S approach well before HealthVault was even available to them. As a result, when it did become available, these two pieces built by separate companies fit together like hand in glove. Maybe that’s why the people I work with tell me more and more that the S+S approach is not only the best approach for solutions like this, but often it’s the only approach that will work at all.