Instrumented Interconnecteds Intelligent
June, 16th 2009

Let me begin by introducing myself. I am a certified IT Solution Architect in the IBM Business Consulting group. Before joining IBM I was a hospital management systems consultant for the New York State Hospital Association, a Senior Manager at Mercy Hospital, a 500 bed acute care facility in Miami, FL and the Vice President of the South Florida Hospital Association, representing 43 of the largest hospitals in Florida. I believe that this resume qualifies me to critique the current state of our health care system.

Put yourself in a patient’s place. It’s not hard. Most likely you have been there one or more times. Now think, what is important to you as a patient?

First, there is your Lifestyle. Like it or not, your lifestyle will influence when and how you will Access the health care system. When you immerse yourself into the scheme of things, you will want to Diagnose what you have or don’t have. For a problem, you will what to choose how best to Treat it. Of course, whatever you do will probably influence your Lifestyle. Then it all starts again, until the end!

Seems simple, right? So why is our health care system so convoluted, incomprehensible and expensive? Should it not be a simple demand and supply equation. Let’s take a closer look at the drivers from the patient’s perspective:

Our Lifestyle will surely influence our need for health care. It is well documented that lifestyles can impact the incidence of health problems emanating from our genetic, endemic and behavioral loci. And surely, our bad behavior is never rewarded when it comes to our health. So put that cigarette out! Can we then agree that by influencing individuals to adopt healthful lifestyles we can affect demand on our health care system?

We play with the cards we are dealt, so at some point we will need to access the health care system. This is not undesirable. In fact, access for preventive measures and screening, to discount risk factors, are proven to be beneficial in the long run. The old FRAM® oil filter adage, “pay me now or pay me latter” heralds reality. On the other hand, Access to health care affects both the demand and supply sides of the equation. Demand is influenced by the price to access, while supply is influenced by the number of facilities, their location and their hours of operation. We choose to access what is convenient and affordable, yet neither of these criteria are easy to determined.

So now that we have blindly plunged into the depths of the health care system, with inadequate up-front information I might add, we want to know what’s wrong. What is the Diagnosis, Doctor? Not so fast! “Let’s do some tests,” he says. This is a critical aspect of health care delivery, the patient-doctor interaction. What the doctor knows about you, what you tell him and his knowledge and experience will determine what happens next. The diagnostic process can be lengthy and painfully (no pun intended) frustrating. It is equivalent to traversing a maze of dead-ends and trackbacks. Why hasn’t someone devised analysis and optimization methods and techniques that cut through the persistent information fog of the diagnostic process? Is this the real value proposition that will justify electronic health care information automation? Move over insurers and government policy makers. The doctors want your transactional data for decision support systems with affinity and fidelity towards serving the patient’s medical needs, not to calculate fees or deny coverage! A better informed patient that consults a better informed doctor is sure to empower a better health care paradigm.

But we can’t just stop here. A diagnosis leads to a prognosis, which invariable leads to a multitude of options to Treat the problem, be it chronic or acute. Again we ask, where are the analytical and optimization tools are? Unlike health care, many industries rely on them profusely, almost to a fault! Why not a Health Default Swap? Well, not to trade, but we are sufficiently knowledgeable to devise treatment strategies that can mitigate risk, while optimizing health outcomes. We need to be at that level of sophistication, NOW! Again, isn’t this our electronic medical information raison d’être?

We have completed the full circle. We are back at Lifestyle. Here is where we need some of Thaler’s Nudge. So that those that choose to meddle, as our government does, can help us make the lifestyle choices “we would make for ourselves – if only we had the strength of will and the sharpness of mind” to access relevant information… “without infringing greatly on our freedom of choice.”

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Oh we humans are such complex creatures aren’t we? Is it really possible to put in place systems that would speed diagnosis and prognosis? I’ve worked with hundreds of smokers over the years and every one of them has different motivations, gremlins, sabotage techniques, family situations, physiology, psychology, education, beliefs and values. Each have to be treated differently so ensure they get the result they want and need. Could a machine ask the relevant questions and notice the subtle signs and signals they give off that tell me when there’s an inconsistency or another question to be asked?

Posted by: Bee Milbourn
July 29, 2010
8:35 am

I would just like to add that I fully agree with the “pay now or pay later” comment. The NHS here in England is beginning to get really hammered and is going to drastically change in the coming decade or two. I hope as a part of this change that there is a bigger focus on prevention which really seems to be lacking at the moment. It may cost £200 for a smoker to get hypnotherapy now to quit smoking but surely that is better than 20 or 30 years from now that same person being in hospital because of lung disease/cancer etc.

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Posted by: Charlotte Jess
June 16, 2009
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For fun, I rewrote this more succinctly to make it more persuasive. (I omitted the bio which I would not change)

Put yourself in a patient’s place. Most likely you have been a patient more than once. What is important to you as a patient?
First, there is your lifestyle. Your lifestyle will influence when and how you will access the health care system. You will want to diagnose your problem and choose how best to treat it. Often course, your choice will influence your lifestyle.
If this is so simple, why is our health care system so convoluted and expensive? Shouldn’t it be a simple demand and supply equation? Let’s take a closer look from the patient’s perspective:
Our lifestyle will influence our need for health care. Lifestyles can impact the incidence of health problems, and surely, our bad behavior affects our health. For example you can stop smoking. If we can influence individuals to adopt healthful lifestyles we can affect the demands on our health care system?

At some point we will surely need to access the health care system. And access for preventive measures and screening, prove to be beneficial in the long run. The old FRAM® oil filter adage, “pay me now or pay me latter” applies here. On the other hand, access to health care affects both the demand and supply sides of the equation. Demand is influenced by the price of access, while supply is influenced by the number of facilities, their location and their hours of operation. We choose to access what is convenient and affordable, but neither of these criteria are easy to determine.

Even though we seek treatment with inadequate information, we still want to know the diagnosis. “Let’s do some tests,” the doctor says. This patient-doctor interaction is a critical aspect of health care delivery. What the doctor knows about you, what you tell him and his knowledge and experience will determine what happens next. The diagnostic process can be lengthy and frustrating. It is equivalent to traversing a maze of dead-ends and backtracks. It would be nice if someone devised analysis and optimization methods and techniques to cut through the persistent information fog of the diagnostic process. Could these proposed methods justify electronic health care information automation? The doctors want your transactional data for decision support systems to serve the patient’s medical needs, not to calculate fees! A better informed patient that consults a better informed doctor is sure to empower a better health care paradigm.

A diagnosis leads to a prognosis, which invariable leads to a multitude of options to treat the problem, be it chronic or acute. Unlike health care, many industries rely on analytical and optimization tools profusely! Are we sufficiently knowledgeable to devise treatment strategies that can mitigate risk, while optimizing health outcomes? We need to be at that level of sophistication, now! Again, isn’t this our electronic medical information’s raison d’être?

Now we return to lifestyle. Here is where we need some of Thaler and Sunstein’s Nudge. So that these analytical systems can help us make the lifestyle choices “we would make for ourselves – if only we had the strength of will and the sharpness of mind” to access relevant information… “without infringing greatly on our freedom of choice.”

Posted by: James Cooper
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