Thursday, February 12, 2015

on this.

With only a few days left until the Affordable Care Act enrollment deadline, The White House pulls a brilliant stunt, featuring a selfie stick, of course.


Monday, February 9, 2015

on the potential of technology to revolutionize healthcare or perpetuate inequality

The past two weeks have been crazy (in a good way) for me. I had midterms and new responsibilities in my internship, finished my BA thesis draft, and of course I've been hard at work on my personal health initiatives (which you can follow more on here or on Instagram at @fitgirl_rachaeln). This was all a long-winded way of saying, sorry!! But I'm back and I do have a cool story and accompanying opinions to share today though.

For those of you who are iPhone users, I'm sure you've noticed your Apple Health app. If you're anything like me, it basically serves as a pedometer. But an article in the New York Times last Thursday suggests it may soon be much more than that.

At least 14 of the nation's best hospitals have been testing out pilot programs that use Apple HealthKit as a means of checking up on patients remotely. Using the app, doctors would be able to monitor weight, blood pressure, heart rate, and other relevant conditions in patients with chronic conditions for whom constant hospital visits are not convenient.

The possibilities of this program and those like it would be revolutionary, especially from a healthcare policy and economic standpoint. With daily information, medical professionals could keep patients more accountable and could use the tracking information to warn patients about their statistics before they enter the hospital. This could help reduce the constant, costly re-hospitalizations many patients with chronic conditions face and that are an economic burden on hospitals.

In the past, I've refrained from mentioning my personal healthcare philosophies on this blog, mostly in the interest of keeping it informational. However, if there is any one area where I think American healthcare needs to focus on ASAP, it is preventative medicine. As new technological developments enable computers to do many of the routine tasks humans used to do, it provides fantastic opportunity for implementing preventative measures.

I recently complete a research project where I went over patients who were coded, by a computer for billing reasons, for having chronic kidney disease (CKD) but who had not been diagnosed with CKD by their doctor during their visit, either because they didn't tell their doctor or because no one checked (maybe they came in for a broken leg, etc. and CKD wasn't on the doctor's radar as a possible cause of the infliction). The computer system analyzed the blood work and found the patients had creatinine levels and a glomerular filtration rate (GFR) suggesting they had chronic kidney disease. Though CKD is treatable, many of these patients end up either being rehospitalized, or even dying, from their condition because they don't seek treatment.

An effective use of technology here could potentially prevent these rehospitalizations and save lives. If a computer is able to identify CKD status by itself already, it could likely be programed to scan creatinine levels and GFRs from previous visits to determine if this patient truly has a chronic condition (which was my job as a research assistant). It could then also likely alert patients and medical professionals to look into the issue. Additionally, technology provides a mechanism for doctors to check in on patient compliance, to see if they're attending dialysis appointments, losing weight, eating right, without patients having to constantly visit the hospital. This would be invaluable considering how difficult it is, for a variety of factors, for patients to make numerous trips to the hospital. And you don't have to have an MD or PhD to figure that the harder it is for a patient to comply, the less likely they are to do it.

Yes, technology is causing us to strain our eyes and necks and wrists as we text and type all day and night but I see amazing promise through proper design and implementation of technology that can assist with preventative medicine. I see Apple Health are just one of the first steps in the right direction.

However, Apple Health alone is not the "future" of medicine.  As I have seen in my research, the patients who are least likely to comply and could most benefit from these programs—i.e. those patients who are older, or of low socioeconomic status, or who live in rural areas far from hospitalsare also least likely to own an iPhone and other Apple technology. Apple HealthKit will likely just allow doctors to better serve the wealthy, who are generally healthier, live closer to hospitals, and/or are more likely to be aware of any conditions and how to treat them and thus will only revolutionize healthcare for a small portion of Americans who the system already serves pretty well.

The only way that this is truly going to offer a turning point in the American healthcare industry, which like our education system, has a major gap between poor and rich patients, is if we develop affordable technology that doesn't just cater to our wealthier population.

Technology provides us the opportunity to better serve our lower classes, older population, and citizens with chronic conditions reducing the costs of Medicaid, Medicare, and rehospitalizations. Now it's up to us to demand it and for our government, insurance companies, innovative biomedical engineers, and technology giants to make it happen.