How Technology Can Improve The U.S. Health Care System

2008-10-24T04:40:00Z

"The United States is far behind other countries when it comes to health care," Deb Levine (Founder, ISIS), told the audience this week at the Health 2.0 Conference in San Francisco, CA.

"One of the United Nations development mandates is to use Information and Communication Technology (ICT) as much as possible to move countries forward in their development. [But] because of the economic split in the U.S. between the small percentage of ultra wealthy and the large numbers of folks in need, Americans need ICT for health care just like folks in Africa, Asia and Latin America," she said.

]]> For a country that is considered one of the leading economic, political and cultural forces in the world, it appears that in the health care arena, the U.S. is still playing catch up to the rest of the world.

In 2004, the U.S. spent $1.9 trillion, an average of $6,280 per person - 16 percent of its GDP - on health care.

With one of the most expensive, yet inefficient, health care systems in the world, you have to know something is broken. Particularly when outside of the U.S., Health 2.0 is taking off.

So what is happening in health care around the world and is there anything we can learn from other nations?

Strengthening Health Communications in South America

The basic idea behind Voxiva was to provide a health care communication system to people with no Internet access. "While the Internet is great for people who have it, it wasn't a reality where we were working," Paul Meyer (co-founder Voxiva) explained.

The first system he created was for public health authorities in Peru. Using a telephone, physicians could enter details about a patient or disease and public health authorities could then access that data. Today, Voxiva works over telephone networks and can be accessed on all phones (mobile and landlines), as well as the Internet.

Over the past year, Voxiva has rolled out an entire suite of free services in Mexico, giving patients and doctors a better means of communication.

Lesson from South America: If you want to make a system that is useful, then make what people need. Don't assume that everyone is going to have a phone, or the Internet.

Technology for Sexual Health Information

In 2006, when the San Francisco Department of Public Health contacted Deb Levine (ISIS) and said that a lot of people were getting Chlamydia and gonorrhea, she did what any other researcher would do: she went and sat down in front of Mission High School (San Francisco). "I was watching the kids, and realized everyone had a cell phone," Levine said.

The ubiquitous presence of cell phones gave birth to the idea that became SexInfoSF, a text-messaging program that lets teens access sex health related resources by sending a numerical code for common questions.

While SexInfoSF is only one of the various services ISIS offers, in the main the company focuses on SMS text messaging. "There is no charge for this service," added Levine, "you'll only be charged if you don't have a bundle for text messages."

Lesson from North America: Work with the community to create culturally appropriate messages.

Monetization in the European Health Industry

Alensa, an e-commerce platform, was founded in 2005 as a way for European pharmacies to expand their retail sales by using the Internet after the company realized that very few pharmacies were online. "In talking with the pharmacists," Alex Savic (CEO, Alensa) said, "we quickly realized the most important thing to them was to see a benefit."

When Alensa created a health blogs network they knew that the medical practitioner bloggers would need to be compensated, so they came up with two ways to monetize their content, explained Savic:

Premium posts: While the majority of the blog is available for free, Alensa encourages their health bloggers to have paid, or premium posts

Widgets: by placing a widgetized version of a shop on their site, health bloggers earn revenue.

Lesson from Europe: The bottom line counts, but select monetization models carefully.

Managing Your Health Data in Germany

According to Thomas Liedtke (Head of Emerging Healthcare, ICW AG), 28-30 percent of patients are getting the wrong information.

Typically, he explained, this is the result of patients having more than one doctor; perhaps a physician, a neurologist and a gynecologist, all of whom prescribe different medicine.

ICW attempts to decrease this margin of error with their core product LifeSensor, a Web-based personal health record that enables data to be collected by and communicated to all interested parties, whatever their location. In a nutshell, it means that you get to manage your health data.

Lesson 2 from Europe: Let patients manage their health data.

England Looks After Her Own

According to Marlene Winfield, (Information Authority, National Health Service [NHS]), England's universal health care program, the NHS, is trying to bring a number of services into one place; their goal is to enable two way communications between patients and physicians. What they're working on right now is 'Health Space' a personal health organizer that will be offered to every adult who wants it.

Using the system, Winfield explained, patients will be able to book appointments online, manage their medications, e-mail physicians through a secure channel, add any self prescribed medicine to the record themselves, keep a calendar of health appointments and get reminders. "It will give them access to a real time summary record that is being updated every time they do something," she said.

This is a massive cultural change for a country that has had a national health service for so long and Winfield admits: "One of the biggest challenges is to get everyone to 'keep the faith' while we work through it."

Lesson from England: Consider a universal health care program.

Of these lessons, which (if any) do you think would benefit the US health care system the most?

Comment from David Thurman on 2008-10-24

2008-10-24T12:39:09Z

I don't know who racks up 6K in medical bills a year, I know I didn't nor did anyone in my family, extended and even my small base of friends. This has to be looking at the top 5% that have the most incurred medical costs.

I think the US system is broken, but not the way the socialized medicine crowd thinks, it is via insurance carriers making me pay for others poor medical maintenance plan and run to ER for a normal office visit.

Rick is right, the OTC vs prescription route is one more example of abuse that those that play the game fair get stuck with a bill for those that game the system.

Comment from rick on 2008-10-24

2008-10-24T07:38:58Z

The last. The S America example is only minimally relevant to the US - the penetration of internet access is very high and, while that system might be applicable in a few areas it's not a long term issue as long as the 'net access we're assuming is dialup.

The LifeSensor is interesting, esp when combined with an online records solution e.g. Healthvault or Google Health. But I think we overestimate the number of people who will actively manage their health data. Most people will become interested at the point of diagnosis, but not as an ongoing matter.

SexinfoSF is a good general lesson, but it's hard to generalize... which is kind of the point after all.

The biggest things we can do is scout out large inefficiencies in the system. I'd imagine these are in records keeping and management, the bureaucracy involved in coding procedures and, in general, dealing with the insurance companies and other players in the healthcare system outside of the care providers.

US citizens also need to properly incented to make good choices. For example, there are over the counter acid reflux drugs like Prilosec. But there are still prescription versions. There are medical reasons for the latter sometimes, but often people insist on them because 'prescription is better' and the co-pay is the same as the OTC medicine... the patient perceives more benefit and the same cost, so they do the seemingly rational thing. But that prescription medicine might well cost the system another $100 over the co-pay, perhaps more. Making the patient bear some of that incremental cost if they can economically is an example of what I mean by a proper incentive.

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