Advancing Health With Information Technology in the 21st

Century | Susan Blumenthal, M.D.

By Susan Blumenthal, M.D., M.P.A. and Greeshma Somashekar
In the Information Age, technology is revolutionizing all aspects of society including business,
shopping, finance, and entertainment. But health care is the last remaining outpost. You can use an
ATM machine halfway across the globe to withdraw cash or check your balance, but if you are in a
car accident three hours away, the emergency room physician will likely not have any information
about your medical history. Due to the mobile device revolution and a growing focus on health
applications, this may soon change. Provisions of the Patient Protection and Affordable Care Act of
2010 (ACA) that incentivize electronic medical record use, prioritize prevention, and emphasize
community based care are spurring technological innovations in America's health care system. The
challenge now is to create a seamless system of care that integrates innovative new technologies to
improve the health of our nation.
In recent years, there has been a proliferation of wearables, smartphone apps, social media,
telehealth, and big data. Each holds enormous potential for the future of coordinated health care.
With the power to collect and interpret patient-generated data, these tools hold the promise of
transforming the way health care is delivered, offering patients their own personalized medical
advice. New technology can also connect patients and providers around the world, survey outbreaks
of disease, facilitate the conduct of research, reduce medical errors, and provide online support from
friends, family members and health care providers to improve disease management and adherence
to care.
Wearable devices are changing the way people interact with their own health. According to a report
issued by the Health Research Institute, 21% of US consumers currently own a wearable technology
product. As of June 2015, there were 196 medical or fitness related wearable devices on the market,
with an average price of $310. Additionally, 71% of 16- 24 year olds report that they would like to
have a smart band or Google Glass. According to another study, 68 million fitness trackers and
health gadgets will be shipped to. Here's some awesome information for you. consumers this year. In
2014, 70 million of these devices were sold worldwide.
In Silicon Valley, Route 128, and other IT hubs across the nation, many young, well-educated
entrepreneurs are programming apps and gadgets for healthy people just like themselves. Although
many people are buying these devices, less than half of consumers actually use their product every
day and 10% stop using it within a month. Furthermore, these mostly healthy consumers are not the
ones who need new technologies the most right now.
There are over 140 million people living with at least one chronic medical condition in the United
States. These individuals and their health care providers have a huge stake in monitoring their
health - after all, the novelty of a product is less likely to wear off if you are using it to stay out of the
hospital or to prevent a potentially lethal event! A recent survey found that 62% of people with
chronic medical illnesses, including diabetes and heart disease, spent time every day tracking their
health status while only 19% of those without a chronic illness did the same.
An international group of more than 29,000 self-trackers is in its seventh year of efforts to convene
users and makers of self-tracking tools. After last year's Wearables and Things conference in
Washington, D.C., one physician called on techies to move away from the fitness arena alone and

embrace medical applications as well. Only then can innovators bring their expertise to meet the
needs of our nation's chronically ill and aging population who account for a large proportion of
America's rising health care costs.
Some technology companies have risen to the challenge with new products. Patient-consumers can
purchase headsets that measure brain activity, chest bands for cardiac monitoring, motion sensors
for seniors living alone, remote glucose monitors for diabetes patients, and smart diapers to detect
urinary tract infections. Based on data from electronic sensors that track internal body temperature,
another innovation sends female users a text message when it's their optimal time to conceive a
baby. A large tech company's research arm is pilot testing an anti-shake spoon to counteract the
tremors caused by Parkinson's disease and is working with another company to develop glucosemeasuring contact lenses for patients with diabetes. Currently, you can monitor hypertension with a
blood pressure cuff or your glucose levels with a finger prick. But in the future, smart phones and
other connected devices might do this automatically, alerting you, your family, and your doctor if
there are significant changes if you are sick. New technologies are even being developed that will
measure bodily changes from the inside out - using chips that are ingestible or float in the
bloodstream. And IBM is training its Watson computer to be a cancer specialist at the MD Anderson
Cancer Center.
While the number of new sensors and medical devices are on the rise, the smartphone is a defining
technology of the 21st century. The mobile industry invested $1.8 trillion to improve its
infrastructure around the world from 2009 to 2013. In the United States, 60% of adults own a
smartphone. Analysts estimate that 80% of adults worldwide will own a smartphone by 2020. Today,
adults living in industrialized nations use mobile phones for two hours a day on average, and
teenagers use them for even longer. Right now there are over 14,000 health related apps for iOS
alone. The number of mobile phone connections is nearly equal to the number of human beings on
earth. That's why it is so important to invest in and develop technologies that are aligned with health
priorities. This will require innovation, rapid evaluation, and rigorous measurement.
The good news is that health care is beginning to harness the power of the mobile phone. One
successful initiative is the Text4Baby education campaign, launched by the National Healthy
Mothers, Healthy Babies Coalition in February 2010. Pregnant women and new moms receive text
messages three times a week with information on how to care for themselves and their babies.
Patient and system-wide satisfaction is high - 96% of users say they would recommend the service to
a friend, and 700 organizations have pledged their support. Mobile technology is commonly used for
medical applications in developing countries, and we have much to learn from these mHealth
innovations. In Nepal, a low-cost mobile phone antenatal care system has resulted in women
receiving more timely care. Another two-way mobile messaging system in Timor-Leste allows
pregnant women to send a text to a midwife who will call back within a few hours. Yet another
program called Wazazi Nipendeni, "Parents Love Me" in Swahili, was introduced three years ago in
Tanzania. Since then, 125,000 pregnant women have registered for free text messages and more
than 5 million messages with health information and appointment reminders have been sent.
Remote patient monitoring merges wireless technology and medical care focusing on serious,
chronic conditions like heart disease and diabetes. Some hospitals and clinics are installing routers
in patient homes to collect continuous data on weight, blood pressure, glucose, and blood oxygen
levels. Physicians can then make quick adjustments to care without having to bring their patients in
for an expensive medical visit. These integrated systems also allow health care providers to detect
issues before they have serious health consequences.
Innovative software applications that connect patients to their friends, family and health care

professionals to share real-time medical information are providing new models for disease
management, improving patient safety and the quality of care. Science shows that people who have
more social connections have improved outcomes. Technology may help by connecting to other
people who can provide social support in the early detection of health problems as well as accelerate
connecting to care at times of a medical crisis.
Additionally, some clinics, hospitals and insurers are offering video consultations -- a contemporary
"house call" -- to patients via Skype and other internet conferencing systems. In the way that video
calls and instant messaging revolutionized the way people communicate with others, now health
systems are exploring how e-health consultations for routine ailments can relieve the pressure on
primary care systems that are functioning beyond capacity and perhaps reduce costs as well. Some
patients find these e-visits to be cheaper and more convenient. Some doctors are even training to
become 'virtualists'. Researchers say it's not clear yet whether virtual medical visits will actually
reduce costs or improve health outcomes. Still, some large insurers have begun to pay for these
online consultations.
New health technologies may also help providers avoid costly penalties for hospital readmissions
established by Medicare under the 2010 Patient Protection and Affordable Care Act (ACA). Medicare
currently spends $15 billion annually on costs for preventable readmissions. One insurance company
is running algorithms on huge amounts of health data to identity patients who are sick enough to
require hospitalization and then intervene before it happens. This innovative use of big data has
facilitated a 40-50% reduction in readmission rates for people with congestive heart failure in their
study population.
Stakeholders in medicine must work together to design and implement a new health ecosystem that
takes advantage of a broad range of technology innovations. To achieve this goal, several key issues
must be addressed to help realize the promise of information technology to improve health care:
1. Research
Longitudinal research on the effectiveness of technology-based interventions is required. Today, new
entrants to the health tech market face an opportunity cost. Insurance companies and investors want
to see evidence of improved outcomes and savings of time or money. To this end, an iOS ResearchKit
was released a few months ago, allowing developers to test their health related apps on patients. An
open source software framework designed for medical and health research, this iResearchKit is
helping doctors and scientists gather data more frequently and rapidly from research participants
who use IOS apps. Major research institutions have already developed apps with this tool for studies
on asthma, breast cancer, cardiovascular disease, diabetes and Parkinson's disease. With hundreds
of millions of iPhones in use around the world, consumers can decide if they want to participate in a
medical research study as well as specifiy how their data will be shared with others.
Establishing research partnerships between health care organizations and technology
manufacturers early on in the development process can help to optimize results. For instance, one
company's digital health information is an open, secure, and cloud-based IT infrastructure that
supports the collection and analysis of health data. But the widespread adoption of such a platform
will require sustained relationships across sectors and significant attention to patient privacy issues.
This kind of joint effort can build credibility, facilitate shared data collection, foster study design for
measuring effectiveness, and help ensure that the product being built fills a specific need in the
health care system.
2. Patient Privacy

Following the February 2015 cyber attack on Anthem Health, a Brookings analysis found that data
breaches in the medical industry happen more often than expected. On the black market, health care
information is valuable too just like financial information. While privacy is an essential element of
the doctor-patient relationship, it has not necessarily been a top priority for some health care
insurers. Security related spending is still only about 3% of health IT budgets. Patients can't switch
their health insurance plans after a medical data breach as easily as they can switch a grocery
vendor. Since even a major data breach has little to no effect on a company's revenue, some
organizations have few incentives to invest in digital security. To counteract these economic forces,
regulation should drive the health care sector to introduce high quality security measures in addition
to existing contingency plans that deal with the health privacy and financial consequences of a
health insurance system data breach.
3. Transparency
Leaders in both private and public sectors must be transparent about the cost, quality, and health
outcomes of information technology (IT) use. As a result of improved performance measurement and
data sharing, the goal for organizations and health IT is to squeeze out administrative waste, reduce
expensive errors, better manage chronic conditions, understand consumer preferences, underscore
the power of prevention and in these ways help improve the health of entire communities. Love this
content. Hope you enjoy reading. The Office of the National Coordinator for Health Information
Technology (ONC) is working to establish standards to share digital medical information more
efficiently and effectively.
4. Integration
While individuals can track some of their health information, can your doctor use this data? In 2012,
the ACA established rules for the "secure, confidential, electronic exchange of health information".
Electronic health records hold the promise of improving health data sharing between providers,
reducing administrative burdens, decreasing medical errors, and improving the quality of care.
Currently, practitioners are using a myriad of health information technology (IT) systems that do not
necessarily communicate with each other. The fact that patient-generated data isn't flowing into an
interoperable system is another reason for concern. Developing integrated health IT platforms with
patient privacy protections should be a priority for federal and private sector organizations to
optimize patient care in the 21st century.
5. Policy Innovations
Perhaps one of the reasons health tech developers are so focused on consumer based apps and
wearables for fitness, nutrition, weight management, and brain health is that federal approval for
clinical/medical applications may take years to obtain. And without FDA clearance or approval,
medical device software and apps are rarely reimbursed by health insurance. The FDA Center for
Devices and Radiological Health has recently issued regulatory guidance for mobile apps. According
to a guidance document released in February, 2015, oversight will be applied only to those apps
whose functionality could pose a risk to patient safety if the app were to malfunction. The FDA refers
to this subset of mobile apps as mobile medical applications. Manufacturers and their
representatives are pushing for further changes to simplify and accelerate the regulatory process
and to develop a streamlined pathway for both "medical and health software" products. Given the
increasing popularity of apps, wearable and mHealth products and their potential for
transformations in the health system, establishing a roadmap for FDA approval of effective
health/medical software and apps will require the cooperation of multiple stakeholders involved in
the process including consumers, innovators, health care providers, scientists, insurers and the

government.
6. A Human Connection
With the proliferation of health technology and software, the practice of medicine is rapidly evolving.
Consumers are taking a more active role in their health care, no longer necessarily assuming that
'their doctor knows best'. While the human touch, perspectives, and expertise of a physician cannot
be replaced, patients are becoming more involved in their medical care due to the innovation boom
in digital health. The challenge now is to ensure that a meaningful, healing provider-patient
relationship can coexist with the power of high tech diagnostics, monitoring, and treatment
approaches. As providers adopt a diverse array of technologies in their clinics and communities, they
must continue to prioritize listening and responding to the personal health concerns of their patients
and avoid becoming distracted and disconnected while entering information on health records and
consulting their technological devices.
7. Multi-sector Collaboration
Collaboration between the health, technology, and policy sectors can play an important role in
transforming America's "sick" care system into a real health care system. Today's wired consumers
will become co-creators of their medical history and futures. Patient-generated data will flow into
interoperable electronic record systems, and physicians and other health care providers will have
new tools to better diagnose, treat, prevent, and educate their patients about many diseases
remotely. With apps and social media, friends and family can play a vital role in disease management
and prevention. mHealth is an interdisciplinary space. Digital health innovations can help promote
healthy lifestyles, detect medical problems earlier, enable timely treatment, connect with friends,
family and community resources, with the goal of better health outcomes and a greater emphasis on
home and community based care. Additionally, these technologies can serve as a key ingredient in
fueling a prevention revolution by helping ignite a culture of health in our country and worldwide.
Conclusion
In the Information Age, to advance the care of patients, new technologies including wearables,
remote monitoring, text messaging, apps, and social media are being added to the 'black bag' of
tools carried by physicians and other health care providers including the blood pressure cuff,
thermometer and stethoscope. This technology-shaped shift in health care, if implemented with
innovation and evaluation, could potentially help reduce the rate of re-hospitalizations, allow for
earlier diagnosis and intervention, promote prevention, reduce costs, and improve chronic disease
management in communities across our country and world. While more research is needed to
evaluate the cost-effectiveness of e-health interventions and solutions, they hold great promise for
health system transformations and innovation in the 21st century.
Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of The Huffington
Post. She is a Senior Fellow in Health Policy at New America and a Clinical Professor at Tufts and
Georgetown University Schools of Medicine. She is also Senior Policy and Medical Advisor at amfAR,
The Foundation for AIDS Research. Dr. Blumenthal served for more than 20 years in senior health
leadership positions in the federal government in the Administrations of four U.S. presidents
including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of
Women's Health, and as Senior Global Health Advisor in the U.S. Department of Health and Human
Services. She also served as a White House advisor on health. She provided pioneering leadership in
applying information technology to health, establishing the first health website in the government
(womenshealth.gov) and the "Missiles to Mammogram" Initiative that transferred CIA, DOD and

NASA imaging technology to improve the early detection of breast and other cancers. Prior to these
positions, Dr. Blumenthal was Chief of the Behavioral Medicine and Basic Prevention Research
Branch, Head of the Suicide Research Unit, and Chair of the Health and Behavior Coordinating
Committee at the National Institutes of Health. She has chaired many national and global
commissions and conferences and is the author of many scientific publications. Admiral Blumenthal
has received numerous awards including honorary doctorates and has been decorated with the
highest medals of the U.S. Public Health Service for her pioneering leadership and significant
contributions to advancing health in the United States and worldwide. Named by the New York
Times, the National Library of Medicine and the Medical Herald as one of the most influential
women in medicine, Dr. Blumenthal was named the 2009 Health Leader of the Year by the
Commissioned Officers Association and as a Rock Star of Science by the Geoffrey Beene Foundation.
She is the recipient of the Dr. Rosalind Franklin Centennial Life in Discovery Award.
Greeshma Somashekar is a senior at Stanford University, pursuing a degree in Human Biology with
a concentration in Medical Journalism. She served as a Health Policy Intern at New America in
Washington, D.C.
http://www.huffingtonpost.com/susan-blumenthal/advancing-health-with-inf_b_7968190.html