Connected Health Symposium 2011: Initial Reflections
I’ve spent the last two days at the Partners’ Connected Health Symposium here in Boston. It has been a fascinating event with a number of brilliant people from academia, clinical practice, government and business. The speakers ranged from Atul Gawande, the surgeon and author, to the Crown Prince of Denmark, who spoke about universal, high-quality, informatics-driven healthcare delivery in his country.
To me the broad themes from the conference can be understood as tensions between some big ideas and values:
1. Society vs. individual
We heard much about how health is affected by the larger context in which we live. Among rich countries, less equal societies are generally less healthy. And inequality affects the health of all members of a society regardless of class— meaning that even the richest people have, for example, higher infant mortality in less equal countries. We also heard about behavior change and how information delivery and incentives can nudge individuals towards healthier decisions. The hope is that giving someone facts when making a decision and motivating them through things like social networks (either real or online), that health status can start to change.
The tension for me stems from the fact that while we talked about social determinants of health, we proposed solutions for individuals: food policy seem more critical to combating obesity than smart-phone apps, even if they can count the number of calories in your food. This critique can, of course, be applied to the entire healthcare system—we manage illness in individuals. Connected health technology can help us get one step further up the chain of events between social context and illness. Before we get to the point of managing diabetes, we might empower and motivate people to keep better track of their food and exercise—and technology can undoubtedly help. My worry, though, is that just like with our pills and shots, we’re fighting a battle against social problems that really need to be addressed on a societal level.
2. Innovation diffusion vs. the medical model
I felt a strong tension between people in business and design and those in healthcare. From the product side, people tended to talk about connected health technology according to a diffusion of innovations model. In this view, the principle obstacle to adoption is getting through the curve from early adopters to the majority of users. Those on the delivery side were more likely to favor a paradigm requiring demonstration of effectiveness, especially for unfamiliar products. In simple terms, it seems that the business perspective sees use as the goal, the design perspective sees usability as the goal and the medical perspective sees effectiveness (and, hopefully, cost-effectiveness) as to goal of any intervention. What I take away is that all of these are required— an ideal service would work, be a pleasure to use and actually be used by people. Having cared for patients, and felt the deep moral responsibility that goes along with that role, I found myself nodding along with physicians who want to see evidence before adopting a service.
3. Patient versus profit
There were varying degrees of patient- and profit-centeredness represented at the conference and people don’t sort neatly into groups by background. There were entrepreneurs deeply committed to improving health and physicians talking about “taking control of more of the diabetes space.” We saw products clearly aimed at capturing a market and products aimed at truly improving the lives of patients. I don’t mean to say that people making a difference can’t make money or vice-versa, but my heart is with the true patient advocates who are motivated by a heartfelt desire to make an impact.
Despite these tensions, there was a broad consensus about one thing—our healthcare system needs to change. The conference made a compelling case that connected health technology will be critical in improving healthcare and lowering healthcare costs, even if it doesn’t quite get at the root causes of our biggest health problems.
I’m looking forward to hearing reflections from others!
