By Robert B. McCray, Co-Founder, President and CEO of the Wireless-Life Sciences Alliance (WLSA)
THE potential of wireless health will be realized in the effective blending of three bodies of learning: high technology; life sciences; and human factors. The last point is critical — end users (including consumers, patients and clinicians) will ultimately determine the successes and failures in wireless health.
There is also a fourth factor in the creation of any convergence sector such as internet commerce, mobile data or digital music. The fourth factor is the ecosystem of innovators, executives, investors, clinicians (for healthcare) and policy makers who are creating the sector.
The following discussion is intended to level set the discussion about why wireless health is important, to provoke conversation, and undoubtedly to set myself up for some predictive failures.
What is wrong with healthcare and what does wireless health have to offer?
Societies have no choice but to change their healthcare systems in the face of exploding demand caused by aging and chronic disease. The U.S. healthcare system is already failing millions of its citizens. Wireless health offers the opportunity to satisfy this demand, thus improving life and creating shareholder value.
Nonetheless, it is apparent that some institutions and professions will resist the demand for more personalized and efficient access to care. In the face of competition and digital information, however, they will ultimately be unable to resist disruptive change any better than the automobile, music or retail industries.
Wireless health is powerful because it creates transparency in healthcare through measurable outcomes, and transparency creates accountability.
What can be done
Looking at developments in the field as a whole, and considering the global economic and social environment in which we exist, I offer the following conclusions and observations:
- If a device or service can be connected, it should be (under penalty of malpractice, obsolescence and/or customer dissatisfaction). How else will you be able to answer questions about how your product works in the field or why someone should buy it? If you do not take this approach and your competitor does, how will you sell against connectivity? This is why we have Merlin, CareLink and Latitude even though St. Jude, Medtronic and Boston Scientific created these wireless services without extra reimbursement.
- In the developing world, increases in chronic disease and demand for access to health services rival or exceed our challenges in the developed world. U.S. life sciences companies should look for markets in the entire world and not just in the dwindling populations of rich and well insured in the U.S. and Europe. Five billion cell phone users constitute the largest distribution channel ever created in the world. How are you going to use it?
- Epocrates was founded on the principal that clinicians needed on-the-fly access to accurate and up to date information via mobile devices and it has grown to establish a platform serving a majority of U.S. practitioners with several important services. It has achieved business success and its investors and founders will be rewarded. Whether Epocrates will extend this platform to the rest of the world or leave that opportunity to others remains to be seen.
- is moving towards free. Access to medical knowledge, including personal genomics, is being distributed directly to consumers. So far, these trends have primarily influenced a motivated minority of consumers and especially the healthy wealthy, but over time they will shift power and responsibility to patients who will have to manage more healthcare decisions for themselves and their families. Digital music ultimately reshaped the music industry. Wireless health will have a similar impact in healthcare.
- In societies with limited access to healthcare and limited spending, wireless health delivers access to knowledge and care. In the U.S., it is disruptive and resisted. Why? Partially because the U.S. spends too much and gets too small a return compared with the rest of the world. There is resistance to change because it is economically, culturally and legally disruptive.
Consider the combined effects of the following:
- Professional licensure is well intended but state licensure and corporate practice restrictions shield physicians from competition.
- The FDA operates on a laudable principle that safety and efficacy must be demonstrated, but this standard should be relaxed if the new device or service is offering a monitoring of dark space where current services leave patients unmonitored.
- The fee for service system has created an environment where innovation depends on reimbursement which, in conjunction with device regulation, tends to freeze the innovation and impede its improvement.
- Notwithstanding these sources of inertia, the immutable forces of population aging, rising rates of chronic disease, and the effects of global competition, mean that (1) individuals will have increasing personal responsibility for coordinating their own and their family’s care and (2) access to fully insured care will continue to decrease. These trends turn “patients” into “consumers” and “caregivers” who demand better products and services than the healthcare industry is accustomed to delivering.
Fortunately, we have the technology tools to tackle these problems:
- Nearly ubiquitous wireless connectivity to the world’s population. Cell phones are a mobile and personal permanent address.
- Data storage, analytics and search capabilities that are declining in cost faster than the declining cost of content creation.
- Secure cloud based access to information via the Internet.
- Embedded wireless technology which enables wearable devices.
- Inexpensive whole genome sequencing and rapidly advancing esoteric diagnostic services, with results reported in a digital format to enable data sharing and analysis.
The Future of Healthcare
What will we do with these tools? What is the future of the healthcare industry in the United States, the world’s most expensive healthcare market?
- Will it follow the trajectory of the music industry, which was controlled by a small number of companies until digital music and the Internet made access to music free, enabled free global distribution for artists, and transformed how music lovers spend their money.
- Will it follow the course of the auto industry which tried to maintain a market for low tech low quality cars, lost its status to international companies and now has downsized, created competitive products and is regaining market share.
- Unfortunately, elements of the U.S. healthcare industry may have more in common with the financial industry, especially its lack of transparency, high cost and government support.
In a sense, the U.S. has run the largest clinical effectiveness study in history with the Medicare program: approximately 50,000,000 patients have participated over 30 years. The U.S. is ranked last among 19 industrialized nations with respect to preventable deaths, despite outspending these nations as much as twofold (Commonwealth Fund, 2008).
The purpose of Medicare is to operate an effective health insurance program for the aged – notwithstanding clear evidence of its failure relative to the world, elements of the professions, key institutions, and consumers (as voters) resist thoughtful efforts at Medicare’s improvement. Fortunately, this problem has the attention of policy makers, entrepreneurs and some globally significant companies.
How fast will the U.S. change? How do businesses thrive and investors earn a return in the face of uncertainty? There is no guide book for this situation, but with healthcare being the largest component of the U.S. economy and with the development of middle class healthcare markets in Asia, it is certainly an area that is replete with opportunity.
Excerpted from Why Wireless Health Matters By Robert B. McCray