Health care: Information tech must catch up to medical marvels

Michael Dowling, Northwell Health's CEO, believes we're entering the age of smart medicine.

  • The United States health care system has much room for improvement, and big tech may be laying the foundation for those improvements.
  • Technological progress in medicine is coming from two fronts: medical technology and information technology.
  • As information technology develops, patients will become active participants in their health care, and value-based care may become a reality.

In his book Health Care Reboot, Michael Dowling, Northwell Health's CEO, argues that "[the United States] is constructing a solid foundation upon which the new American health care is being erected." To those steeped in news of health care's administrative bloat, under-performing primary care, and low levels of insurance coverage, such a thesis may seem bold, wishful, or downright delusional.

But Dowling does not ignore the health care system's need for improvement. Rather, he believes that contemporary trends can foster such improvement if we recognize their value. He cites advances and disruptions in areas such as consolidation, education, payment reform, and mental health to support his progressive view that "better, safer, and more accessible care" is coming.

Among those trends is big tech's move into health care, or as Dowling puts it, technology may soon move us into the age of smart medicine.

Medical tech marvels

Dowling sees big tech's stride into health care as coming from two fronts: medical technology and information technology. On the medical technology front, the technology available to doctors has accelerated at an unprecedented pace, resulting in tools and techniques that are "the stuff of Star Wars."

"Some of the most advanced technology tools ever developed in any field are in use to care for patients. Look at any modern operating room or intensive care unit, and the technology to treat patients and keep them alive is remarkable," writes Dowling.

To pick one of many examples, Northwell Health's Cohen Children's Medical Center was the first pediatric program on Long Island to institute ROSA, a "robotic operating surgical assistant." Before ROSA, children suffering epilepsy would have to undergo a full craniotomy to target and monitor areas of seizure activity. With ROSA's assistance, surgeons can get the same results through a minimally invasive procedure, reducing the risk of infection and strain on the patient.

Even technology not designed for therapy has been co-opted to play small, yet supportive, roles in quotidian treatment. A study out of the Children's Hospital Los Angeles found that virtual reality can help reduce a child's anxiety and stress during basic procedures such as a blood draw.

Information tech plays catch up

phone xray

Photo: Sisacorn / Shutterstock

Dowling characterizes the information technology front as "less impressive," pointing to the well-known difficulties of onboarding electronic health records. Beyond concerns of cybersecurity and interoperability, such systems have caused widespread burnout and dissatisfaction among practitioners thanks to their time consumption and complicated workflows.

But progress is being made. Apple recently added a Health Records app to its iPhone, giving patients from 39 health systems access to their medical records.

"This existing new reality is that a fat file, that until recently was stored away unavailable to the patient, now sits in its entirety on the patient's phone," writes Dowling. "For patients with chronic conditions who make frequent use of medical services, this leap forward enables them, whether a mile from their doctor's office or a thousand miles, to track and share with their doctor essential data on blood pressure, heart rate, glucose levels, and scores of other important clinical markers."

But to succeed, this information must be gatherable, accessible, and understandable to any patient. Big tech will need to streamline such systems for maximum user-friendliness, all while keeping operations on a device with which patients and practitioners are intimately familiar.

That device will be the smartphone and tablet. 77 percent of Americans own smartphones. Among Americans over 65 years of age — the demographic most in need of such advancements — 46 percent own a smartphone, a number that is likely to climb.

Big tech's vision of integrating information technology with health care is some ways off. Much experimenting must be done, and big tech needs to better collaborate with traditional health care stakeholders. Even so, these incipient steps may lead to a framework where practitioners can gather more data more quickly and with greater ease, while patients become partners, not passive recipients, of their health care team.

Accelerating value-based care

In the United States, value-based health care exists today as a should-we, could-we debate topic. Big tech's entry into the field could push value-based care closer to practice. As noted on the health care blog Tech Prescribed, integrating improved data acquisition with AI-powered platforms could turn value-based care into a manageable venture.

"As a result, we will see the move to VBC accelerate even further as more firms turn a profit through this business model. Good news for docs — this will make you the primary customer for provider technology and really improve your user experience as a side effect," writes Colton Ortolf of Tech Prescribed.

The Northwell Health entity Pharma Ventures was created both in response to collaborating with big pharma and as a means to promote value-based care. Pharma Ventures was designed "to link drug prices to drug performance" and "to serve as a super-site for clinical trials." The goal is to drive down costs while simultaneously improving patient experience. Such an initiative is only possible due to Northwell's integrated systems and system-wide electronic health records.

Entering the smart age of medicine

For Dowling, health care in the United States is laying an important foundation for the medicine of tomorrow. We're moving away from the view that health care is something the patient receives at a medical facility. Soon, health care will see the patient take an active role alongside a team of health care providers.

"The new American medicine is proactive and has physicians working in teams with nurses and other caregivers to reach out to patients and guide them along a pathway to health and wellbeing," writes Dowling.

By creating new machines, proliferating information, and making that information easier to obtain, big tech's dive into health care will be a fundamental element in this upcoming paradigm shift.


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Robot pizza delivery coming later this year from Domino's

The pizza giant Domino's partners with a Silicon Valley startup to start delivering pizza by robots.

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  • Domino's partnered with the Silicon Valley startup Nuro to have robot cars deliver pizza.
  • The trial run will begin in Houston later this year.
  • The robots will be half a regular car and will need to be unlocked by a PIN code.

Would you have to tip robots? You might be answering that question sooner than you think as Domino's is about to start using robots for delivering pizza. Later this year a fleet of self-driving robotic vehicles will be spreading the joy of pizza throughout the Houston area for the famous pizza manufacturer, using delivery cars made by the Silicon Valley startup Nuro.

The startup, founded by Google veterans, raised $940 million in February and has already been delivering groceries for Kroger around Houston. Partnering with the pizza juggernaut Domino's, which delivers close to 3 million pizzas a day, is another logical step for the expanding drone car business.

Kevin Vasconi of Domino's explained in a press release that they see these specially-designed robots as "a valuable partner in our autonomous vehicle journey," adding "The opportunity to bring our customers the choice of an unmanned delivery experience, and our operators an additional delivery solution during a busy store rush, is an important part of our autonomous vehicle testing."

How will they work exactly? Nuro explained in its own press release that this "opportunity to use Nuro's autonomous delivery" will be available for some of the customers who order online. Once they opt in, they'll be able to track the car via an app. When the vehicle gets to them, the customers will use a special PIN code to unlock the pizza compartment.

Nuro and its competitors Udelv and Robomart have been focusing specifically on developing such "last-mile product delivery" machines, reports Arstechnica. Their specially-made R1 vehicle is about half the size of a regular passenger car and doesn't offer any room for a driver. This makes it safer and lighter too, with less potential to cause harm in case of an accident. It also sticks to a fairly low speed of under 25 miles an hour and slams on the breaks at the first sign of trouble.

What also helps such robot cars is "geofencing" technology which confines them to a limited area surrounding the store.

For now, the cars are still tracked around the neighborhoods by human-driven vehicles, with monitors to make sure nothing goes haywire. But these "chase cars" should be phased out eventually, an important milestone in the evolution of your robot pizza drivers.

Check out how Nuro's vehicles work:

Two hours of nature per week is critical to your wellbeing, Exeter Medical School researchers say

Spending between 120–300 minutes per week in nature shown to increase wellbeing.

Photo credit: Ozkan Bilgin / Anadolu Agency / Getty Images
Surprising Science
  • New research from Exeter Medical School shows that 120 minutes a week in nature increases wellbeing.
  • Nearly 20,000 urban-dwelling British citizens took part in this large-scale study.
  • Health benefits associated with being in nature include lowered risk of obesity, diabetes, and mental distress.

As with much health advice, the simplest prescriptions seem to be the most effective. Common sense reigns supreme. That's the consensus of a new study, published in Scientific Reports on June 13, which offers the most basic guidelines imaginable: spending at least two hours a week in nature will do wonders for your health.

The researchers, based at the U.K.'s Exeter Medical School, scoured previous studies to better understand how simply being outside benefits us. What did they find? They discovered being immersed in nature lower probabilities of asthma hospitalization, cardiovascular disease, diabetes, mental distress, obesity, and mortality in adults; it has also been shown to reduce obesity and myopia in children.

Two hours weekly appears to be the sweet spot, with peak positive associations capping between 200–300 minutes. One caveat: the research is based on nearly 20,000 people that live in dense urban regions. This makes sense, as it is this population most in need of woods, lakes, and mountains. There's only so much one can take staring at asphalt (or a screen).

That being in nature bestows health benefits shouldn't be surprising; it is where humans spent most of their time until quite recently. Many other prescriptions, from Japanese forest bathing to Swedish plogging (cleaning up trash in natural environments) have been touted as being mentally and physically positive activities. It seems the further disconnected from nature we become, the more we crave it.

It doesn't matter how you break up the weekly 120 minutes. A daily walk or a once-weekly hike both do the trick. The researchers also don't differentiate between environments. A local park appears to be as effective as an oceanside hike or heading deep into the forest.

Prescribing Nature for Health | Nooshin Razani | TEDxNashville

Such information is especially important considering that 68 percent of the world's population is expected to live in urban areas in the next three decades. Social animals by nature, the allure of cities is pulling residents to congregate in tighter proximity. The trade-off is further disconnection from the land that first gave birth to our species.

Of course, escape is always possible. Motivation and time management are key factors. Consider the varied possibilities for those living in New York City. You can always jump on a train in any direction: east to the Rockaways and Long Island, north to New York State's incredible hiking, west to the Delaware Water Gap, south to plenty of green space in Jersey. Making it part of your week is the real challenge for Manhattanites that rarely leave their borough.

On the other side of the nation, nature is everywhere in Los Angeles. Ironically, the metropolis boasts the fewest public parks in the world for a city of this size. Again, time management and motivation: getting to the mountains is possible from most parts of the city within 20 minutes. The benefits are worth it. Being proactive about your health is the challenge.

Interestingly, the study draws the line at 120 minutes. Participants that logged between one and 119 minutes reported no better subjective well-being than those who spent no time in nature. The threshold appears to be 120 minutes, with benefits lasting up to 300 minutes. At that point, no further benefits accrue.

Photo credit: Blake Richard Verdoorn on Unsplash

Medical professionals are also recognizing this trend. In Scotland, doctors are authorized to prescribe nature walks to their patients. As far back as the '70s doctors realized that hospital patients with more natural light in their rooms healed quicker than those facing buildings or other obstructions.

City governments realize that urban regions need to include plenty of green space. The Brooklyn waterfront is being transformed from ports of industry to parks of leisure. In 2008, Portland, Oregon, launched its Grey to Green initiative to reimagine its entire infrastructure. Even as Copenhagen is becoming a tech leader, the nine artificial islands under construction of the city's coast includes plenty of green space.

While cities and doctors are playing a role in bringing us closer to nature, it's still up to us city dwellers to put in the effort. Personal history, biodiversity, and even ethnicity are involved in the study above. As the team writes,

"Research considering the quality of the natural environment in terms of plant and/or animal species richness suggests that experiences may be better in more biodiverse settings. Contact with nature is more than just a complex multi-sensory experience, to varying degrees personal histories and meanings, longstanding cultural practices, and a sense of place play some role in the benefits realized, factors which may account for why we did not find the same pattern for health individuals not identifying as White British."

Even weighing in these factors, the message is clear: get outdoors. We were born of this earth. The less time we spend locked away from it, the more likely we are to experience negative mental and physical health. Fortunately, the opposite is also true. We just have to step outside.

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