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Doc in a Box/ The Future of Medicine

Bonnie Bracey Sutton Teacher Agent of Change, Power of US Foundation

The Future of Medicine: The Doc-in-a-Phone
By Ceci Connolly
July 13, 2011 | 6:00 a.m.

Reporters don’t like making predictions. And even though I’ve left journalism, the prediction-aversion gene remains dominant. So when National Journal asked what I thought would be the next decade’s great medical innovation, I started reporting.
The thrilling news is that the health care field is teeming with possibility. In the developing world, seemingly simple oral-rehydration therapy for children is an innovation that saves lives and money. Researchers tell us that breakthroughs in molecular science could lead to an era of personalized medicine in which the body’s own materials replicate, regenerate, and repair it.
But what I heard about the most was the potential explosion of mobile health, the marriage of medical care and cell-phone technology.
Think of it as Doc-in-a-Phone.
Mobile networks today cover 98 percent of the world’s population. Across the globe, cell phones are used to conduct banking, monitor elections, and teach classes. The technology has broken geographic, socioeconomic, political, and even generational barriers.
Early efforts in mobile health care, known as mHealth, have focused on simple information transfers. A Mexican cell-phone company is offering 24/7 medical consultations and deep discounts on items such as lab work and medications for a monthly fee of about $5. More than 1.2 million households subscribe to the service, called MedicallHome.
In the United States, mobile communications already deliver medication alerts and appointment reminders. A clinical trial was just launched for patients to track overactive-bladder symptoms with the help of a smartphone.
The next step in the mHealth journey involves taking standard tools of the health care trade—stethoscopes, glucometers, and electrocardiogram machines—and connecting them wirelessly to a data hub or medical command center. This two-way communications ability offers the hope of better compliance, earlier detection of warning signs, and faster interventions.
Imagine a heart patient who has a tiny chip on her chest. Readings it sends to a nursing station detect an irregularity. The system alerts the patient to go to the emergency room, drastically improving her health prospects and reducing care costs.
But to make a truly significant impact, this burgeoning field will need to address fundamental problems such as chronic conditions, physician shortages, and the need for robust outcome measurement. In the United States alone, nearly 26 million people live with diabetes, a disease that exacts an enormous toll on patients, productivity, and budgets. Perhaps mHealth can finally help patients and doctors coordinate a real-time, personalized drug, diet, and exercise regimen.
Success will require strategic partnerships. Physicians may love the idea of getting radiology results on their smartphones, but they might be much more skeptical about dispensing medical advice without an in-person examination. The pending demise of Google Health illustrates that high-tech/medical partnerships are far from a sure thing.
On the other hand, a 2009 McKinsey survey of 3,000 people in Brazil, China, Germany, India, South Africa, and the United States found that up to one-third of respondents indicated some willingness to pay for mHealth services such as drug delivery, physician phone consultations, and remote monitoring with alerts.

In the decade ahead, the ubiquitous mobile device has the potential to help drive down skyrocketing medical costs, improve access, tailor therapies, and improve quality of life. Consumer appetite will play a major role in the future of mHealth. But even more important, the medical community, technology companies, and regulators will have to overcome their differences if Doc-in-a-Phone is to deliver on its most ambitious promises.
The author is a senior adviser to the McKinsey Center for U.S. Health System Reform. She previously was a national staff writer at The Washington Post.
Source National Journals Innovation Works/ Conference

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