MMVR researchers utilize the tools and methods of information technology to design improved human well-being. Visualization, simulation, modeling, robotics, sensors, networking: data becomes the key to better diagnosis and therapy. IT efficiencies have the potential to eliminate the customary tradeoffs between quality and cost. However, imbalances in healthcare threaten this potential.
Although the United States spends more on healthcare than any other nation, returns on this investment remain questionable. The ubiquitous fee-for-service model rewards physicians for the quantity of procedures performed, thus encouraging more procedures. Accordingly, time spent weighing the value of each procedure in light of medical evidence and patient history decreases; odds for waste and malpractice increase. The greater quantity of procedures in turn motivates insurance payers to reduce payment per procedure and increase the premiums obtained from their covered population. Lower per-procedure reimbursement means more procedures done in order to maintain financial equilibrium. Higher premiums result in more individuals for whom insurance becomes unaffordable and healthier patients opting out of the insurance system, increasing premiums for those left behind. Those without coverage are unable to negotiate the discounted rates enjoyed by insurance payers, so they pay more for identical care.
The complexity of the United States healthcare delivery system is expensively maintained by legions of administrators, accountants, technicians, and clerical staff. In spite of their limited medical expertise, they indirectly determine who receives what kind of treatment. Physicians must masterfully navigate a shifting web of insurance protocol while they consider therapies, while in the background, malpractice lawyers console patients failed by this out-of-balance system.
This system would not exist if it offered no benefits. Private insurance companies generate profit and guard their turf with political influence. This system offers ample employment for those who do not provide care but regulate its delivery. Patients with good insurance enjoy treatment that equals that of other rich nations. Drug and device makers invest heavily in R&D since blockbuster products reap long-term rewards. The downward spiral of per-procedure reimbursement creates incentives to design and adopt technology that is cheaper, more accurate, and (for better or worse) reduces the time a physician must spend with each patient.
Is this system sustainable? Currently, while we watch the financial industry implode, we must wonder whether healthcare is heading toward a similar crisis. Convinced by years of advertising, Baby Boomers expect a healthy old age, enabled by breakthrough technologies, just as resources to pay for care are evaporating. A current survey by the Physician's Foundation reports that nearly half of primary care doctors would retire today if they had sufficient financial means; a similar proportion plans to reduce patient load or retire altogether within the next three years. How will these trends affect care for an aging population?
Broader imbalances—and perhaps solutions—exist outside US healthcare. In October 2008, the World Future Society offered ten forecasts for 2009 and beyond. The first predicts, “everything you say and do will be recorded by 2030.” The second projects, “access to electricity will reach 83% of the world by 2030.” The disparity implied by the two scenarios is startling. The first requires—in addition to electricity—countless sensors, processors, bandwidth, search engines, technicians, and tremendous wealth. The second defines a population whose poverty denies it the most basic modern tool, along with its countless tangential benefits.
Reflecting on the first forecast: if an omnipresent sensor and data network were built, how would healthcare benefit? Utilizing such a network, we can imagine a medical research utopia, where every individual becomes a subject in a universal clinical trial. Daily exercise, diet, psychological stresses, and environmental factors are measured and analyzed in conjunction with genetic profile and medical history. Patient non-compliance? It's just another variable providing new insights. Evidence-based, decision-support algorithms replace therapeutic trial and error. When N = everybody, the quantity and quality of data will blur the distinctions between diagnosis and illness, prediction and therapy, experimentation and personalized care. Well-being can be designed more intelligently and efficiently.
The second forecast warns of challenges outside the developed world. To start, modern healthcare demands electricity, yet the unstoppable proliferation of cell phones in the developing world, bypassing landlines that were never built, bodes well for medical data technology. Can the lack of a power grid be overcome with cheap, solar-powered Internet terminals? Might cloud computing be done through the clouds instead of wires? Technological efficiencies from the developed world have the potential to benefit those who have less to pay, allowing their participation in a global wellness intelligence network.
It's an idealistic vision, for sure. Privacy advocates (and anyone who has applied for individual health insurance) fear the widespread dissemination of sensitive data. Will today's credit-identity hacking pale in comparison to future crimes of medical piracy? How will the insurance industry utilize predictive medicine? How will the creativity of academia and industry be supported in a precarious financial environment? Must government's role in the healthcare marketplace change dramatically to sustain well-being for its citizens? Many questions remain unanswered.
At MMVR, where we are privileged to explore and act at the forefront of medical technology, answers emerge. Creating and utilizing data networks to design human well-being is not an abstract vision of the future; it is the challenging task of every day. In these imbalanced times, when harsh realities dominate personal and public dialogue, we congratulate MMVR researchers on their successes and continuing determination.