Thursday, Jan. 15, 2009
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ONLINE EXCLUSIVE
'Health 2.0' Could Prove Worth The Bill
The Obama Administration Could Apply New Technologies To Reform Health Care -- If They Focus On The Essentials
When a busy working mother gets home, she can walk into the living room and play a game of tennis or attend a yoga class using a popular video game system. The "Personal Trainer: Cooking" game on her Nintendo DS will guide her through preparing a healthy dinner. And before she goes to bed, she can flip open her laptop, go online and refill a prescription to pick up at the pharmacy in the morning.
It's a basic routine for the millions of Americans who have embraced technology to help them improve their health. Nintendo's Wii Fit video game sold 3.53 million copies from its March 2008 launch through November, according to the company. And according to a study by Harris Interactive, 150 million Americans looked up health-related information online last year, 81 percent of those who regularly use the Internet. The Pew Research Center found in 2006 that, of those who turned to the Web for help, most of them gave consideration to the information they found online in deciding how to take care of themselves or someone else.
"Increasingly, people are getting their health information from blogs, from social networks, from virtual worlds, from Twittering, from mobile applications and this whole sphere," said Janice Nall, director of the Division of e-Health Marketing for the Centers for Disease Control and Prevention.
The government has generally been slower than those it serves in embracing health IT, but there are signs of change. President-elect Barack Obama has pledged to spend $50 billion over the next five years on health IT, a commitment that experts applaud. Those in the health care community, however, are advising the transition team to approach any e-health initiative narrowly and methodically. Most agree that there are two areas where the government has a role to play: adoption and interoperability.
Digitizing the health care system, most experts agree, would save money, eliminate waste and empower patients by giving them easier access to their records. But progress toward getting providers on board has been remarkably slow. One of the greatest barriers has been the expense of installing the hardware and software and training employees to use it. With the average system's cost ranging from about $25,000 to $45,000, plus annual maintenance fees of $3,000 to $9,000, providers -- particularly small practices -- have been reluctant to make the up-front investment, especially in a crumbling economy. Janet Marchibroda, chief executive officer of the eHealth Initiative, a nonprofit dedicated to improving health care through information technology, said that one thing the administration can do is "provide federal funding support through a combination of grants, loans, increased Medicare payments and tax incentives to providers" who adopt new health IT systems.
Getting doctors' offices and hospitals wired is a critical first step. But a report released this week by Booz Allen Hamilton and the Federation of American Hospitals finds that electronic medical records alone won't necessarily cut costs or improve care unless that information can also be shared easily. Karen Davenport, director of health policy at the Center for American Progress, argues that "building the information exchange -- the interoperability pipes and plumbing" -- is a task ideally suited for government because "it's really a public good." While it's not necessarily in the business interest of any given segment of the health care system, "it's in the systemic interest to have that exchange. So there's really appropriately a public role in pulling that together."
The investment of public funds would likely be a tough sell in the current economy, but if the administration could successfully drive this two-pronged approach, the repercussions would be huge. Former New York Times futurist and new media consultant Michael Rogers says that, depending on which study you read, projected cost savings of implementing e-health range between $20 billion and $1 trillion.
The potential benefits of health IT go far beyond the pocketbook, however, as demonstrated by those individuals already using "Health 2.0" technology. "We know that being healthy isn't just going to the doctor to get treated when you're sick and that most of the things that you can do to be healthy are things that you as an individual can do," Nall said. "You're going to have better health if it's incorporated" into daily life, Nall points out, and technology is becoming a larger and larger part of everyone's daily routine.
Nall has led the CDC's effort over the last several years to branch out into new social media in an effort to improve public health. The agency started small, posting podcasts on its Web site, but it has since expanded efforts to include campaigns in virtual worlds like Whyville and Second Life, partnerships with social networking sites like MySpace, and a dedicated channel on YouTube. In one text messaging campaign, the CDC partnered with the Kaiser Foundation to disseminate information about HIV testing in conjunction with World Aids Day. By texting in their ZIP code, people could receive the addresses of testing centers near them.
But Nall recognizes that those who go online in search of health information are often getting it from their peers rather than experts. On sites such as DailyStrength.org, for example, patients and caregivers can read about others' experiences with disease and treatments, while other sites serve more specific populations. Grouploop.org offers a forum for teens with cancer and their families, allowing them to participate in weekly support groups moderated by a professional or find others who share their diagnosis or live in there area. Disaboom prides itself as an "online community for people with disabilities and those whose lives they touch"; diabetics can link up on DiabetesConnect.
The challenge from a government perspective is maintaining quality control. "We need to be out in that outer circle of where people are getting health information and be there to make sure they're getting accurate information," Nall says.
Still, Rogers said, "I think everybody agrees that patients have to be more involved in their own health care. I don't think there's a doctor in the country that doesn't think that's a good idea."