Reducing Health Care Costs by Reducing the Cost of Research
A common theme in my blog posts is the impact of the Internet on the practice of medicine. A recent comment in a news article pointed to an opportunity worthy of further thought. The article: Tai chi may improve quality of life in chronic heart failure patients. The comment: this has not been rigorously tested in a large clinical sample.
Why not? Because it would be expensive to conduct the research using traditional methods and there is no product or service that can provide the necessary funding. If something causes 100,000 people a year to die prematurely the impact is large; if there is a potential solution that will generate profits, money will flow. If there are 1,000,000 people who will have a noticeably better life by changing their lifestyle — without a profit motive — it will remain just a good idea. An ounce of prevention is not worth a pound of cure in the medical research market place.
If we can’t raise the value, can we lower the cost? I think we can by using some of the technologies spawned by the Internet. The following ideas have been developed as an illustration of cost reduction in the context of doing rigorous testing in a large clinical sample for products, procedures and devices for which there is limited patient risk and little or no profit incentive.
Traditional studies start with a test group and a control group. If, over time, the control group does not match the test group the results will be of little or no value. Costs can be reduced by starting the testing and then building the control group to match the test group.
Web-based EMRs like Practice Fusion with more than 10 million patient records make it possible to create the control group after testing begins. There may be some issues or opportunities in the early testing that will lead to changes in the test group. Define the key parameters of the test group and then look at 10 million records and define a closely mapped control group. If the 20% of the test group were women with chronic heart failure in their 60’s who weighed between 100 and 110 pounds at the time the study started, you can find a comparable number of people who fit each of your categories as of the start date. Adjust the control group as necessary, particularly if this is a long duration study.
Doctors, nurse practitioners and other qualified professionals can collect the data as part of their normal medical practice and record it in a single electronic medical record system. They are highly trained with a stake in getting good data as part of their practice to serve their patients. There is only limited extra cost in data acquisition; little or no extra time on the part of the doctor to examine the patient or record their findings.
Use web-based devices to capture re-occurring data points. How often does the patient practice tai chi, how long and how vigorously? What were the results? iPhones and Android phones have sensing capabilities that can be used to track physical activity including rhythmic patterns such as those of tai chi. If Mrs. Jones agrees to do 30 minutes of tai chi every day, her daily workout can be tracked by her phone and transmitted to her EHR. With technology that may be available today — or is at least already designed and patented–data about the physical impact of the workout can be captured and transmitted.
Apple currently has a number of fitness-oriented features available in its iPod line, but its latest patent describes an extremely advanced system … for measuring exertion during physical exercise including … measuring the user’s body temperature, heat flux and heart rate. In another example, a light source and photodetector allow the hardware to determine a user’s blood oxygen content.
According to the patents, this can be embedded or attached to the earbud of a headset attached to an iPhone. If it is not available now, it probably will be in the near future.
Using current — or soon-to-be-released — technology the study can assure that each participant is actually doing what is required for the study. It can also gather event-by-event results that can be combined with the results of periodic check-ups in the physician’s office. Marginal cost will be small, particularly for patients who have the required smart phones.
Interim results can be available in a matter of days to provide for early course corrections and preliminary findings to optimize the value of the research. Preliminary results can be shared, new questions can be added, the sample group can be modified, etc. Once established, a study can be continued indefinitely by periodically updating the test and control groups as patients drop out.
Patients can be introduced to the study gradually with duration and intensity tailored to their specific responses to minimize risk and optimize the pace of improvement.
The phone can be used by patients to create support groups to provide encouragement to continue with a practice that is contributing to their wellbeing and also keep participants interested in the study. Individuals and groups can share results as incentive for others to join in the study even if they are not part of the test group; studies could even go viral. What could be better than finding a life-changing practice that is proven to have value and become part of today’s social media?
A group of doctors who share a research interest and use a common EHR could do this informally as a beta test for a supplement or OTC product to determine whether or not a more formal study would be worth the effort. The basic requirement here is rigorous testing in a large clinical sample. This research does not involve the types of risks associated with new drugs and does not require the same level of rigor. It is based on new but well-established EHR and other technologies that are creating opportunities to capture and analyze data at significantly lower cost.
Lower-cost research offers the promise of testing, proving value, and adding products, procedures and devices that today lie just outside the scope of traditional medicine because they have not been adequately tested. Many of these, like tai chi, are lower cost products that may reduce healthcare costs and improve healthcare quality.