Who Cares?

The father of a wireless engineer, who made a good living designing mobile devices, contracted a rare and chronic form of athlete’s foot. Over the course of a few months, the father’s condition worsened and eventually he died. Vowing he would make sure that no-one suffered the way his father had during the last few weeks of his life, the engineer set about developing a wireless athlete’s foot detector.

After obtaining the backing of a venture capitalist, he licensed technology from a university spinout that specialised in bio-sensing and embedded it onto a wireless chipset, which he then packaged into a simple mobile device. The athlete’s foot monitor is now on the market and our wireless engineer is talking to a number of healthcare providers, including the NHS.

There are two important things about this story; first it is complete fiction – and  second; anyone who has been involved in the wireless and mobile industry, will have come across real life examples of personal quests masquerading as business plans.

A paragraph in a press release or a slide in a PowerPoint presentation recalls the traumatic series of events that inspired an engineer to develop a device that will help eradicate the disease that ended the life of a family member. In real life the loved one will have been scythed down by a stroke, heart attack or complications arising from diabetes or COPD.

And in real life the device would not have been a wireless athlete’s foot detector but a mobile communications-enabled blood pressure monitor, blood glucose monitor or ECG.  However, in nearly every case the project ends in disappointment as the engineer discovers that even though he was able to convince a venture capitalist to fund his quest, healthcare providers are less enthusiastic.

Analysing what went wrong for these enthusiastic entrepreneurs throws some light on a number of fault lines in the healthcare industry itself. So let’s deconstruct the story of the man who developed the wireless athlete’s foot detector.

Fear Is The Key

Let us start with the declaration that the engineer did not want anyone else to suffer the same fate as his father. Healthcare providers will be familiar with this sentiment – the relatives of a person who has met a premature end due to a mistake by a clinician make similar claims as they are standing on the courthouse steps waving the multi-million dollar compensation cheque. The death of their loved one has forced the engineer, and the compensation recipients, to confront their own mortality. Social niceties are wrapped around a basic instinct for survival and they are really thinking of themselves rather than ‘anyone else’. The engineer would, as it is a potential threat to his own survival, like to see the disease that killed his father completely eradicated. The compensation recipients, afraid of appearing motivated by greed, claim they are acting for the good of all patients, when in fact they are being driven by the same basic instincts as our engineer. Rather than helping ‘anyone else’, they are, as an act of revenge, attempting to destroy the healthcare provider.

The basic instinct to eliminate potential threats is a powerful motivator – it enabled the engineer to make a passionate case when presenting his business plan to potential investors.

From Docking Cradle to the Grave

Despite his enthusiasm, and that of his backers, the engineer will find it difficult, if not impossible, to sell his idea to the healthcare provider. His business model and the one employed by providers are incompatible. Healthcare providers are very good at everything that happens between diagnosis and death, but seldom engage with their customers prior to this period and tend to end their involvement if the patient recovers. A majority of ehealth and mhealth devices and services are designed for use as preventative healthcare tools or to manage patients who are recovering after treatment. The healthcare provider is not interested in equipment that increases communication between themselves and people they do not regard as customers. For similar reasons healthcare providers have little faith in mhealth as a tool to drive down costs. If the rather Orwellingon named National Health Service needs to cut costs, as it will do over the next twelve months, it will simply reduce the number of people it treats. This is not something you do by increasing the ease with which an expanding customer base can contact you.

No Health 2.0 Without Society 2.0

With a lack of interest and engagement on the part of the healthcare provider, preventative health and managing existing conditions falls on the patients themselves – or, in many cases, members of their families. Recognising this, Orange Mobile supported a project called Circles of Care, which involved family members using mobile technology to provide social and healthcare related support for each other. Unfortunately Circle of Care was based on a model of the family that ceased to exist during the 1960s and resulted in the absence of any clear line of responsibility for care of the patient.  The need for social engineering as a prerequisite for the deployment of patient and family centric healthcare has been recognised by more recent projects, for example the Mehrgenerationenhäuser (Multi-Generation House) programme in Germany. The growth in market for the next generation of healthcare technology – especially devices and services designed to promote well-being, will be heavily dependent on projects such as the Multi-Generation House and increased input from and support for family carers.

When Healthcare Spending Meets Macro Economic Policy

If you want an indication of a major fault line in the economies of developed countries, spend a few moments studying the protests over student tuition fees in the UK or the rise in the retirement age in France. As in the 1960s, today’s social tension is intergenerational. Fifty years ago baby boomers were aggrieved that, even though they had pockets stuffed with cash, they had little political power. Today they have both wealth and power and are reluctant to part with either. This is unfortunate for today’s younger generation and is creating a situation that is economically unsustainable. Taking money out of the pockets of tomorrow’s consumers and spending on people who are economically inactive will result in stagnation within a decade and social tension even sooner. Healthcare spending lies at the root of this problem as much of the money that is being taken away, or withheld from the younger generation, is being used to provide healthcare and social care for the elderly.

David Willets, author of the book The Pinch and now a minister in the UK government, suggested that what is missing is a contract between ageing baby boomers and the younger generation. In view of the fact that baby boomers are living longer, part of such a contract would be an agreement to stay economically active for longer. This is where technology that supports preventative healthcare has a key role to play, as staying fit and active is a prerequisite of staying economically active. Keeping elderly people economically active for two or more years would see sufficient wealth transferred between generations to minimise intergenerational conflict and, at the same time, prevent a long term fall in GDP. Technology that is accessible to older people and helps them stay connected with colleagues will also be important to ensuring the elderly remain engaged and productive.

Healthcare providers are not the only organisations that spend heavily on the elderly. Municipal authorities are providing an increasing amount of social support for senior citizens and special transport for people who can no longer drive. Here too family carers are undertaking tasks that would otherwise have to be carried out by the municipal authorities themselves. As well as providing social care, family carers and other members of the community drive senior citizens to hospital appointments, shops or social events. As many of these volunteer drivers are themselves recently retired, these schemes help both the driver and their passengers remain economically active. At a micro economic level, automating these services with smart ‘dial a ride’ technology can help cut costs. Another way of reducing costs for such services is involving partners from the private sector – something else Germany’s Multi-Generation House programme is working towards.

Sometimes Just Keeping People Alive Is Just Not Enough

Perhaps rather than passionately devoting himself to building yet another mobile health monitor device, our entrepreneur should have spent his time developing smarter infrastructure to support all the existing mhealth devices and applications on the market. The next phase of innovation in healthcare will be as much social as it is technical and will see mobile health integrated with a range of other technologies used to help older people remain fit and active for longer. It will also pose some important questions. The first being as people live longer, who will be most interested in their well-being; a cost cutting organisation, that regards them as one of those costs, or commercial organisations that have a vested interest in the elderly remaining fit and healthy as prerequisites to them remaining economically active? And the second, who will be most likely to purchase and use mhealth technology and health 2.0 services; an organisation that only engages with its customers when they become ill or ageing baby boomers and members of their families who have an incentive to ensure they do not become ill in the first place?  These are important questions for engineers and entrepreneurs – especially those with itchy feet.

The author, Peter Kruger, has worked in the healthcare IT industry for ten years. Prior to this he founded the me
dical imaging company, Digithurst. He is author of the report. “Alpha Moms Become Alpha Daughters.”  and is currently developing a healthcare and social support service called Alpha Daughters. http://www.alphadaughters.com

Details of the Multi Generation House project can be found at : http://www.mehrgenerationenhaeuser.de

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3 replies »

  1. Interesting post. The athlete’s foot angle caught me off-guard and, after reading on, it was apparent that my disbelief was appropriate.
    There is no doubt that American’s in general need to be more pro-active about their health. I am in the middle of treatment for Lyme disease, but my optimum state of health at 42 has made the disease take less of a toll on me.
    Keep up the good posts and I’ll be sure to check back regularly.
    All the best,

  2. I came upon this article while searching for treatments for venous insufficiency. As a 60-year-old exercise instructor, my observation is that toned muscles probably allow less room for leaking around valves. In a water environment, where I teach, the water also exerts even compression, so no folds to host sub-optimum circulation.
    Many participants show up in our classes because doctors have told them to. One woman attributed surviving a fall with an intact hip to her years of working out as instructed.
    Ancient forms of exercise such as yoga seem to be designed to prevent some of the issues that have become chronic with modern lifestyles. At most health clubs where I have observed recently, grandma’s yoga has been turned into this bootcamp sort of thing where it is easy to get hurt, but there could be more careful attention to getting participants in appropriate levels.
    I appreciated this thoughtful article. It is easy for me to just write off conventional medicine, as I did for some time after searching lymphedema treatment and finding compression devices and medications advised with what I felt was an afterthought toward exercise.

  3. I’m a believer. Generational theft is at the heart of federal spending. Boomers need to be ready to sink or swim as they get older and lose political power.