The challenges in health care are well known. First among them is the rising bill. Health care spending in the U.S. reached $2.9 trillion in 2013 — more than double the expenditures in 2000.
At the 2015 Symposium on Innovation in the Health Sector, hosted by the Health Sector Supply Chain Research Consortium at the W. P. Carey School of Business, a group of bioscientists, technologists and health care experts gathered to talk not just about the tremendous health care challenges we face, but about the opportunities to redefine and resolve them.
Health care costs are rising in no small part because of a rapidly aging population. Michael Birt, director of the Center for Sustainable Health and the Biodesign Institute at ASU, explained that in 1990 people older than 65 made up about six percent of the global population and young children aged 0-5 made up about 12 percent. For the first time in 2015, people over 65 will make up a larger share of the population than young children. By 2030, more than 14 percent of the global population will be older than 65.
At the same time, the global burden of disease — a measure of the relative impact of communicable diseases, non-communicable diseases and injuries on global health — has shifted. In 1990, communicable diseases (such as hepatitis and measles) had the greatest impact on global health. Today, non-communicable diseases (such as cancer and heart disease) have a greater relative impact. Many of these non-communicable diseases are preventable, can be detected early and, when managed, can be livable.
In other words, health care costs are already rising rapidly, the population is aging and a greater share of sick or injured people have diseases that are preventable, detectable and manageable.
But, there are tremendous opportunities, too.
New problems demand a new solution, Birt explained. That solution is “new math for the 21st century.” Take an aging population (the last baby boomer has already turned 50) with preventable, detectable and manageable diseases, put a smartphone in everyone’s pocket (already 64 percent of American adults own one), and the result is a connected population equipped to manage their own health.
Al Di Rienzo is a former professor at Syracuse University’s Forensic and National Security Sciences Institute and founder of RedSky Technologies, a health care-oriented concept-to-commercialization company. He described the opportunity as a shift in focus on the continuum of care. Today, much of the focus (and spending) on health care is at the end of life. The focus could be at the opposite end of the continuum — on keeping people healthy longer and managing or mitigating health risks.
Technology can help
Prevention, early detection and management are the solution to the challenges of rising costs, an aging population and increasing prevalence of livable diseases. Biosensors will help make that solution a reality. The sensors can detect, record and transmit information regarding anatomy, communication, context, demographics, environment, function, lifestyle, physiology and socioeconomics.
Biosensors can be contact-based, implanted, ingested, injected and/or non-contact. They are much more sophisticated, more integrated and “stickier” than today’s popular consumer wearable devices like Fitbit, Di Rienzo said. “Wearables are nice but biosensors will have to integrate into the environment.” And, they’ll have to be “sticky.” Today the average wearable consumer loses interest after about three months.
Di Rienzo shared his experience working as a principal investigator on a project to remotely monitor soldiers. “A soldier won’t put on a wearable. So we created a system of context-aware, predictive biosensors integrated into their clothing and equipment. For example, the number one injury for soldiers is a leg injury, so we developed a system of sensors that could sense if the soldier was about to take a misstep, and then tighten his boots to prevent the misstep.”
Di Rienzo shared a number of examples of biosensors being developed for prevention, early detection and management of health:
For prevention, Di Rienzo described a device that predicts if the patient will become diabetic. The device shines a blue laser light into the patient’s eye; the light reacts with flavoproteins — a marker of diabetes. The clinician can tell the patient, “This is where you’re at today on the path to diabetes. You can prevent diabetes if you make a change today.” As Di Rienzo explained, there is great power in predicting a health trajectory and giving the patient the chance to change it.
One of the challenges associated with disease prevention, Di Rienzo said, is that health status information collected during clinical visits often does not provide accurate, meaningful and individualized trend data for disease prediction and prevention. A personal status monitor would counter that challenge by collecting heath data that notes context, performs analysis, transmits information and then stores it all. “Via longitudinal data and predictive algorithms, patient context is generated and adverse health events are predicted.”
For early detection, Di Rienzo described an Alzheimer’s disease screener. “Well over 10 million Americans have either Alzheimer’s disease, mild cognitive impairment or cognitive complaint. Millions more have Parkinson’s disease and multiple sclerosis — collectively costing over $500 billon annually.” Di Rienzo said those diseases can be quite difficult to diagnose.
The screener is noninvasive (it looks a bit like Google Glass) and low cost (tens of dollars instead of thousands). It analyzes the patient’s visual field to predict neurologic disease years in advance. “The scanner takes cost out of the system and helps drug companies create new pharmaceuticals to hold these diseases at bay,” explained Di Rienzo.
For health management, Di Rienzo described an injected glucose monitoring device that is both low cost and unobtrusive. The device is a nanoparticle injected into the patient to continuously monitor their glucose levels and generate trend and predictive information to improve disease management strategies. The nanoparticle fluoresces based on the glucose in the patient’s blood; the patient puts a reader over the top of their arm, or wherever they had the injection, to get their glucose reading.
“For diabetic patients, the inconvenience, discomfort and expense of regular glucose testing compromises compliance with recommended testing schedules and reduces the patient’s ability to manage their condition,” Di Rienzo explained. So the injected glucose monitoring device not only lowers cost, but improves health outcomes and quality of life too.
But changing the model is not only about the technology
Changing health care is not only about new technology, although developing biosensors that provide accurate, usable health information is an important component.
According to Di Rienzo, one of the greatest challenges is interoperability. “Everybody creates these different sensors, different systems but they don’t talk to each other.” That points to a broader challenge: that this is a fundamentally different approach to health care, one that requires changes at all points in the chain of care — from the payer to the hospital administrator to the care provider to the patient.
“Technology is completely changing the game,” explained Lee Hartwell, professor and chief scientist of personalized medicine at the Biodesign Institute at ASU. “Monitoring physiological parameters that are useful in predicting early-stage disease was at one time done in the clinic by a clinician. Now it’s done at home by the patient. That raises a huge need for education for patients to understand how to interpret the medical information they’re getting from these devices.”
It also raises a huge need for a change in how clinicians are educated, explained Hartwell, who was awarded the Nobel Prize in Physiology or Medicine in 2001. “Clinical education is very prescribed, and it hasn’t changed in decades.”
Meeting those needs is where Project HoneyBee comes in. Launched by Hartwell and housed within the Center for Sustainable Health at the Biodesign Institute at ASU, Project HoneyBee is so named because “The honey bee is nature’s best collector and communicator of data; it is an inspirational model for the collection and validation of data to sustain human health.”
“The idea,” Hartwell explained, “is to do clinical trials with various health care agencies with relatively small groups of patients to understand how patients deal with biosensor information; how clinicians deal with the fact that patients have all that information and whether the devices are actually providing useful and reliable information.”
It’s a brave new world out there, delivering many opportunities to reduce health care costs while improving health and quality of life. It also means many opportunities for confusion. “We need to explore the sociology of this new ecosystem,” said Hartwell. “The goal in the first years of Project HoneyBee is just to understand how this system could work.”
The technology itself, by comparison, might be easy.
- Rising health care costs, a rapidly aging population and an increase in preventable, livable diseases are new health care challenges that demand a new health care paradigm. There is an opportunity to shift focus (and spending) from end of life care to keeping people healthy longer and managing or mitigating health risks.
- Biosensors — devices that detect, record and transmit information regarding anatomy, communication, context, demographics, environment, function, lifestyle, physiology and socioeconomics — are being developed for disease prevention, early detection and health management.
- Changing the paradigm is not only about new technology. It’s also about creating an ecosystem that facilitates interoperability, educating patients to understand how to interpret the medical information they’re getting from their devices and changing how clinicians are educated.
- Project HoneyBee at ASU is designed to learn how patients deal with biosensor information, how clinicians deal with the fact that patients have all that information and whether the devices are actually providing useful and reliable information.