When it comes to mobile health, Eric Dishman, director of health innovation and policy at Intel, for Intel's Healthcare Innovation Group, is a realist.
"On one hand, Intel is really excited about the future of m-health and mobile health. On the other hand, we're a little worried that there's a lot of hype around it right now," Dishman told MobiHealthNews in an interview at the just-concluded Medical Group Management Association (MGMA) annual conference in Las Vegas, where he delivered a keynote address.
Dishman also will be speaking at the mHealth Summit near Washington, D.C., in December. "One of my messages is going to be, look, just because there's 33,000 smartphone apps around about health and wellness and diabetes management, doesn't mean people are using them," he said. "If you actually look at the data, not that many people are downloading them. Not that many people, even if they've downloaded them, are using them more than once to be a part of their everyday care."
"Over time, it's certainly true that mobile devices, whether they're implantable devices or cell phones, are going to be used to collect data and coach us, but it's not taking off nearly as quickly as we want. That's because there's got to be someone on the other end—a clinician, a nurse or someone that's trained to intervene."
And that is why Intel is interested in what Dishman calls "virtual care coordination" and "real-time care coordination" as part of a changing, more connected healthcare environment that promotes wellness, prevention and independent living.
"In a world in which there's not going to be enough doctors and nurses and hospital beds to take care of an increasingly older and sicker population, Intel's really focused on how do we use disruptive technologies to enable care of people in the home and in the community," Dishman explained. "And how do we enable self-care technologies for patients themselves and how do we make family members and neighbors who are already doing $275 billion worth of care a year, according to AARP, how do we use IT to enable them to make sure that they're delivering high-quality care?"
During his MGMA keynote, Dishman showed images of a research prototype home-based assessment device to measure symptoms of Parkinson's disease, a rather important subject at Intel because company co-founder and former CEO Andy Grove suffers from the progressive neurological disorder. There is no cure for Parkinson's, and treatments tend to be hit-or-miss. Grove and his foundation contributed to the project to help measure disease progression at home.
The prototype is intended to collect multitudes of real-time data on symptoms of movement disorders that physicians can't possibly gather during a brief, sporadic office visit. "Most of the symptoms of Parkinson's, whether it's a quiet voice or a tremor, they can be very variable," Dishman noted. "If you happen to see your doctor on a day that's not representative of how you're really doing, they're going to give you a bunch of drugs based on how they saw you once a year, and it's almost criminal," he continued.
"I'd hate to be a neurologist making life-or-death decisions about [common Parkinson's drug] levodopa and other horrible drugs based on that one little sparse data sample. The ability to get something potentially 24/7 or at least multiple times a week really changes the game, potentially."
The laptop-sized assessment device runs the patient through a series of dexterity and vocal tests, in hopes that the data can help doctors better spot signals of improvement or deterioration and adjust medications appropriately. It also helps track a person's gait, which is useful for predicting a wide range of other ailments, including falls, congestive heart failure and stroke.
"It's really about personalized medicine and having a tool in the home that could do that," Dishman said. "We didn't do anything new. We just did it at home."
Intel, of course, spun off its former Digital Health Group into the GE-Intel Care Innovations joint venture with GE Healthcare earlier this year. (See our recent interview with Care Innovations CEO Louis Burns.) "There will continue to be tight collaboration from the parents, both GE and Intel," Dishman said, though Care Innovations will have freedom to try out new ideas.
And Intel will push coordinated care as an element of healthcare reform. "We want to make sure that care coordination and the locus of care doesn’t have to just be a clinic or hospital. Increasingly, the nurse or the certified nursing assistant or the volunteer community health worker is going to need to interact with patients through electronic means," Dishman said.
He noted that Intel and others successfully lobbied for the removal of language in the Patient Protection and Affordable Care Act that may have unintentionally required certain kinds of care to take place in clinics or hospitals. "One of the big things I pushed for in health reform in the U.S. was to make sure in our legislation that we didn't end up preventing e-care, electronic care or virtual care from happening," Dishman said. We've got to trust clinicians to be able to make choices about what's the right modality of care for that particular need, and right now we don't have that.
What the legislation does do is help move American healthcare somewhat away from fee-for-service, mostly through bundled payments and Accountable Care Organizations, which will provide incentive for remote and Internet-based care. But Dishman called ACOs "the beginning of the story, not the end." More changes are on the horizon.
"Nobody is happy with the status quo, so stop fighting so hard to keep it," Dishman told the MGMA audience.