Although Intel likes to put on a good show for its Developer Forum keynote speeches, it's rare to sit through one and not filter it through marketing sensitive sunglasses. It's even rarer to be so in agreement with the speaker that by the end, you're moved to stand up and say "Where do I sign?"
Yet that happened on Tuesday, after seeing Louis Burns' keynote on the thinking behind Intel's new Digital Health division. Burns is in charge, and has two reasons for wanting to run the division, he said, one professional and one personal. First, there was nothing as exciting or full of potential from a commercial angle as digital health. If you judge the size of opportunity by the size of the need, there was nothing to touch it. The personal reason? He has a 19-year-old special needs daughter, and has had 19 years of direct contact with the health system. He had seen the very best and the very worst of the system; the best was the people, and the worst was the system itself.
Normally, the sight of an executive playing the family card to bolster an argument is enough to make a journalist reach for the largest can of cynicism in the store. There was no question of that here. The doctor on a 36 hour shift who accidentally made a factor of ten mistake when prescribing post-op sedatives for Burn's daughter — and the nurse who caught it — is a story nobody will have any problem believing. Likewise the premature baby that had managed to double its body weight from 300g to 600g in its six weeks of life — and acquire a 16-inch thick stack of paper, which would have follow that child for the rest of its life. Nobody can disagree that technology, so often over-prescribed as a magic bullet, can only help here if properly applied. The health industry runs on paper and IT from the early 90s — Burns asked if anyone could be expected to run their business that way in 2005.
As for the figures, they are almost beyond imagining. $6tr a year is spent on health worldwide, but in a spirit of chaos and mutual incomprehension. In the US, there are two million adverse drug reactions a year and 100,000 avoidable deaths, because there are no systems in place to catch dangerous interactions. Nor can one be created, because there are no standards. There are more checks in place when you buy a book from Amazon than in hospital medication administration, claimed Burns.
He repeatedly drew comparisons between health care and IT. The very things health care needs the most — universal standards for all data, standards for interfaces, standards for interoperability — are the things that IT does best. It's a unique industry, he said, where the competitors fight like crazy all day and agree on how to work together afterwards. The biggest single software cost in health, he said, was for proprietary software that links proprietary systems together: with standards, fully $2tr of those $6tr could be saved. In pharmaceutical research, information needs to get out to patients quickly, intellectual property issues need to be handled efficiently...
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...data needs to be collected and analysed efficiently. All matters where the IT industry has both the tools and the experience to help create a revolution.
But the biggest challenge is far greater than any of the above considerations. In the US, 15 percent of GNP is spent on health — a huge amount. Yet to maintain that level of care, this will have to grow to 25 percent by 2015 — which it cannot possibly do. Burns called it the bruising of the economy. The developed world is aging rapidly: by 2050, a fifth of its population will be over 60. The current system will not scale to cope with that. It cannot. If we started training doctors and nurses today, said Burns, the gap could not be closed. Healthcare as it exists today will not cope.
IT — and nothing else — has enormous potential to solve this problem. It can bring early diagnostics — infinitely better than treating a developed disease — into the home. It can also let elderly people stay at home far longer, giving them a much greater quality of life at a much lower cost than if they had to move into a traditional managed environment. It can help bring expertise to bear faster, with better data and more efficiency, than any imaginable alternative. There is no part of medicine where IT cannot make a huge difference, freeing the practitioners to do the jobs they trained for.
Of course, IT has had a chequered history in health care. Too many companies have come in, messed up and run away, generating a great and well-deserved suspicion with many health professionals and managers. More than ever, it's important to listen first, listen second, then listen again before deciding what to do. The people in healthcare are the ones qualified to make the decisions. But IT knows how to solve problems. There is no more pressing problem on the planet, let alone one that can so clearly be delineated as an issue of collecting, analysing and acting on data.
The potential is indeed huge — so big, it's hard to know where to start. How can universal standards be generated? How can the IT industry coordinate itself to create what will become a brand new industry bigger than any other on the planet? How can we even begin to know how to talk across the administrative, political, technical, legal and personal boundaries that mark the state of health and IT today? Yet nothing smaller than the biggest possible effort will do: anything else will fail, and failure will be miserable in every possible way.
Louis Burns and Intel are clearly determined to give this their best effort. It is unthinkable that anyone else should do less.