Ezra Butler reports on the changes technology has made to medicine and the current state of medical informatics.
“In truth, no private company would have been capable of developing a project like the Internet, which required years of R&D efforts spread out over scores of far-flung agencies, and which began to take off only after decades of investment. Visionary infrastructure projects such as this are part of what has allowed our economy to grow so much in the past century.”
— Michael Moyer, Technology Editor of Scientific American, in response to Gordon Crovitz’s revisionist Wall Street Journal editorial on the birth of the Internet.
In the the past year, much digital ink has been spilled against platforms who choose to protect their data, namely Twitter and Craigslist. The self-righteous protectors of the weak and flailing, exemplified by LinkedIn and PadMapper, have lined up to pen one caustic essay after another questioning how these “free” and “open” platforms could possibly stand in the way of a quasi-competitor potentially benefiting financially from their data. Heaven’s forbid!
The irony is that both Twitter and Craigslist were flukes of circumstance; they began as side projects that subsequently went viral. Both are paradigms of simplicity, replete with user-initiated conventions and norms. Neither was originally intended to become a household name, nor did either anticipate the scandals that would accompany the success.
Many darlings of Silicon Valley have similarly humble beginnings, including Apple, Facebook and Google. A commonality between these companies is that the interest of the public caused their exponential growth.
All of these companies have spawned ecosystems around them, enriching not just themselves and other developers, but companies designed to profit off the platforms they created. They each inched their way into the hourly lives of hundreds of millions of people. They have all made mistakes and missteps, most of them touting products perpetually in beta. Due to their utility, though, their user bases have forgiven their faults.
Consumer-facing companies are able to weather a bit of downtime, a privacy scandal or two, and an open debate about the publicness of their data. The only ones medically affected by changes are those chemically addicted to the dopamine bursts with every received tweet or comment on a status update.
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Around the same time Craigslist and Google were born, two companies located 400 miles due south of the Valley also came into being. But their products weren’t consumer-facing, nor did they have the luxury of launching beta products that skirted privacy or security issues. From the beginning, they knew that if their products turned out to be faulty, people would die. If their private information should accidentally become public, they would be breaking laws impossible to sidestep with an apologetic blog post.
The Virtual Pediatric Intensive Care Unit (or VPICU) was conceived almost 14 years ago by a group of doctors who recognised the need for introducing technology to help identify patterns and solve difficult cases from afar. They understood the obstacles in their path, including a lack of uniformity of data between different hospitals and departments, and the lack of technological recording solutions. They created a vision for medical informatics, starting with a single department: the paediatric intensive care unit. The group envisioned a system that identified common patterns in patients across the country and assisted doctors in diagnoses.
After many false starts and growing pains, VPICU has achieved many of the forming committee’s goals. It has linked together Children’s Hospitals in the United States and in many other countries. It records every piece of patient data automatically. As a dynamic database, it assists the attending physician in a diagnosis and identifying solutions that may have been helpful in other similar cases.
That isn’t all. As a secure linked database, the VPICU allows researchers to do previously impossible research and epidemiological trials. Yet the project is far from complete. In an interview with The Kernel, founding member and director Dr Randall Wetzel said his vision included a complete digital medical record from birth, including every EKG and every blood test from every hospital visit. A true medical informatic solution helps the patient and the entire ecosystem: “We take a family history when talking to a new patient, why shouldn’t we know that patient’s entire personal history?” To that end, he is organising MucMD (pronounced “muck-med”), an upcoming conference dedicated to the “meaningful use of complex medical data”.
In the decade and a half since inception, they’ve created a solution which saves lives and cuts back on time and mistakes. Hundreds of articles have been written with the assistance of the VPICU system. Data is now complete and uniform in every hospital on the system. That said, Dr Wetzel admits that the complete digitalisation process for all departments in every hospital will be long, arduous and expensive.
Zynx Health is another technology company which provides “evidence-based clinical decision support solutions“ for hospitals and clinics. They help their clients reduce costs and improve patient care quality. An acknowledged leader in the field, it was founded in 1996 by medical professionals, including the president and chief executive officer Dr Scott Weingarten, MD, MPH. According to their own numbers, in 2011, Zynx products were present for clinical decision support in almost 2,000 nationwide hospitals in the United States. Its UK-based sister company “Map of Medicine” is employed by over 50 NHS Primary Care Trusts and was designed by two London doctors.
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Most patients would never know about either of the aforementioned companies. Because they aren’t meant for the patient. They were designed by medical professionals to help medical professionals.
As Michael Moyer stated in his above-quoted essay about the history of the Internet, most companies are unable to invest decades of research and development and untold millions in the products of which 99 per cent of beneficiaries will never hear. These companies were never intended to “disrupt” the healthcare industry but rather remove a lot of the existing friction from a $2.5 trillion behemoth. It is not an industry keen on shortcuts or upstarts wishing to skirt regulations, because those regulations are what keep patients alive and breathing.
According to an informational document from the California Biomedical Research Association, it takes an average of 12 years for a new drug to progress from lab to patient. During that period, it undergoes a stringent battery of trials on both animal and human subjects. In the United States, the Federal Drug Administration (FDA) heavily regulates any introduction of a new medicine onto the market. The entire process, on average, costs $359 million (roughly 35 per cent of an Instagram).
To compare healthcare start-ups with social, search or hardware startups is akin to equating oranges with cake. The stakes are higher. The lead time is longer. The chance of success is not tied to an unforeseeable trend. And the astronomical returns in 4 years are improbable for venture capital funds like Andreessen Horowitz.
While VPICU and Zynx are saving lives and increasing patient care, Facebook is enabling virtual farming, and the Apple iPhone is helping closeted gay athletes and trainers locate temporary companionship whilst in London for the Olympic games. But don’t mistake the glut of “health” start-ups flooding out of Silicon Valley to make any significant difference to the well-being of our species. The real advances lie elsewhere.