Info Technology + Healthcare + Gaming = DiaBetNet

Recently I was flipping through Revolutionary Wealth, a book about the trends giving birth to a new "Third Wave" of economics, and read about an interesting concept: a game that kids play on PDAs (e.g., Palm) to learn about their own body works and to better manage their chronic disease, in this case Type I diabetes.

The name of the game is DiaBetNet. The Roche webpage and a collaborator's webpage explain the who, what & why of the game. The project was headed by a pathology resident named Dr. Vikram Kumar, who was a medical student at the time and who studied computer engineering in college.

It turns out DiaBetNet was successful in getting young diabetics to more closely monitor their blood sugar throughout the day, which is key to managing diabetes and avoiding its ghastly complications. A NY Times article from November 2004 explains the challenge of getting kids to become vigilant about their disease.

Getting children with diabetes to prick themselves four times a day to check their blood sugar levels can be a challenge. But doctors have found that if they turn the chore into a game involving a personal digital assistant, young patients will do the checks more consistently.

That article also explains the design of the study conducted by the Joslin Center, one of the world's premiere diabetes treatment & research centers, to test the game's effectivness.

So the researchers divided 40 young patients into two groups and gave them all hand-held computers for keeping track of their blood sugar levels, their insulin use and their carbohydrate consumption. They were asked to monitor themselves four times a day.

For half of the children, however, the P.D.A.'s also contained game software tied to the monitoring and designed by one of the study authors, Dr. Vikram S. Kumar, when he was a medical student.

The children earned points when they played the game and more points if they accurately predicted their fourth blood sugar score of the day.

The study found that those children with the game software checked their sugar significantly more often over four weeks compared with those who did not have the game. At the end of that time, they also showed more knowledge about diabetes.

What were the results? According to the Joslin Center's press release:

The study found that 78 percent of the Game Group participants checked their blood glucose four or more times daily compared to only 68 percent of the Control Group participants. Game Group participants also had fewer episodes of hyperglycemia (elevated blood glucose), with 318 instances reported vs. 377 instances reported by Control Group participants. What’s more, surveys given to all participants before and after the study showed an increase in diabetes knowledge among all participants, with a significant increase in knowledge only among the Game Group participants. “We are encouraged by the results of this pilot study. It demonstrated the ease of introducing new technology to pediatric patients with diabetes, with an additional benefit of increased blood glucose monitoring among the Game Group participants,” Dr. Laffel said.

After showing that info technology + healthcare + gaming works in improving the management of this chronic disease among children, Kumar founded a company called Dimagi to spread the use of DiaBetNet and similar PDA programs that help individuals and communities take better care of themselves with cheap wireless technology. More on Kumar & his company on this World Changing webpage.

Time mag essays illustrate cliched flaws in our healthcare

In the May 1st issue of Time, an article titled "What Doctors Hate About Hospitals" showed that even physicians, being the smartest guys & girls in the room so to speak, have a hard time getting their insurance companies to pay for procedures that made sense & were shocked by how often medical mistakes -- like a discrepancy between how much of a medicine the doctor prescribes and how much is actually given to a patient by the nurse -- are made in top-notch hospitals.

While the article isn't available to people like me who do not subscribe to the magazine, the related essay "How to Fix the System" written by Dr. Donald Berwick, president of the Institute of Healthcare Improvement, is.

One of his recommendations encourage the formation of a nationalized healthcare system:

The assertion that making health care a human right isn't feasible — isn't affordable — nearly makes me mad. It's just not true; in fact, we are the only developed Western country that fails to view health care as a human right. Leadership for change must come from the President and Congress. Without the promise of health care for all, we aren't likely to muster the energy and political will we need to meet the needs of our entire population.

Another recommendation places the responsibility of care not on the system or the government but on the individual:

The more control patients have over their own care—the more they know, the more involved they are in the design of their care—the better... Some people fear that, given choices, patients will not choose wisely or will demand too much. I doubt it—one study found that when patients actively shared in decisions about whether to have surgery, the rate of surgery fell 23% and satisfaction and outcomes both improved.

And while I try to maintain a non-partisan perspective by not taking sides on policy prescriptions, I feel no guilt in asserting that this recommendation makes plain sense:

Our current system of fragmented payment — for hospital stays, office visits, lab tests, drugs, and therapists — destroys the patterns of care that patients need, and leaves them confused and, too often, simply abandoned. Funding care for people over time, instead of for specific medical events, reduces the burden of illness by focusing on high quality preventive care.

To paraphrase Dr. Berwick, he believes implementing these seven recommendations will fix our healthcare system(s): making healthcare a basic right, incentivizing preventative medicine instead of acute care, enabling patients to make their own healthcare decisions, digitizing medical records, using techniques from engineering and human behavioral science to improve processes in care, encouraging people to have careers in primary care and nursing, and teaching people that conservative care is better care.

Seeing a doctor at your local CVS?

Well you won't find a doctor, actually. Instead you'll find a nurse practitioner, who provide much of the same care as physicians and prescribe medicine in 44 states, according to the Wikipedia entry on NPs.

This post isn't about NPs, however. It's about "quick clinics," the nascent healthcare setting that has been increasingly present in drugstores. In June 2005, the AP article "Big demand for medical care in a jiffy" highlighted the trend. What makes these quick clinics so appealing?

Basically, it's that MinuteClinic, RediClinic & others make "health care a little more convenient and affordable for everyone,” according to the CEO of MinuteClinics. "The average MinuteClinic visit does not require an appointment and costs the patient less than $50." (According to a 27 April 2006 article in the Baltimore Sun, that cost is typically $59.)

At the quick-service clinics, nurse practitioners diagnose and treat strep throat, pink eye, bronchitis and other common ailments. Howe and other MinuteClinic executives say their business is to health care what ATMs are to banks — making ordinary transactions easier while freeing up traditional providers for more complicated cases.

The cost savings of quick clinics have been recognized: major insurers like Blue Shield and UnitedHealth and some employers are already encouraging their clients and employees to visit quick clinics for basic care using incentives like lower insurance co-payments than they'd pay for visits to the doctor.

According to the Baltimore Sun article, Black & Decker set the co-payment for visits to quick clinics at $15 compared with $25 for physician visits, "which is much more costly to [the company]." And interestingly, the Baltimore article quotes "85 percent of visits to [MinuteClinics] are now paid by insurers or other third parties."

And the revenues that these clinics can generate has also been discovered, convincing Wal-Mart to rent space for quick clinics inside their stores. This actually kills two birds with one stones, providing low-cost care to customers as well as employees.

As expected, doctors' groups are unhappy about this new threat to their monopoly power over healthcare and people being seen in places other than clinics and hospitals, where more complicated medical conditions are best diagnosed, treated & managed.

But "Mai Pham, a senior researcher at the nonpartisan Center for Studying Health System Change, said the clinics could provide a better alternative for patients who might otherwise go to an emergency room for care or skip it altogether. 'It’s clearly meeting a market need, but there’s also concerns about why it is there is such a need,' Pham said."

And MinuteClinics' CEO adds that quick clinics "limit their work to common illnesses and are quick to send patients to emergency rooms or back to their primary doctors if other symptoms turn up." They also run tests and give immunization shots. "The clinics also pass records on to patients’ doctors and help those who do not have a physician find one."

In summary then, my take is quick clinics appeal to people because they're 1. cheap, 2. fast, 3. upfront about prices, 4. conveniently found in places they can shop, 5. the wait is shorter and 6. is a less-hassle option to get basic healthcare.

And quick clinics make business sense because 1. there are millions of uninsured or partially insured Americans who want healthcare, 2. millions shop at stores like Walgreens and Wal-Marts everyday, 3. the basic care they provide has lower overhead costs than a full-fledged MD-run clinic and 4. NPs provide high-quality primary care at a lesser cost than MDs.

Day One

This is a catalog of people, companies and trends where medicine, business, healthcare, human behavior, creativity & problem-solving intersect. Free free to comment!