Wireless Technology Leading to ‘New Age of Medicine’

BI&T: How can wireless technology help to lower healthcare costs? Joseph Smith: Even a superficial view of U.S. healthcare spending would suggest there should be many opportunities to reduce overall healthcare costs while simultaneously increasing both quality and access. After all, we lead the world by a substantial margin in per-capita spending on healthcare, while we rank well down the list in important metrics of healthcare outcomes, such as infant mortality and overall life expectancy. Many have already drawn attention to the impact of perverse incentives (rewarding physicians and hospitals for procedures and visits while hoping to achieve a marginally related goal of a healthier population, which would ideally result in less of each); the enormous wasted expenses related to defensive medicine (physicians’ rational response to exceptionally aggressive plaintiffs in the absence of medical malpractice reform); and gaming of the complex and uninspired reimbursement systems. At WWHI, we are taking a direct approach of innovating and validating solutions that when broadly deployed can change the process of healthcare. It is illustrative to consider that our current healthcare system was developed to treat accidents and emergencies. Yet it is chronic diseases that consume the overwhelming majority of our healthcare dollars. Our delivery systems are best designed to rescue and resuscitate while the need is more for continuous course correction. We need to move the delivery of care for chronic diseases from the doctor’s office and hospital wards and emergency rooms back to the home—effectively placing the patient in the center of an infrastructure-independent healthcare network. This decentralized view of healthcare requires a mixture of near-, on-, or in-body sensors; wireless communication; analytics and decision support, all married to titratable therapeutics. Early and ubiquitous examples of this model of decentralized care are in diabetes and cardiac disease. In diabetes, we are all familiar with home glucometers now giving way to continuous glucose sensors and self-administered insulin now yielding to smart insulin pumps. The marriage of the continuous glucose sensor to the insulin pump is a closed-loop system that illustrates the concept of infrastructure-independent care. Similarly, implanted defibrillators (ICDs) are a closedloop solution to the problem of intermittent ventricular tachycardia/ventricular fibrillation. The embedded sensor detects the problem—in this case, a malignant ventricular tachyarrhythmia—and provides an appropriate and often life-saving therapy in seconds. At WWHI, we are working to extend this same model of infrastructure independent care to the management of chronic diseases that would otherwise consume significant resources at times of clinical decompensation or in relation to predictable complications. Congestive heart failure and chronic kidney disease are two very significant examples.