Monday, January 19, 2015

Making the Old New Again

I always love it when someone looks at something familiar in a completely new way.  I only wish health care had more examples of that.

The example of this kind of totally fresh thinking that caught my eye concerns traffic lights.  Yes, traffic lights.  We all know traffic lights.  Most of us have stopped at traffic lights (and sped through some yellows!), probably more often than we'd like.  They've been around in virtually the same format for over a hundred years now, and are indelibly part of the urban/suburban landscape.  Cities without them would seem like chaotic third world cities.

Well, if researchers from Carnegie Mellon University, led by Professor Ozan Tonguz, have their way, those familiar yellow boxes with the lights could become unnecessary.

The CMU researchers have developed "virtual traffic lights" (not to be confused with the separate CMU "smart traffic signals" project).  Instead of using physical traffic lights, lights would show up on the driver's dashboard as needed.  As Professor Tonguz told CNN: "With this technology, traffic lights will be created on demand when [two cars] are trying to cross this intersection, and they will be turned down as soon as we don't need it,"

The researchers claim the virtual, on-demand signal could reduce commuting times by 40%, as well as reduce carbon emissions and accidents.  And, of course, we wouldn't need all those physical lights; think of the savings on new lights, poles, and wires, plus on ongoing maintenance.

All that would be required is that every car -- and that means, every car -- is equipped with the required vehicle-to-vehicle communications technology.  No small task!  Some think this could happen in a year or two, others a decade or two.  Either way, it's mind-blowing to think that such a familiar part of our driving experience could be so utterly transformed by what seems, in retrospect, such an obvious solution.

Of course, with driverless cars coming on quickly, we may not even need the visible virtual lights.

Let's contrast this kind of thinking with health care.  You go to your doctor's office, and chances are he/she will come into the exam room wearing the usual white lab coat, a stethoscope around his/her neck, and with your medical record.  The lab coat goes back a hundred years, originally intended as a symbol that you really are dealing with a physician and yet now serving more as an incubator of germs; the stethoscope goes back 200 years with only minor changes since then; and, while the medical record may be kept in an electronic format now, the fundamental content and presentation hasn't really changed from the traditional paper versions.

Yes, I know -- health care has plenty of new technology and many kinds of improved treatments, but I'm not sure we're getting a lot of reinventing.  Where are our virtual traffic lights?

One small -- well, maybe not so small at that -- health care example is a new patient tracking system called PatientStormTracker, developed by Lyntek Medical.  As the name suggests, PatientStormTracker borrows from weather tracking to present patient monitoring data as systemic color monitoring.  Instead of trying to follow the usual rows and rows of data, clinicians can actually see a patient's status -- color-coded -- and watch it progress in real time, including which body systems are currently being impacted and how much.  

The video is pretty cool.  

Lyntek's founder and CEO, Dr. Laurence Lynn, told The Columbus Dispatch that traditional patient monitoring is like a fire alarm -- either on or off.  As he said: "We have this simple fire alarm idea that existed from the 1980s, and it didn’t evolve, it didn’t improve."  I think saying it only dates to the 1980's is being generous.

Dr. Lynn wants to monitor patterns and detect trends earlier, when interventions are more likely to be effective.  "People don’t just die of some instantaneous thing,” Dr. Lynn said. “There’s an evolution of instability that is often unrecognized.”

PatientStormTracker is in clinical trials.  

One proponent of radical changes in health care has long been Dr. Eric Topol, who happens to have a new book out (The Patient Will See You Now: The Future of Medicine Is In Your Hands).  I have not yet read his book, but I did read his related op-ed in The Wall Street Journal.  His version of virtual traffic lights, if you will, is the smartphone.

Dr. Topol outlines not just increasingly common functions like virtual visits or monitoring using a smartphone, but also apps that assist with testing and even diagnosis.  He gives the example of an app that allows you to take a picture of a worrisome rash, and have a computer algorithm generate a message that suggests what you should do about it -- instead of worrying for weeks while you wait to consult a dermatologist.

I especially like his prediction that wearable sensors will make it possible that "...except for ICUs, operating rooms and emergency rooms, hospitals of the future are likely to be roomless data surveillance centers for remote patient monitoring."  That would certainly upend how we view hospitals...finally.

Perhaps those remote patient monitors will use something like PatientStormTracker.

Dr. Topol is not alone in proclaiming this DIT (do-it-yourself) movement; PwC listed it as one of their top trend healthcare trends for 2015.  As their report says: "“Apps formularies,” smartphone plug-ins and intuitive devices may become as important to clinicians as the prescription pad was to an MD in 1960."

Of course, even that prescription pad is likely to be smartphone-based now too, or at least electronic.

The smartphone technology options are cool, but what Dr. Topol sees as an even more important trend in putting all the newly-captured data in the cloud, mining it, and using it to target interventions. thereby "transforming it [medicine] from a weakly evidence-based practice to a data science, with empowered individuals at center stage."  Sadly, both the data science and truly having individuals at center stage would be pretty radical changes.

Changes are going to come at us from seemingly left field.  We can never be quite sure where they will lead.  Apple wanting to sell music online led to the iTunes store which led to selling apps in it which led to smartphones exploding in popularity which is now leading to using Apple Pay instead of credit cards, and now ATM cards and drivers licenses are also starting to follow the smartphone trail. Who'd have guessed -- and who can tell where it will lead next?

It just takes some innovator to see the familiar in a different way -- and then manage to convince us, and the medical-industrial complex, to change.  I fear the convincing is harder than the seeing.

Hey, I'm still waiting -- and hoping -- to see the holographic medical record I've suggested before...


  1. Virtual traffic lights are a pretty cool idea, and there are many great inventive ideas in healthcare based on the latest technology, a few of which Kim describes. I am in private equity, and one of my first tests of a new idea is the 'practicality test'. These are my thoughts about the practicality of virtual traffic lights: (1) I assume that there will be at least 10% of cars where the technology is on the fritz (a conservative assumption, after all it is technology and car maintenance is not at the top of most people's to-do list), either it's just not working or it's giving bad signals ... so with this technology I will be slowing at every intersection just to be cautious, whereas now if I have a green light I'm totally confident. This would frustrate me and slow me down tremendously. (2) This is pretty dangerous for bicyclists and pedestrians, who would have no idea what to do at an intersection if it weren't for traffic lights. (3) Finally, and most importantly, this technology would not be at all helpful in traffic jams, which are arguably the most frustrating, time-consuming and gas guzzling part of driving. So virtual traffic lights, at least for now, do not pass the practicality test in large part because of unintended consequences. Of the many new inventive healthcare technologies I've seen, most do not pass the test as well for various reasons, but let's not stop trying! It's truly an exciting time.

  2. Great point, Donald. My mind had boggled about getting all cars enabled, but hadn't considered cyclists or pedestrians. To be fair, even now one must approach intersections cautiously because of drivers, cyclist or pedestrians who ignore the lights, with obliviously, aggressive, or because they are impaired.

    Practical or not, I just like rethinking the basic concept. As you say, let's not stop trying!