If It Ain't Real-Time, It Ain't Really Real

Here’s a damning opening paragraph from an article in The New York Times about the frustrations that COVID-19 vaccinations are causing:

For a vast majority of Americans, a coronavirus vaccine is like sleep for a new parent: It’s all you can think about, even if you have no idea when you will get it.

Because, as Kaiser Health News reported: “Many states don’t know exactly where the doses are, and the feds don’t either.” 

Think about that: in 2021, we can’t – or don’t – track something as vital as where vaccine doses are, in the midst of the pandemic they were designed in record time to mitigate. Nor, as it turns out, are we doing a good job of tracking how many have already had them, who is now eligible for them, or assuring that essential workers or disadvantaged populations are getting them. 

Credit: MedCity News

Amazon tells me when my purchases have shipped, where they are in the shipping process, and when they’ve been delivered.  They even send me a picture of purchases sitting on my porch to make sure I notice. Walmart’s supply chain management is equally vaunted. 

Health care executives evidently aren’t required to learn supply chain management. 

What started me thinking about this was an article in The New York Times by three economists: Raj Chetty (Harvard), John N. Friedman (Brown), and Michael Stepner (University of Toronto) on economic data.  Early in the pandemic they realized that existing economic indicators were lagging indicators, based on surveys and transactions that happened weeks or months ago.  So, they built “a new publicly available economic tracker to better monitor the economy in real time.”

As they explain:

But we live in the age of information, where virtually all economic transactions leave a digital trail — from credit card receipts to paychecks to loans. These data are routinely used by companies and financial analysts to make better business decisions. And when the same data are put in the hands of the public, they can be used to guide our most important policy decisions, too.

The data provide “an unprecedented lens into how the economy is functioning — county by county, day by day, for low-income and high-income Americans.”  For example, they were able to show that people spent last April’s $1,200 stimulus checks very differently than December’s $600 ones.  Higher income people saved most of the latter, whereas lower income people spent most of both. 

Since Congress is now debating another round of stimulus checks, this information seems important.  The authors assert “if we make policy in February 2021 based on economic conditions in April 2020, we risk reaching the wrong conclusions.”   Good rule of thumb: the older the data, the less confidence we should have in decisions based on them.

Meanwhile, in healthcare we don’t know where our vaccines are, much less how many people are already (or have been) infected.  Other important questions like how many people lack health insurance are only estimated, months late.

Of course, the pandemic started with us failing at testing and contact tracing, so we started in a data deficit that has only gown worse, and more lethal.  It’s happening again right now, as we’re failing to accurately track and react to the new coronavirus variants that are spreading rapidly in the U.S. 

Tracking COVID-19 cases, hospitalizations, and deaths has become something of a cottage industry, with each county health department, hospital and state trying to figure out how to track and report these important data.  We may never know how accurate most of it is.  One only need look at what has been happening in Florida to get a sense of how shaky the data might be. 

Some good work has been doing during the pandemic about using more real-time data, such as use of cell phone data to track how much people are travelling and even degree of social distancing.  Similarly, there are apps that allow cell phones to warn of potential COVID-19 exposure, although the low rate of uptake has hampered their usefulness.  

But it’s not enough, and it shouldn’t just be for COVID-19.

You've got to be kidding me

It is beyond me why, for example, there’s not a universal app for people to register for COVID-19 vaccines, alert them when there are local doses, allow them to schedule appointments (including second doses as needed), track vaccination (including which vaccines were used), and report to state and federal health agencies.  It should be technologically feasible, except maybe not in healthcare due to the various siloed, creaky IT infrastructures.

I’ll go a step further.  People worry about potential vaccine side effects, but there is no systemic way to track them – just as there isn’t for other prescription drugs.  It falls to the patient to determine if they think their side effects are serious enough to alert anyone, and even then that report may not get passed on.  Again, there aren’t technological barriers to tracking these, just inertial ones.

Similarly, it has always concerned me that, if you’ve had a surgery or have been discharged from the hospital, tracking how you are doing is a rather loose affair. Patients usually have some sort of follow-up visit or phone call, but those might be days or weeks later.  Otherwise, the premise is, if the physician doesn’t hear from the patient, all is well. 

Apple Watch activity tracking rings

In fact, that is usually the premise most physicians rely on.  Their patient may suddenly be bed-ridden, or have a sharp decline in mobility, and only if the patient is concerned enough – or able – to contact them would they know.  Anyone who wears an Apple Watch, for example, can track daily, even hourly, mobility, but physicians aren’t alerted to any sudden changes in patterns.

They could, and should. 

We need “real-time, granular data,” as the professors said about their economic data, to know what is happening in our healthcare system, and to those of us who might use it.  We need to be proactive, not reactive. 

Yes, there are privacy concerns.  Not everyone will want even their physicians to know how they ae doing in real time.  It needs to be specifically targeted and permission based.  Nor will physicians be able to manage the amount of data that such tracking would generate.  This is the kind of monitoring where A.I. can help: understanding norms, identifying deviations from them, and reporting when they may pose potential health risks. 

We can’t keep running our healthcare system, or managing our health, using ad hoc, dated data.  It’s time for healthcare to be real-time and proactive.