Friday, November 27, 2015

Hoping for Some Health Care Pi

Raspberry Pi thinks even $20 or $35 is way too much to pay for a computer.  That's why they just announced the Raspberry Pi Zero, which they're happy to sell for a startling $5.  That's right, $5.  Not $5 on some sort of monthly installment plan or as a cloud-based monthly subscription service, but a straight up purchase of a programmable computer for only $5.

I wish health care had a Raspberry Pi to drive down its costs in a similar fashion.

For those of you who had not been familiar with Raspberry Pi, their mission is to get inexpensive computers in the hands of more people, especially children.  They recognized that many families can't afford several hundreds or thousands of dollars for a computer, as you'd normally pay at Best Buy or Amazon.  And they believe it is imperative to let more people -- again, especially children -- have the opportunity to experiment with programming.

Their first computer, the Raspberry Pi 1 Model B, was introduced in 2012 for $35, and was followed over the next few years with other models that were as low as $20.  They made them cheaper and/or more powerful, but never more expensive.  Not content with selling some 6 million of these low cost computers, and following the advice of Alphabet Inc's Chairman Eric Schmidt that it was "hard to compete with cheap," they developed and rolled out the Zero, figuring $5 was as low as they could go.  No kidding.

The initial batch of the Zeros sold out within a day.    

Sure, for the $5 you're not getting an Apple MacBook or a Microsoft Surface Book, but it is powerful enough to play games, connect to the Internet, and use its simple programming language to connect it to home devices, create your own games, maybe even build a robot or two.   I'll probably be sticking to my PC -- I'm not likely to be building any robots anyway, much as they fascinate me -- but I'll bet there are a bunch of teens or even preteens who could do some pretty cool things with a Zero.

For $5, why not?  It might be a great stocking stuffer or Hanukkah gift.  

Meanwhile, in health care we're not surprised to read headlines like "Cost of Skin Drugs Rising Rapidly," reporting on a study that found prices of 19 brand name dermatologic drugs have risen 5 fold, on average, over the past six years, with most of those increases happening more recently.  It'd almost be funny if we weren't the ones paying these huge increases, which of course we are, either directly or through higher health premiums.

I'm not going to pile-on any further about prescription drug increases, especially not after reading the analysis in Health Affairs by Kenneth Thorpe and Jason Hockenberry that suggests prescription drugs may not be quite the culprits we're getting used to thinking they are.  No, there are plenty of parties in the health care system that make the health care equivalent of a $5 computer almost impossible to imagine.

We have, after all, a health care system in which heart patients apparently do better when the top cardiologists aren't around, because fewer things are done to them, and in which "inaccurate and unreliable tests" are resulting in unnecessary care, raising costs, and putting patients at risk, according to the FDA.

Sure, we have organizations like Diagnostics For All, which works on developing "low-cost, easy-to-use, point-of-care diagnostics," with particular interest in their use in developing countries.  (A couple of months ago I might have cited lab pioneer Theranos as another example, but that's probably not such a good idea right now).  Many people think mHealth is a particularly potent way to introduce low-cost care options, again mostly for developing nations.  UNICEF is sponsoring The Wearables for Good campaign to help spearhead this kind of effort.

But let's face it: when it comes to health care, we are a developing nation; we just pay more for it than anyone else.  

Even after ACA, we still have some 32 million non-elderly uninsured, some 44 million insured people avoid getting care due to concern about costs, only half of Americans rate the quality of our care as at least good, and by more objective measures our health care system is closer to the bottom than to even the middle when compared to other "developed" countries.

So where is, say, our $5 EHR?  We can't even get EHRs that physicians like.  Where is our $5 MRI?  Their range in prices is eye-opening, but it's safe to say even the cheapest would make a full price computer look cheap.  One could argue that we have $5 drugs, what with close to 80% of prescriptions filed being generic, but I don't see many people jumping up and down with excitement about how cheap their prescriptions are.

For that matter, where is our Mozilla, our Wikipedia, or our Linux, offering widely used free services of tremendous value?

In our health care system, we think we're winning if we slow the rate of growth, although it remains above overall inflation.  Even new entrants seem to be more interested in getting their piece of the $3 trillion pie than in doing what Raspberry Pi is doing for computers.  

Who is going to be our Eben Upton, our Jimmy Wales, our Linus Torvalds?  Wouldn't it be cool if it ended up being one of those kids tinkering on his Zero?

1 comment:

  1. I found it!

    On Monday I secured my first institutional client for the (ok... a) solution to the $60B problem of avoidable hospitalizations for the frail elderly.... for $5! (per caree per month)

    The genius of the Pi is that it provides a _platform_ for computing at a negligible cost. Whereas most of us cannot build a computer (at any cost), Pi is proving there are hundreds of thousands of committed folks who, if this platform barrier is removed, are anxious to unleash their creativity and commitment to create solutions.

    In U.S. healthcare, one equivalent is the 49 million informal caregivers (source:AARP). Many would embrace collaborative, connected, data-driven tools to share care of their loved one among their informal care team (siblings, children, aides, friends) as well as to connect as needed with their loved one's doctors, nurses, specialists, case managers... were one available. Instead, informal caregivers - who provide more than 80% of care for our frail elderly - are stuck in a paper based, disconnected, non-data empowered world... and getting sucked dry in the process from the isolation.

    What mine and many other innovative companies are doing is unlocking the potential of informal caregivers to become visible, valued and supported members of an integrated Formal-Informal care team at low Pi-like marginal costs!

    We are doing this by providing mobile collaboration platforms we call Personal Care Managers (PCMs). PCMs are geared to the interests and needs of the Informal caregiver and caree's family that are also HIPAA-compliant and EMR- based for interoperability with Formal caregivers as needed.

    Finally, PCMs are shifting people's thinking about what "healthcare" and in the process unlocking massive distributed "caring power", in the same way Pi creates a new paradigm of massive distributed "computing power".

    The future is looking bright!