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.
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.
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.
You've got to be kidding me
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.
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.
Apple Watch activity tracking rings
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.
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