On Wednesday, November 3, Joseph Smith, a Hopkins graduate and physician, spoke on a topic at the intersection of health care and engineering.
Smith was the keynote speaker for the annual Medtronic lecture, which is a part of the Hopkins Biomedical Engineering Distinguished Lecture Series. Smith is currently the Chief Medical and Science Officer for the Gary and Mary West Wireless Health Institute. This foundation supports research on wireless technologies that could serve to detect, prevent or treat disease.
While the company that sponsored the talk, Medtronic, is primarily involved in the development of increasingly cutting-edge medical devices, Smith discussed how these rapidly evolving technologies can be used instead for the improved delivery of health care.
“We are living in the middle of the perfect storm,” Smith said, in reference to the country’s health care situation. “We added 30 million people . . . to a system that is admittedly already broken.”
But the most pressing issue is the financial burden that health care delivery is having not only on individuals, but an entire nation. “Growing health care costs are unsustainable,” he said. “Something clearly has to change.”
Specifically, Smith said, was that the quality of care Americans receive is nowhere near what they should be getting for the amount that they spend. But the problems run even deeper. “It’s not just that we can’t afford it, it’s that we’re not rigged for it,” Smith said. “There’s a mismatch between what we’re good at and what we need to do.”
“We have a health care system that has always been designed for acute illnesses and emergencies, and we are deluged with chronic diseases,” he said. Currently, chronic diseases account for 96 percent of all Medicare spending, and approximately 75 percent of all U.S. health care spending.
Despite the dire prognosis, Smith articulated a vision on how to use wireless gadgets and technologies to tackle these illnesses. “We should look at the metrics of the therapy while we’re giving the therapy,” Smith said.
In other words, Smith explained, the time constant of a disease, or the duration over which it progresses, is oftentimes different than the time constant at which medical care can be offered. For example, the fact that a patient with heart failure sees a clinician every six months does not necessarily mean that a doctor’s visit once every six months is the ideal rate at which to monitor the disease. Health care is being offered at the time constant of the health care delivery system or the physician’s schedule, not the disease.
Smith envisions a future where chronic disease is met with continuous, not intermittent, care. “The path forward is near, on or in-body sensor technology, providing actionable diagnostic information,” he said.
Though Smith described the health care system as relatively inept at dispensing continuous care, there are cases in medical care that address diseases at their time constant using these technologies. “The good news is we’re using wireless sensors for our aging infrastructure already,” he said.
For someone with an arrhythmia, for example, if his heart were to suddenly stop, by the time an ambulance or a defibrillator could be called to the scene, his chance of survival is low. However, the implantation of a pacemaker can shock the heart to eliminate the arrhythmia and allow the heart to resume beating normally.
Some other examples of wireless technologies that can continuously monitor and act upon a patient’s disease are glucose pumps for diabetics, heart failure sensors, drug delivery microchips and devices that can sense the onset of a seizure and stop it.
To our benefit, the infrastructure for implementing wireless medical technologies is already in existence. For instance, there are more cell phones in existence than living human beings. But there are still obstacles. “If you’re going to change a paradigm of care, there is an enormous amount of system work you need to do,” Smith said. “I don’t view it as a technical challenge; I view it as a marketing issue.”
Though the notion of wireless health care is still in an early stage, Smith believes that it holds enormous promise. “I think we have in front of us an irresistible opportunity for revolutionary change,” he said. Others share this view. Smith described speaking with Martin Cooper, the inventor of the cellular phone. “He thinks the single best thing the cell phone is good for is health care,” Smith said.
Smith remains optimistic of the future of health care. “Health care reform is one of those catalytic moments that will drive us to a solution.”
