Remember when you first burned your finger on something hot? Here’s how it worked. Temperature, pressure and pain fibers in the skin of your hand sent a signal to your brain that something was wrong (afferent limb). Your brain mysteriously and miraculously processed the information in a split second (central processing), and then sent a signal to the nerves that innervate the muscles of your arm and hand to respond and pull away (efferent limb). There are many neurologic diseases that affect the afferent, central and efferent components of this remarkable system, and that can cause lots of problems.
It’s the same with remote sensing devices and wearables. We’re seeing an explosion of systems that do everything from check for oral cancer via a device linked to an iPhone, to checking your vital signs via a remote gadget, to the latest iteration of the Tridorder that will measure analytes in your blood , through your skin, in the bat of an eye and transmit the results. Here’s another example.
Bill Gates described this feeeback loop in his book, Business @ The Speed of Thought, in 1999. He called it the digital nervous system and most of his predictions have happened way beyond what he predicted. What he called a nervous system has become the wiring for the 4th industrial revolution.
Like a growing fetus though, the cyberworld digital nervous system continues to evolve and develop. Unfortunately, despite all the hype and hope, there are considerable barriers to widespread adoption and penetration of remote sensing devises, systems to analyze the data and ways to respond to it that fall into four general categories:
1. Afferent limb problems: These are issues that involve the data that is derived and sent to the next step, the central processing station. For example, how do we know that the scale measuring your weight at home is actually accurate? How do I know that the person standing on the scale is actually the patient? How can we protect the data that is being sent from intruders or third party intermediaries?
2. Central processing problems:These are problems with how , when and where all this data is processed, stored, analyzed and displayed to create actionable information and generate a valuable efferent signal. For example, should the data be analyzed by a machine, a non-medical professional or someone else? How? How do we prevent “alert fatigue”, i.e. not sending some many false positive signals that users ignore the real emergencies?
3. Efferent limb problems: These are problems that involve who gets the information and what they are expected to do with it. For example, should the patient get the alerts or the doctor? What are the tools we offer to patients to change their health and wellness behavior and will they work? How do we get doctors to adopt these new technologies and use the information to prescribe interventions that will measurably reduce per capita costs, improve health outcomes and improve the patient experience.
4. End organ responses problems Perhaps the biggest problem of all is getting doctors and patients to change their behavior in response to the signals they are receiving.
All of this means that we need to build behavior modification central nervous systems. Given the complexities of human behavior the multiple factors involved, it won’t be easy.
Here’s what some people think the HIT brain will look like.
Getting doctors and patients to use a Tricorder to achieve the triple aim is fraught with obstacles that even Captain Kirk and Dr. Spock would find challenging. The first step will be to create a regulatory, reimbursement and intellectual property environmnent that creates an ecosystem with an incentive to deploy existing technologies using businesses models that create a profit. Welcome to the Starship Enterprise.
Image credit: Johns Hopkins Hospital
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