The time when we will all walk around with non-invasive, wearable medical sensors and use simple devices that will point to potentially harmful physiological changes is nearing.
Electronic medical records (EMR) are already making it possible to diagnose and monitor patients' condition in the community clinic and any hospital. A newer development will be individuals monitoring their own health.
Alerts on high blood pressure, cholesterol and sugar will automatically be produced; a parent will place a put a CellScope device into his child's eardrum to detect an infection, with a prescription for antibiotics being dispatched to his home to treat it. A respiratory monitor will detect early asthma spasms.
Irregular heartbeats will be detected through a sensor attached to the chest with a piece of tape, and transmitted to a call center over the phone.
But what about the economically and educationally disadvantaged who don't have access to these services or the ability to understand and use them? The practice of medicine is about to change drastically, threatening to turn individuals into their own layman doctors. But physicians and medical students will argue that despite all the digital gadgetry, doctors will always be needed to listen, observe, counsel and prescribe.
An afternoon symposium on "
"Information technology is crucial in the health system," said Dr.
"Huge challenges face
All countries face the problem that health reform fails if it isn't available to all in the country, pointed out Dr.
"Americans spend more than 16 percent of their gross domestic product on healthcare, compared to only 7.5% in
"For 2,000 years, healthcare consisted of giving potions for acute conditions. In the past century it has been medications – and you either survived or died. For a hundred years, we have been treating mostly chronic illness such as congestive heart failure, 'dropsy' [swelling of soft tissues due to the accumulation of excess water] and diabetes. Before insulin was produced, kids with type 1 diabetes were starved so they could live longer."
Today, continued Javitt, 70 percent of healthcare spending is on chronic illness. People who are economic and socially disadvantaged, living alone, or have chronic pulmonary disease are disproportionately suffering.
"How do we invent new system that deals with the problems of today? In 1988, we suddenly realized that we knew more about the healthcare system than we thought. Most Americans, but not all, had health insurance and left an electronic trail. If you went to one
"You can use electronic data to identify medical errors. For example, you look at people who got a heart attack but never were given a beta blocker [to protect against a second heart attack]. Everybody does it now.
Electronic medical records are slowly becoming the rule in the US."
Javitt noted that because
"Today," said Javitt, "patients with chronic illness can be helped to manage their condition, avoid complications and superfluous hospitalization and have longer and more satisfying lives. Just a 10% reduction in diabetics' blood sugar can reduce complications such as stroke, heart attack, blindness and amputation of limbs by 40%. This significantly reduces the need for hospitalization ad reduces costs."
Connectiveness means that in the US, pharmacy chains can refill prescriptions by scanning labels, and can provide medication reminders to customers. Patients no longer have to be alone. "There is always somebody out there to help with healthcare," Javitt noted.
The US expert looks forward to a future with medical sensors.
"It will be possible to identify patients who are not yet in trouble but will be if they are not treated early. Developers of sensor technology need a lot of imagination – to think out of the box. Missile identification technology was adapted to identify asthmatic children who need steroids, for example."
Israeli hi-tech people are "full of good ideas, and sensors are inexpensive. The industry is perfect for Israeli minds and situations."
But he noted that Israeli physicians "are as resistant to change as in the US. If they get paid by the visit, they won't have financial incentives to go along with the revolution.
But if they do get paid, they will cooperate," Javitt concluded.
DR. BOAZ Lev, the associate director-general of the
"I can't predict what will happen in a decade. Things develop so quickly. We realize many of the benefits, but we don't know what problems the new technologies will bring us.
We also don't know what the ministry's role, as a regulatory agency supervising the health system, will take."
He suggested that it was the
"They know that everybody checks their bank accounts and moves money around via the Internet, and nobody's accounts have been emptied out, so they should realize that health data can be shared and privacy still protected."
Coping with the outbreak of wild polio virus in
"We knew who had been vaccination and even who had wild polio virus in their stools, that we traced to see who had been transmitting the virus through the sewage."
"All the heath funds now have digital medical records, and any doctor can see everything that has been collected on his patients. Just as important is the fact that patients have the right to access their personal medical records with their test results, list of medications, data on vaccinations and so on. The challenge we face is to use the information intelligently, efficiently and effectively," said Kaye.
"Yet we must always remember that access to a computer cannot substitute for human interaction between the physician and the patient. Prescriptions can be obtained efficiently by cellphones, but the chronically ill patient has to be monitored by his doctor."
Kay also warned that very little in health promotion and disease prevention is being sought out by patients using their smartphones.
A CARDIOLOGIST at
"We all have ID numbers, the country is small and its health system highly centralized and regulated and there are only four public health funds." The Ofek system, he said, "is very welcome, as it united not only the community clinics and hospitals but also medical care in the Israel Defense Forces. Linking all of this saves a lot of money, but we are missing psychiatric services, nursing homes, geriatric hospitals and private hospitals, foreign or illegal residents and medical tourists. We still need big chunks of aggregated data and then decide what to do with it." Another problem is that different hospitals used different codes to describe the same medications and other things, he said.
"One hundred years ago, we were blind.
Now there is an explosion of sensing technology.
Decades from now, we will say that it's unbelievable we lived without it all. We didn't know what was going on in our bodies. People went to their doctors only when they didn't feel well. It was very primitive. In the near future, we will reach the age of continuous monitoring, and it could save our lives.
Maybe we'll be able to predict a heart attack three days before it occurs. We'll be able to identify cancerous tumors when they are only half a centimeter in size. The technology is all there," said Singer. "What's holding us back are bureaucratic and legal problems."
The symposium was held in memory of American Jewish healthcare pioneer
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