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8/13/2002

Innovators Share Visions of Health Care's Future

Donna Young

Health care professionals got a glimpse of the future at the Emerging Technologies and Healthcare Innovations Congress, or ETHIC 2002, held in June in Washington, D.C.

The three-day conference featured futurists, strategists, and health care, policy, and technology experts.

New York dermatologist Alice P. Pentland, chair of the University of Rochester Medical Center’s Dermatology Department, and her brother, Alexander Pentland, founding director of the Massachusetts Institute of Technology Media Lab in Cambridge, lead a project that is developing a "smart medical home."

The envisioned home would have sensors; motion, video, and voice recognition technology; and other electronic devices that actively monitor the vital signs of residents and detect pathogens in the home’s environment.

Medical data collected by the smart home could be electronically transmitted directly to a physician’s office or to a relative or caregiver, said Alice Pentland.

Much of this technology, said Alexander Pentland, is already on the market or in production in Europe and Japan. But the United States, he said, is "lagging behind" in making it a reality. There is also a major question about how to integrate the expensive technology into the nation’s health care system, he added.

Jeff Goldsmith, a futurist and president of Health Futures Inc. of Charlottesville, Virginia, said the United States has been terrible at assimilating new technology into the health care system. Even with the many technological advances in recent years, he said, a good reality check is that many health systems still have problems sending out correct billing statements in a timely manner and health insurers still make printing errors on enrollment cards.

Goldsmith theorized that genomics will play a central role in disease management and care.

FDA will use genomics in its drug approval process, he said, to determine whether some people might have a genetic predisposition that causes them to have an adverse reaction to a drug. The agency, he reasoned, could approve a drug and require physicians to conduct genetic tests on patients before prescribing it—an alternative to not approving a drug after a handful of clinical trial participants have adverse events.

"Why should the rest of us be denied?" he said.

J.D. Kleinke, president of Health Strategies Network of Denver, Colorado, is skeptical that the health care system would willingly pay for available technology.

"You can build the systems, but then who is going to pay," he said. "Breakthroughs ultimately have a price. The people paying for things are the people standing in the way."

Managed care organizations, Kleinke said, have claimed that insurance costs have been rising because of new, innovative drugs. But, he said, health insurance costs have increased "because HMOs decided to raise them."

The original theory behind managed care, he said, was that the use of innovative drug therapy would keep people out of hospitals and keep health care costs down. But that vision, he said, has been lost.

The problem with innovation, he said, is that it does not always pay for itself right away.

"There is lots of good, innovative useful stuff," he said. But managed care needs to differentiate between cost-effective innovation and hype.

The paradox, he added, is that managed care organizations too often presume that because an innovation is expensive, it is hype.

"They don’t look at things in the long run," he said.