Saturday, November 14, 2020

Why does the medical community in general not seem more interested in early detection?

Background

For a number of years I have been investigating and working on how to use IT/IOT/mobile devices to reduce the amount of time that passes, from when a frail/elderly or person with a chronic condition becomes ill, to the appropriate reaction/treatment can be started.
This process has almost in all cases historically been a reactive process. The person in question needed to become objectively visibly ill before someone would/could react. The history of medical diagnosis is a long and interesting one and have varied over time historically, but in general they have moved from rather crude to more and more sophisticated. Even if this has improved greatly it is still a reactive process. 


"Things that take time"

  • The patient's condition starts exhibiting itself or worsens
  • The patient's condition has to be perceived as "bad enough" to cross the patient's "do I call the medical services"-threshold
  • Physical transport time to the health care professional
  • Potential waiting times at health care professional (waiting time at the emergency room or opening hours of a private physician )
  • The health care professional may not have prior knowledge of the patient's condition and may misdiagnose it
  • Tests are done
  • Treatments are started

Depending on many factors like the

  • the patient's condition
  • the patient's "do I call the medical services"-threshold
  • the patient's physical location in relation to the relevant health care provider
the time from the condition starts exhibiting itself or worsens to the appropriate treatment has begun, can be from a few hours (at probably very best in non life threatening conditions) to several days.

This is not optimal use of important time and this can cause the health condition of the patient to deteriorate to a lesser or larger degree.

An example: COPD
( https://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_disease )


Since
2013 we have been working with a list of objective rules 

  • some rules use fixed ranges for a given value and if you are outside of this that will trigger a yellow or a red color (as opposed to a green color - where things are as good as they can be given the conditions).
  • some uses percentages deviation from a baseline
These rules have been set fairly conservative, and then based on remote monitoring we get frequent data from the patient. This rule algorithm has more or less eliminated most of "things that take time". 

It is still a reactive process in that until the exacerbation manifests itself in a measurable way like colored sputum ( spit / mucus ) or by the lung function declining. But these are still in many cases measureable days, if not up to a week, before the patient's condition worsens to the degree that they are admitted to hospital. This early detection often makes the medical corrections needed, significantly smaller.

If this is paired with a nurse with a specialty in COPD and a medical doctor that is specialising in COPD  as a backup that monitors the patients' values and receive alarms when the situation starts to decline. This paired with emergency medication located with the patients' then in the majority of the cases you can preempt patients being admitted to the hospital.


A question 


People in general are really good at using step counters, Apple watches and other health related devices for exercise purposes and other reasons. Why have the medical community and the hospitals not pushed for a greater adoption of remote patient monitoring in general?