Article - Issue 19, May/June 2004
Heath informatics initiative
Dr John Forrest CBE FREng
The healthcare industry is an industry which must surely go through a transition akin to those of agriculture and manufacturing. Both of these sectors employed vast numbers of people in their heyday, but as a result of engineering and technology now involve a small fraction of the population. The healthcare sector is currently over-managed, labour-intensive and inefficient, despite the fact that amazing progress continues to be made in a number of techniques and technologies. Computer-aided tomography scanning and nuclear magnetic resonance imaging have, for example, revolutionised diagnosis and made for much more precise treatment.
A major concern for all governments worldwide is the escalating cost of healthcare, exacerbated by ageing populations and the cost of treating the diseases of the older age group. Governments will inevitably seek to place more financial responsibility for healthcare on the individual and to limit increases in the proportion of national budget spent on healthcare. Both of these trends will drive a focus on achieving demonstrable value and efficiency in healthcare.
The changes in the future have to come through improved management of the sector, which requires massive cultural change akin to what happened in manufacturing, but continued advances in technology, particularly in health informatics, can play a major role. It is interesting to reflect that many machines, such as motor vehicles, are now fitted with condition monitoring systems that far exceed anything we have conceived for the human body. A revolution is already starting to occur in machine–machine communication, highlighted in a previous Editorial.
Engineering and information technology may be used innovatively to make radical progress in the quality and efficiency of personal healthcare. In many cases, relevant technologies exist or are in early stage development but have not been applied to healthcare since they derive from solutions in other engineering sectors.
One interesting concept is the personal health monitor – a wearable device that would give certain key indications of body functionality and condition. Devices are already available on the open market for the measuring of blood pressure, blood sugar level, heart rate, heart rhythm, body temperature and ovulation. All are open-loop systems, relying on the individual to take a decision on appropriate action. Many other externally accessible parameters could be measured. Certain other cultures have put considerable diagnostic store on the substances exhaled in breath; the indication of ketosis is an example. Much more recently, Arup have conducted experiments on the diagnosis and quantification of effects experienced by sufferers from so-called ‘sick building syndrome’ through the use of a device to measure skin acidity in those affected.
A key point, however, is the extent to which these gross external parameters can give useful indications of health and body performance. It may be that it is necessary to get into much greater depth in the measurement and understanding of changes that are occurring at the micro level in the body, associated with changes in aminoacids, for example. This is where some of the developments in nanotechnology at centres such as Cambridge and the CMI collaboration may have major impact.
There are also interesting social issues, as always with engineering innovation. How acceptable will it be for people to have a wearable health monitor? Many people in our society clearly have no concern whatsoever for their health, as evidenced by their eating, drinking and smoking habits to say the least. However, the increase in health clubs and interest in active sport might indicate that it could be acceptable to a sector of the community. Might these get preferential health treatment or lower health insurance premiums as an incentive?
In the whole arena of health informatics, a concept known as the wireless pill was demonstrated practically in the 1960s, but has been forgotten. It was a marvel of microelectronics at the time and transmitted a signal indicating pressure changes as it passed through the digestive system. An updated concept could involve a microchip on each pill (costing a fraction of the market price of the pill) which could be interrogated by a simple external monitor about uptake and reaction to the drug within the body. This could lead to lower and more effective dosage. Health informatics could be at the point that the transistor was in the 1950s.
Dr John Forrest CBE FREng