At its recently-concluded Medical Innovation Summit, The Cleveland Clinic identified ten technology advancements they predict will transform health care in 2019. While they will undoubtedly improve health for many individuals, they are collectively unlikely to move the needle on health in our own population. Based on what Blockchain is promising for health care, to "better manage and have a clear understanding of patient records," I don't expect to see much change. As an antidote to the hype, I offer my own list of top ten trends or innovations that could, in fact, move the needle on health:
- Health disparities: Social disadvantages associated with race, income and neighborhood explain far more of the 23 year difference in life expectancy seen across the County than does health care. Our region cannot achieve its full potential without understanding and addressing disparities.
- Data visualization: Interactive maps, charts and data stories can motivate action much more powerfully than data along. At hdm.livestories.com, you can see maps and charts that show differences in health and health risks by Cuyahoga County neighborhood, and the lingering effects of 1940s era discriminatory lending practices on the ability of residents of some neighborhoods to live healthy lives.
- Predictive analytics: Organizations already use health care data to proactively contact patients showing signs of worsening health and avoid a visit to the emergency room. Public health practitioners could use the same techniques to identify individuals before they begin engaging in risky behavior such as smoking, and offer anti-smoking messages through the social media channels such as Facebook and Instagram.
- Changing how health care is paid for: Federal financial incentives now pay doctors to keep people well rather than to care for them when sick. This should tip the balance toward prevention and enabling people to manage their conditions without costly treatment.
- Screening patients for Social Determinants of Health (SDOH): Care plans tailored around patient's access to transportation, level of health literacy and social support is more likely to be followed than care plans that do not account for patients' circumstances.
- Referral for Social Determinant of Health gaps. After identifying SDOH gaps, health systems are starting to use technology to identify local organizations able to patient needs that affect health such as mold in a house that keeps sending a child to the emergency room with an asthma attack. Community-wide coordination of such social services makes it easier for patients to access services and increases the efficiency of social service delivery.
- Affordable access to home broadband: Cleveland is the fifth worst connected city in the country and gave rise to the term "digital redlining." People living in neighborhoods devastated by financial redlining two generations ago cannot access high speed broadband today. Community organizations can help people get low cost access to internet, and provide training needed to use connected health tools such as telehealth and remote monitoring of health conditions.
- Smartphones: By guiding patients to vetted “apps,” health care providers can support patient efforts to quit smoking, to exercise, find healthy food, take their medication daily, track their blood sugar, and learn from other patients. Digital skills and connectivity are a “super social determinant of health” that enable a patient to address not only their health but many of the social determinants of health as well.
- Free portals enable patients to access their electronic health records, schedule appointments online, message their providers, look up test results and learn about their conditions. These tools are applicable to every health condition, can be tailored to address barriers such as language and are especially helpful for patients who lack secure, private access to a telephone.
- Community Health Workers (CHWs) are uniquely able to help patients manage their health, their health care, and to address social determinants of health. Trained CHWs can screen and refer patients to community organizations for low cost data plans, computers or smartphones, and for basic digital skill training. CHWs can then coach "digitally ready" patients to use connected health tools such as telehealth and to use online tools such as on-demand transportation services.
Medical innovation will continue to advance at breakneck pace and Blockchain appears to be here to stay. Applying innovation to factors that go beyond health care, and ensuring that Blockchain addresses challenges of our most vulnerable members can put Cleveland atop a list we want to be on.
Amy R. Sheon, PhD, MPH