By MICHAEL MILLENSON
A Deere tractor developed in Moline, Illinois and a stethoscope-for-patients from Singapore pointed to the future of digital health at CES 2023, the Consumer Technology Association gathering that’s become a global innovation hub.
The tractor appeared on a large video screen during the opening keynote by Deere & Company chief executive officer John May. The industrial company exec clearly relished the chance to trumpet the way Deere had turned tractors into high-tech tools to optimize farmers’ outcomes – an accomplishment inspiring envy among medical information mavens hoping to similarly transform patients’ outcomes.
“The John Deere presentation was one of the best technological presentations I have ever seen,” enthused ResMed chief medical officer Dr. Carlos Nunez at a later panel. Nunez pointedly noted that “you think health care would be difficult,” yet here Deere had revolutionized a centuries-old, rural, agrarian, manual profession.
Deere’s “smart machines” incorporate computer vision, soil moisture sensing, GPS with precise signal correction, machine learning and cloud computing, all of which enable farmers to plant corn, cotton and other crops “with precision beyond human capacity.” Farmers can track the tractor’s data collection with their smartphone and make real-time adjustments. In health care terms, that all adds up to personalized, evidence-based farming.
The technology gap between physicians and farmers is actually wider than May let on.
Farmers are known for conservatism and stubborn independence, yet they embraced an early version of Deere’s computerized moisture-sensing tractor more than two decades ago. By comparison, only a handful of hospitals at that same time even utilized a basic electronic health record.
Go back even further? In 1918, when John Deere himself put an engine on a plough to replace horses, many doctors were still dumping fertilizer (figuratively speaking) on the idea that patient care would benefit from a written, sharable hospital medical record.
(The John Deere Health Plan, which was eventually sold to United Healthcare, was also a pioneer in evidence-based, high-quality care, as I wrote for the Chicago Tribune back in 1993.)
The biggest change between today and 20 or 115 years ago, of course, has been incentives. The “outcome” of planting is critical to the farmer’s livelihood. In medicine, financial incentives are only now starting to reward outcomes and efficiency. With appropriate adaptation, medicine may yet reap rewards from what agriculture has sowed.
“We’re building something new in health care, not just in the United States, but across the world,” noted Nunez during the panel he moderated, “The Future of Care in America: A New Hybrid Model.” Panelists described how the pandemic, the rise of value-based care and technological innovation had not just pushed the industry towards a hybrid model of in-person and remote care, but had also broken down barriers among clinicians, insurers, hospitals and others.
“All are trying to understand how technology is going to change what we do, how we practice healthcare,” Nunez said in a video recording of the panel.
But if Deere ploughed an information-use furrow for physicians to follow, Aevice Health’s “world’s smallest wearable stethoscope for patients” highlighted the difference between soybeans and sick people. People demand a dynamic relationship with the health care system. No cornstalk ever contradicted a farmer, and no soybean ever sought a second opinion.
The AeviceMD stethoscope, recognized with a CES Innovation Award, is designed to “continuously and passively analyze chest sounds and log measurements onto an app to track disease progression” for individuals with chronic respiratory disease. But while the Singapore-based company pitches the product as helping doctors make better decisions, the symbolism of the patient wearing the stethoscope is clear: those decisions will be mutual.
The participatory medicine cry of “Gimme my damn data!” is gradually coming to fruition. Patients have a growing ability to access their electronic medical records, aided by new government rules, and a concomitant ability to analyze that information and bring that analysis into the therapeutic relationship.
The health improvement opportunities offered by sensors such as those contained in a smartphone, a specialized device or woven into “smart clothing” are just starting to be realized.
Yet the growing flood of patient-generated data will inevitably generate its own problems. One vendor, for instance, promoted a baby monitor whose “unique algorithm” learns the baby’s face, its facial expressions and its sleep positions, then sends parents a notification “every time a baby is in danger.”
“Alarm fatigue” for parents or saving a child? Device accuracy data was not included in the press release.
Michael Millenson is President of Health Quality Advisors, and an adjunct associate professor of medicine at Northwestern University’s Feinberg School of Medicine. As well as a long time THCB regular, he’s also a Forbes columnist where this piece first appeared.
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