Access = Good. Prevention = Better.

I have blogged previously about using technology to improve access to health information (for instance see Health, the next (online) frontier and Health in the Palm of your Hands). But while making health information more widely available improves the system, it is not a fundamental paradigm shift. Technology is truly exciting when it can change human behavior. And there is scope for this if the major forces in this space understand where our health care is broken.

For one thing, the United States does not have health care, it has "sick care". Our whole system is built on acute care. The vast majority of us go to the doctor when something needs fixing, whether it be a broken knee or an upset stomach. At the same time, doctors have economic incentives to do procedures, especially the most dramatic ones such as placing a stent in your heart. Chronic care is available but very expensive. A long-term condition like cancer costs the patient or the insurer hefty sums of money. Preventive care, which is arguably the most sensible approach, is on the sidelines. By and large we agree with the principle that people leading healthier lives get less sick, which ultimately means less suffering and economic cost -- and then fail to put resources towards this direction.

Imagine a world where technology would actively help in doing better preventive care:

• A person with high risk of diabetes uses his cell phone to measure the glucose content of the food he is going to eat, avoiding choices that can lead to poorer health.
• A community of casual runners uses pedometers that keep their history. The runners can then share their data, providing them an additional incentive to reach their goals.
• Better organization tools allow insurers to incentivize targets on preventive care. For instance, Kaiser analyzes the incidence of diabetes is high in an area and identifies risk behavior. It then requires physicians to spend say 50% of the consultation time specifically on prevention, which presumably gives Kaiser long-term savings.
  

This is a big issue. In the developed world especially, people are living longer and suffering from illnesses that can be prevented. Our grandparents may have had tuberculosis or malaria, chances are we will suffer from heart disease and arthritis. Acute care is not going to away but with the reduced incidence of infectious and water-borne diseases, prevention is going to become much more relevant in medicine.

In a perfect world, access to all information should lead to the best outcomes. An so we are focusing on the first step, which is providing the information. But we need to also consider the second step, which is how to use this information. A huge challenge -- but maybe some of you reading this share my faith that we can successfully leverage technology towards prevention.