I have been blogging a lot lately about various types of health monitoring devices and medical apps that can be attached to, or run on, smart phones (see: "Check Engine Light" for Health Surveillance on Our Smart Phones; Healthcare Consumers as Self-Trackers; Process Enabled by New Apps). Smartphones are fast becoming the "brains" for ECG testing, ultrasound scanners, and lab analyzers such as glucometers and pulse oximeters (see: iHealth adds smartphone-enabled glucometer, pulse ox). This wave of innovation is going to have a major impact on healthcare delivery in both developing countries as well as the more developed ones. Consider the following ideas connected to this prospect:
- There is a long history of developing countries being able to leap over previously essential steps in the evolution of technology. For example, a number of countries have been able to avoid the installation of fixed telephone land lines, going directly to the construction of cell phone towers.
- One of the most challenging and expensive steps is the diagnosis of complex disease (e.g., malaria, AIDS). Once a diagnosis has been established, some treatments can be as simple as dispensing the appropriate drug at a specified dosage.
- There is a major movement underway to develop low-cost technologies such as medical imaging that are connected to smartphones. Such technologies can be then deployed in developing countries quickly and inexpensively (see: Using an iPhone as an imaging device in developing countries; LOW-COST X-RAY IMAGING SYSTEMS).
- Test results and imaging study results can be uploaded to "the cloud" from developing countries where they can be interpreted by algorithms or by physicians participating in expert networks. Such an approach will be essential for deployment of some of these new technologies in developing countries with a shortage of diagnostic physicians like pathologists and radiologists.
I believe that all of this will result in a new type of sophisticated healthcare delivery system that is technology-driven but staffed by healthcare practitioners with less training than physicians. Some of the necessary expertise is provided by the point-of-care device, the smartphone, and the cloud. This is analogous to the deployment in the U.S. of physician extenders such as nurse practitioners who will provide the first level of care and diagnosis, supplementing the PCPs (see: A Solution to the PCP Shortage: Nurse Practitioners). These physician extenders will refer the most complex patients to physicians operating at the next care level.