Prognositcations and Health Policy

This week a number of interesting articles and announcements occurred.  The annual Consumer Electronics Show in Las Vegas provided lots of fodder for the quantified self-movement and prognosticators from around the world were exclaiming health innovation predictions for 2013.  Much of the exciting news centred on mobile health solutions, quantified-self tools and the emerging role of the consumer in the future of healthcare.

Mixed into all of this the Government of Ontario (Canada) and the Ontario Medical Association (OMA) announced that healthy people don't need physicals.   The agreement to eliminate the service will save millions of dollars in what the OMA claims are unnecessary tests and procedures as part of the annual physical or Periodic Health Examination (PHE).  In Canada, physicians and governments control the healthcare system and when they create a void by taking a service away such as annual physicals, one would think there would be an obligation to educate healthcare consumers on how to fill that void. 

Wow, I thought, what an incredible opportunity for the medical community to promote digital solutions for self-monitoring health status as a replacement for the annual physical.  What a great policy window for a government to offer tax rebates to consumers who purchase digital monitoring devices to self-manage their health.  But that didn’t happen.  Medical associations, while denying any value in annual physicals, continue to deny the effectiveness of digital self-monitoring. 

So, if the OMA claims that annual physicals are unnecessary, what is the role of physicians in preventative health care?  Who will benchmark an individual’s health status and who will assess and monitor an individual’s risk for chronic illness given that many factors are behavioural but many are also inherited? 

We know that chronic illnesses (diabetes, hypertension, arthritis, asthma, COPD and types of cancer) are creating a tremendous burden on healthcare systems around the world.  We know that managing chronic illnesses costs $190 Billion annually  in Canada and in the US, total direct and indirect costs from chronic disease were estimated to be $1.1 Trillion in 2003 (last time data was available).  We know that chronic illnesses are largely preventable. We know that certain behaviours increase our risk for chronic illness (smoking, being overweight, poor eating habits).

Preventing chronic illness and managing risk factors should be a collective priority for healthcare consumers, the medical community and governments. 

That said,  I don't oppose this shift away from physician-centric annual physicals but I want my primary care provider to acknowledge the role of self-monitoring and I want her to work with me to build our collective capacity in interpreting data from self-monitoring devices.  We need physicians and governments to agree on standards for self-monitoring devices that work from existing clinical practice guidelines and approved risk assessment tools.   We need them to partner with us.

Programming devices to alert individuals when their health is at risk is here now and it’s easy; however, having the medical community endorse the use of digital devices is a battle we will see played out for years to come.  The Fainting Goat optimistically predicts that annual physicals will be replaced by digital monitoring by 2015!!!  Well, maybe 2017 ... anyone for 2020? 

It's your health.  It's your health information. Manage it well.