Coye, head of the UCLA Innovates
Healthcare initiative at the University
of California, Los Angeles. “We will
know what your blood pressure is ev-
ery morning at 8 o’clock, or how it var-
ies during the day, instead of every six
or eight months when you go to the
Such increased monitoring could
catch potential problems earlier, per-
haps leading to more effective treat-
ment or outright prevention of some
conditions. It could also reduce costs.
The VA estimates its in-home moni-
toring saves thousands of dollars per
patient by reducing doctors’ visits and
nursing home care.
The growth of the “Internet of
Things,” in which now-discrete devices are networked, could provide both
monitoring and feedback, suggests
Isaac Kohane, professor of pediatrics
and of health sciences and technology at Harvard Medical School and
director of informatics at Boston’s
Children’s Hospital. Your refrigerator, for instance, might offer suggestions to help you adhere to your diet,
devices, “we will
know what your
is every morning
at 8 o’clock,
or how it varies
during the day,
instead of every
six or eight months
when you go to
the doctor,” notes
molly Joel Coye.
or the motion sensor in a gaming sys-
tem could be used to guide physical
therapy. “Pretty much everything we’re
doing today could have a sensor,” Ko-
hane says. “Your scale could have an IP
There’s already a package of sen-
sors that many people carry around
with them every day: their smartphone.
“People are walking around with de-
vices that make it much easier to cap-
ture in-the-moment data,” says Debo-
rah Estrin, director of the Center for
Embedded Network Sensing at UCLA.
Analyzing patterns of a smartphone’s
GPS traces could reveal changes in a
person’s behavior, perhaps signaling,
for example, a bout of depression or
an increased risk of suicide.
Estrin is a proponent of developing
an open architecture for mHealth, the
practice of using mobile communication devices for monitoring patient
health. A patient telling a cellphone
app about symptoms or pain levels
will be more accurate about how he’s
feeling right now than trying to recall
these details in a visit to the clinic days
or weeks later, she says. Existing apps
already help people keep track of diet
and exercise, for instance, but if they
could feed the information back into
a permanent health record available
to the doctor, they could offer much
Protecting Patient Privacy
If all this is to work, strong privacy
protections will be important. Latanya
Sweeney, professor of computer science at Carnegie Mellon University,
says data should be segmented and in
the control of the patient. This way, a
patient could share information about
an HIV test only with her primary-care
doctor while letting everybody know
about her allergies. There also should
be a way to track who sees patient data
to help prevent abuse, Sweeney says.
If a bank, for instance, is buying information about a customer’s cancer
risk and using it to adjust their credit
scores, a patient ought to know. Sweeney worries that a lack of privacy incentives in the health-care initiative
will produce a backlash.
Even with patient names stripped
away, it’s possible to cross-correlate
data and expose private information,
the way some researchers have used
public data to deduce an individual’s
Social Security number. On the other
hand, Graham points out, prevent-
ing all such correlations could mean
missing connections and patterns
that might improve patients’ health.
Reaching the right level of data protec-
tion, Graham says, is both a technical
challenge and a policy issue.
Coye, M.J., Haselkorn, A, and DeMello, S.
Remote patient management: Technology-enabled innovation and evolving business
models for chronic disease care, Health
Affairs 28, 1, Jan.–Feb. 2009.
Graham S., Estrin D., Horvitz, E.,
Kohane, I, Mynatt, E., and Sim, I.
Information technology research
challenges for healthcare: From discovery
to delivery, Computing Community
Consortium, May 25, 2010.
Realizing the Full Potential of Health
Information Technology to Improve
Healthcare for Americans: The Path
Forward, The White house, Office of Science
and Technology Policy, Dec. 8, 2010.
Designing a Digital Future: Federally Funded
Research and Development in Networking
and Information Technology, The White
house, Office of Science and Technology
Policy, Dec. 16, 2010.
Schiff, G.D. and Bates, D. W.
Can electronic clinical documentation help
prevent diagnostic errors? New England
Journal of Medicine 362, 12, March 25,
neil Savage is a science and technology writer based in
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