Monday, June 1, 2009

Heart disease, prevention -The 35th Innovation: Back on Track

June 1, 2009- Ever since I wrote Innovation-Driven Health Care: 34 Key Concepts for Innovation (Jones and Bartlett, 2007), I’ve been looking for a 35th innovation – something big, something that makes a difference.

I think I’ve found it. It’s called SHAPE (System of Heart and Pulmonary Evaluation).
More on SHAPE later.

I started this blog nearly 2 ½ years and more than 846 blogs ago in search of innovations. But somewhere along the way, the biggest innovation of them all – U.S. health care reform- captured my attention and waylaid me from calling attention to private innovations bubbling up from below.

It is tempting to think of health reform as a huge public innovation – a monumental way of recasting the health system into a new and improved model.

But health reform is not my cup of tea, though my book Obama, Doctors, and Health Reform is due out any week now. The trouble is that I’m basically entrepreneurial and for freeing up doctors and liberating medical markets to bring costs under control without sacrificing quality. The major thrust of government reform is to rein in doctors – to bring the so-called medical industrial complex to heel to make health care affordable.

I’m a physician cheerleader, and I don’t buy into the concept that doctors are the main health cost-drivers. Yes, physicians sometimes overcompensate to make up for low Medicare and Medicaid fees. Yes, physicians sometimes practice defensive medicine and order too many tests. Yes, a few physicians self-refer. Yes, some technologies are over used, partly because they have become the standards of care in the eyes of the public and because physicians want to cover all the bases.

The movement towards reform is often too political, moralistic, and socialistic for my blood. As Winston Churchill said, “It is a socialistic idea that making a profit is a vice. I consider the real vice is making a loss.” If the title of his co-authored book No Margins, No Missions: Health Care Organizations and the Queset of Ethical Excellence (Oxford University Press, 2003)is any indication, even President Obama’s principle medical advisor, Ezekial Emanuel, MD – cancer oncologist, ethicist, and brother of Rahm Emanuel, Obama’s chief of staff – knows that profit is essential for the functioning of our health system.

In essence, I believe it is possible to do well, do good, and bring down costs at the same time and that the path to an efficient health system sometimes relies on market-based innovations and competing private health organizations. I do not beleive private plans can compete with government plans. They playing field is simply not level.

Which brings me to SHAPE and the fundamentals of true health innovation. To me the fundamentals of true and lasting health care innovations are these.
Ideally, the innovation should be,

• a genuine advance over previous methods;

• profitable enough to sustain itself and those who deploy it;

• of proven value in improving health;

• of sufficient scale to make a difference in the public's health;

• safe enough to do no harm and be FDA spproved;

• portable enough to be used in multiple health care settings;

• preventive enough to catch chronic diseare early enough to reverse its course;

• effective and targeted enough to chronic disease costs;

• understandable enough and easy enough to interpret for patients and physicians alike;

• specifie enough to forewarn patients of consequences of lifestyle misbehaviors.

• Data-producing enough to measure presence or absence of a disease, grade its stage, and track its response to therary.

• Affordable enough for patients and the system.

. profitable enough for physicians to justify its use.

Now onto SHAPE. For the last three or four years, I’ve been speaking to Stephen Anderson and following his work. Steve is an electrical engineer who has been working for more than 3 decades in the field of cardio-respiratory physiology. His long-time collaborator is Dean McCarter, a PhD in the same field, who has helped Steve develop the concept of SHAPE, which is based on the premise that measuring efficient breathing is key to understanding many of the major diseases that bedevil Western civilization.

These diseases include coronary artery disease, congestive heart failure, obesity with secondary diabetes, chronic obstructive lung disease secondary to smoking, and asthma. Taken together, these diseases account for at least 50% of all U.S. health care costs. If you give the matter any thought at all, you will realize most of these diseases are accompanied by inefficient breathing and shortness of breath. Breathing is vital to life, and troubles with breathing signal something seriously wrong.

Basically, SHAPE is a modification of the traditional treadmill cardiac stress test with these important differences.

• It has no treadmill. Instead it requires only a six minute leisurely walk, or stepping up and down on a one step staircase, to elicit problems of cardiac insufficiency. It is not stressful, and some patients have said it is a “cake-walk” compared to the traditional stress test.

• It is “safe” in that it does not drive patients to maximal exertion and does not require the presence of a cardiologist should something go wrong. In addition, it can be repeated often should tracking of response to therapeutic drugs or pacing be needed.

• It simultaneously measures cardiac and pulmonary function by analyzing oxygen and carbon dioxide exchange.

• It is small and portable and can be performed in settings such as primary care offices, health fitness facilities, and even in the home.

• It is sensitive to early changes in breathing function in coronary artery disease, congestive failure, pulmonary disease, asthma, and lack of fitness secondary to sedentary life style or obesity.

• It is helpful in predicting what patients are likely to respond to cardiac pacing devises to detect or correct cardiac arrhythmias.

• It is easy to interpret and can be programmed to indicate what patients need further evaluation.

• It is programmed to predict the odds for hospitalization or death.

I shall report and elaborate on SHAPE in future blogs.

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