Thursday, April 9, 2015

On engineering the future of healthcare

I'm an engineer. I'm an engineer in the sense that my paid vocation is in engineering, but I'm also an engineer in the broader sense that I enjoy solving problems wherever I can. This isn't always a virtue - I sometimes find that one problem is just the top of the rabbit hole, and the rabbit hole gets deep very quickly. Nonetheless, it means I think frequently about the gap between what's possible with current technology and what currently exists. Nowhere is this more apparent than in the field of medical technology, where I currently spend most of my time.

Medicine is a funny area, disconnected from the market norms that define most of the world. People are willing to spend all their money on their health, and often do (and then some). Given this, I feel there is an ethical obligation on those of us who provide medical technology and services to do so in a way that is not driven by pure profit maximisation.

Unfortunately much of healthcare is not like this, irrespective of the precise structure underpinning its provision.

In countries with socialised medicine, such as the UK, in which maximal "profit" typically manifests as political profit, skewed by public perception of healthcare provision and driven by metrics such as access to emotionally charged treatments, there is a huge problem of initiating meaningful improvement without causing political disruption.

In countries with private systems like the US, the arguably bigger problem exists that the cost of healthcare provision is inflated to the extent that a disproportionate percentage of GDP is diverted to it, and those who can't pay often do without.

My point is this: it behoves every one of us - those who work in the medical sector, as well as patients - to work hard against the easy route of allowing more and more resources to be sunk into fewer improvements.

This comes back to where I started. Every change should be done with a view to improving the world, and every problem that is apparent should be fixed wherever it can be. This isn't a new notion. Much of industry has adopted the approach of continuous and evolutionary improvement, and it's largely done by engaging all the stake holders in the process, from shop floor workers through to end customers. Many systems and processes exist to help with this. The time is here for this to become the norm in healthcare. I'm aware there are many attempts to make this happen, but medicine is still far behind many areas, such as manufacturing.

It should not be acceptable to have tech with inflated prices just so the cost can be shifted to a per-use model. It should not be acceptable that a patient coming to Accident & Emergency is re-assessed by five different healthcare workers asking the same questions. It should not be acceptable for patients to visit the emergency department with a cold.

Everyone, from the porter, to the patient, to the top consultant, can be a problem-solver. They can be engineers. If anyone is interested, my start-up is involved in developing a super low-cost medical ultrasound system. The technology is 30 years old, it's about time the cost reflected that. Please feel free to get in touch if any of this interests you, or if your area happens to align with mine!


Henry Gomersall
heng[AT]smartacoustics.co.uk
Oxford, UK

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