A Story of Design, Technology & Cardiovascular Preventive Care
How an obsession for Design and the opportunities in new technology trends led to an I.O.T. Solution for improving the management of Hypertension.
There’s this saying I put out there all the time:
“I’m a designer. I can’t possibly be anything else”
and now I know that it has confused a number of people — teachers, parents, mentors and even my own classmates back in medical school. People just assume that it means I don’t want to have anything to do with medicine. So bad that I won the “most unlikely to practice” award for my graduating class. But obviously, at least to me, I’m not going to stop being a physician and I’ll bet that I care about medicine more than 99.9% of doctors today. A long term career goal of mine has been to help move care delivery from a disease focused reactive approach to a more productive, wellness focused system and my mind wouldn’t retire from exploring options through which that goal can be realized.
Be that as it may, it doesn’t mean the saying is wrong. I’ll think of it as when someone says — “I’m human”; or “I’m a Christian”. It doesn’t mean they stop everything else they care about. It just means that the values, philosophies and other mental framework of this identity, contrary to its alternatives influences everything that they do. So all statement expresses is that Design is big deal for me and in my journey as a physician as with other areas of endeavor, design will be a major deciding factor. It means I’ll never settle in the search for ways to reach the ultimate goal of medicine; It means I’ll value prevention than I value cure; It means I’ll value impacting millions of lives at once as deeply as I value caring for people on an individual basis.
Human life on earth is going to change significantly in the next few decades of our lives. Many of those changes will be driven by advancements in technology, Globalization and an increasing rate of human enlightenment. Every human discipline or institution (Medicine, Law, Government, Religion, etc.) will need to re-evaluate what it stands for, it’s core value proposition in relation to a fundamental human need, how it’s been meeting this need thus far and what opportunities abound for meeting this need in ways that much larger returns are delivered for efforts invested. Medical practice was previously restricted to medicines in delivering its goals of managing human health. Then came the realization that the human body could be opened up through surgery and the structural culprits of disease could be physically manipulated. Then came the use of radiation, and everything else that forms the armamentarium of care today. We should realize that new insights(science) and technologies continue to emerge that presents us with the opportunity to meet the fundamental human need we’ve chosen the more such that we can create solutions that are 10–100 times or more better, faster or more efficient. We should harness these opportunities.
What are these opportunities and how do we harness them?
There are a number of new and re-emerging insights and technologies that are recognizably relevant to that fundamental need of “wellness” and many more than we realize if we probe deeper. Off the top of my head — The science of complex systems applied to biology i.e. Systems Biology, Artificial Intelligence, Synthetic Biology, 3D Bio-printing, Genomics, Internet of Things (or Networks & Sensors), Nanotechnology, Robotics, Computational Thinking, The Virtual Physiological Human Project, to name a few. All these can have an impact on care in unimaginable ways. Some have already started having impact while some others will take a few more years to be noticed.
Of these “opportunity” technologies, some are more within our capacities to utilize than others. With Internet of Things (Networks & Sensors), Artificial Intelligence, we can start taking transformation steps towards the ultimate goal of medicine — maintaining, promoting and restoring wellness.
To start thinking proactively about care delivery, we can consider an area of practice where comparatively, a preventive approach is already the norm — Cardiovascular Preventive Care or more specifically, Hypertension management.
Hypertension in itself is not a lot of trouble to the patient since it is seldom symptomatic but physicians use pharmacological and non pharmacological approaches to keep the blood pressure below certain levels as this reduces the risk of complications and improves health outcomes overall. Furthermore, the 7th report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High blood pressure (JNC 7) reports that with proper anti-hypertensive therapy alone;
incidence of stroke can be reduced by 35–40%
incidence of myocardial infarction can be reduced by 20–25%
incidence of heart failure can be reduced by more than 50%
in patients with stage 1 hypertension and additional cardiovascular risk factors, achieving a sustained 12 mmHg reduction in Systolic BP over 10 years will prevent 1 death for every 11 patients treated
Beyond therapy to control blood pressure, the method utilized for monitoring can also offer advantages — Home Blood Pressure Monitoring (HBPM) when compared with Office Blood Pressure Monitoring (OBPM) had the following benefits;
better preclinical detection of target organ damage and cardiovascular events that’s closer to what obtains with the measurement gold standard
better detection of the white coat and masked hypertension phenomena
better blood pressure decline when utilized for treatment adjustment
better long term adherence with anti-hypertensive medications
The situation in reality today however is that most hypertensive patients are still poorly controlled. Even in the world’s most funded healthcare system (The United States’ Health System), less than 25% of known hypertensives have their blood pressure well controlled and hypertension still remains a significant contributor to cardiovascular deaths. In our own environment, Africa, which has a higher prevalence of hypertension (46% of the adult population) compared to the 25% global average, problems around access to optimal preventive care practices, and effective blood pressure monitoring have graver consequences.
A question arises from considering these circumstances and it is this;
If through design and technology, we create a service that makes the optimal hypertension care and the benefits of Home Blood Pressure Monitoring available to as many people as possible, can we reduce the complications and consequent 7.5 million deaths yearly from hypertension?
Finding the answer to this question is the motivation behind “The Hearty Project” on which we’ve embarked since February this year.
Introducing The Hearty Project
Over the past 6 months, we’ve explored multiple solutions and approaches for finding an answer to the above raised question. We’ve decided from all our experience and learning to focus on a simple goal:
Support, improve hypertension management by improving blood pressure monitoring
To put that in context, many patients have Blood Pressure Devices and they measure their Blood Pressure, but more often than not, this data lies on their devices when it could be of more value if it contributed to physician decision making. Essentially, this data, in combination with others can offer many advantages as already seen from the JNC 7 Report and the Research on Home Blood Pressure Monitoring.
So over the next couple of months, we’ll be testing and optimizing a system of remote monitoring that allows physicians to track patient blood pressure readings, pulse and medications being used. This will help improve physician efficiency in controlling Blood pressure; drugs that aren’t working well for patients can be detected earlier and changed, and providers can better sort between patients who just need medication refill and those who actually require clinic visits.
Beyond these benefits, there’s much more to look forward to if we succeed with this plan:
better insights on what medications actually work for what patients with what situation;
richer intelligence on the best approach for managing hypertensive patients.
clearer picture of the actual percentage morbidity and mortality for chronic hypertension which previously has been distorted by poor patient compliance or inefficiencies in medication titration to Blood Pressure, etc.
We can only imagine how such benefits will contribute to health outcomes and to overall patient care.