A necessary next step

A necessary next step

Reports coming out of the South by Southwest Interactive conference speak of the increasing focus on the role technology plays in wellness. This is hardly shocking as everyone pretty much knows that it’s just a matter of time before mobile technology in particular becomes an integral part of diabetes management. Today there are hundreds of apps that do everything from track a patient’s glucose levels to calculating insulin doses. These apps also offer a seamless and simple way for the patient to communicate with their physician. It’s also well known that diabetes management is no longer the domain of drug and device companies as tech titans Apple, Google and Samsung are also entering the market.

Diabetic Investor sees this shift as generally positive but as we have noted several times in the past there are some very high hurdles to overcome before all this way cool technology becomes commonplace. Again as we noted in the past one the biggest hurdles is the FDA, an agency which at times seems to be stuck in the past. The simple fact is none of this way cool technology will stand a chance if the FDA doesn’t somehow adapt to the fast moving world of high tech. This is not an easy task for the FDA as it’s not just way cool technology they must consider but also the wild of west of mobile apps.

Yet the FDA isn’t the only hurdle that must be cleared. While it may seem obvious getting all this way cool technology to work and then into the hands of patients isn’t as easy as everyone seems to think it is. It always amazes Diabetic Investor how much attention anything worked on by Google or Apple gets, hat people seem to believe that because Apple and Google are working on something that it will work.  Recently it was big news that Apple’s new iWatch wouldn’t monitor glucose levels that the company may add this feature in the future but just can’t get it to work right now. Many saw this as setback for Apple; Diabetic Investor didn’t as this is pretty much par for the course when it comes to new way cool diabetes technology; an area where failure is the norm and success the exception.

Beyond the FDA, getting the technology to actually work and then getting this technology into the hands of patients there is another hurdle that hasn’t been talked about or even considered. This focus on bringing technology and diabetes management together is based on several assumptions, not just that patients will actually use the technology but the patient’s healthcare team will be woven into the process. Look at almost every one of these new technologies, whether it’s a device or app a critical element is the ability to easily transmit data to the patients’ healthcare team. The theory is that armed with this information the physician can better assist the patient who ultimately will achieve better outcomes.

Yet weaving in the patients’ healthcare team into this process isn’t as easy as it seems. As we have noted in the past physicians are not traditionally compensated for this type of interaction. While the reimbursement environment is slowly changing, typically physicians are not compensated for patient emails or text messages. But this only half the equation as someone has to analyze the information collected from the patient, whether this is the physician or someone in the physician office. Most dismiss this side of the equation as they assume that software can do all the analytics, while software can and will play an important role by itself it won’t be adequate. Someone still has to look at all reports generated by the software, as it’s doubtful that the FDA would ever approve any software package that offered medical advice. It’s equally doubtful that physicians would embrace such a system either as this would minimize their role.

Another hurdle is patient privacy. Most studies and surveys on the subject indicate that patients are comfortable sharing their personal healthcare electronically. However as we have seen recently securing information, protecting it from hackers isn’t that easy either.

A huge often unconsidered hurdle is the changing nature of diabetes management. The fact is the physician is no longer at the center of a patient’s diabetes management team. Pharmacy retailers like Walgreens, CVS and Rite Aid see the pharmacist as leading the way as they adapt their own versions of the Asheville protocol. Insurers also want to be involved, employers want to be involved and let’s not forget about the various diabetes entities, i.e. the American Diabetes Association (ADA) who will likely want a seat at the very crowded diabetes table. And as much as we wish we didn’t have to deal with this big bother those pesky, picky people in Washington D.C. will want a seat as well.

Diabetic Investor actually sees a solution here but quite honestly we’re not sure it’s possible to implement. What’s needed to make this move towards integrating technology into diabetes management is set of standards that everyone can follow. Think of it this way, think of what the world be like with hundreds of mobile operating systems, that Apple’s iOS and Google Android didn’t control 95% of the market. Because of this and the standards that come with each system app developers have a clear path to follow. In the case of mobile technology the marketplace determined which operating systems won out, this won’t happen with diabetes management.

For diabetes management and technology to come together and actually work industry, government, the medical community, retailers, insurers and patient advocates will need to agree to set of standards. Not an easy task when one considers that each of these groups will come to the table with different agenda’s. The fact is if this were to happen everyone would win in the long term however it’s difficult seeing this coming about in today’s short term thinking world. This is not to say this is an impossible task as other industries and disease states have done it.

There is no question that mobile technology should be integrated into diabetes management. There is no question that patients would benefit. The real question is who will lead the way, who has the vision and fortitude to make this happen.