Better Health Care for All at Lower Cost

The digital revolution was supposed to expand health care to be better, safer, and cheaper for all. After spending $36 billion over the last decade, however, the health care industry is no closer to effectively using and navigating systems of digitized medical records. In many cases, patients cannot access their own medical information, and electronic health record systems are slow, glitchy, incomplete, and prone to inflating bills instead of reducing them. Meanwhile, the cost of health benefits keeps escalating.

Innovation of novel technologies like electronic health records, data-driven personalized medicine, health care apps, and mobile health is important, but innovative deployment is also needed for how to effectively apply such technologies. Dr. Amar Gupta, a researcher in the Institute for Medical Engineering and Science (IMES), the Department of Electrical Engineering and Computer Science (EECS), and CSAIL, has spent much of his career finding new approaches for practical deployment. While he has spent much of his career finding new research management activities at MIT, he has also served as endowed and tenured full professor at two other universities in the U.S., and as Dean of Computer Science and Information Systems at one of them. His comprehensive research, as well as his earlier role as concurrent endowed Professor of Entrepreneurship, Professor of Computer Science, Professor of Public Health, Professor of Law, Professor of Social and Behavioral Sciences, and Senior Director for Research and Business Development, takes on the technology and medical implications of the deployment process as well as the legal, business, and policy issues.

What’s Plaguing the Current Health Care System?

According to Dr. Gupta, whose work concentrates on telemedicine, there are currently many barriers to making health care better, safer, and more affordable for everyone, despite government claims that electronic health records would revolutionize the system. These legal and policy hurdles have only been exacerbated by recently raised concerns about privacy and cybersecurity, in reaction to proposed access rules that could offer greater interoperability between systems in addition to researcher access to health information.

The main challenges with current operations for electronic health records is that different institutions use disparate systems that do not share data, and there are different regulations at state and federal levels in the U.S. as well as in and across other countries.

Dr. Gupta touched on a personal example of the dysfunction between different health care systems: When he and his wife were on a trip in Los Angeles, his wife fell and broke her wrists. When she sought care for the multiple fractures she suffered, however, she was told that because she was not a member of the hospital’s network, she could not be treated there. Instead she was directed to fly over 2,000 miles from California to Boston to get treatment.

This incident intensified Dr. Gupta’s efforts to get to the bottom of why the current U.S. health care system is so dysfunctional and why it is not using novel technologies to improve interoperability. Virtual communication between facilities and networks, for instance, could help save lives, especially for patients being treated in rural areas. “In the U.S., if a trauma incident takes place, the chances of survival for a patient in the rural areas is one half of the chances of survival in the urban areas,” he said. This is because of the time it takes to transport the person to a medical facility.

He had discovered earlier that Arizona had already set up a sophisticated teletrauma network at the state level, by which people can go to a rural clinic and get the care they need through the connections. In the course of his research, however, he was told by his colleagues that it would be illegal to make this type of service nationwide because a physical exam was required before administering medication.

Investigating further, he asked a question that shaped his research path: Why and when did the government get involved in health care?

Effecting Legal and Policy Changes Across Borders

Dr. Gupta discovered that the first place that the government got involved in health care was New Haven, Connecticut, due to an imposed regulation to prevent the spread of yellow fever. “Then I studied the laws from that time and wrote a very controversial paper,” he said, “stating that since all these restrictions on interstate telemedicine had been imposed solely by state governments, these regulations conflicted with the interstate commerce provisions of the U.S. constitution, and accordingly, all these regulations were unconstitutional and therefore illegal.”

In part due to the paper that Dr. Gupta co-authored with Deth Sao and published in Health-Matrix: The Journal of Law-Medicine in 2012, the Department of Veterans Affairs changed its U.S. policy in part due to the paper’s ideas and opinions. Now, the practice of telemedicine practiced by the VA is governed exclusively by federal regulations, overwriting all of the state regulations. Dr. Gupta said, “The VA spends $1 billion a year in transportation costs of patients from their homes to medical facilities. If we are able to use telemedicine, this $1 billion will gradually go away and also help patients.”

As a growing number of people are practicing telemedicine across international boundaries, Dr. Gupta advised that we have to think about what should be done at local, state, national, and international levels, in order to open up health care accessibility for all.

At the international level, there are a growing number of people using telemedicine across continental boundaries. Dr. Gupta illustrated an example of a specifically international challenge that telemedicine can solve. Working at night is a cause of prostate cancer in men and breast cancer in women. In addition, working at night (and lack of sleep) causes doctors and nurses to make more errors. Dr. Gupta wrote another paper in the Journal of Clinical Sleep Medicine arguing that medical professionals should work during the daytime, and further, that intercontinental telemedicine makes this possible as part of the “24-Hour Knowledge Factory” concept. Doctors and nurses working during the day in one continent can virtually look after patients at night in a different continent.

As a result of the paper’s findings, the practice has some adoption around the globe. Emory University, mentioned Gupta, has recently transferred some of its doctors and nurses to Australia. They work from Emory during the daytime in Atlanta to look after patients during the nighttime in Australia, and doctors and nurses in Australia look after the Emory patients during nighttime in Atlanta. “It’s just a matter of time,” said Gupta, “where we will have more practice of telemedicine across international boundaries.”

Adopting a Knowledge-based Framework in Health Care

In order to continue to deploy novel technologies and make health care more accessible, Dr. Gupta proposes that institutions, academia, and governments work together to effect policy change. He has structured a knowledge-based framework for health care consisting of four areas.

  1. Knowledge Acquisition
    Knowledge acquisition involves acquiring information from human beings, paper-based documents, sensors, and other traditional media. This type of acquisition could be on a one-time basis only, a periodic basis, or a continuous basis. Having all of this knowledge up-to-date will also help address common research problems like the reproducibility crisis, because in addition to being able to share data with others, this knowledge acquisition step could require justification as to why certain results could not be reproduced.
  2. Knowledge Discovery
    Knowledge discovery is where neural network-based approaches come in. While human beings are good at visualizing in two or three dimensions, neural networks can perform good visualization in more dimensions. We have already used neural networks for applications such as prediction, data mining, and pharmacy chains, and according to Dr. Gupta, they seem ideal for detecting trends that human experts may find difficult to identify. Their data-mining techniques appear ideally suited for large data analysis, the securing of data and problems of missing or conflicting information, retraining entire systems periodically, and addressing the tasks of organizing and discovering new information across electronic health records systems.
  3. Knowledge Management
    The goal of knowledge management is to integrate heterogeneous information systems for better health-care interoperability. Because every organization currently tends to store information in its own form and expects others to be able to both use it and convert it from the previous form to the standard form of the new organization, it is difficult to ensure that all of this information transfers over. Currently, knowledge management depends greatly on the willingness of the people involved and the resources available. Dr. Gupta hopes to change the way that hospitals manage this information and gave examples of potential solutions, such as fostering multi-constituency collaborations as in previous examples of the Internet, Internet telephony, check processing, and lean aircraft. Typically, these collaborations include government, industry, and academia.
  4. Knowledge Dissemination
    Knowledge dissemination involves open science that aims to ensure the availability and usability of the data and methodologies, including codes or algorithms, that were used to generate the data. Dr. Gupta explained that the amount of information available can be overwhelming, so to avoid an information overload crisis, we need to be able to abstract the data effectively, which is challenging. Health care professionals should not be flooded with so much information that they are distracted; instead, Dr. Gupta said that data should be abstracted to the level the professional needs to perform the job.
Continuing Advances in the Deployment of Novel Technology

Patients will receive better, faster, and less expensive health care no matter where they live, if we follow an interdisciplinary and collaborative approach to information technology, telemedicine, and beyond for our health care systems. Dr. Gupta is working with various organizations on projects involving telemedicine, telehealth, drug inventory optimization, privacy, cybersecurity, and more to put these ideas into practice.

For example, Dr. Gupta was inspired by the banking industry to connect electronic health record systems across hospitals, taking a similar approach used for machine-based reading of the numbers on bank checks in electronic bank processing. The latter technology was developed by his research group, and MIT was awarded a broad patent with Dr. Gupta as the lead inventor. (He also applied this technique to mammography by developing neural-network algorithms that reduce false negatives and false positives in mammogram readings.)

Removing current barriers to health care systems through the deployment of novel technologies is making significant steps toward a brighter future. Greater interoperability between hospitals will not only increase the effectiveness of medical care but could also lead to the inclusion of lab systems and pharmacies, as well as technology such as the Internet of Things. Widespread adoption of telemedicine research and deployment helps patients get treatment at home and can help in times of global pandemics and other crises.

Dr. Gupta said, “This is an area, if we want to make any major change, in which the whole world needs to work together.”