I first started this blog in hopes of a better understanding of where mhealth and health IT is headed. A few individuals who went to the mhealth Summit wrote about how the general industry outlook seems droll. The fact of the matter is that our current system is complex enough where there needs to be innovation from entrepreneurs. The government knows it, the patients know it, the doctors know it but where do we start? By first understanding how the system basically works.
From a very general perspective basically we have this (where lines between areas means bidirectional flows and pharma and other services, while detached is still connected with its respective locations above):

Pharmaceutical, medical device and diagnostic companies supporting pharmacies and hospitals to help patients do better. Through a simple diagram the complexities are drastic. There are money flows, care flows, communication flows, knowledge flows to name a few. All of which have voids and are vulnerable to disruption. Each one is not one industry but several and can be expanded.

How did we get here? Through advancement in technologies and cures. From 3-5 generations that have not only cured disease but also increased life expectancy. Pre 1800 we had this:

A straightforward process: doctor dealing with patient and patient pays out of pocket, but without proper diagnostic tools, blood tests or others. Remedies were picked by the doctor or others close to the doctor. Doctors were beginning to be required to be certified through education but it wasn’t complete.

When it approached 1850, some beginning R&D into x-rays and other pharmacological agents became known which spurred a growth of some remedies that worked and others that didn’t. Vaccines were successfully developed. 

Sadly, a lot of the diagnostic and safe pharmaceutical agents were still not clear. Mercury, cocaine and other remedies were used as curealls. This persisted all the way into the early 1900s. AMA has long been established but has lots of difficulties getting government to support them. Battles back and fourth went on up to 1850s until they become national in the 1900s.

Due to market reasons, doctors finally successfully push for licenses for doctors nationally. Drugs were having problems with deaths and false benefits. Basic regulations with drugs established FDA as we know it still nonexistent, but precursor exists as Department of Agriculture.

By the 1920s, more and more research was being done such that pharmaceutical companies, drug manufactures and doctors knew better what was going on. There were journals and others that brought people together to discuss new technologies. But technologies were not widely implemented. But due to regulations doctors worked in groups and now able to charge more for their services.

Between 1930s and 1933, doctors and pharmacies successfully integrate a miniscule portion (as we know it) of modern medical science into the mainstream. However due to rising costs, insurance companies come into being hoping to ensure everyone costly “high tech” care. Vaccines widely used, various drugs ready to use, diagnostics (x-rays) used.

In the 30 years between 1930s to 1960s technologies continue to gain ground. Without the help from insurance companies, technologies could not have been developed and profits realized. However due to the profitability nature of insurance, government intervenes and instates Medicare for the older generations. By this time nearly all the modern pharmaceutical giants have been established (if not already), some fundamental medical device companies established advanced medical devices in research.

However, since the 1960s, it has been primarily the development of technologies that would sell to doctors and be paid by insurance companies. Some can say that modern medical structures still follow the basics of care from the 1960s-1980s. The primary difference is better doctors and better tools for doctors. The fundamental structure remains the same until modern times. Which finally brings us to this.

In part 2, I will talk about a few problems in this trillion dollar ecosystem and how modern technologies have and can change the healthcare market.