In 1983, a Korean commercial airline, en route from Anchorage, Alaska, to Seoul, mistakenly entered the Soviet Union’s airspace. A Soviet fighter jet shot it down, killing 269 people. To minimize future navigational errors, President Ronald Reagan allowed civilian access to GPS. But that access came with a catch—to protect national security, he imposed a filter that blunted the accuracy, as compared to what was available to the military. President Bill Clinton, an advocate of using GPS for “addressing a broad range of military, civil, commercial, and scientific interests, both national and international” throughout his two terms, took away the restrictions prior to leaving office. On May 1, 2000, he ordered an end to the intentional degrading of GPS accuracy: “The decision to discontinue Selective Availability is the latest measure in an ongoing effort to make GPS more responsive to civil and commercial users worldwide ... This increase in accuracy will allow new GPS applications to emerge and continue to enhance the lives of people around the world.”
Propelled by the government’s support, more private sector entities began experimenting in this space. Those innovators began offering a variety of commercial applications. Prices for GPS chips fell dramatically, allowing phone carriers to offer navigation as an inexpensive, standard feature in products. And the GPS industry—requiring roughly $1.3 billion a year from the U.S. Treasury for procuring satellites and furthering systems development—has grown into a $65 billion enterprise. That includes an array of smartphone apps helping users find anything from an art museum to an aunt’s house.
In the mid-2000s, Dr. David Van Sickle had a more critical cause in mind. While working as a respiratory disease detective in the Epidemic Intelligence Service at the Centers for Disease Control and Prevention (CDC) in Atlanta, he didn’t need to dig much to identify a major problem in the health care system. That was easy as breathing—breathing for him, anyway. “People think about asthma, and think we must have a handle on it in the U.S.,” Van Sickle said. “But the grim reality is that most patients’ asthma in this country is uncontrolled. There’s a higher rate of going to the hospital than there should be. We have been doing the same thing about asthma for years, and we have made basically no dent in hospitalizations. The majority of those people think they are doing fine, so no one treats them with a course correction. And, so, there’s inexcusable morbidity. There’s this really ridiculous gap between what we should be able to do and what we’ve been able to accomplish.”
In his view, this has been largely a product of information gaps on both the public health and clinical sides of the equation. During his time at the CDC, including his work examining asthma outbreaks due to mold exposure in the aftermath of 2005’s Hurricane Katrina, he kept coming across the same obstacles: asthma data that was often years old and long outdated by the time he saw it; data that only accounted for deaths and hospitalizations rather than informative events such as school and work absences. Due to these limitations, research at the public health level was often done by “carpet-bombing a community” rather than targeting specific, smaller areas.
These gaps made it nearly impossible to tackle the issue in any productive, proactive, individual way. “You would never have to ask a credit card company to review data on an annual basis,” he said. “But you have to ask public health or health care to do that? This is vastly behind where other industries are.”
Nor was America an outlier. While at the CDC, Van Sickle read about an acute asthma cluster in Barcelona. “It sent a bunch of people to the hospital and a bunch of people died,” he said. “The investigative team finally asked where people were when they were having symptoms. They mapped that, and finally figured out that the filters hadn’t been installed correctly in the harbor silos, which meant that when people were loading soybeans, it created a potent soybean dust. It was the first time we recognized that as a powerful allergen. But it took them ten years to figure out what was happening.”
America certainly doesn’t have that sort of time for delays in discovery, not with its pressing health care cost crisis: those costs are rising sharply and seemingly without end, with an expectation they will far exceed their already-excessive current chunk of the Gross Domestic Product in the United States. According to the World Bank, the U.S. spent 17.9 percent of its GDP on healthcare, compared to 11.2 percent for Canada, 9.3 percent for the United Kingdom, and 5.2 percent for China. There’s a crying need for innovation aimed at greater efficiency, and a focus on preventative measures that will allow patients to avoid factors that could trigger a condition, and thus further strain the system. There’s a need to empower doctors and patients.
That’s what Van Sickle set out to do after leaving the CDC, armed with a generous fellowship from the Robert Wood Johnson Foundation to serve as a Health and Society Scholar at the University of Wisconsin-Madison. “I had this great mandate to do something, to solve a problem that had always been bugging me,” he said.
And he had this great tool, GPS, to use to improve public health. Early during his time in Wisconsin, Van Sickle decided to attach an asthma inhaler to electronics. The resulting device, called a Spiroscout, created a time and GPS location record of symptoms as the inhaler was used. The onset of those symptoms could be linked to a place—and thus, to the elements of exposure. If the person was using the inhaler more than twice per week, it probably meant an emergency room visit was imminent.
Van Sickle initially built a small batch of those devices, “just to show I wasn’t completely crazy.” He benefited from participants’ understanding that, by sharing information, they might help others avoid symptoms. Still, he attempted to address privacy concerns. “It was done sensibly and protected,” he insisted.
Over time, the devices became more advanced, smaller, and with better battery life. He has also changed his vantage point, choosing to come at the problem from the private sector—from “industrial size, not professional size, without everything that is in the way on the academic side.” He started a company, Asthmapolis, to improve asthma management and public health surveillance, striving to lower costs associated with asthma while providing a novel data stream for health improvement. By 2013, his device had earned FDA approval, his hypothesis that information could lower asthma attacks had been validated in testing in North Carolina and Kentucky, and his business had attracted $5 million in venture capital to tackle a market of more than 20 million asthma patients in the United States alone.
Patients with uncontrolled asthma spend thousands more per year than those with controlled asthma. As more health systems enter into population health contracts with insurance companies, taking responsibility for improved outcomes, there is an emerging market incentive to adopt a program such as Von Sickle’s and integrate it into a physician’s regular practice.
“The doctor can take the data from a daily list for the patient, make it meaningful, and get it back to the patient,” Van Sickle said. “Such as, ‘You should not be having symptoms every night. Here’s what is going on with you.’ It’s personalized guidance, personalized education, captured from daily life and put to use.”
This piece was excerpted from Innovative State: How New Technologies Can Transform Government; reprinted with the permission of the publisher, Atlantic Monthly Press.
Aneesh Chopra was the first chief technology officer of the United States.