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Today, some 30 years later, Eddy has built just such an elaborate mechanisma complex software program he calls Archimedes, named for the ancient Greek mathematician who boasted he could move the world with a single lever. The software model, for the first time in medical history, uses mathematical algorithms and equations to translate the beat of a heart or the twitch of a muscle into the ones and zeros of the Digital Age, replicating in numbers the behavior of a disease and creating a "virtual reality" in which patients, providers and institutions interact as they would in the real world.
Put simply, Archimedes is to doctors what airline cockpit simulation software is to pilotsa way to manipulate the variables of human behavior and environment to mimic real-life outcomes. The model can analyze everything from the onset of disease in the cells of the pancreas to the number of parking lots in the medical center complexand the need for more lots five years from now. In other words, it's a complete model of systems as well as patients and diseases.
For example, using Archimedes, physicians can see the impact of age, sex, race, income, employment, behaviorto name just a few variableson human health, along with the influence of various treatment decisions, and do it all at the accuracy level of traditional clinical trials that can last years and involve thousands of real-life patients. Want to know the chances a 29-year-old male with cancer and who smokes will respond better to one treatment over another? Now, Eddy says, some trials that used to take years can be run by Archimedes in a half-houror less.
But it's not just about potential savings for cash-strapped hospitals and medical institutions. Eddy believes evidence-based care, as represented by Archimedes, may one day help patients determine the affect of a drug, itself, over time on individual patientsand help prolong the lives of those with heart disease or HIV or diabetes. Ultimately, he says, it's all about delivering the best treatment to the right people at the right price, a mission analogous to the original dream of managed care that HMOs like Kaiser Permanente are still struggling to provide.
Naturally, Eddy's groundbreaking project is raising eyebrows. "What David has done is really important," says Alain Enthoven, Ph.D., senior fellow at Stanford's Center for Health Policy, and one of the pioneers of managed care. Enthoven praises Archimedes' accuracy at mimicking actual outcomes of clinical trials; the American Diabetes Association (ADA) is already using it to devise treatment guidelines so as to prove whether lifestyle changessuch as improved diet and weight lossoffer better results than merely popping pills.
But not all physicians are sold on Eddy's workafter all, it's their authority that the Archimedes program is targeted to topple. Even Richard Smallwood, a longtime admirer of Eddy's and his adviser at Stanford, says most people don't think "as logically as Dave does," particularly when it comes to a field as emotionally charged as medical care. "Dave might have a really good system, but selling it to the rest of the world will be tough," he says. Peggy O'Kane, president of the nonprofit National Committee for Quality Assurance (NCQA), which rates HMOs based on quality, agrees that political opposition to Archimedes could be its Achilles' heel. Resistance will come from many quarters, she says, including physicians who have their own way of doing things, medical manufacturers who sell high-priced technologies, and consultants promoting their own pricey systems for healthcare reform.
Healthcare CIOs, too, question the politics of it. Says Terry Jackson, corporate director of information systems at Trover Foundation, a healthcare services organization in Madisonville, Ky.: "Any time you get down to a clinical system like that, the physicians are going to dictate whether or not they're going to use it. They are partners in providing care. You don't go to your partners and force them to do things that they don't want to."
Eddy acknowledges he's stepping on toesfrom those of pharmaceutical manufacturers whose pills Archimedes may judge to be no better than less-expensive generics, to trial lawyers sniffing out medical malpractice suits.