There is another broad transformation in health care under way, a powerful force for decentralized innovation. It is fueled in good part by technology — low-cost computing devices, digital sensors and the Web.

The trend promises to shift a lot of the diagnosis, monitoring and treatment of disease from hospitals and specialized clinics, where treatment is expensive, to primary care physicians and patients themselves — at far less cost.

The new models emphasize early detection of health problems, prevention and management of chronic disease. The approaches have adopted a range of labels including “wellness,” “consumer-directed health care” and the “medical home.”

The potential transformation faces formidable obstacles, to be sure. Some of those hurdles include getting patients to embrace healthier lifestyles and persuading the government and insurers to reimburse at-home testing and monitoring devices.

Yet the promise, according to Dr. David M. Lawrence, the former chief executive of Kaiser Permanente, the nation’s largest private health care provider, is “an array of technology-enabled, consumer-based services that constitute a new form of primary health care.”

To glimpse the business opportunity — and the challenge — at the forefront of this emerging, decentralized health care market, let’s look at a start-up in the field of sleep medicine.

The start-up, Watermark Medical, offers an at-home device and a Web-based service for diagnosing sleep apnea. Characterized by snoring and pauses in breathing, sleep apnea is a serious health problem that often goes undiagnosed.

Typically caused by tissue in the back of the throat obstructing the airway to the lungs, it contributes to the severity of chronic conditions including diabetes, heart disease, obesity, hypertension and depression, adding an estimated $3.4 billion to the nation’s health costs.

Sufferers battle chronic fatigue, and sleep experts suspect that apnea is the cause of many workplace and car accidents.

Treatments include a masklike apparatus that pumps air to keep the patient’s airway open; an oral appliance, resembling an orthodontic retainer, that helps open the throat; and surgery to shave tissue that blocks the air passage.

Today, sleep apnea diagnoses are mainly done in specialized sleep clinics, where the patient sleeps under observation for a night or two, at a cost of up $4,000 — with the expense usually shared by insurers and patients.

Watermark Medical traces its technical origins to the work of Dr. Philip Westbrook, a Stanford-educated sleep expert who led the sleep disorder centers at the Mayo Clinic in Rochester, Minn., and at Cedars-Sinai Medical Center in Los Angeles. He teamed up with a pair of medical-device technologists and won an innovation grant from the National Institutes of Health to finance a prototype.

They came up with a headband that holds a blue plastic device — smaller than a deck of cards and resting on the forehead — equipped with a microprocessor and sensors, and a tube that fits into a patient’s nose. If the tube falls out, the patient hears a voice prompt. (NYT)