This insight is related to all of you and your children and relatives. It is about the health and healthcare. I feel confident to envision the progress for five years, but cautious to guess for longer. Even next five years seem pretty exciting and revolutionary. Hope you will enjoy they pathway.
We have problems today
I will not bind this to any country, hence American readers will not find Obamacare, ACO or HIE here. I will go globally as I like to do.
The old industry of healthcare still sucks. It sucks everywhere in the world. The problem is in uncertainty of our [human] nature. It’s a paradox: the medicine is one of the oldest practices and sciences, but nowadays it is one of least mature. We still don’t know for sure why and how are bodies and souls operate. The reverse engineering should continue until we gain the complete knowledge.
I believe there were civilisations tens of thousands years ago… but let’s concentrate on ours. It took many years to start in-depth studying ourselves. Leonardo da Vinci did breakthrough into anatomy in early 1500s. The accuracy of his anatomical sketches are amazing. Why didn’t others draw at the same level of perfection? The first heart transplant was performed only in 1967 in Cape Town by Christiaan Barnard. Today we are still weak at brain surgeries, even the knowledge how brain works and what is it. Paul Allen significantly contributed to the mapping of the brain. The ambitious Human Genome project was performed only in early 2000s, with 92% of sampling at 99.99% accuracy. Today, there is no clear vision or understanding what majority of DNA is for. I personally do not believe into Junk DNA, and ENCODE project confirmed it might be related to the protein regulation. Hence there is still plenty of work to complete…
But even with the current medical knowledge the healthcare could be better. Very often the patient is admitted from the scratch as a new one. Almost always the patient is discharged without proper monitoring of the medication, nutrition, behaviour and lifestyle. There are no mechanisms, practices or regulations to make it possible. For sure there are some post-discharge recommendations, assignments to the aftercare professionals, but it is immature and very inaccurate in comparison to what it could be. There are glimpses of telemedicine, but it is still very immature.
And finally, the healthcare industry in comparison to other industries such as retail, media, leisure and tourism is far behind in terms of consumer orientation. Even automotive industry is more consumer oriented than healthcare today. Economically speaking, there must be transformation to the consumer centric model. It is the same winning pattern across the industries. It [consumerism] should emerge in healthcare too. Enough about the current problems, let’s switch to the positive things – technology available!
There could be Care Anywhere
We need care anywhere. Either it is underground in the diamond mine, or in the ocean on-board of Queen Mary 2, or in the medical center or at home, at secluded places, or in the car, bus, train or plane.
There is wireless network (from cell providers), there are wearable medical devices, there is a smartphone as a man-in-the-middle to connect with the back-end. It is obvious that diagnostics and prevention, especially for the chronical diseases and emergency cases (first aid, paramedics) could be improved.
I personally experienced two emergency landings, once by being on-board of the six hour flight, second time by driving for the colleague to another airport. The impact is significant. Imagine that 300+ people landed in Canada, then according to the Canadian law all luggage was unloaded, moved to X-ray, then loaded again; we all lost few hours because of somebody’s heart attack.
It could be prevented it the passenger had heart monitor, blood pressure monitor, other devices and they would trigger the alarm to take the pill or ask the crew for the pill in time. The best case is that all wearable devices are linked to the smartphone [it is often allowed to turn on Bluetooth or Wi-Fi in airplane mode]. Then the app would ring and display recommendations to the passenger.
4P aka Four P’s
The medicine should go Personal, Predictive, Preventive and Participatory. It will become so in five years.
Personal is already partially explained above. Besides consumerism, which is a social or economic aspect, there should be really biological personal aspect. We all are different by ~6 million genes. That biological difference does matter. It defines the carrier status for illnesses, it is related to risks of the illnesses, it is related to individual drug response and it uncovers other health-related traits [such as Lactose Intolerance or Alcohol Addiction].
Personal medicine is an equivalent to the Mobile Health. Because you are in motion and you are unique. The single sufficiently smart device you carry with you everywhere is a smartphone. Other wearable devices are still not connected [directly into the Internet of Things]. Hence you have to use them all with the smartphone in the middle.
The shift is from volume to value. From pay to procedures to pay for performance. The model becomes outcome based. The challenge is how to measure performance: good treatment vs. poor bedside, poor treatment vs. good bedside and so on.
Predictive is a pathway to the healthcare transformation. As healthcare experts say: “the providers are flying blind”. There is no good integration and interoperability between providers and even within a single provider. The only rationale way to “open the eyes” is analytics. Descriptive analytics to get a snapshot of what is going on, predictive analytics to foresee the near future and make right decisions, and prescriptive analytics to know even better the reasoning of the future things.
Why there is still no good interoperability? Why there is no wide HL7 adoption? How many years have gone since those initiatives and standards? My personal opinion is that the current [and former] interoperability efforts are the dead end. The rationale is simple: if it worth to be done, it would be already done. There might be something in the middle – the providers will implement interoperability within themselves, but not at the scale of the state or country or globally.
Two reasons for “dead interop”. First is business related. Why should I share my stuff with others? I spent on expensive labs or scans, I don’t want others to benefit from my investments into this patient treatment. Second is breakthrough in genomics and proteomics. Only 20 minutes needed to purify the DNA from the body liquids with Zymo Research DNA Kit. Genome in 15 minutes under $100 has been planned by Pacific Biosciences by this year. Intel invested 100 million dollars into Pacific Biosciences in 2008. Besides gene mechanisms, there are others, not related to DNA change. They are also useful for analysis, predicting and decision making per individual patient. [Read about epigenetics for more details]. There is a third reason – Artificial Intelligence. We already classify with AI, very soon will put much more responsibility onto AI.
Preventive is very interesting transformation, because it is blurring the boarders between treatment and behaviour/lifestyle/wellness and between drugs and nutrition. It is directly related to the chronic diseases and to post-discharge aftercare, even self aftercare. To prevent from readmission the patient should take proper medication, adjust her behaviour and lifestyle, consume special nutrition. E.g. diabetes patients should eat special sugar-free meal. There is a question where drug ends and where nutrition starts? What Coca Cola Diet is? First step towards the drugs?
Pharmacogenomics is on the rise to do proactive steps into the future, with known individual’s response to the drugs. It is both predictive and preventive. It will be normal that mass universal drugs will start to disappear, while narrowly targeted drugs will be designed. Personal drugs is a next step, when the patient is a foundation for almost exclusive treatment.
Participatory is interesting in the way that non-healthcare organisations become related to the healthcare. P&G produce sun screens, designed by skin type [at molecular level], for older people and for children. Nestle produces dietary food. And recall there are Johnson & Johnson, Unilever and even Coca Cola. I strongly recommend to investigate PWC Health practice for the insights and analysis.
Personal Starts from Wearable
The most important driver for the adoption of wearable medical devices is ageing population. The average age of the population increases, while the mobility of the population decreases. People need access to healthcare from everywhere, and at lower cost [for those who retired]. Chronic diseases are related to the ageing population too. Chronic diseases require constant control, interventions of physician in case of high or low measurements. Such control is possible via multiple medical devices. Many of them are smartphone-enabled, where corresponding application runs and “decides” what to tell to the user.
Glucose meter is much smaller now, here is a slick one from iBGStar. Heart rate monitors are available in plenty of choices. Fitness trackers and dietary apps are present as vast majority of [mobile health] apps in the stores. Wrist bands are becoming the element of lifestyle, especially with fashionably designed Jawbone Up. Triceps band BodyMedia is good for calories tracking. Add here wireless weight… I’ve described gadgets and principles in previous posts Wearable Technology and Wearable Technology, Part II. Here I’d like to distinguish Scanadu Scout, measuring vitals like temperature, heart rate, oxymetry [saturation of your hemoglobin], ECG, HRV, PWTT, UA [urine analysis] and mood/stress. Just put appropriate gadgets onto your body, gather data, analyse and apply predictive analytics to react or to prevent.
Personal is a Future of Medicine
If you think about all those personal gadgets and brick mobile phones as sub-niche within medicine, then you are deeply mistaken. Because the medicine itself will become personal as a whole. It is a five year transition from what we have to what should be [and will be]. Computer disappears, into the pocket and into the cloud. All pocket sized and wearable gadgets will miniaturise, while cloud farms of servers will grow and run much smarter AI.
Everybody of us will become a “thing” within the Internet of Things. IoT is not a Facebook [it’s too primitive], but it is quantified and connected you, to the intelligent health cloud, and sometimes to the physicians and other people [patients like you]. This will happen within next 5-10 years, I think rather sooner or later. The technology changes within few years. There were no tablets 3.5 years ago, now we have plenty of them and even new bendable prototypes. Today we experience first wearable breakthroughs, imagine how it will advance within next 3 years. Remember we are accelerating, the technology is accelerating. Much more to come and it will change out lives. I hope it will transform the healthcare dramatically. Many current problems will become obsolete via new emerging alternatives.
Predictive & Preventive is AI
Both are AI. Period. Providers must employ strong mathematicians and physicists and other scientists to create smarter AI. Google works on duplication of the human brain on non-biological carrier. Qualcomm designs neuro chips. IBM demonstrated brainlike computing. Their new computing architecture is called TrueNorth.
Other healthcare participatory providers [technology companies, ISVs, food and beverage companies, consumer goods companies, pharma and life sciences] must adopt strong AI discipline, because all future solutions will deal with extreme data [even All Data], which is impossible to tame with usual tools. Forget simple business logic of if/else/loop. Get ready for the massive grid computing by AI engines. You might need to recall all math you was taught and multiply it 100x. [In case of poor math background get ready to 1000x efforts]
Education is a Pathway
Both patients and providers must learn genetics, epigenetics, genomics, proteomics, pharmacogenomics. Right now we don’t have enough physicians to translate your voluntarily made DNA analysis [by 23andme] to personal treatment. There are advanced genetic labs that takes your genealogy and markers to calculate the risks of diseases. It should be simpler in the future. And it will go through the education.
Five years is a time frame for the new student to become a new physician. Actually slightly more needed [for residency and fellowship], but we could consider first observable changes in five years from today. You should start learning it all for your own needs right now, because you also must be educated to bring better healthcare to ourselves!