The digitization of healthcare data, sensor technology, monitoring devices, hyperdata, and technology yet to come will contribute to the acceleration of healthcare. This chapter takes into account some of the possibilities that could occur in the near future.
Perpetual Transformation
Newton’s First Law of Motion states that a body at rest will remain at rest unless an outside force acts on it, and a body in motion at a constant velocity will remain in motion in a straight line unless acted upon by an outside force. Healthcare in the United States was at rest until the outside force, the Affordable Care Act (ACA), put it in motion. Now it will remain in motion until an outside force is applied. So far, healthcare has withstood one outside force, a challenge that went to the U.S. Supreme Court on whether applicants enrolled in market exchange plans on the federal website, Healthcare.gov, were eligible to receive premium assistance. The Supreme Court ruled in favor of eligibility, and the ACA provision remains intact.
The biggest transformation in healthcare is the consumer. They are more interested than ever before in staying healthy and avoiding illness—and saving money in the process. They are focused on prevention: gathering information such as genetic makeup, using the latest effective behaviors and agents to ward off disease, and finding treatments geared to attack the exact genes causing the disease. These factors all reduce treatment for both acute and chronic illnesses because of the absence of disease. The lifestyle choices made by consumers will be the single largest factor in reducing the cost of healthcare. It also means that we will need to spend money educating a wide spectrum of consumers in finding ways to stay healthy, and to support their healthy choices. It benefits society as a whole to have a healthier population.
DIY Health for the Future
The smartphone is the new platform for patient care. People own smartphones because they are mobile and provide connection to the online world in lieu of a personal computer. It will become commonplace for consumers to collect data when illness occurs, send it to a doctor, and receive a diagnosis and treatment. Consumers will perform many of the basic functions of a physical exam with a smartphone and specialized attachments. A parent will be able to take measurements, photos, and vital signs including skin, eyes, ears, throat, heart, and lungs of a sick child for processing and initial analysis before transmission to a clinician. Apps on a smartphone will soon be able to analyze and process the data collected using a validated computer algorithm—built on thousands of real-life cases—and deliver a diagnosis and treatment or recommendation to see a physician.
As the devices for capturing people’s biometrics improve in accuracy and reliability, more of the acute illnesses that require an urgent visit can be diagnosed and treated at home by a family member with instructions from a primary care doctor. Drones will deliver drugs; sensors in pills will keep track of medication that is consumed and send reminders sent to patients and caregivers; and more sensors on or in the body will give off information to feed dashboards that automatically send alerts when a problem is detected.
The do-it-yourself (DIY) health of the future goes beyond the smartphone; many other forces have converged to enable the pursuit of health. For example, test kits that unlock the genetic composition of a person will soon be available at the corner drug store at affordable prices. While doctors and geneticists are necessary to provide interpretation of test results, the consumer can make the decision to be tested.
Lab tests are another example of self-directed healthcare. Innovative and cost-effective lab test equipment has been created for use in countries with rural areas where traditional lab equipment is not practical. One example is the Swasthya Slate,1 a cake-tin-sized device that performs 33 common tests including blood pressure, blood sugar, heart rate, blood hemoglobin, urine protein, and glucose. It also tests for diseases such as malaria, dengue, hepatitis, HIV, and typhoid. The device connects via Bluetooth to an app on an Android phone or tablet that run 33 diagnostic tests. Each test only takes a minute or two and the data are uploaded to a cloud-based medical-record management system that can be accessed by the patient. It is integrated into a patient management and AI-based diagnosis system designed for use by minimally trained front-line health workers in India. The data is reported to be within 99 percent accuracy of far more complex machines.2
A blood test in the United States requires one or more test tubes of blood drawn from the patient, costs around $200, and the results come back in two days. The Swasthya Slate uses a drop of blood and the results are back in five minutes. And the Swasthya Slate costs a mere $600. Doctor’s offices could purchase the tool and avoid lab referrals and the resulting paperwork, and consumers can go to speed clinics or their doctor’s office for the test.
The idea that basic lab tests can be done inexpensively is staggering. The implication for addressing healthcare disparities related to cost of lab tests and expensive equipment are huge, and Swasthya Slate could be the lab industry disruptor.
Improving the healthcare system is like a jigsaw puzzle. You need to keep trying to fit different pieces in place until the pieces create the whole picture.3 One way to do this is population health, which finds determinants of poor health among subpopulations. Hopefully, we can use what we learn to lessen the healthcare disparities in the system and in Americans’ personal health.
In the near future, diagnoses will be made by swallowing an ingestible diagnostic micro-device that self-absorbs after transmitting its data to a physician who will make a decision on how to treat the patient. Barton Health4 in Lake Tahoe, California, partnered with Proteus Digital Health to conduct the first clinical trial of an ingestible sensor. What makes this different is that the sensors are “green” and will selfdestruct in the body and dissolve. The concept of implanted sensors isn’t new—pacemakers, defibrillators, implanted blood glucose monitors, and electrodes implanted in the brains of patients with epilepsy or Parkinson’s have been used for years. But while these are permanent or long term, and require periodic testing, the Proteus ingestible sensors aren’t permanent so there is no maintenance.
As prices drop and the technology becomes more accessible, 3D printing will be found in more medical treatments. 3D printers will allow the customization of body parts and medical supports. Experts have created 3D-printed skin for burn patients and airway splints for babies who suffer from a condition that causes the tiny airways around the lungs to collapse. 3D-ankle replacements and 3D-printed casts that heal bones 40 to 80 percent faster have been developed recently. A team at Princeton built a bionic ear that hears radio frequencies beyond the normal human capability. It’s possible that 3D-printed livers, kidneys, and lungs could become a reality and eliminate waiting lists for transplants. These types of technologies will advance healthcare by empowering the patient with more care of themselves.
Mental health will be integrated with physical health and a scanner will tell the doctor in seconds what problems the body is experiencing just like the venerable doctor, Bones, did on Star Trek. Technology and artificial intelligence could bring the ability for diagnosis and treatment to be continuous and seamless; the patient doesn’t notice.
In the future, robots will take care of mundane tasks and remove hassles in places that provide care, such as hospitals and doctor’s offices. Hospitals will learn from the hospitality business and use robots to greet patients at the front door and drive them in a cart to their first check-in stop. Meanwhile, a fellow robot valet will park the car and return it to the door when the patient is discharged, triggered by the hospital’s billing system. An app will allow visitors to enter the name of the patient they are visiting, display visiting hours and rules, and guide the visitor to the room once he enters the hospital using a customized hospital navigation system that sets a course away from restricted areas. Mechanical bots will be programmed to fetch supplies and assist the physician by sending spoken orders directly to nurses and the pharmacy, while recording entries into the stored electronic medical record. The bot will free up the nurses and doctors to spend quality time caring for patients.
Tomorrow’s Doctors
It is natural to assume that the blizzard of changes in healthcare means that the education of physicians in medical schools would adjust to incorporate the reality of practicing medicine. That assumption would be incorrect. Medical school education hasn’t changed significantly in the 100 years since medical schools were formed.
The American Medical Association (AMA) decided that medical education needed a shakeup and set out to transform it in this country by creating a diverse network of medical schools … unifying them and inspiring them to think bigger. “The tremendous challenges we face today in healthcare require creative solutions from forward-thinking teams that can thoughtfully harness the remarkable potential of new medical technologies,” said AMA CEO James L. Madara, M.D. “That’s why the AMA is focused on giving physicians a voice in the development of digital healthcare innovations to support efficient, effective care; centralize the doctor–patient relationship; and help shape the future of medicine in America.”
They saw a big gap between how medical students are trained and how healthcare is delivered. To close the gap, the AMA gave $1 million each to 11 medical schools to form a consortium that shares ideas and innovative ways to better prepare medical students for a physician career. This initiative now includes 32—almost a quarter—of our country’s medical schools, and helps them innovate, share practices, and push the boundaries of traditional medical education.
One of the AMA-funded schools, New York University’s School of Medicine, decided to teach their students how to use health data to improve community-wide health and individual health by giving them access to large clinical databases. One dataset contains the 2.5 million hospital admissions to New York’s 227 hospitals per year and includes demographic, clinical, length of stay, and charge data that can be analyzed by student teams. Students gain experience with the limitations and strengths of datasets and develop data analysis skills.
This kind of introductory experience provides value for medical students in their perspective of improving health outcomes and will give them the background to think about how the questions they want to answer can be affected by the data they are analyzing or collecting. In the not-so-distant future, more physicians will be able to participate in medical research outside of formal clinical trials by contributing patient data (with appropriate permissions) and searching for treatments that work for patients with similar conditions and characteristics as data sources are merged and analysis tools achieve user-friendly sophistication.
Changing medical education to adapt to a transforming healthcare system is essential to establishing a new ecosystem that allows healthcare providers and consumers to flourish. While the consumer may be the center of care, there is no care without physicians.
Convergence
There is an old saying that you can lead a horse to water but you can’t make him drink. That’s true of technology in healthcare. The difference is that the consumer is already at the water. But the water is different from the water provided by the current vendors and apps. Consumers need technology that is mobile, on-demand, and convenient. They are getting that from other industries and expect it from healthcare too. Today’s consumer knows more about staying healthy and is far more informed about diseases and treatments than yesterday’s patients.
As the five drivers converge—consumerism’s rise, on-demand delivery, instant communication, hyperdata, and predictive analytics—the brisk pace of healthcare transformation will continue as long as the political barriers such as telehealth reimbursement and interoperability requirements, and legal barriers of privacy and data ownership are addressed.
Unlike the financial prospectuses that warn consumers “historical performance is not a predictor of the future,” healthcare will definitely use the historical data of each person to more precisely predict how to prevent disease and to determine the best treatment when ill. Precision medicine and genomics will pave the way to better individual treatment that avoids making patients sick while making them better. The same type of analyses can be used to tell a person exactly what she should do to maintain and improve her health as she ages.
The patient experience will be totally transformed in the future. When a patient needs to see a clinician in the future, they will see clinicians who are not doctors. It has to be that way because there are not enough primary care doctors to take care of all the consumers, and medical schools cannot produce the quantity of doctors needed. A team composed of physicians, nurses, behavioral health specialists, and pharmacists will provide primary care. Appointments will quickly and easily get scheduled online with the triage clinician who determines the appropriate team member. Care will be provided in the patient’s native language preference, as will follow-up materials.
Soon technology will fade into the background and become invisible. It will monitor individuals, control medication, and send alerts to patients and their doctors. Disease prevention will keep children and adults healthy.
We aren’t there yet, but the bionic person and Star Trek scanners that both diagnose and treat are all possible. As educated and engaged consumers, we fully expect that our healthcare system will get there.
References
Wicklund, E. January 21, 2016. “Ingestible Sensors Give Doctors Something to Digest.” mHealth Intelligence.
Wunker, S. November 22, 2014. “How the Swasthya Slate is Revolutionizing Healthcare, And Why It Steers Clear of the US.” CMO Network. www.forbes.com/sites/stephenwunker/2014/11/22/how-the-swasthya-slateis-revolutionizing-healthcare-and-why-it-steers-clear-of-the-united-states/#3e0a32ef5902
1 A newer version tested in Peru is called HealthCube.
3 Thomas LaRatta, Discussion on February 20, 2016.