The Future of Medicine

If you have time this holiday season, you may want to read The Patient Will See You Now by Eric Topol. In the event you have little downtime or are just interested in some quick highlights, please check out some of the key findings from my reading.

  • The flow of data and information was restricted to certain people prior to the advent of the printing press. The printing press made books, articles, and other printed materials available to all people, increased literacy, and impacted all areas of life. The smartphone is having a similar impact in today’s world. The flow of medical information will no longer have to go to your doctor first, but your smartphone will collect all your data and connect it back to the cloud.
  • The power in health care will (and has to) shift from the seller to the buyers – this movement will require a number of changes (e.g., data ownership, regulations, incentive models, etc…), including a deep rooted cultural shift in how medicine is practiced today (moving from a traditional and paternalistic approach to a collaborative partnership). The current day American Medical Association’s Code of Medical Ethics still supports a paternalistic approach to medicine.
  • Using a business world analogy of what the new health care operating model may look like in the future, the patient would become the COO (no longer an individual contributor) and responsible for monitoring his/her body. The COO would also oversee the IT department, seeking to leverage technology assets to obtain, store, and analyze data. With relative ease (e.g., on-demand), the COO would provide updates and reports to the CEO. The CEO would be readily available, likely virtually/remote, to consult and offer guidance to the COO as-needed using his/her experience, knowledge, and wisdom. Any time an investment was warranted or a strategic direction needed, this would result in a shared-decision among the COO and CEO.
  •  In the future, patients will have access to their data, medicine will be available on-demand, smartphones will be used for labs and imaging, pricing information will be available beforehand, doctors will be rated on the care they provide, and artificial intelligence will be used to a greater degree to diagnose conditions.

Other random and interesting notes:

  • Smartphone innovation relative to health care is already occuring at faster paces in developing worlds because their lack of regulation and reimbursement incentives.
  • The earliest noted physician was Imhotep in 2600 BC.
  • The author Arnon Grunberg of The Qualified Writer: Monitoring the Physiology of the Creative Process, used brain sensors and cameras to record his emotions while writing the book, in order to compare them later with emotions felt by his readers.
  • 23andMe was one of the first direct-to-consumer genomics companies, offering different reports for a cost. However, your data could be used against your best interests (e.g., insurance).
  • Google Flu Trends (GFT) was one of the first attempts to predict health information based on a population in 2008.
  • The cost of phones is projected to dip below $50 in the next couple of years.
  • Free Wi-Fi is emerging in rural areas around the world. Government sponsored aid like Lifeline is now available to promote the adoption and use of smartphones.
  • With the adoption of EMRs, physicians are spending 43% of their time entering data into a computer and only 28% talking to their patients.
  • Kaiser Permanente refers to their patients as members.
  • The OpenNotes project started in 2012 and included Beth Israel Deaconess’s participation in providing patients with their office visit notes. The project found that patients increased their understanding and engagement as a result of reading their notes. About 65% of patients improved their medication adherence.
  • Smartphone applications from Mango Health, CyberDoctor, AiCure, Nightingale, MediMinder, MideSafe, and Care4Today are seeking to improve medication adherence.
  • Gamification is underused in health care and could be a great incentive for many patients to take more control of their health (not in the book, but a personal conclusion).
  • Proteus received initial FDA approval in 2012 for a digestible microchip that can be placed in pills.
  • No significant efforts have been made to find the genomic or biomarker for predicting responsiveness in medications for patients (100 of the 6K available prescriptions has this information available).
  • PillPack was conceived from a hackathon and produces prepackaged medication designed to increase adherence by providing printed schedules on the packages.
  • Medical imaging is commonly abused (over prescribed/ordered) within health care today and the risks to patients aren’t highlighted (e.g., 3% to 5% of individuals getting scans will get cancer because of the cumulative exposure to radiation). MRI and ultrasounds are generally more safe alternatives.
  • More than 30 states in the US are considering or pursuing legislation to increase price transparency.
  • There is 1 licensed doctor to every 370 people in the US. The average US wait time for a primary care visit is 2.5 weeks (about 2 days in Dallas). Virtual consultations (televisits) are growing and there are currently a number of companies/apps with this service available today from LiveHealthOnline, MD Live, American Well, Ringadoc, Teladoc, InteractiveMD, and First Opinion (prices start at $38/video chat).
  • Hippocrates is considered the father of medicine.
  • Tom Daschle (former Senator) started a group known as the Alliance for Connected Care to address federal telemedicine law.
  • Half of the physicians in the US are over the age of 55.
  • Why are doctors still using stethoscopes? they don’t store or analyze data and are somewhat subjective to the user.
  • Coursera and Udacity were the first to dominate the online course world.
  • PatientsLikeMe is the largest online health community.
  • The Open Access Button initiative was designed to locate free versions of research information.
  • DuckDuckGo is a smaller search engine that doesn’t store user information.
  • Angry Birds and the Brightest Flashlight apps gave companies the ability to track a lot of user data.
  • 43% of identity thefts in the US are medical-related.
  • Drawbridge can provide insights into what devices an individual user is accessing, etc.
  • In the 1960’s, 88% of physicians had a policy to not share cancer diagnosis with their patients.
  • In the 17th century, many coffeehouses were dedicated to specific subjects of interest (e.g., science, health, literature, etc…).
  • 95% of the world’s population is covered with a mobile signal.
  • In general, U.S. doctors don’t like smart patients.
  • The patient is the single most unused asset in health care.
  • The average person is projected to have more than 5 connected devices by 2020; current average is ~3.5 connected devices per person.
  • When considering how much personal data is worth to the public or businesses, look at the valuation of Amazon, Facebook, and Twitter, or the increasing number of successful security/data breaches.
  • Less than 5% of data is analyzed today.
  • The medical community has taken on average seventeen years from innovation to adoption.
  • Power of One
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