Dr. HAL 9000 will see you shortly

Does your doctor speak to your health record? Does your health record speak to your pharmacist? Does your pharmacist speak to your pill bottle? Does your pill bottle speak to your blood pressure monitor? Does your blood pressure monitor speak to your watch? Does your watch speak to your phone? Does your phone speak to your doctor? Does your doctor speak to your health record?

Despite what Hal tells you, all of the technologies and infrastructures are in place that you CAN create an automated workflow of all the processes described above. The Internet of Things is bringing sensors and devices into the world of connected health and it is moving at such a rapid pace that there is nothing we can do to stop it.

Connected health means more than simply connecting with people who share your interests or conditions. The industry is witnessing an entirely new form of connectivity that refers to the connection between all of your devices (medical and otherwise) with regards to your health. It is evolving to a point where in the future much of the tasks performed by doctors and nurses will be relegated to a robot in the hospital or a device in your home. For better or worse, the human element is being removed from the point of care which as of today people aren’t quite ready for. I bet Hal is ok with it though…

Fair enough, but I agree with you Hal. In P’s opinion, this is the direction that healthcare NEEDS to go. It will benefit the research we conduct, it will benefit the care you give to yourself, and it will make patient quality of care outcomes as a whole better. It will not be without its faults but if you take action now to understand the ways in which your devices at home will integrate with your body and share that information with the devices at your clinician’s office – you will be healthier in the long run. We have the ability to remove the elements of human input error and biases while offering immediate communication between device, patient, and physician. What a world.

Ok Hal I get it, let’s examine some companies and ideas that are really innovating in this space.

Wearables – If you are reading this blog, chances are you are familiar with fitbit, currently the most successful consumer aimed health focused wearable. simple.b-cssdisabled-png.hdf3b6763ae7262168fb0c41e99bafbbfFitbits come in different flavors and are packed with sensors to monitor the user’s heart rate, activity levels, and sleep patterns. Using the accompanying app, users can also track food and weight differences. Having the data is the first step, but fitbit also encourages users to lead healthier lives, reminding them when they’ve been still for too long or by encouraging better food choices. It allows for sharing your achievements amongst friends and family or, via your popular social media network or of course its own application.

Fitbit is not the only player and the space is about to get a lot more busy. With the release of the Apple watch two days ago, some industry experts are predicting the device will revolutionize the market. The Apple Watch already has applications that track medication adherence – give reminders to increase activity –  consult with a doctor – manage stress – manage health records – and monitor glucose levels. This is the tip of the iceberg as they say, and this area will continue to advance in the coming years.

Applications – This is where we see more hitech companies diving in. Perhaps they read the recent report that the health application market is projected to reach $26 billion in revenue by the end of 2017. Indeed, all the big players have their own solutions: Microsoft’s Health Vault, Google’s Google Fit, and Apple’s HealthKit and ResearchKit. These products represent just a fraction of what is available. All are poised to take a lead in the health application space but they may be a bit ahead of their time. Of those listed, I believe we will see the biggest impact on healthcare come from Apple’s ResearchKit, but that’s just P’s opinion and will warrant a dedicated post as to why. Regardless, here is a breakdown from March 2014 of the types of medical apps that are currently available for download:

R2G-chart

As we see, the market is dominated by fitness and medical reference applications. As technologies continue to evolve we should (hopefully) see this chart balance out a bit more. The New York Times may have predicted the onslaught of doctor prescribed apps back in 2012, but currently the only company having success in this space is WellDoc. Their application BlueStar for diabetes management not only successfully gained approval by the FDA to be prescribed by physicians, but also landed deals to be reimbursed just like a normal medication would. It doesn’t come cheap either, as a monthly prescription for this application costs roughly $100 per person.

Of course, if we aren’t comfortable trusting an application with our health data or to manage our conditions then these solutions will be left for dead. How quickly that will happen remains to be seen. The quicker they can show data that proves their apps can be viable treatments, the quicker they will see the money pouring in. If/When a company can prove that using an application is as effective as a pill, that is when the value (and hence the interest) will start pouring in.

Connected Medical Devices – As we head further down the rabbit hole we start to enter a territory where people are increasingly uncomfortable. We have adjusted to fitbits and applications that remind us to be healthy, we are also comfortable with glucose monitoring systems and asthma devices that sync with our smartphone. Maybe you are even comfortable with taking matters into your own hands and using a device like the Scanadu that will help you diagnose your own health problems via vital signs and blood draws. Are you ready to summon a driverless ambulance to escort your loved one to the hospital? But how are you with needles? Are you ok with a robot drawing your blood or do you prefer a human?

If you are taking risk of an adverse event into account then your answer should be yes, as the robot is much more accurate than your typical nurse. There are cultural shifts that will need to occur before these ideas are fully implemented. Entities like Hal have conditioned us to fear the machine and while it is important to be aware of the dangers that a poorly produced medical device can have on our health, there are regulatory systems in place to evaluate these devices. In addition, they will need to prove they are safe not only to the FDA but also to the medical world. That said, the impact that they have on our health may soon be larger than the innovations coming from the pharmaceutical and biotech industries.

Advanced AI

I am in the camp that is concerned about super intelligence. First the machines will do a lot of jobs for us and not be super intelligent. That should be positive if we manage it well. A few decades after that though the intelligence is strong enough to be a concern. I agree with Elon Musk and some others on this and don’t understand why some people are not concerned.

– Bill Gates

Hal’s favorite topic. I will make this one short as we are still figuring this technology out and especially when it pertains to health. Elon Musk’s, Bill Gates’, and Stephen Hawking’s opinions on AI aside, there are big data scientists and engineers coding AI and machine learning systems to identify health trends and best treatment practices from EMR’s right here at Johns Hopkins and I’m sure we are not alone in that goal.

Perhaps the most notable “person” in this space is Watson, IBM’s supercomputer who is notorious for handily beating the best Jeopardy players in the history of the game show. Notably, at HIMMS this year IBM announced a deal for Watson that brings on Apple, Johnson & Johnson, and Medtronic as partners. With revenues of $170b, $70b, and $17b respectively, there will be no shortage of funding to introduce Watson to Healthcare.

Take a look at how it works (click to enlarge)

infographic_lrg

Well if that doesn’t sum up ICT in personalized healthcare then I don’t know what does. This IS the future, but we’re not there yet. Nonetheless it will be exciting to see what Watson and similar systems have in store for us.

P’s opinion/summary – We have to conquer our fears of the machine and accept the fact that the days of in-home doctor’s visits are over. With new provisions in the ACA reimbursing providers for better outcomes and decreased costs, more and more we will see doctor’s prescribe applications or devices for us to take our care into our own hands. I’m not ready to hire Hal as my personal doctor, but I wouldn’t mind hearing Watson’s opinions on my treatment plan. For now, let’s use the machines to our advantage before the distant future gets here…

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