Technology trends are clearly observable. Beyond the obvious – and usual suspects – such as the cloud, mobility and big data, one witnesses the surge in sensors, both in terms of types and in the degree of quality and reliability of the measurement of biological parameters, which add to the individual-specific data points stemming from the identification of biomarkers and genetic testing. On the therapeutic intervention front, the second wave of biotechnology products brings about very effective and finely targeted solutions, which will see their efficacy/safety ratio further enhanced by the expanding use of medical informatics processing patient data and of the insights of cognitive science regarding patients’ behaviors.
“In the search for ways to address inefficiencies of our current healthcare systems, good care will remain a function of good testing, adequate treatment and properly trained healthcare providers, organized in affordable packages.”
The technology and metrics frame crystallizing around the patient casts an increasingly comprehensive web, but it’s not just these solutions around the patient which will be connected… It’s not even only the patient journey which will be engulfed in this web, but the entire life of the people, granting us the visa to cross the ultimate frontier of personalized medicine, i.e. knowing ourselves to maximize our degree of satisfaction with our healthcare procurement system. A recent article of The Economist focusing was very aptly entitled “health and appiness”…
As a less rejoicing aside, we may be legitimately concerned that the acquisition of such data could be used for political reasons, in search for some form of supremacy. After all, when the Chinese government makes no secret that it is sequencing the genome of all nationals with IQs greater than 160, what other goal could be pursued other than identifying the genetic recipe to churn our more geniuses? And as the possibility to sequence the DNA of fetuses already exists, so is the possibility to perform selective abortions prior to any legal deadline on grounds unrelated to a medical condition. The specter of eugenics rears if ugly head again…
Let’s not digress too much towards the dark side of the force and look at the collective benefits of the above cited trends.
As the technologies will allow the automation of previously individually crafted approaches, the cost of these complex interventions is bound to decline as the opportunities for data mining and insights sharing will surge. The resulting economic benefit should be so fatally attractive that data mining will progressively supersede clinical examinations, hopefully heralding a new era in which the individual patient benefit will be better served in an ever increasingly cost-conscious environment. That should assuage some concerns, but that opens the perennial debate from a fresh perspective: who’s actually in charge?
That is an essential question, and possibly the most important one.
As computing power is becoming pivotal to harnessing the value of the data and as a result will further fuel the exponential evolution of technological changes in healthcare, the power – and the value – may ultimately reside with the owners of the codes, the algorithms, the expert systems and ultimately the insights.
As a consequence, the power of the patient should be declining. And many a physician would be relieved to see the progressive extinction of the population of “clipboard patients”. But will that actually be the case? Another scenario may be that the nature of the demand from the patient will evolve from a specific care intervention based on a self-diagnosis to more transparency about who controls the expert systems, how they’ve been designed and most importantly for which purposes. As trust in the healthcare system is volatile and elusive, the “trust infarction” may be just around the corner…
And the patient may also legitimately enquire about the fate of the other stakeholders along its healthcare journey. Will the physicians become mere integrators of insights provided as a consolidated patient-specific dashboard addressing all dimensions, from biological to psychological, and possibly up to care procurement recommendations entirely driven by guidelines, themselves balancing the latest from evidence-based medicine and financial priorities?
Will the authorities and payers abandon totally the educational programs targeting healthcare practitioners and patients to focus solely on fine-tuning the parameters of the frame of reference? And then again, on the basis of which evidence and with what set of goals?
“Will the sets of data be truly comprehensive and made available in an accurate, transparent, intelligible and trustworthy way? And what type of “ethics board” will supervise the entire process?”
In the absence of existing answers to these questions and as the debate will go on for some time, let’s enjoy a moment of solace and get back to the space of science fiction and visionaries… Maybe Dr Spock was half right… The Medical Tricorder will actually exist! But not under the shape of a hand held device, rather as a sensor-fed, cloud-backed, fully integrated solution made of a myriad of pixel-applications… As Ray Kurtzweil puts it, the singularity is near, yet possibly and paradoxically at the expense of the human touch… But as Dr Spock famously says, humans are not rational.