Data driven, based on evidence, adept at identifying problems and providing solutions. One would have thought there would be a wealth of web-based technological approaches to marrying medical information and cures. And one would be sorely disappointed. As are many in both the tech and medical communities.
The technologies exist and are not necessarily expensive. The research on the benefits of monitoring and sharing information are manifest. And yet, the breakthrough has yet to be made. The reasons are varied and sometimes complex, but they typically come down to relatively simple, age-old human attitudes: greed and fear of change. JL
Leslie Saxon comments in Venture Beat:
Every single person in the world has a health story. As a doctor, my job is to help people edit the story that your health is telling and to treat your story as unique to make you healthier. It’s our signature challenge to become more efficient and accurate editors as digital healthcare begins to scale worldwide, which can create 8 billion health stories.
Today, we have thousands of health and fitness apps connecting us to digital “coaches” and helping us socialize with our friends, but we don’t have a medical platform. We don’t have a medical Google, or an Amazon, or a Facebook. We don’t even have an AOL of medicine. What we mostly have is a Wikipedia for medicine, which I and my fellow clinicians and colleagues quote daily. (That’s a good thing.)
My own story as an MD — and my interest in Big (Health) Data — started when I was an intern in my hometown at St. Louis City Hospital in 1985. I thought I could make a contribution treating people in the inner city.
I spent many on call nights in the ER. The ER itself was like a war zone: violent, dirty, full of law enforcement officials, and in the middle of this chaos, families bringing in their sick kids for elective things. There wasn’t and still isn’t an evening option for working parents, and the system fails the indigent poor most dramatically.
After three years in the inner city hospital system, I realized that neither patients nor providers had the tools to deliver effective care and that the solutions to health problems there were largely political and out of my control.
I left St. Louis and moved on to training as a cardiologist and then as an interventional electrophysiologist. Seven years later, I became a high-tech specialist working at a major university in San Francisco, implanting sophisticated devices that treat and actually prevent sudden cardiac death.
It was lucky timing: 1995 was the beginning of an incredible 10-year high-tech wave in heart disease innovation. When I was in San Francisco during the 1990s dotcom boom, I watched as Silicon Valley introduced us to the Information Age. It has changed my world, but it hasn’t much changed how I practice medicine. Back then, we doctors and dotcomers were sitting in the same restaurants, but we weren’t drinking the same Kool-Aid.
It took a decade but the digital revolution finally started coming to medicine. I found myself sitting in meetings on Sand Hill Road with venture capitalists and technologists talking about the big opportunity in health: scaleable health care that could help hundreds of millions of people. But technology companies were too afraid to assail — or too timid to tame — the beast of healthcare.
Mostly, they still are.
We have had some big successes with digital medicine. In my field about six years ago, device companies started putting antennas into implanted devices. We now analyze data from those devices in more than 200,000 patients. We’ve collected information on 20 million device downloads, recorded 150,000 life-saving interventions, and collected millions of pieces of valuable additional data. The numbers were clear. Here is what we’ve learned:
If you open up this implanted device to the network, people live longer.
We live longer and healthier lives when our health is continuously monitored by a device and exceptions to normal health are reported by the device to our caregivers. The technology exists and is often very inexpensive. It keeps people out of hospitals; saving money and lives. We’ve proven that.
So why aren’t we doing more monitoring? It’s not a regulatory problem or a lack-of-vision problem in the medical and technology companies; it’s that there’s too much perceived risk in changing the medical structure.
These technologies could profoundly improve the basics of how we practice medicine. Being connected fundamentally changes the doctor-patient relationship.
We get continuous data, review exceptional events daily, and can alert patients when they need help. We can catch disease patterns as they are happening. We have the potential to act within minutes or hours versus months in the traditional follow-up clinic. Patients can learn to partner in their care. They can be meaningfully engaged and empowered. We live in the so-called Information Age. A time when you can look up anything: bank records, flight information, and the price of tea in china. Just about anything.
But how many of us have a copy and control of our own health records or that of our family members? How many of us interact with our own health data as fluently and seamlessly as we do with our finances or sports scores?
A common view in the medical community is that people don’t know how to handle their own health information. That it takes a professional to interpret it. How would we feel if we were told we couldn’t handle our own banking information or our kids’ report cards? Meaningful access to our personal health information is a right, and encouraging that access will become one of the most important civil rights issues of our era.
Over the next two years mobile phones and inexpensive sensors will better connect us, if we choose this path. We will see individualized care on a scale that would have been unimaginable just a few years ago.
Imagine your doctor calling you to schedule an appointment because she knows the condition of your body, rather than vice versa. We see products at the University of Southern California Center for Body Computing before they hit the market: sensors are becoming more powerful and much smaller.
At the USC Center for Body Computing, we conducted a study using the AliveCor ECG case. (We presented the results a couple weeks ago at the American College of Cardiology.) We gave it to 50 people with iPhones who attend our yearly Body Computing Conference. We found people transmitted an average of 36 30-second tracings a week.
I personally reviewed all the tracings. In one situation, I was able to diagnose acute cardiac ischemia in a Nigerian gentleman in Mumbai from my home in Los Angeles by reviewing a 30-second ECG collected on the iPhone. Helping this person was personally gratifying and represents a brilliant example of leveraging our experts across the globe.
We have a global wireless network that is ruthlessly efficient, more mobile phones than people, and global carriers that can deliver medical data continuously. We have tablets with medical grade image and video quality capability. We have diverse digital storage capabilities. We have vast social networks. The most successful companies in the world right now make or enable most of these products. That means there is a lot of interest. That means there is a lot of investment.
Sensors are becoming ubiquitous and advanced. They are in phones, in shoes, in your teeth, in small patches. At the CBC we’re testing them in cars, in athletes, and in kids games.
This is an important advance for several reasons. One night a few months ago, I was playing tennis with a 19 year-old who plays for a local junior college. On our last point, at the end of the 90-minute game, I was at the net and she missed a ball. She stumbled to the back fence and collapsed against it.
I ran over and felt her pulse and it was going extremely fast. I used the AliveCor case to diagnosis her arrhythmia and was able to terminate it with a physical maneuver before she passed out. Turns out that she’d already played several hours of tennis that day, hadn’t really eaten or hydrated and hadn’t gotten enough sleep the night before.
I had been thinking about, doing research on, and implanting devices in patients (including athletes) at risk for sudden cardiac death for 20 years, and yet I never considered that some of those sudden deaths occur because of the type of rhythm I witnessed first hand in the tennis player that night. What is generally considered a more pedestrian nonfatal rhythm in others can be deadly in an elite athlete.
This is the kind of on-demand medical information I was looking for my entire professional life.
By simply collecting basic vital signs we can help a kid in Ecuador with a heart arrhythmia, and a kid in Washington DC with diabetes. We can create ways to eventually help billions of people. The 21st Century version of the house call will be as far away as a smartphone.
So how do we start to deliver on the outrageously great and transformational potential that personalized digital medicine holds? We think it starts with that first point of contact. We need to get everyone connected—at least once—to the digital health ecosystem
To encourage wide adoption, we are building a platform to bridge the digital divide and connect the more than 5 billion mobile phones in the world to the health ecosystem. We want to use every day mobile phones to collect one piece of the world’s health data stream to increase the health information flow and to create “Big Data” life analytics. Our initiative is called www.everyheartbeat.org. By 2013 we hope to create a system in which anyone can log-in and start recording their health narrative through their wireless phone. We estimate that recording 6 billion people’s heart rates will consume 1 terabyte of information a day; that is 1000 less than the movie Avatar. (As part of an ongoing study we have already recorded heart rates from 20 million device downloads.)
I think about the world in a few years and imagine owning and sharing health data just like we can share our life on social networks.
What will billions of heart beats show us?
It’s like the Human Genome Project.
We can use Big Health Data to study life patterns, identify disease, solve endemic health problems, and give us more control over our health.
It’s the beginning of an evolution toward knowing oneself and accepting the commonality of health needs and awareness across humanity. We are trying to tell the story of eight billon heart beats because we know it will help that sick kid in the ER at 3 a.m. in Mumbai, in Bangladesh, in Sao Paulo, in the Bronx, in East Los Angeles, in St. Louis. Everyone in the world can participate, and push medicine toward a health information revolution. This is the Internet of You. That helps 8 billion people. That helps all of us. One heartbeat at a time.
Image courtesy of Monika Wiesniewska, Shutterstock
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