The Patient Will See You Now, With Data
An Exploding Medical Digital Frontier in Search of a Consumer Business Model to Support It
Eric Topol’s recent book, “The Patient Will See You Now: The Future of Medicine is in Your Hands” is an excellent primer on the state of technological development to promote patient health. Rich in detail, the author envisions a multi-layered data map — the “Graphic Information System” or “GIS” — that captures virtually everything about you that is or may one day be quantifiable, down to the molecular and genetic level. This information, “pre-womb to tomb,” will usher in new age of personalized medicine, as well as provide the breadcrumbs down a trail to a healthier you.
Topol writes — believably I would add — this will be terabytes of data over a lifetime, obtained by increasingly cheap smart phone plug in sensors, among other mechamisms, that will more accurately and seamlessly capture what is happening inside your body. Further, it will map this enzymatic information against increasingly larger, open access data bases of physiology. Think N to 1 and 1 to N.
The author compares this potential state change within the medical community and personalized health to no less that the Guttenberg press. Considered perhaps to be the single most important invention of modern man, the Guttenberg press accelerated the recording of knowledge, enabling new ideas to compound and unleashing a creative wave of innovation unthinkable during the dark ages.
With this level of detail, an order of magnitude beyond what is available to your general practitioner during any given annual check-up, an obvious question is will one need to travel anywhere for diagnosis? Topol doesn’t think so. This idea is less revolutionary today than even five years ago. We are post-Castlight IPO (NASDAQ: CSLT) and the investment bankers — one yardstick — are circling others. Innovalon, Pokitdoc, Teledoc, Zocdoc, and a host of other innovators are successfully chasing the “datafication” and scalable consumer access of the health industry. Change is not only coming, one might plausibly argue it has arrived.
However, while the cost to collect and maintain this personalized information is indeed falling, I worry about the absence of a unifying pull to organize and apply these increasingly informative bits and bytes. As Topol notes, “we are still far away from what could be considered the optimal personal health record.” Kaiser Permanente’s mobile app provides access to events and certain lab results, but the majority of us receive care from “multiple providers that cut across different health systems, markedly reducing the ability to have easy and singular access.” (italics mine) To enable this digital health utopia, the author writes, we need the raw data to be fully accessible, not simply clinicians’ notes and analysis.
Topol sees signs of light in secure, cloud-based mobile storage providers. He highlights Nick Dawson, President of the Society for Participatory Medicine, who uses Evernote as his digital medical record, storing sensor data and sharing information with providers and family members as necessary. There are many doctor practice-focused electronic health record vendors serving the health provider market, including Practice Fusion, athenahealth, and Allscripts Professional, to name a few. These software packages coordinate data sharing between payers (insurance companies), pharmacies, care providers, patients and patient advisors. [see my review of athenahealth co-founder, Jonathan Bush’s bestseller, “Where Does it Hurt: An Entreprenuer’s Guide to Fixing Healthcare” here.]
However, with a business focus on the medical practice and the author’s guidance that “over the course of your lifetime, you may see tens of different doctors in as many different health systems and clinics,” one wonders whether a B2B organized digital effort will maintain patient relevance, much less consumer interest over their lifespan. With medicine “morphing into a data science” and the ability to “map out many disease arcs” over the course of years and decades, maintaining patient engagement would seem to be paramount.
It is not enough, as Topol contends, that you must “own all of your medical data,” a consumer also needs to couple data availability with a purpose and an incentive. As any consumer-based enterprise knows all too well, “engagement” is an art unto itself.
Coincidentally, perhaps, with the arrival of miniaturized sensors and virtually free cloud storage, this consumer purpose and incentive may be developing in the form of consumer health plans. As others have written, many of today’s qualifying High Deductible Health Plans (HDHP) or Consumer Directed Health Plans (CDHPs) represent true “catastrophic” insurance, leaving the consumer the “direct payer” for much of their health maintenance and support. It is conceivable that as growing numbers of employees and consumer health insurance purchasers become accustomed to paying $1,000, $2,000 or even $5,000 a year out of pocket for health “products and services,” a new model of consumer alignment and service will develop.
Underneath this “alignment” may be the expectation that raw health data, lab results and the corresponding medical findings truly belong to the “customer.” For a $20 co-pay one may be willing to concede ownership of the raw data and defer to the establishment and knowledge of a highly trained practitioner; at $500 a consumer (i.e. patient) may reasonably reach a very different conclusion on who owns what. Similarly, given the expense shifting and disproportionate growth of health expenses, consuming a higher “share of wallet” in a family’s disposable income, a behavioral economist might predict higher user “engagement” over time. This may represent a silver lining should it lead to a new equilibrium in health data access, if not a new way of doing business altogether, one that results in “bending the cost curve.”
At HelloWallet we understood that money is a very emotional topic, perhaps second only to health in a consumer’s life. As new health devices come online with higher usability, convenience and relevance, all while addressing underlying emotions of finance and health, we should expect pressure to be applied against a “business as usual” mentality. Change is coming (see First Derm blog here). Dr. Topol, among others, is ready.
Thanks for reading. Comments and suggestions for other topics welcome.
Reasons to Digitally Store Health Documents here. Within the genre of medical industry, my review of Brill’s book, “America’s Bitter Pill: Money, Politics, Backroom Deals and the Fight to Fix Our Broken Healthcare System” here.
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