How Technology Is Going to Change Your Annual Physical
Goodbye, once-a-year snapshot of your health. Hello, continuous real-time picture.
You don’t have to be a medical expert to recognize what a dramatic year 2020 was for healthcare. Frontline workers dealing with the coronavirus. Researchers developing a Covid-19 vaccine at warp speed. And then there are the patients, doctors and hospitals who’ve so quickly adapted to innovations like telehealth and virtual care.
In fact, if there’s a silver lining to this year, it’s the way it’s given us a glimpse of — and sped up the arrival of — a new approach to healthcare. The two of us — Steve runs a large health system, Hemant is an entrepreneur and investor — have had a front-row seat to what’s happening, and we believe this is healthcare’s “iPhone moment,” a point in time similar to when the iPhone debuted and all sorts of new technology, new products and new companies followed in its wake.
This new era of healthcare, called health assurance, will put people first, creating consumer experiences as friendly as those of Netflix and Amazon. It will bend the cost curve, allowing healthcare to be more efficient and more equitable. And it will use real-time data and AI — responsibly — to keep people well, not just treat them when they’re sick.
The best way to grasp how health assurance will change things? Let’s look at its impact on one staple of our current healthcare system: the annual physical.
The Static Physical of the Past
The physical has long been the foundation of the doctor-patient relationship. But it’s also, when you think about it, a slightly ridiculous exercise.
Let’s say you’re having your physical next week. After you strip down to your underwear and get poked and prodded for several minutes, your doctor will tell you that your blood pressure is X, your EKG is Y, your calcium level is Z — on that particular day. The data comes with no context — no sense of what your heart rate or breathing pattern are like on other days and whether they’re showing troubling patterns. It also doesn’t connect with any other data in your life — what you eat, where you’ve been, who you’ve met, how much stress you’ve been under. Oh, and because your doctor is on a tight schedule, he or she will probably only have about five minutes to even ask you about any of that stuff.
Let’s be honest: your car gets better care than this. Even as it’s sitting in your garage, your vehicle is giving off continuous signals about its well-being — alerting you to small problems before they become big ones. Hey, can you fill up my right front tire? It’s a little flat.
The good news is, companies and technology are starting to emerge that will let us create that same kind of experience in taking care of ourselves. In the health assurance era, we’re going to move from a static, once-a-year snapshot of our health to what we might think of as a real-time, always-on digital physical.
The Perpetual Physical of the Future
In this new era of healthcare, you won’t necessarily make an annual appointment with your doctor. So how will he or she know what’s going on with you? A few different ways:
> Your DNA. The cost of getting a sample of DNA from your saliva has gone down so far, so fast, that consumers now do it for sites like Ancestry.com just to find out where they came from. Within a few years, genetic tests will be as routine as a blood test used to check cholesterol, except people will analyze their DNA only once because the results never change. It won’t be long before everyone has their DNA tested at birth, making it part of each person’s health record for life.
And that record is powerful. Your genome tells doctors whether you have a predisposition for certain cancers and other diseases, and it gives all sorts of clues about how to care for you, including what drugs are likely to be effective for you. It can even guide you to understand how fast you metabolize caffeine — important to know if, say, you have insomnia.
> Your microbiome and your blood. Another rich source of data is the bacteria in your gut, which is unique to every individual. Companies are emerging to analyze the microbiome and make it an important piece of your medical data. Meanwhile, another batch of companies are taking the blood test to new places, pulling data never before accessible. A firm called Grail is on course to offer a blood test that can detect cancer with few false positives and identify the location of the tumor.
> Your connected devices. While your genome, your biome and your blood yield static data, connected devices will record and analyze a constant flow of data in real time. Which devices and what data will depend on the person. Some people will never want to wear a gadget that records any physiological data. Others will want everything measured, maybe wearing a connected watch loaded with apps that constantly record steps taken, heart rate, hours of sleep, body temperature and so on.
Already companies are capitalizing on connected devices to take care of patients. Livongo (which Hemant’s firm invested in and is now part of Teladoc) uses real-time information to help people manage diabetes and other chronic conditions. A firm called Spire makes a tiny tag that’s sewn into the band of your underwear and tracks your breathing patterns — it can help detect asthma, panic attacks, even drug overdoses that slow breathing.
> Your behavior. One final data source is your own behavior. Mindstrong, another company we both work with, uses artificial intelligence to analyze what you type on your phone’s keypad to understand whether you’re depressed or manic. Many companies will be built around this always-on mental health space, and data about your mental health will help doctors diagnose your physical health — because the two are connected in ways that will become even more obvious once we’re able to start analyzing this rich trove of data.
The New Healthcare Experience
The ability to collect all this data will revolutionize healthcare — and the way you interact with the healthcare system. Care will become an always-on proactive way to keep you healthy, as opposed to reactive care once you’re sick. The beauty of all that health data is that an artificial intelligence can be built to learn from it and come to understand your health patterns, and compare them with knowledge about health in general.
Let’s fast forward to when Steve’s hospital system, Jefferson Health, adopts this new health experience. Jefferson could offer a subscription service to a technology-plus-human package that becomes a new first layer of healthcare — a kind of pre-primary care. You’d sign up with Jefferson’s service and give it access to your data — both static data (like DNA) and real-time data (heart rate from your Apple Watch). The AI gets a baseline of your health and then watches and learns from your patterns. If the AI spots something unusual — you’re not sleeping, your temperature is up — it might send a text asking some basic questions. Your answers at first go to an AI bot, and perhaps you figure out that not much is wrong — you’re just stressed about a big decision at work or have a cold. But if the AI suspects there’s something more, it sends the information to a doctor at Jefferson — a doctor who has enough time to talk to you because the AI is handling a lot of the data collection work that used to suck up the doctor’s time.
On the flip side, if you’re worried about something — like a weird pain in your side — you could text the AI or talk to it like you talk to Siri or Alexa. Because the AI has access to your data, it might be able to make a quick judgement about whether you should take a couple of Advil, or get a doctor on video, or rush to the emergency room. (For those of you who are worried about an AI diagnosing patients: AI is just a first point of preventive care and triage, and it will elevate anything troubling to a physician.)
What happens when you want to see a doctor? You’ll meet in a comfortable room, not while sitting on paper pulled off a roll and spread over an examining table. You don’t have to take off your clothes, unless there’s something you want the doctor to see or a physical examination is needed to confirm something. That’s because there’s no new data to collect — your data record already has everything the doctor needs to know, and it’s been delivered ahead of your meeting.
The doctor isn’t seeing you to collect data — he or she is seeing you to talk to you. The best doctors will act as health coaches and sleuths. They’ll work with you to help you feel better, or be more productive, or maybe just play better tennis. If something is wrong, they’ll have the time to dig deep and diagnose it. If you’re otherwise well, the physician might ask about your goals for the coming year. Do you want to lose weight before a college reunion? Train for a marathon? Figure out why you’re not sleeping? Based on your data, the doctor can help formulate a plan and set up data-driven goals so you’ll know if you’re staying on track. The doctor becomes the human in the middle as your online data meets your offline physical and mental status.
None of what we write about here is going to happen overnight — it will come about gradually, over the next couple of decades. And we need to make sure the evolution is done responsibly. We need better ways of sharing and protecting data, for instance. We need to figure out access, so that the perpetual physical doesn’t just make the wealthy healthier. We need to understand how health assurance will transform the healthcare industry so that we can retrain people for the jobs of the future.
But, as 2020 has shown us, the future has a way of coming faster than you think. In the case of the new physical, that future has the potential to be bright.
