The Gates’ Letter & Digital Health

Digital Health can help with the Eradication of Disease

Solving Disease

Bill and Melinda Gates wrote a great article in WSJ last week on how many of the gains in poverty and public health in the last two decades are threatened due a lack of continued government and societal commitment. They posit that “disease and poverty are the clearest examples we know of solvable human misery, and the moral case for wiping them out is clear on it’s face.”

For us, the Gates’ annual letters and writing are thought-provoking and provide perspective. It made us reflect about how digital health (which we are happy to be a small part of) can help with this multi-decade objective.

‘Solving’ disease will take long-term investment and commitment from governments, communities, societies, healthcare organizations & clinicians, employers, and of course — individuals themselves. Each stakeholder will both need to know what to do and then ‘comply’ over long periods. This is daunting, but with multiple concerted efforts from different angles — we can make a dent.

Through Treating and Eradicating Disease

Digital Health is a promising approach and ‘angle’ as it is the convergence of technology, science, medicine, and society. We can effectively translate technology & science to medicine & society to:

  1. Treat the disease once an individual has acquired it: Identify those who already have diseases, and reverse, cure, and manage the diseases.
  2. Eradicate the disease in the first place: Detect, understand, and course-correct the disease, and sustain these efforts.

We have to find a way to treat the 100s of Millions of people who are diabetic or have other chronic diseases. This is the here and now.

We need to do this and find a way to eradicate the diseases once and for all. How can we eradicate the disease once and for all?

Can we have an entire generation of people who don’t have to live with or experience a disease?

Eradicating disease through precision prevention

Digital health is one important tool in eradicating disease, through precision prevention. Digital health can help by solving the problems of: Detecting, understanding, and course-correcting disease, and sustaining these efforts.

Detecting disease is difficult because we need to solve three problems — getting access to patients, to gather data, and to obtain knowledge tools to interpret the data. Solving the access problem to people involves being able to have the opportunities to gather varied data points in a periodic manner for diagnosis. Today, access is primarily from primary care physicians, nurse practitioners, and retail clinics. Digital health allows accessing the patient in order to gather data outside the four walls of a hospital, clinic, or pharmacy. Wearable device hardware and software will allow the collection of a multitude of data.

Knowledge tools need to help interpret this data to make this data actionable. In particular, whether this is data from the EMR, wearables devices, or any future data sources (maybe sensors in a car even!) — this needs to be relevant to a clinician, patient to manage their own health, and other stakeholders in the ecosystem. The interpretation needs to be relevant to the understanding and decision-making behind the course-correcting efforts.

Today, the course-correcting efforts happen primarily through intuition and experience of a clinician, case managers to help follow up with the plan, and sporadic and inconsistent follow-ups and monitoring. The course-correction needs to start with better decision making and improve patient compliance. Digital health companies like Glooko (*) empower better decision making for a clinician and help in being able to provide guidance on how to interpret data outside the four walls of the hospital. Companies such as HealthPals bring population health to the point of care and allow doctors to leverage guidelines and best practices that are the most relevant based on similar patients’ outcomes. The course-correction can take the form of medication prescriptions, lifestyle changes, follow-ups, and tests.

Decision making is useless without patient compliance (and vice versa): digital health companies like Omada today are allowing the behavioral health ‘nudges’ for a patient to stay on track. Once an individual goes through this process for a disease, the existing course-corrections need to be maintained as well as a vigilance to continually detect for diseases.

The future is bright

Like many nascent approaches to difficult problems, there has been hype and correspondingly failures. These failures and the hype cycle is necessary to have breakthroughs. There is plenty of reason to be optimistic. Through a combination of augmentation (to existing medicine, health, business, and workflow) and disruption (new ways of diagnosing and treating), we can hope to target people are those that 1, 5, 10, 20, 30 years from now — will get diseases, select the right set of treatments that will avoid this decline towards disease, and remain vigilant.

(*) Disclaimer: the founder of Glooko is an investor in HealthPals.

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HealthPals’ provides actionable clinical context to any healthcare data, to help with preventive efforts to find high-risk patients and know what to do to treat them. HealthPals believes this information should be accessible to every stakeholder involved in an individuals’ health.