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By Dr. Chris Stout, VP, Research and Data Analytics, ATI
An old friend has a new book that I think is somewhat of a harbinger of what we can expect in the near future of healthcare, medicine, and technology. Joshua Cooper Ramo recently penned The Seventh Sense. The title is a bit of a homage to what comes after Nietzsche’s sixth sense (a sense or understanding of history or context) and Josh explains the importance of “…understanding our new age of networks. Not merely the Internet, but also webs of trade, finance, and even DNA.” Indeed, we are just at the beginning of an integrative understanding of complexly connected and seemingly diverse areas with a greater integrative ability than ever before. Enterprise architecture is the structure from which synthetic understanding and action will result.
I believe that the proverbial value proposition in healthcare is a bit different from general commerce in that value is delivered with clinical outcomes divided by cost. There are, of course, a myriad of technologies in medicine that are not digital or enterprise-based (e.g., pharmaceuticals, many device manufacturers, etc.). In this conversation, I will limit my perspective to the digital and enterprise spheres.
Key factors of expeditious healthcare delivery is what cloud computing can deliver such as scalability and secure access of patient data in real-time via data feeds of sensors, apps, and other clinical inputs (genomic data, lab findings, medical history, etc.) can be securely housed but nevertheless rapidly accessed via budding Blockchain technologies that offer super-secure Patient Health Information (PHI) protection and HIPAA compliance.
There are 318,000 healthcare apps today with a growth rate averaging around 200 a day
I believe the days of what Eric Topol famously referred to as “homeless medical data” will soon be a thing of the past. Cloud-based situations also bode well for the National Institute of Health’s nascent program of precision medicine to be more robustly actualized, with greater scale and inclusivity. Interoperability of electronic medical/health records with various inputs/feeds (sensor, internet-of-things, etc.), data-sources (genomic, app responses, imaging, laboratory), clinician intervention (pharmacologic, diet, psychotherapeutic), and empirical findings will merge to better inform clinical decision making.
I have written in the clinical literature for the past two decades on treatment guidelines and evidence- based practice. The initial problem in the early days was a paucity of literature. That’s been solved, but the result is a situation that is akin to fire-hydrant sipping—too much to be current with and too little time to “manually” scour the literature. Machine learning and AI come to the rescue. Work is afoot to bring together formerly diverse and disconnected, albeit quite important, idiopathic and idiosyncratic “N of 1” patient data with the scientific medical literature and filter through available treatment options.
In my LinkedIn Influencer posts, I recently noted that I incorrectly predicted a decline in the 165,000 healthcare and wellness apps that had flooded phones in 2015. To my surprise, I learned that in a new report by IQVIA Institute, there are 318,000 today with a growth rate averaging around 200 a day. Most of the growth in this area is in behavioral health, which makes sense as apps are a good fit for such issues. I have been working with Prevail Health and I have to say, their tech, which is a hybrid of supervised and trained peer support blended with Cognitive Behavioral Therapy, is impressive and as best I can tell, unparalleled.
A key difference today in mobile health (mHealth), development echoes the evidence-based approach to healthcare that is augmented by whatever technology (app, cloud, enterprise) in that medical apps are increasingly being vetted via randomized controlled trials (RCT). One of the interesting aspects of Prevail Health was their RCT findings that were published in two top-ranked peer-reviewed journals which focused on demonstrating their clinical outcomes. Now the Food and Drug Administration (FDA) recently has begun vetting a new care approach—digital therapeutics— via the 21st Century Cures Act. This includes regulation of medical software, apps, and includes a “broad scope of digital health such as mHealth, health information technology (IT), wearable devices, telehealth and telemedicine, and personalized medicine.” I predict we will see more widespread adoption of such integrative and empirically validated tools by payers and healthcare systems.
It is thus incumbent on us to further develop the tools at-hand as well as iterate new approaches, technological applications, and innovative payment systems in order to optimize medical and healthcare services and platforms. Greater integration with policymakers as well, will go far to help migrate the value of such technologies. Indeed, many of those currently available help to increase access and immediacy of care. Perhaps a good dose of innovative and integrative evangelism is just what the doctor ordered.